The use of continuous glucose monitoring to guide glucose administration in very preterm infants may provide more accurate and effective glucose control compared with standard-of-care glucose monitoring, according to a study published in Pediatrics.
Researchers identified a total of 50 very premature infants ≤32 weeks’ gestation or with birth weight ≤1500 g in Italy and assigned them 1:1 to receive computer-guided glucose infusion rate (GIR) with either blinded or unblinded continuous glucose monitoring (CGM) in a prospective study. Time spent in the euglycemic range (72-144 mg/dL) was the primary outcome observed in this study.
Results showed that not only did neonates in the unblinded group have a higher percentage of time spent in the euglycemic range (median, 84% vs 68%, P <.001) compared with the blinded CGM group, but they also spent less time in mild and severe hypoglycemia (P =.04 and P =.007, respectively) and in severe hyperglycemia (P =.04). In addition, the use of CGM decreased glycemic variability in both groups overall (SD 21.6 ± 5.4 mg/dL vs 27 ± 7.2 mg/dL [P =.01]; coefficient of variation: 22.8% ± 4.2% vs 27.9% ± 5.0% [P <.001]).
The investigators concluded that “CGM-guided glucose titration can successfully increase the time spent in euglycemic range, reduce hypoglycemia, and minimize glycemic variability in preterm infants during the first week of life.” Therefore, variations in glucose levels in neonates may be strongly related to inappropriate glucose titration in the clinical setting rather than a result of impaired insulin secretion in the neonate.
Galderisi A, Facchinetti A, Steil G, et al. Continuous glucose monitoring in very preterm infants: a randomized controlled trial. Pediatrics. 2017;140(4):e20171162.