Introduction and Objective: Continuous glucose monitoring (CGM) is a diagnostic tool widely used to monitor glucose levels in patients with diabetes and to guide insulin dose adjustments in outpatients. In the critical setting of inpatient care, however, special regulatory requirements on glucose measurements necessitate accuracy of CGM measurements as a prerequisite for its integration into clinical decision support.Methods: Strategies to optimize CGM accuracy were explored to meet the specific requirements of in-hospital care. Accuracy of glucose measurements was assessed in 226 patients using paired CGM glucose (CGM-G) and point-of-care glucose (POC-G) measurements, by calculating Mean Absolute Relative Difference (MARD) and estimation of numbers in the different zones of the Clarke Error Grid (CEG). Using raw CGM data, a dynamic, patient-specific algorithm was developed to minimize MARD through time lag optimization and linear modeling. The algorithm was integrated into the clinical workflow and applied to a second cohort of 24 patients.Results: Data analysis showed an initial MARD of 10.18% of the CGM measurements, with 99.02% of data points located in zones A and B of the CEG. The application of the patient-specific optimization algorithm improved the MARD by 4.33%. Integration of the patient-specific algorithm into the clinical workflow reduced intrapersonal MARD by 5.58%, and demonstrated significant improvements in glucose monitoring performance on an individual level.Conclusion: Patient-specific algorithmic refinements of CGM data demonstrate the potential to adequately address the unique demands of inpatient diabetes care by reducing intrapersonal MARD, paving the way for the adoption of CGM systems into hospital environments.
J. von Conta: None. F.H. Bahnsen: None. L. Heinemann: Consultant; Dexcom, Inc., Roche Diabetes Care. Board Member; Lifecare. Stock/Shareholder; Science Consulting in Diabetes GmbH, Profil Institut für Stoffwechselforschung GmbH, diateam GmbH. Consultant; Indigo. L. van Baal: None. J. Kleesiek: None. D. Fuhrer: Other Relationship; Abbott Diagnostics. Speaker’s Bureau; Sanofi-Aventis Deutschland GmbH. Other Relationship; Ascendis Pharma A/S. Advisory Panel; Eli Lilly and Company, Eisai. Consultant; IPSEN, Merck & Co., Inc, Sanofi-Aventis Deutschland GmbH. S. Reger Tan: Advisory Panel; Abbott. Research Support; Boehringer-Ingelheim, AstraZeneca, Bayer Pharmaceuticals, Inc, Eli Lilly and Company, Novartis AG, Novo Nordisk. Consultant; Sinocare Inc. Other Relationship; Berlin-Chemie AG, Dexcom, Inc.
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