Accuracy of a Continuous Glucose Monitor During Pediatric Type 1 Diabetes Inpatient Admissions.

Erin C Cobry, Laura Pyle, Lauren A Waterman, Gregory P Forlenza, Lindsey Towers, Angela J Karami, Emily Jost, Cari Berget, R Paul Wadwa
Author Information
  1. Erin C Cobry: Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. ORCID
  2. Laura Pyle: Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
  3. Lauren A Waterman: Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. ORCID
  4. Gregory P Forlenza: Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. ORCID
  5. Lindsey Towers: Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
  6. Angela J Karami: Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
  7. Emily Jost: Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
  8. Cari Berget: Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
  9. R Paul Wadwa: Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. ORCID

Abstract

Continuous glucose monitors (CGMs) used for type 1 diabetes management are associated with lower hemoglobin A1c. CGMs are not approved for inpatient use, when close glucose monitoring and intensive insulin management are essential for optimal health. Accuracy data from adult hospitalizations have been published, but pediatric data are limited. This retrospective review of Dexcom G6 data from youth with type 1 diabetes during hospitalization assessed CGMs and matched (within 5���min) point-of-care (POC) and laboratory glucose values. Glucose values >400 and <40���mg/dL were excluded due to sensor reporting capabilities. Standard methods for CGM accuracy were used including mean absolute relative difference (MARD), Clarke Error Grids, and percentage of CGM values within 15%/20%/30% if glucose value is >100���mg/dL and 15/20/30���mg/dL if value is ���100���mg/dL. A total of 1120 POC and 288 laboratory-matched pairs were collected from 83 unique patients (median age 12.0 years, 68.7% non-Hispanic white, 54.2% male) during 100 admissions. For POC values, overall, MARD was 11.8%, that on the medical floor was 13.5%, and that in the intensive care unit was 7.9%. The MARD for all laboratory values was 6.5%. In total, 98% of matched pairs were within Clarke Error Grid A and B zones. Findings from our pediatric population were similar to accuracy reported in hospitalized adults, indicating the potential role for CGM use during pediatric hospitalizations. Additional research is needed to assess accuracy under various conditions, including medication use, as well as development of safe hospital protocols for successful CGM implementation for routine inpatient care.

Keywords

References

  1. Diabetes Technol Ther. 2022 Jun;24(6):409-415 [PMID: 35099306]
  2. J Diabetes Sci Technol. 2016 Aug 22;10(5):1169-73 [PMID: 26880390]
  3. Diabetes Technol Ther. 2018 Jun;20(6):428-433 [PMID: 29923775]
  4. J Diabetes Sci Technol. 2022 Nov;16(6):1550-1554 [PMID: 34218715]
  5. J Diabetes Sci Technol. 2017 May;11(3):558-566 [PMID: 27697848]
  6. Diabetes Care. 1987 Sep-Oct;10(5):622-8 [PMID: 3677983]
  7. Diabetes Care. 2022 Jul 7;45(7):1666-1669 [PMID: 35485908]
  8. Clin Biochem. 2014 Jun;47(9):840-3 [PMID: 24457064]
  9. J Diabetes Sci Technol. 2024 Jul;18(4):899-903 [PMID: 36416103]
  10. Diabetes Care. 2021 Jul;44(7):1641-1646 [PMID: 34099515]
  11. Diabetes Technol Ther. 2018 Jun;20(6):395-402 [PMID: 29901421]
  12. Diabetes Technol Ther. 2020 Oct;22(10):727-733 [PMID: 32105513]
  13. J Diabetes Sci Technol. 2022 Sep;16(5):1136-1143 [PMID: 33971753]
  14. J Clin Med. 2021 Apr 27;10(9): [PMID: 33925523]
  15. Diabetes Care. 2022 Jan 1;45(Suppl 1):S97-S112 [PMID: 34964871]
  16. Diabetes Technol Ther. 2019 Feb;21(2):66-72 [PMID: 30657336]
  17. J Diabetes Sci Technol. 2019 Mar;13(2):254-258 [PMID: 30198331]
  18. J Diabetes Sci Technol. 2023 May;17(3):642-648 [PMID: 35876258]

Grants

  1. T32 DK063687/NIDDK NIH HHS

MeSH Term

Adult
Adolescent
Humans
Male
Child
Female
Diabetes Mellitus, Type 1
Blood Glucose
Blood Glucose Self-Monitoring
Inpatients
Reproducibility of Results
Hospitalization

Chemicals

Blood Glucose

Word Cloud

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