A Feasibility Study to Detect Neonatal Hypoglycemia Using Real-Time Continuous Glucose Monitoring

Abstract

Introduction: Infants of diabetic mothers are at high risk of hypoglycemia (<47 mg/dl) after birth, with rates approaching 50% in the first 48 hours of life (HOL). Methods: Infants born at ≥34 weeks gestation to mothers with diabetes had a CGM placed after birth and were remotely monitored by research staff during their hospitalization. Clinical staff and families were blinded to CGM data. For CGM readings <45 mg/dl, research staff requested a heelstick blood glucose (BG) using the hospital glucometer. Results: Eleven infants were studied. Mothers had an average A1c of 5.6% (range 4.7-6.8%) prior to delivery and 82% required insulin. Hypoglycemia (<45 mg/dl) was confirmed in 7 of 11 infants with 14 events at less than 12 HOL, 2 events between 12-24 HOL, and 1 event at >48 HOL. CGM detected hypoglycemia 4 times when the infant was not due for a BG check based on the standard of care. The true positive rate for sensor-detected hypoglycemia was 40% and the false positive rate was 60%. CGM detected 24% of the hypoglycemic events that the usual intermittent pre-prandial BG checks would have missed. Conclusion: We conclude that CGM is safe and may provide added benefit for detecting hypoglycemia when used early after birth.Table. Neonatal characteristics and duration of hypoglycemia based on CGM readings. Reported as mean ± SD, (range).Neonatal CharacteristicsRemote Monitoring (n=11)Gestational Age (wk)38.4 ± 1.6 (34 - 39.4)Birth weight (kg)3.4 ± 0.6 (2.4 - 4.2)Mean CGM Glucose (mg/dl)64 ± 20 (50 - 114)CGM placed (HOL)2.9 ± 0.6 (1.5 - 3.7)CGM recording started (HOL)6.0 ± 0.7 (5.1 - 7.3)Duration of CGM records (hr) **Median (IQR)31.2 (13.2 - 41.5)Duration of Time BG <45 mg/dl (hr) **Median (IQR)2.7 (0.1 - 5.0) Disclosure L.M. Nally: None. N.W. Bondy: None. J. Doiev: None. B. Buckingham: Advisory Panel; Self; Novo Nordisk Inc., ConvaTec Inc.. Research Support; Self; Medtronic, Insulet Corporation, Dexcom, Inc., Tandem Diabetes Care, Inc.. Consultant; Self; Tandem Diabetes Care, Inc., Becton, Dickinson and Company. D. Wilson: Research Support; Self; T1D Exchange, Medtronic MiniMed, Inc., Dexcom, Inc., National Institute of Diabetes and Digestive and Kidney Diseases, Insulet Corporation. Advisory Panel; Self; Tolerion.