Limits...
Real-time continuous glucose monitoring reduces the duration of hypoglycemia episodes: a randomized trial in very low birth weight neonates.

Uettwiller F, Chemin A, Bonnemaison E, Favrais G, Saliba E, Labarthe F - PLoS ONE (2015)

Bottom Line: Forty-three monitorings were analyzed (IGM n = 21, CGM n = 22), with a median recording time of 72 hours.Furthermore, it reduced the number of blood samples (CGM 16.9 ± 1.0 vs IGM 21.9 ± 1.0 blood sample/patient, p<0.001).The clinical significance of the biological differences observed in our study need to be explored.

View Article: PubMed Central - PubMed

Affiliation: Médecine Pédiatrique, CHRU de Tours, Université François Rabelais, Tours, France; Réanimation Pédiatrique et Néonatologie, CHRU de Tours, Université François Rabelais, Tours, France.

ABSTRACT

Objectives: Hypoglycemia is frequent in very low birth weight (VLBW) neonates and compromises their neurological outcome. The aim of this study was to compare real-time continuous glucose monitoring system (RT-CGMS) to standard methods by intermittent capillary blood glucose testing in detecting and managing hypoglycemia.

Study design: Forty-eight VLBW neonates were enrolled in this prospective study. During their 3 first days of life, their glucose level was monitored either by RT-CGMS (CGM-group), or by intermittent capillary glucose testing (IGM-group) associated with a blind-CGMS to detect retrospectively missed hypoglycemia. Outcomes were the number and duration of hypoglycemic (≤ 50 mg/dl) episodes per patient detected by CGMS.

Results: Forty-three monitorings were analyzed (IGM n = 21, CGM n = 22), with a median recording time of 72 hours. In the IGM group, blind-CGMS revealed a significantly higher number of hypoglycemia episodes than capillary blood glucose testing (1.2 ± 0.4 vs 0.4 ± 0.2 episode/patient, p<0.01). In the CGM-group, the use of RT-CGMS made it possible (i) to detect the same number of hypoglycemia episodes as blind-CGMS (1.2 ± 0.4 episode/patient), (ii) to adapt the glucose supply in neonates with hypoglycemia (increased supply during days 1 and 2), and (iii) to significantly reduce the duration of hypoglycemia episodes per patient (CGM 44[10-140] min versus IGM 95[15-520] min, p<0.05). Furthermore, it reduced the number of blood samples (CGM 16.9 ± 1.0 vs IGM 21.9 ± 1.0 blood sample/patient, p<0.001).

Conclusion: RT-CGMS played a beneficial role in managing hypoglycemia in VLBW neonates by adjusting the carbohydrate supply to the individual needs and by reducing the duration of hypoglycemia episodes. The clinical significance of the biological differences observed in our study need to be explored.

Show MeSH

Related in: MedlinePlus

Number of hypoglycemic episodes per patient in the IGM-group and examples of hypoglycemic episodes.Number of hypoglycemic episodes per patient detected by capillary blood glucose testing or continuous glucose monitoring in the IGM-group (A) and examples of hypoglycemic episodes (B and C). In 21 patients from the IGM-group, glucose level was monitored by capillary blood glucose testing performed every 4 hours and by blind continuous glucose monitoring system (CGMS, Guardian Clinical, Medtronic) that was analyzed retrospectively. Hypoglycemia was defined by a glucose level ≤50mg/dL. Number of hypoglycemia episodes per patient are expressed as mean ± SE; **p<0.01. In the first example (B), blind continuous glucose monitoring detected a hypoglycemic episode 100 min before capillary blood glucose testing. In the second example (C), hypoglycemic episode (90 min of duration) was detected solely by continuous glucose monitoring.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4295867&req=5

pone.0116255.g002: Number of hypoglycemic episodes per patient in the IGM-group and examples of hypoglycemic episodes.Number of hypoglycemic episodes per patient detected by capillary blood glucose testing or continuous glucose monitoring in the IGM-group (A) and examples of hypoglycemic episodes (B and C). In 21 patients from the IGM-group, glucose level was monitored by capillary blood glucose testing performed every 4 hours and by blind continuous glucose monitoring system (CGMS, Guardian Clinical, Medtronic) that was analyzed retrospectively. Hypoglycemia was defined by a glucose level ≤50mg/dL. Number of hypoglycemia episodes per patient are expressed as mean ± SE; **p<0.01. In the first example (B), blind continuous glucose monitoring detected a hypoglycemic episode 100 min before capillary blood glucose testing. In the second example (C), hypoglycemic episode (90 min of duration) was detected solely by continuous glucose monitoring.

Mentions: In the IGM group, capillary blood glucose testing performed every 4 hours detected 10 hypoglycemic episodes ≤50 mg/dl in 7 patients. Blind-CGMS, which was analyzed retrospectively, detected a significantly higher number of hypoglycemia episodes (n = 27, Fig. 2A) than capillary blood glucose testing (1.2±0.4 vs 0.4±0.2 episode/patient, p<0.01). The 10 previously described episodes were detected prematurely in 8 cases, 59 ± 19 min before capillary blood glucose testing. The 17 other hypoglycemia episodes were not identified by capillary blood glucose testing in a total of 11 patients. Some examples of monitoring are shown in Fig. 2B and 2C.


