CGM-Guided Insulin Infusion in Critically Ill Patients Promotes Safety, Improves Time Efficiency, and Enhances Provider Satisfaction.

Objectives: Evaluate the integration of real-time continuous glucose monitoring (rtCGM) into an insulin infusion computer calculator (IICC) to improve glycemic control, time efficiency, safety, and clinician workflow in the intensive care unit (ICU).

Methods: A retrospective analysis was conducted on 35 critically ill adult patients requiring insulin infusion in the surgical and medical ICUs. Dexcom G7 rtCGM values were integrated into an institution-developed IICC using an ongoing validation protocol, allowing for non-adjunctive CGM use. The accuracy of rtCGM was assessed by comparing matched CGM and POC glucose values using mean absolute relative difference (MARD), Surveillance Error Grid, and Parkes Error Grid analyses. CGM time-in-range (TIR) metrics, clinician turnaround time (TAT) for glucose monitoring, and nurse satisfaction were also evaluated.

Results: A total of 1,291 matched glucose pairs were analyzed. The rtCGM system demonstrated a MARD of 12.5%, with 99.6% of values falling within clinically acceptable error zones (A+B) on the Parkes Error Grid. Patients in the rtCGM-IICC protocol had mean glucose 141.9 mg/dL, with mean TIR (70-180 mg/dL) 82.8%, time above range (>180 mg/dL) 14.5%, and time below range (<70 mg/dL) 0.5%. Clinician time efficiency improved significantly, with POC testing requiring a mean TAT of nearly 5 minutes compared to 3-second CGM retrieval. All surveyed nurses (n=20) reported rtCGM increased efficiency and improved safety, and preferred rtCGM with POC over POC testing alone.

Conclusions: Integrating rtCGM with an IICC protocol in the ICU enhances glycemic control, improves workflow efficiency, and reduces clinician workload while maintaining high accuracy.