Real-time continuous glucose monitoring reduces the duration of hypoglycemia episodes: a randomized trial in very low birth weight neonates

Abstract

Objectives: Hypoglycemia is frequent in very low birth weight (VLBW) neonates and compromises their neurological outcome. The aim of this study was to compare real-time continuous glucose monitoring system (RT-CGMS) to standard methods by intermittent capillary blood glucose testing in detecting and managing hypoglycemia.

Study design: Forty-eight VLBW neonates were enrolled in this prospective study. During their 3 first days of life, their glucose level was monitored either by RT-CGMS (CGM-group), or by intermittent capillary glucose testing (IGM-group) associated with a blind-CGMS to detect retrospectively missed hypoglycemia. Outcomes were the number and duration of hypoglycemic (≤ 50 mg/dl) episodes per patient detected by CGMS.

Results: Forty-three monitorings were analyzed (IGM n = 21, CGM n = 22), with a median recording time of 72 hours. In the IGM group, blind-CGMS revealed a significantly higher number of hypoglycemia episodes than capillary blood glucose testing (1.2 ± 0.4 vs 0.4 ± 0.2 episode/patient, p<0.01). In the CGM-group, the use of RT-CGMS made it possible (i) to detect the same number of hypoglycemia episodes as blind-CGMS (1.2 ± 0.4 episode/patient), (ii) to adapt the glucose supply in neonates with hypoglycemia (increased supply during days 1 and 2), and (iii) to significantly reduce the duration of hypoglycemia episodes per patient (CGM 44[10-140] min versus IGM 95[15-520] min, p<0.05). Furthermore, it reduced the number of blood samples (CGM 16.9 ± 1.0 vs IGM 21.9 ± 1.0 blood sample/patient, p<0.001).

Conclusion: RT-CGMS played a beneficial role in managing hypoglycemia in VLBW neonates by adjusting the carbohydrate supply to the individual needs and by reducing the duration of hypoglycemia episodes. The clinical significance of the biological differences observed in our study need to be explored.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow chart.

CGM: continuous glucose monitoring. IGM: intermittent glucose monitoring.

Figure 2. Number of hypoglycemic episodes per patient in the IGM-group and examples of hypoglycemic episodes.

Number of hypoglycemic episodes per patient detected by capillary blood glucose testing or continuous glucose monitoring in the IGM-group (A) and examples of hypoglycemic episodes (B and C). In 21 patients from the IGM-group, glucose level was monitored by capillary blood glucose testing performed every 4 hours and by blind continuous glucose monitoring system (CGMS, Guardian Clinical, Medtronic) that was analyzed retrospectively. Hypoglycemia was defined by a glucose level ≤50mg/dL. Number of hypoglycemia episodes per patient are expressed as mean ± SE; **p

Figure 3. Comparison between IGM- and CGM-group: number of heel pricks, number and duration of hypoglycemic episodes per patient.

Number of heel pricks per patient for capillary blood glucose testing (A), number (B) and duration (C) of hypoglycemic episodes per patient. Results are expressed as mean ± SE (A and B) or as median, 25% and 75% percentiles (box) and extreme values (whisker) (C) *p

Figure 4. Daily carbohydrate supplies in IGM- and CGM-group.

Results, expressed as mean ± SE, represent daily carbohydrate supplies during the first 4 days of life in IGM versus CGM-group (A), and in patients with (HYPO) versus without (NORMO) hypoglycemia in each group (B and C); *p