Purpose

Glycemic control poses a challenge in intensive care unit (ICU) patients and dysglycemia is associated with poor outcomes. Continuous glucose monitoring (CGM) has been successfully implemented in the type 1 diabetes out-patient setting and renewed interest has been directed into the transition of CGM into the ICU. This scoping review aimed to provide an overview of CGM accuracy in ICU patients to inform future research and CGM implementation.

Methods

We systematically searched PubMed and EMBASE between 5th of December 2023 and 21st of May 2024 and reported findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline for scoping reviews (PRISMA-ScR). We assessed studies reporting the accuracy of CGM in the ICU and report study characteristics and accuracy outcomes.

Results

We identified 2133 studies, of which 96 were included. Most studies were observational (91.7%), conducted in adult patients (74%), in mixed ICUs (47.9%), from 2014 and onward, and assessed subcutaneous CGM systems (80%) using arterial blood samples as reference test (40.6%). Half of the studies (56.3%) mention the use of a prespecified reference test protocol. The mean absolute relative difference (MARD) ranged from 6.6 to 30.5% for all subcutaneous CGM studies. For newer factory calibrated CGM, MARD ranged from 9.7 to 20.6%. MARD for intravenous CGM was 5–14.2% and 6.4–13% for intraarterial CGM.

Conclusions

In this scoping review of CGM accuracy in the ICU, we found great diversity in accuracy reporting. Accuracy varied depending on CGM and comparator, and may be better for intravascular CGM and potentially lower during hypoglycemia.

中文翻译：

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重症监护病房患者连续血糖监测系统的准确性：范围综述

 目的

血糖控制对重症监护病房 （ICU） 患者构成挑战，血糖异常与不良结果相关。连续血糖监测 （CGM） 已在 1 型糖尿病门诊环境中成功实施，并且人们对 CGM 过渡到 ICU 的兴趣重新引起。本范围综述旨在概述 ICU 患者 CGM 的准确性，为未来的研究和 CGM 实施提供信息。

 方法

我们在 2023 年 12 月 5 日至 2024 年 5 月 21 日期间系统检索了 PubMed 和 EMBASE，并根据系统综述和荟萃分析首选报告项目 （PRISMA） 综述范围指南（PRISMA-ScR） 报告了结果。我们评估了报告 ICU 中 CGM 准确性的研究，并报告了研究特征和准确性结局。

 结果

我们确定了 2133 项研究，其中 96 项被纳入。从 2014 年至今，大多数研究是观察性的 （91.7%），在成年患者 （74%） 和混合 ICU （47.9%） 中进行，并使用动脉血样本作为参考测试 （40.6%） 评估皮下 CGM 系统 （40.6%）。一半的研究 （56.3%） 提到使用预先指定的参考测试方案。所有皮下 CGM 研究的平均绝对相对差 （MARD） 范围为 6.6% 至 30.5%。对于较新的工厂校准 CGM，MARD 范围为 9.7% 至 20.6%。静脉内 CGM 的 MARD 为 5-14.2%，动脉内 CGM 为 6.4-13%。

 结论

在对 ICU 中 CGM 准确性的范围审查中，我们发现准确性报告存在很大差异。准确性因 CGM 和对照而异，对于血管内 CGM 可能更好，而在低血糖期间可能更低。