NEW YORK (Reuters Health) - In very preterm infants, glucose administration guided by continuous glucose monitoring (CGM) and a computer-based algorithm for adjusting glucose infusion is more effective in maintaining normal blood sugar than standard intermittent blood glucose monitoring, a new clinical trial suggests.
CGM-guided glucose titration also cut the risk of hypoglycemia and hyperglycemia and lowered glucose variability, report Dr. Alfonso Galderisi from the University of Padova, in Italy, and colleagues.
“Impaired glucose control in very preterm infants is associated with increased morbidity, mortality and poor neurologic outcomes. To date, there are no effective strategies for effectively and continuously adapting glucose infusion that ensures tight glucose control,” they note in their report, online September 15 in Pediatrics.
Dr. Galderisi and colleagues conducted a randomized controlled trial involving 50 newborns born at or before 32 weeks' gestation or weighing 1,500 grams or less at birth. Within 48 hours after birth, they were randomly allocated either to a treatment group in which glycemic control was achieved by using an unblinded CGM with active alarms, coupled with a computer-guided glucose infusion algorithm (UB-CGM group); or to a control group in which a blinded CGM was used and the glucose-infusion rate was calculated based on standard-of-care blood glucose levels measured with a glucometer (B-CGM group).
Babies in the UB-CGM treatment group spent a greater percentage of time in the euglycemic range than their peers in the control group (median, 84 percent vs. 68 percent, P less than 0.001). Babies managed with CGM-guided glucose titration also had less variability in blood sugar levels than did controls (coefficient of variation, 22.8 percent vs. 27.9 percent, P less than 0.001).
“Previous studies on preterm infants have largely been focused on insulin administration for hyperglycemia management and have not explicitly linked a CGM with a control algorithm to guide adjustments in the insulin infusion rate,” Dr. Galderisi and colleagues note in their paper.
“In contrast, we highlight that linking a CGM to control algorithm guiding glucose titration alone can successfully achieve glucose control in this population without need for insulin. Moreover, it can do so without sacrificing adequate nutrition to sustain growth in very preterm infants, as evidenced by loss of less than 10 percent of birth weight in neonates belonging to the UB-CGM treatment group,” they say.
The ability to rapidly change glucose infusion rates allows for the prevention of both hypoglycemia and hyperglycemia while maintaining glucose intake and weight gain, they add.
The researchers say further studies in larger samples are needed to assess long-term clinical outcomes related to this form of glucose management in very preterm infants.
Continuous glucose monitoring materials for the study were provided by Dexcom Inc. The company had no role in study design, data collection, data analysis, data interpretation, or writing the report. One author reported research support from Dexcom.
SOURCE: http://bit.ly/2wg1teJ
Pediatrics 2017.
