Prospective detection of hyperglycemia in critically ill children using continuous glucose monitoring

Objective: To evaluate the extent of hyperglycemia in nondiabetic children admitted to a pediatric intensive care unit using an interstitial continuous glucose monitor, and to compare the ability of this interstitial continuous glucose monitoring system to detect hyperglycemia with that of intermittent laboratory monitoring. Design: Prospective observational study. Setting., Ten-bed pediatric intensive care unit in an academic referral medical center in western Massachusetts. Patients: A convenience sample of 20 nondiabetic children, aged 1-18, anticipated to require intensive care > 2 days. Interventions: Placement of a subcutaneous continuous glucose monitor for 72 hrs with a subsequent second sensor placed if the patient and family agreed. Glucose levels were compared with laboratory glucose values. Measurements and Main Results. Elevated glucose levels were revealed by 16,337 sensor glucose readings over a mean of 68 +/- 5.2 hrs per patient. Forty-three percent of readings were > 125 mg/dL (6.9 mmol/L), 27.2% were > 140 mg/dL (7.8 mmol/L), and 4.0% were > 200 mg/dL (11.1 mmol/L. Laboratory glucose measurements demonstrated hyperglycemia less frequently and missed significant periods of hyperglycemia. Conclusions. Significant hyperglycemia is present in pediatric intensive care patients and may be underestimated by intermittent laboratory monitoring.