LBSUN214 Accuracy Of A Continuous Glucose Monitor In The Intensive Care Unit
Notice bibliographique
Résumé
Abstract Studies have shown that hyper/hypoglycemia and glycemic variation are associated with adverse outcomes in critically ill patients. Currently, frequent blood point-of-care (POC) glucose measurements from an arterial or capillary sample is the only technology available to minimize glycemic excursions in the ICU. Continuous glucose monitoring (CGM) is becoming the standard of care for outpatient diabetes care and has shown improved glycemic control in the non-ICU inpatient setting. The Dexcom G6 sensor (G6) is the first CGM device approved by Health Canada for outpatient diabetes management without the need for calibration, but it has not yet been approved for inpatient use. We collected data from 23 adults who were on an insulin infusion in a medical-surgical ICU in Vancouver, British Columbia to evaluate the accuracy of uncalibrated CGM in the ICU. A blinded G6 was attached to the patient's arm and collected glucose measurements every five minutes without calibration. Nursing staff continued POC arterial glucose measurements using the AccuChek Inform II machine per standard of care. Excluding four outliers (with mean absolute relative difference (MARD) ≥ 25%), the overall MARD was 13.24% (SE 0.43) over 649 matched CGM and arterial glucose values. A Clarke Error Grid demonstrated 99.1% of CGM measurements within zones A and B. The MARD using three-point rolling averages of CGM measurements in five-minute intervals was 13.49% (SE 0.68). There were 573 matched pairs between glucose ranges of 3.9-13.9 mmol/L with two pairs <3.9 and 74 pairs >13.9 mmol/L. Eleven patients had renal replacement therapy and twelve had vasopressor use. There was no significant difference in MARD with renal replacement or across glycemic ranges ≥3.9. The MARD for patients with vasopressors was lower than for patients without (13% vs 13.55%, p<0. 01), a finding of doubtful clinical relevance. There is no expert agreement yet about the acceptable accuracy for CGM use in hospital. Our overall MARD meets the 2013 Critical Care expert consensus recommendations for MARD <14%. The FDA guidance on standard of accuracy for conventional POC glucometers require 98% of values within 15% for BG ≥ 75mg/dL. Our data showed 65.18% of values were within 15%. Previous studies using CGM in the ICU, even those using G6, all used calibration. The majority were non-blinded, and none met FDA criteria for inpatient use. Our study is the first uncalibrated and blinded study that was able to demonstrate acceptable accuracy in a large sample size. Since CGM accuracy may be affected by various factors, our comprehensive data can potentially identify specific interferences and quantify a calibration or correction criteria to improve CGM accuracy in critically ill patients. Overall, our results show that CGM shows strong potential to be an accurate, resource-efficient, and intuitive alternative to POC glucose monitoring to meet glycemic targets in the ICU. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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