Continuous Glucose Monitoring for Hyperglycemia in Critically Ill Patients

Study Purpose:

The purpose of this study is to compare the use of continuous glucose monitoring (CGM) versus point of care (POC) glucose monitoring in the intensive care unit (ICU) setting for differences in glycemic control and other important outcomes.

Research Plan:

This will be a prospective, single-center, randomized comparative trial of adult patients at North Florida/South Georgia Veterans Health System anticipated to be admitted to an ICU for a minimum of 48 hours after enrollment. Study participants will be randomly assigned to one of the study groups (CGM or POC) after being found eligible for inclusion and giving consent to participate. The CGM group will receive glycemic management based on CGM readings. The POC group will receive glycemic management based on POC glucose readings.

Study Outcomes:

Groups will be compared for differences in clinical and safety outcomes. The primary outcome will be the proportion of time in target range (BG 70-180mg/dL). Secondary outcomes will include mean glucose, hypoglycemia, hyperglycemia, ICU length of stay, mortality, glucose variability, cost, and patient satisfaction. Safety outcomes will include new infection, acute kidney injury, delirium, agitation, and pain.

Analysis Methods:

Descriptive statistics and inferential statistical methods will be used as appropriate to report findings of this study.

Inclusion criteria

• Patients age 18-89
• Past medical history of any diabetes mellitus OR patients with at least 1 measured BG of 180 being treated with insulin (subcutaneous or infusion)
• Enrollment will occur within 72 hours after being admitted to an ICU if history of diabetes
• Enrollment will occur within 72 hours after developing hyperglycemia in ICU if no diabetes

Exclusion criteria

• Pregnant patients
• Patients using CGMs in the outpatient setting
• Diagnosis of diabetic ketoacidosis (DKA)
• Diagnosis of hyperosmolar hyperglycemic state (HHS)
• Anticipated to require prone positioning while on insulin therapy
• Any contraindications to CGMs based on manufacturer labeling
• BG above maximum reading for CGM (e.g. greater than 400 mg/dL)
• Receiving medication that could interfere with CGM readings (based on manufacturer specifications)
• Receiving any dose of hydroxyurea as this could falsely elevate the sensor readings (if applicable for specific CGM)
• Receiving greater than 1,000mg acetaminophen every 6 hours in any form as this could falsely elevate the sensor readings (if applicable for specific CGM)