CGM-guided glucose titration improves glycaemic control in very preterm infants
Continuous glucose monitoring (CGM)-guided glucose titration appears to safely and effectively increase the time spent in the euglycemic range, while reducing the risk of both hypoglycaemia and hyperglycaemia and minimizing glucose variability in preterm infants during the first week of life, according to a study.
In a cohort of 50 neonates (27 girls) born ≤32 gestational weeks or with birthweight ≤1500 g, the primary outcome of percentage of time spent in euglycemia (72 to 144 mg/dL) was greater among neonates randomized to receive computer-guided glucose infusion rate (GIR) with CGM within 48 hours than among those who received GIR without CGM (median, 84 vs 68 percent; p<0.001). [Pediatrics 2017;doi:10.1542/peds.2017-1162]
Results for secondary outcomes were also better in the CGM group, with time spent in mild (p=0.04) and severe (p=0.007) hypoglycaemia and severe hyperglycaemia (p=0.04) being shorter than in the no-CGM group. Furthermore, use of CGM led to decreased glycaemic variability (standard deviation: 21.6 vs 27 mg/dL; p=0.01; coefficient of variation: 22.8 vs 27.9 percent; p<0.001).
These data suggest that hyperglycaemia in the cohort is not necessarily due to impaired insulin secretion but rather to inappropriate glucose titration, researchers pointed out.
Additionally, the study “highlight[s] that linking a CGM to control algorithm guiding glucose titration alone can successfully achieve glucose control in [preterm infants] without need for insulin,” they said.
Importantly, glucose control can be attained without compromising adequate nutrition to sustain growth in very preterm infants, as evidenced by loss of <10 percent of birth weight in the CGM group and following the minimum increase in glucose administration of 1 g/kg per day GIR recommended by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition, researchers continued.
CGM devices were well received by parents given that all families approached accepted participation in the current study. The devices were safe to use, without any CGM-related adverse events ever occurring.
However, routine use of CGM-driven control algorithms in the neonatal intensive care unit may be limited by the need to log CGM values in an Excel spreadsheet every 3 hours and to calibrate CGM at least twice a day.
“Such limitations will likely be of short duration … as CGM technology continues to rapidly improve. New generation CGM models are also now expected to require only a single daily calibration and to last 10 instead of 7 days, thus potentially reducing the burden of frequent blood glucose sampling,” researchers said.
“Future studies of larger samples size are needed to assess long-term clinical outcomes related to [the use of CGM for] glucose management in very preterm infants,” they added.