Continuous glucose monitoring (CGM) commonly used in the outpatient setting is yet to be implemented in the pediatric intensive care unit (PICU) setting. The purpose of this study was to evaluate the feasibility, reliability and accuracy of the system in pediatric patients with DKA.
Objective: Determine the accuracy of CGM Dexcom G6™ in the setting of pediatric DKA compared to point of care capillary (POC) and serum glucose testing. Secondly, determine if the degree of acidosis impacts CGM when compared to POC and serum glucose testing.
Methods: Single institution IRB approved prospective trial. PICU patients that met inclusion criteria receiving standard DKA therapy were enrolled. CGM Dexcom G6™ sensors was applied to the patient’s abdomen on admission. Hourly POC and every 6 hour serum basic metabolic panels were obtained. CGM data was obtained every 5 minutes and matched to the nearest POC capillary and serum glucose levels ± 3 minutes. Reliability and feasibility analysis included frequency of data display, data gaps and any reasons for sensor removal.
Results: 35 pediatric patients, 11.9 ± 4.1 years old were enrolled. 51.4% were known diabetics and were older compared to the new onset diabetics, mean age 13.9 vs. 9.7 years respectively (p= 0.001). Clark Error grid of serum glucose versus CGM reveals 95.6% of readings within zones A and B, the Clark Error grid for POC versus CGM reveals 95.4% of readings within A and B zones. There was a negative correlation (-0.27) between the serum glucose and CGM delta when compared to serum bicarbonate level (p=0.007), while a positive correlation (0.24) between the POC and CGM delta when compared to serum bicarbonate level (p = 0.056). There were no sensors removed or adverse events that occurred during the study.
Conclusion: CGM use in patients with DKA seems both feasible and accurate. Serum bicarbonate level does not appear to impact the accuracy of CGM in the setting of DKA. Further studies examining the use and cost effectiveness of CGM in treatment decisions in DKA are warranted.
T.R. Pott: None. J.M. Jimenez Vega: Consultant; Self; Dexcom, Inc. J.L. Parker: None. R. Fitzgerald: None.