1040-P: Feasibility and Performance of Continuous Glucose Monitoring (CGM) to Guide Computerized Insulin Infusion Therapy in Cardiovascular Intensive Care Unit (CV-ICU)

Abstract

We evaluated the utility of real-time CGM for titrating intravenous (IV) insulin via a validated institutional computerized insulin infusion (CII) algorithm in the CV-ICU. We used a hybrid approach of combining CGM with periodic point-of-care blood glucose (POC-BG) tests to validate the continued accuracy of CGM. We also surveyed nurses on this care change. Dexcom G6 CGMs were applied to 61 post-surgical patients with hyperglycemia (34% with diabetes) receiving IV insulin. CGM values were validated with POC-BG every(Q) 1-2 h per the CII protocol. Once validated (i.e., within 20% of POC-BG values if BG ≥100 mg/dL or within 20 mg/dL if BG <100 mg/dl), sensor values were then used to titrate IV insulin doses per CII algorithm. POC-BG checks were then reduced to Q6h validation. Among 857 paired POC-BG and CGM values analyzed, the mean and median average relative difference between POC-BG and CGM values were 13.2% and 9.8%, respectively. 99.6% of paired CGM and POC-BG were in Zone A and B of the Clarke Error Grid (Figure). Thirty nurse respondents found CGM very or quite convenient (n=28; 93%) and favored it over POC-BG testing (n=28; 93%). This pilot study demonstrates that using CGM via a hybrid approach for CII titration protocol is feasible, has high accuracy, and higher nursing convenience. Disclosure L.Ang: None. Y.Qu: None. R.Freeman: None. N.H.Esfandiari: None. R.Busui: Board Member; American Diabetes Association, Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp., Novo Nordisk, Roche Diagnostics, Procter & Gamble, Research Support; Novo Nordisk, Medtronic, National Institutes of Health. R.Gianchandani: None. F.Akanbi: None. L.F.Schroeder: None. Y.Lin: None. C.A.Degeorge: None. P.Arnold: None. S.Knotts: None. E.Dubois: None. N.Desbrough: None.