Citation Information :
Ramachandran B, Kanjani A, Prabhudesai S, Ravikumar KG. Accuracy of a real-time continuous glucose monitoring system in children with septic shock: A pilot study. Indian J Crit Care Med 2015; 19 (11):642-647.
Aims: The aim of this prospective, observational study was to determine the accuracy of a real-time continuous glucose monitoring system (CGMS) in children with septic shock.
Subjects and Methods: Children aged 30 days to 18 years admitted to the Pediatric Intensive Care Unit with septic shock were included. A real-time CGMS sensor was used to obtain interstitial glucose readings. CGMS readings were compared statistically with simultaneous laboratory blood glucose (BG).
Results: Nineteen children were included, and 235 pairs of BG-CGMS readings were obtained. BG and CGMS had a correlation coefficient of 0.61 (P < 0.001) and a median relative absolute difference of 17.29%. On Clarke′s error grid analysis, 222 (94.5%) readings were in the clinically acceptable zones (A and B). When BG was < 70, 70-180, and > 180 mg/dL, 44%, 100%, and 76.9% readings were in zones A and B, respectively (P < 0.001). The accuracy of CGMS was not affected by the presence of edema, acidosis, vasopressors, steroids, or renal replacement therapy. On receiver operating characteristics curve analysis, a CGMS reading <97 mg/dL predicted hypoglycemia (sensitivity 85.2%, specificity 75%, area under the curve [AUC] =0.85). A reading > 141 mg/dL predicted hyperglycemia (sensitivity 84.6%, specificity 89.6%, AUC = 0.87).
Conclusion: CGMS provides a fairly, accurate estimate of BG in children with septic shock. It is unaffected by a variety of clinical variables. The accuracy over extremes of blood sugar may be a concern. We recommend larger studies to evaluate its use for the early detection of hypoglycemia and hyperglycemia.
Hirshberg E, Lacroix J, Sward K, Willson D, Morris AH. Blood glucose control in critically ill adults and children: A survey on stated practice. Chest 2008;133:1328-35.
Preissig CM, Rigby MR. A disparity between physician attitudes and practice regarding hyperglycemia in pediatric intensive care units in the United States: A survey on actual practice habits. Crit Care 2010;14:R11.
Vogelzang M, Nijboer JM, van der Horst IC, Zijlstra F, ten Duis HJ, Nijsten MW. Hyperglycemia has a stronger relation with outcome in trauma patients than in other critically ill patients. J Trauma 2006;60:873-7.
Faustino EV, Apkon M. Persistent hyperglycemia in critically ill children. J Pediatr 2005;146:30-4.
Christiansen C, Toft P, Jørgensen HS, Andersen SK, Tønnesen E. Hyperglycaemia and mortality in critically ill patients. A prospective study. Intensive Care Med 2004;30:1685-8.
Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc 2004;79:992-1000.
Krinsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc 2003;78:1471-8.
van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001;345:1359-67.
Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, et al. Intensive insulin therapy in the medical ICU. N Engl J Med 2006;354:449-61.
Lorencio C, Leal Y, Bonet A, Bondia J, Palerm CC, Tache A, et al. Real-time continuous glucose monitoring in an intensive care unit: Better accuracy in patients with septic shock. Diabetes Technol Ther 2012;14:568-75.
Bridges BC, Preissig CM, Maher KO, Rigby MR. Continuous glucose monitors prove highly accurate in critically ill children. Crit Care 2010;14:R176.
Goldstein B, Giroir B, Randolph A; International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005;6:2-8.
Clarke W, Kovatchev B. Statistical tools to analyze continuous glucose monitor data. Diabetes Technol Ther 2009;11 Suppl 1:S45-54.
Clarke WL, Cox D, Gonder-Frederick LA, Carter W, Pohl SL. Evaluating clinical accuracy of systems for self-monitoring of blood glucose. Diabetes Care 1987;10:622-8.
Beardsall K, Ogilvy-Stuart AL, Ahluwalia J, Thompson M, Dunger DB. The continuous glucose monitoring sensor in neonatal intensive care. Arch Dis Child Fetal Neonatal Ed 2005;90:F307-10.
Brunner R, Kitzberger R, Miehsler W, Herkner H, Madl C, Holzinger U. Accuracy and reliability of a subcutaneous continuous glucose-monitoring system in critically ill patients. Crit Care Med 2011;39:659-64.
Goldberg PA, Siegel MD, Russell RR, Sherwin RS, Halickman JI, Cooper DA, et al. Experience with the continuous glucose monitoring system in a medical intensive care unit. Diabetes Technol Ther 2004;6:339-47.
Corstjens AM, Ligtenberg JJ, van der Horst IC, Spanjersberg R, Lind JS, Tulleken JE, et al. Accuracy and feasibility of point-of-care and continuous blood glucose analysis in critically ill ICU patients. Crit Care 2006;10:R135.
Branco RG, Chavan A, Tasker RC. Pilot evaluation of continuous subcutaneous glucose monitoring in children with multiple organ dysfunction syndrome. Pediatr Crit Care Med 2010;11:415-9.
Piper HG, Alexander JL, Shukla A, Pigula F, Costello JM, Laussen PC, et al. Real-time continuous glucose monitoring in pediatric patients during and after cardiac surgery. Pediatrics 2006;118:1176-84.