Feasibility and performance of continuous glucose monitoring to guide computerized insulin infusion therapy in cardiovascular intensive care unit
Open accessAbstract
Background: We evaluated the feasibility of real-time continuous glucose monitoring (CGM) for titrating continuous intravenous insulin infusion (CII) to manage hyperglycemia in postoperative individuals in the cardiovascular intensive care unit and assessed their accuracy, nursing acceptance, and postoperative individual satisfaction. Methods: Dexcom G6 CGM devices were applied to 59 postsurgical patients with hyperglycemia receiving CII. A hybrid approach combining CGM with periodic point-of-care blood glucose (POC-BG) tests with two phases (initial-ongoing) of validation was used to determine CGM accuracy. Mean and median absolute relative differences and Clarke Error Grid were plotted to evaluate the CGM accuracy. Surveys of nurses and patients on the use of CGMs experience were conducted and results were analyzed. Results: In this cohort (mean age 64, 32% female, 32% with diabetes) with 864 paired POC-BG and CGM values analyzed, mean and median absolute relative difference between POC-BG and CGM values were 13.2% and 9.8%, respectively. 99.7% of paired CGM and POC-BG were in Zones A and B of the Clarke Error Grid. Responses from nurses reported CGMs being very or quite convenient (n = 28; 93%) and it was favored over POC-BG testing (n = 28; 93%). Majority of patients (n = 42; 93%) reported their care process using CGM as being good or very good. Conclusion: This pilot study demonstrates the feasibility, accuracy, and nursing convenience of adopting CGM via a hybrid approach for insulin titration in postoperative settings. These findings provide robust rationale for larger confirmatory studies to evaluate the benefit of CGM in postoperative care to improve workflow, enhance health outcomes, and cost-effectiveness.
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Hospital CGM was successfully used in conjunction with periodic POC monitoring in hybrid protocols used for intravenous insulin titrations, decreasing the burden of hourly POC testing.
“However, hospital CGM was successfully used in conjunction with periodic POC monitoring in hybrid protocols used for intravenous insulin titrations, decreasing the burden of hourly POC testing (54)(55)(56).”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [56]
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16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s016 · Cited by 80 · see citing works
- Authors
- Ang, L., Lin, Y. K., Schroeder, L. F., Huang, Y., DeGeorge, C. A., Arnold, P., Akanbi, F., Knotts, S., DuBois, E., Desbrough, N., Qu, Y., Freeman, R., Esfandiari, N. H., Pop-Busui, R., & Gianchandani, R.
- Affiliations
- University of Michigan (US)
- Michigan State University (US)
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Cedars-Sinai Medical Center (US)
- Corresponding author
- Ang, Lynn
- ORCID
- Venue
- Journal of Diabetes Science and Technology
- Publisher
- SAGE Publications
- Published
- 2024-04-02
- Volume
- 18
- Issue
- 3
- Pages
- 562-569
- ISSN
- 1932-2968 (ISSN-L)
- PMC
- PMC11089859
- OpenAlex
- W4393716705
- Cited by
- 11
- References
- 7
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 2
- Type
- conference abstract
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Diabetes Science and Technology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- JDRF (Center of Excellence at University of Michigan)
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK129724, R01DK107956, R01DK11672, U01DK119083)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Surgery › Healthcare Technology and Patient Monitoring
- Keywords
- continuous glucose monitoring, continuous intravenous insulin infusion, hyperglycemia management, postoperative care, cardiovascular intensive care unit, CGM accuracy, Clarke error grid, insulin dose adjustment, patient satisfaction, Dexcom G6
- MeSH terms
- Continuous Glucose Monitoring, Aged, Blood Glucose, Diabetes Mellitus, Feasibility Studies, Female, Humans, Hyperglycemia, Hypoglycemic Agents, Infusions, Intravenous, Insulin, Insulin Infusion Systems, Intensive Care Units, Male, Middle Aged, Blood Glucose Self-Monitoring
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