Intermittent scanning continuous glucose monitoring is safe and useful in postsurgical glucose monitoring after pancreatoduodenectomy
(2023) In Acta Diabetologica 60(12). p.1727-1733- Abstract
Aims: Intermittently scanned continuous glucose monitoring (isCGM) systems have not been thoroughly evaluated during in-hospital stay, and there are concerns about accuracy during various conditions. Patients undergoing pancreatoduodenectomy have an increased risk of hyperglycaemia after surgery which is aggravated by parenteral nutrition therapy. This study aims to evaluate glycaemic control and safety during insulin infusion in a surgical non-ICU ward, using a hybrid glucose monitoring approach with isCMG and periodic point-of-care (POC) testing. Methods: We prospectively included 100 patients with a resectable pancreatic tumour. After surgery, continuous insulin infusion was initiated when POC glucose was > 7 mmol/l and titrated... (More)
Aims: Intermittently scanned continuous glucose monitoring (isCGM) systems have not been thoroughly evaluated during in-hospital stay, and there are concerns about accuracy during various conditions. Patients undergoing pancreatoduodenectomy have an increased risk of hyperglycaemia after surgery which is aggravated by parenteral nutrition therapy. This study aims to evaluate glycaemic control and safety during insulin infusion in a surgical non-ICU ward, using a hybrid glucose monitoring approach with isCMG and periodic point-of-care (POC) testing. Methods: We prospectively included 100 patients with a resectable pancreatic tumour. After surgery, continuous insulin infusion was initiated when POC glucose was > 7 mmol/l and titrated to maintain glucose between 7 and 10 mmol/l. Glucose was monitored with isCGM together with intermittent POC, every 3–6 h. Median absolute relative difference (MARD) and hypoglycaemic events were evaluated. Mean glucose was compared with a historic control (n = 100) treated with multiple subcutaneously insulin injections, monitored with POC only. Results: The intervention group (isCGM/POC) had significantly lower POC glucose compared with the historic control group (8.8 ± 2.2 vs. 10.4 ± 3.4 mmol/l, p < 0.001). MARD was 17.8% (IQR 10.2–26.7). isCGM readings were higher than POC measurements in 91% of the paired cases, and isCGM did not miss any hypoglycaemic event. About 4.5% of all isCGM readings were < 3.9 mmol/l, but only six events were confirmed with POC, and none was < 3.0 mmol/l. Conclusions: A hybrid approach with isCGM/POC is a safe and effective treatment option in a non-ICU setting after pancreatoduodenectomy.
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- author
- Fagher, Katarina LU ; Ekström, Eva LU ; Rystedt, Jenny LU ; Tingstedt, Bobby LU ; Andersson, Bodil LU and Löndahl, Magnus LU
- organization
-
- Diabetes lab (research group)
- Surgery (Lund)
- Hepato-Pancreato-Biliary Surgery (research group)
- LUCC: Lund University Cancer Centre
- Surgery (research group)
- Artificial Intelligence in CardioThoracic Sciences (AICTS) (research group)
- eSSENCE: The e-Science Collaboration
- Medicine, Lund
- EXODIAB: Excellence of Diabetes Research in Sweden
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- CGM, Continuous glucose monitoring, Hospital, Surgery, Total parenteral nutrition
- in
- Acta Diabetologica
- volume
- 60
- issue
- 12
- pages
- 7 pages
- publisher
- Springer
- external identifiers
-
- pmid:37540239
- scopus:85166631050
- ISSN
- 0940-5429
- DOI
- 10.1007/s00592-023-02158-0
- language
- English
- LU publication?
- yes
- id
- c8ee9070-4cf1-4f26-a423-f05f436a2ff1
- date added to LUP
- 2023-11-21 13:02:39
- date last changed
- 2024-04-18 16:14:49
@article{c8ee9070-4cf1-4f26-a423-f05f436a2ff1, abstract = {{<p>Aims: Intermittently scanned continuous glucose monitoring (isCGM) systems have not been thoroughly evaluated during in-hospital stay, and there are concerns about accuracy during various conditions. Patients undergoing pancreatoduodenectomy have an increased risk of hyperglycaemia after surgery which is aggravated by parenteral nutrition therapy. This study aims to evaluate glycaemic control and safety during insulin infusion in a surgical non-ICU ward, using a hybrid glucose monitoring approach with isCMG and periodic point-of-care (POC) testing. Methods: We prospectively included 100 patients with a resectable pancreatic tumour. After surgery, continuous insulin infusion was initiated when POC glucose was > 7 mmol/l and titrated to maintain glucose between 7 and 10 mmol/l. Glucose was monitored with isCGM together with intermittent POC, every 3–6 h. Median absolute relative difference (MARD) and hypoglycaemic events were evaluated. Mean glucose was compared with a historic control (n = 100) treated with multiple subcutaneously insulin injections, monitored with POC only. Results: The intervention group (isCGM/POC) had significantly lower POC glucose compared with the historic control group (8.8 ± 2.2 vs. 10.4 ± 3.4 mmol/l, p < 0.001). MARD was 17.8% (IQR 10.2–26.7). isCGM readings were higher than POC measurements in 91% of the paired cases, and isCGM did not miss any hypoglycaemic event. About 4.5% of all isCGM readings were < 3.9 mmol/l, but only six events were confirmed with POC, and none was < 3.0 mmol/l. Conclusions: A hybrid approach with isCGM/POC is a safe and effective treatment option in a non-ICU setting after pancreatoduodenectomy.</p>}}, author = {{Fagher, Katarina and Ekström, Eva and Rystedt, Jenny and Tingstedt, Bobby and Andersson, Bodil and Löndahl, Magnus}}, issn = {{0940-5429}}, keywords = {{CGM; Continuous glucose monitoring; Hospital; Surgery; Total parenteral nutrition}}, language = {{eng}}, number = {{12}}, pages = {{1727--1733}}, publisher = {{Springer}}, series = {{Acta Diabetologica}}, title = {{Intermittent scanning continuous glucose monitoring is safe and useful in postsurgical glucose monitoring after pancreatoduodenectomy}}, url = {{http://dx.doi.org/10.1007/s00592-023-02158-0}}, doi = {{10.1007/s00592-023-02158-0}}, volume = {{60}}, year = {{2023}}, }