Use of Continuous Glucose Monitor in Critically Ill COVID-19 Patients Requiring Insulin Infusion: An Observational Study.
The coronavirus disease 2019 (COVID-19) pandemic has created a need for remote blood glucose (BG) monitoring in the intensive care unit (ICU).To evaluate feasibility and patient safety of a hybrid monitoring strategy of point of care (POC) BG plus continuous glucose monitor (CGM) in the ICU.Retrospective analysis.ICU of an academic medical center.Patients with COVID-19 on intravenous (IV) insulin.After meeting initial validation criteria, CGM was used for IV insulin titration and POC BG was performed every 6 hours or as needed.Outcomes included frequency of POC BG, workflow, safety, and accuracy measures.The study included 19 patients, 18 with CGM data, mean age 58 years, 89% on mechanical ventilation, 37% on vasopressors, and 42% on dialysis. The median time to CGM validation was 137 minutes (interquartile range [IQR] 114-206). During IV insulin, the median number of POC values was 7 (IQR 6-16) on day 1, and declined slightly thereafter ( 71% reduction compared to standard of 24 /day). The median number of CGM values used nonadjunctively to titrate IV insulin was 11.5 (IQR 0, 15) on day 1 and increased thereafter. Time in range 70-180mg/dl was 64+/-23% on day 1 and 72+/-16% on day 2-7 while time <70 mg/dl was 1.5 +/-4.1% on day 1 and <1% on days 2-7.This study provides data to support that CGM using a hybrid protocol is feasible, accurate, safe, and has potential to reduce nursing and staff workload.
Authors: Eileen R Faulds, Andrew Boutsicaris, Lyndsey Sumner, Laureen Jones, Molly McNett, Keaton S Smetana, Casey C May, Elizabeth Buschur, Mathew C Exline, Mathew D Ringel, Kathleen Dungan