Real-time continuous glucose monitoring reduces the duration of hypoglycemia episodes: a randomized trial in very low birth weight neonates.

Uettwiller F, Chemin A, Bonnemaison E, Favrais G, Saliba E, Labarthe F - PLoS ONE (2015)

Number of hypoglycemic episodes per patient in the IGM-group and examples of hypoglycemic episodes.Number of hypoglycemic episodes per patient detected by capillary blood glucose testing or continuous glucose monitoring in the IGM-group (A) and examples of hypoglycemic episodes (B and C). In 21 patients from the IGM-group, glucose level was monitored by capillary blood glucose testing performed every 4 hours and by blind continuous glucose monitoring system (CGMS, Guardian Clinical, Medtronic) that was analyzed retrospectively. Hypoglycemia was defined by a glucose level ≤50mg/dL. Number of hypoglycemia episodes per patient are expressed as mean ± SE; **p<0.01. In the first example (B), blind continuous glucose monitoring detected a hypoglycemic episode 100 min before capillary blood glucose testing. In the second example (C), hypoglycemic episode (90 min of duration) was detected solely by continuous glucose monitoring.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4295867&req=5

pone.0116255.g002: Number of hypoglycemic episodes per patient in the IGM-group and examples of hypoglycemic episodes.Number of hypoglycemic episodes per patient detected by capillary blood glucose testing or continuous glucose monitoring in the IGM-group (A) and examples of hypoglycemic episodes (B and C). In 21 patients from the IGM-group, glucose level was monitored by capillary blood glucose testing performed every 4 hours and by blind continuous glucose monitoring system (CGMS, Guardian Clinical, Medtronic) that was analyzed retrospectively. Hypoglycemia was defined by a glucose level ≤50mg/dL. Number of hypoglycemia episodes per patient are expressed as mean ± SE; **p<0.01. In the first example (B), blind continuous glucose monitoring detected a hypoglycemic episode 100 min before capillary blood glucose testing. In the second example (C), hypoglycemic episode (90 min of duration) was detected solely by continuous glucose monitoring.
Mentions: In the IGM group, capillary blood glucose testing performed every 4 hours detected 10 hypoglycemic episodes ≤50 mg/dl in 7 patients. Blind-CGMS, which was analyzed retrospectively, detected a significantly higher number of hypoglycemia episodes (n = 27, Fig. 2A) than capillary blood glucose testing (1.2±0.4 vs 0.4±0.2 episode/patient, p<0.01). The 10 previously described episodes were detected prematurely in 8 cases, 59 ± 19 min before capillary blood glucose testing. The 17 other hypoglycemia episodes were not identified by capillary blood glucose testing in a total of 11 patients. Some examples of monitoring are shown in Fig. 2B and 2C.

Bottom Line: Forty-three monitorings were analyzed (IGM n = 21, CGM n = 22), with a median recording time of 72 hours.Furthermore, it reduced the number of blood samples (CGM 16.9 ± 1.0 vs IGM 21.9 ± 1.0 blood sample/patient, p<0.001).The clinical significance of the biological differences observed in our study need to be explored.

View Article: PubMed Central - PubMed

Affiliation: Médecine Pédiatrique, CHRU de Tours, Université François Rabelais, Tours, France; Réanimation Pédiatrique et Néonatologie, CHRU de Tours, Université François Rabelais, Tours, France.

ABSTRACT

Objectives: Hypoglycemia is frequent in very low birth weight (VLBW) neonates and compromises their neurological outcome. The aim of this study was to compare real-time continuous glucose monitoring system (RT-CGMS) to standard methods by intermittent capillary blood glucose testing in detecting and managing hypoglycemia.

Study design: Forty-eight VLBW neonates were enrolled in this prospective study. During their 3 first days of life, their glucose level was monitored either by RT-CGMS (CGM-group), or by intermittent capillary glucose testing (IGM-group) associated with a blind-CGMS to detect retrospectively missed hypoglycemia. Outcomes were the number and duration of hypoglycemic (≤ 50 mg/dl) episodes per patient detected by CGMS.

Results: Forty-three monitorings were analyzed (IGM n = 21, CGM n = 22), with a median recording time of 72 hours. In the IGM group, blind-CGMS revealed a significantly higher number of hypoglycemia episodes than capillary blood glucose testing (1.2 ± 0.4 vs 0.4 ± 0.2 episode/patient, p<0.01). In the CGM-group, the use of RT-CGMS made it possible (i) to detect the same number of hypoglycemia episodes as blind-CGMS (1.2 ± 0.4 episode/patient), (ii) to adapt the glucose supply in neonates with hypoglycemia (increased supply during days 1 and 2), and (iii) to significantly reduce the duration of hypoglycemia episodes per patient (CGM 44[10-140] min versus IGM 95[15-520] min, p<0.05). Furthermore, it reduced the number of blood samples (CGM 16.9 ± 1.0 vs IGM 21.9 ± 1.0 blood sample/patient, p<0.001).

Conclusion: RT-CGMS played a beneficial role in managing hypoglycemia in VLBW neonates by adjusting the carbohydrate supply to the individual needs and by reducing the duration of hypoglycemia episodes. The clinical significance of the biological differences observed in our study need to be explored.

Show MeSH
Related in: MedlinePlus