Continuous Glucose Monitoring Reduces Time Preterm Infants Spend in Severe Hypoglycemia, Hyperglycemia

A newborn, preterm infant
A newborn, preterm infant
An international team of investigators sought to assess outcomes with real-time continuous glucose monitoring to manage glycemic control in preterm infants.

Real-time continuous glucose monitoring (CGM) of preterm infants was found to reduce prolonged, severe hypoglycemia and hyperglycemia, according to the results of an international, open-label, randomized controlled trial that were published in The Lancet Child & Adolescent Health.

Infants (N=180) born at or before 33 weeks’ gestation between 2016 and 2019 from 13 neonatal intensive care units in the Netherlands, United Kingdom, and Spain were included in the Real-Time Continuous Glucose Monitoring in Neonatal Intensive Care (REACT) study. The infants were randomly assigned at 24 hours of age to receive real-time CGM (n=85) or standard care (n=95) for 7 days. Instances of severe hypoglycemia (£2.2 mmol/L) and severe hyperglycemia (>15 mmol/L) were assessed.

Infants in the intervention and control cohorts were born at a mean of 27.7 weeks (range, 24.0-33.7) and 27.4 weeks (range, 23.3-31.3), respectively; 54% and 47% were boys, they weighted 910 grams (standard deviation [SD], 160) and 880 grams (SD, 180), and 77% and 74% were singleton births, respectively.

The average number of glucose assessments was 1538 (SD, 341) among the CGM group and 1412 (SD, 424) among the standard-care cohort and occurred every 7.1 hours (SD, 4.7) and 5.7 hours (SD, 4.4), respectively.

The proportion of time the infants had a normal glucose concentration (2.6-10 mmol/L) was 94% (SD, 11%) among the intervention group and 84% (SD, 22%) among the control group (adjusted mean difference [aMD], 8.9%; 95% CI, 3.4%-14.4; P =.005). The increased amount of time the infants who underwent CGM had a normal glucose concentration equated to 13 hours (95% CI, 5-21) during the first 6 days of life.

No significant between-group differences were observed for mean glucose concentration (aMD, -0.46; 95% CI, -1.00 to 0.09 mmol/L), mean glucose variability (aMD, -0.01; 95% CI, -0.15 to 0.13), mean time in hypoglycemic range (aMD, -0.09%; 95% CI, -1.52% to 1.33%), or mean time in hyperglycemic range (aMD, -0.92%; 95% CI, -2.03% to 0.19%).

During the first week of life, more infants in the CGM group received insulin compared with those in the standard-care cohort (61% vs 37%). Infants in the CGM cohort also received more daily insulin than the standard-care cohort (aMD, 0.69; 95% CI, 0.02-1.35 g/kg; P =.043); however, there was no difference in the total amount of insulin infused between both groups (aMD, 0.08; 95% CI, -3.3 to 3.5 U/kg/d; P =.96).

No serious adverse events were reported to be associated with the CGM device. Most parents (80%) and staff (70%) reported improvement in care with the device.

This study may have been limited by the hand insertion procedure of the CGM device, which was prone to technical difficulties.

These data indicated real-time CGM among preterm babies allowed for earlier detection and intervention of severe hypoglycemia and hyperglycemia events.

Disclosure: An author declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.


Beardsall K, Thomson L, Guy C, et al; and the REACT collaborative. Real-time continuous glucose monitoring in preterm infants (REACT): an international, open-label, randomised controlled trial. Lancet Child Adolesc Health. 2021;5(4):265-273. doi:10.1016/S2352-4642(20)30367-9