The Role of Calibration Practices in Optimizing Continuous Glucose Monitor Accuracy in Critically Ill Patients

CHEST critical care Pub Date : 2025-07-05 DOI:10.1016/j.chstcc.2025.100193

Melanie Natasha Rayan MD, MPH , Eileen R. Faulds PhD, RN , Brooke Lee , Molly McNett PhD, RN , Matthew Exline MD, MPH , Chyongchiou J. Lin PhD , Laureen Jones RN , Amanie Rasul , Kathleen M. Dungan MD, MPH

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Abstract

Background

In the ICU, continuous glucose monitors (CGMs) may improve glycemia and reduce the need for point-of-care blood glucose (POC BG) monitoring, but face challenges because of clinical conditions that affect accuracy.

Research Question

What is the feasibility of using POC BG calibration to improve CGM accuracy?

Study Design and Methods

This feasibility study pooled data from a retrospective study of patients with COVID-19 in the ICU and a prospective single-arm clinical trial of patients in the ICU. Our sample included 110 patients receiving IV insulin monitored using a hybrid CGM plus POC BG protocol with a factory-calibrated Dexcom G6 CGM (Dexcom, Inc.). Validation was required for initial and ongoing nonadjunctive use or for standalone use and was defined as CGM ± 20% of POC BG measurement for values of ≥ 100 mg/dL or ± 20 mg/dL for values of < 100 mg/dL. In the cohort with COVID-19, calibration was performed at the nurse’s discretion. In the prospective study, calibration was performed after persistent failure to achieve validation.

Results

A total of 55 patients (50%) underwent 167 calibrations. Those with a calibration had a mean age of 57.9 ± 13.6 years, 49% were male, 83% were White, and 60% had type 2 diabetes. After calibration, validation was achieved in 72.6%, 66.7%, and 77.8% of patients at 6, 12, and 24 hours after calibration, respectively. The mean absolute relative difference (MARD) was 25% at calibration, decreasing to 9.6%, 12.7%, and 13.2% at 6, 12, and 24 hours. Similar percentages were observed after eliminating pairs with multiple calibrations. Calibration was timely, within 5 minutes of the POC BG measurement in 70% and < 10 minutes in 83%. No statistical difference in MARD was found between timely and late calibrations or based on sensor rate of change at the time of calibration.

Interpretation

Our feasibility study demonstrated an improvement in CGM accuracy with POC BG calibrations in ICU patients. Further research is needed to understand optimal implementation strategies and impact on outcomes.

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校准实践在优化危重患者连续血糖监测准确性中的作用

背景：在ICU，连续血糖监测仪（cgm）可以改善血糖，减少对即时血糖（POC BG）监测的需求，但由于临床条件影响准确性而面临挑战。使用POC BG校准提高CGM精度的可行性是什么？研究设计和方法本可行性研究汇集了一项针对ICU患者的COVID-19回顾性研究和一项针对ICU患者的前瞻性单组临床试验的数据。我们的样本包括110名接受静脉注射胰岛素监测的患者，使用工厂校准的Dexcom G6 CGM （Dexcom, Inc）的CGM + POC BG混合方案。初始和持续的非辅助使用或单独使用需要验证，并且定义为CGM±20%的POC BG测量值≥100mg /dL或±20mg /dL值为<； 100mg /dL。在COVID-19队列中，由护士自行进行校准。在前瞻性研究中，在持续未能获得验证后进行校准。结果55例患者（50%）共进行了167次校准。校正者平均年龄57.9±13.6岁，49%为男性，83%为白人，60%患有2型糖尿病。校准后，72.6%、66.7%和77.8%的患者分别在校准后6、12和24小时获得验证。平均绝对相对差（MARD）在校准时为25%，在6、12和24小时分别降至9.6%、12.7%和13.2%。在多次校准消除配对后，观察到相似的百分比。校正及时，70%的POC BG测量在5分钟内，83%的校正在10分钟内。在及时和延迟校准之间或基于校准时传感器变化率的MARD未发现统计学差异。我们的可行性研究表明，在ICU患者中使用POC BG校准可以提高CGM的准确性。需要进一步研究以了解最佳实施策略及其对结果的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

CHEST critical care Critical Care and Intensive Care Medicine, Pulmonary and Respiratory Medicine

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