Accuracy of Subcutaneous Continuous Glucose Monitoring in Critically Ill Adults: Improved Sensor Performance with Enhanced Calibrations

作者：Leelarathna Lalantha; English Shane W; Thabit Hood; Caldwell Karen; Allen Janet M; Kumareswaran Kavita; Wilinska Malgorzata E; Nodale Marianna; Haidar Ahmad; Evans Mark L; Burnstein Rowan; Hovorka Roman^*

来源：Diabetes Technology & Therapeutics, 2014, 16(2): 97-101.

DOI：10.1089/dia.2013.0221

Objective: Accurate real-time continuous glucose measurements may improve glucose control in the critical care unit. We evaluated the accuracy of the FreeStyle((R)) Navigator((R)) (Abbott Diabetes Care, Alameda, CA) subcutaneous continuous glucose monitoring (CGM) device in critically ill adults using two methods of calibration. Subjects and Methods: In a randomized trial, paired CGM and reference glucose (hourly arterial blood glucose [ABG]) were collected over a 48-h period from 24 adults with critical illness (meanSD age, 6014 years; mean +/- SD body mass index, 29.6 +/- 9.3kg/m(2); mean +/- SD Acute Physiology and Chronic Health Evaluation score, 12 +/- 4 [range, 6-19]) and hyperglycemia. In 12 subjects, the CGM device was calibrated at variable intervals of 1-6h using ABG. In the other 12 subjects, the sensor was calibrated according to the manufacturer's instructions (1, 2, 10, and 24h) using arterial blood and the built-in point-of-care glucometer. Results: In total, 1,060 CGM-ABG pairs were analyzed over the glucose range from 4.3 to 18.8mmol/L. Using enhanced calibration median (interquartile range) every 169 (122-213) min, the absolute relative deviation was lower (7.0% [3.5, 13.0] vs. 12.8% [6.3, 21.8], P<0.001), and the percentage of points in the Clarke error grid Zone A was higher (87.8% vs. 70.2%). Conclusions: Accuracy of the Navigator CGM device during critical illness was comparable to that observed in non-critical care settings. Further significant improvements in accuracy may be obtained by frequent calibrations with ABG measurements.

• 出版日期2014-2-1