title: Accuracy of a real-time continuous glucose monitoring system in children with septic shock: A pilot study.
abstract: OBJECTIVE
  The aim of this prospective, observational study was to determine the accuracy of a real-time continuous glucose monitoring system (CGMS) in children with septic shock.
  
  
  METHODS
  Children aged 30 days to 18 years admitted to the Pediatric Intensive Care Unit with septic shock were included. A real-time CGMS sensor was used to obtain interstitial glucose readings. CGMS readings were compared statistically with simultaneous laboratory blood glucose (BG).
  
  
  RESULTS
  Nineteen children were included, and 235 pairs of BG-CGMS readings were obtained. BG and CGMS had a correlation coefficient of 0.61 (P < 0.001) and a median relative absolute difference of 17.29%. On Clarke's error grid analysis, 222 (94.5%) readings were in the clinically acceptable zones (A and B). When BG was < 70, 70-180, and > 180 mg/dL, 44%, 100%, and 76.9% readings were in zones A and B, respectively (P < 0.001). The accuracy of CGMS was not affected by the presence of edema, acidosis, vasopressors, steroids, or renal replacement therapy. On receiver operating characteristics curve analysis, a CGMS reading <97 mg/dL predicted hypoglycemia (sensitivity 85.2%, specificity 75%, area under the curve [AUC] =0.85). A reading > 141 mg/dL predicted hyperglycemia (sensitivity 84.6%, specificity 89.6%, AUC = 0.87).
  
  
  CONCLUSIONS
  CGMS provides a fairly, accurate estimate of BG in children with septic shock. It is unaffected by a variety of clinical variables. The accuracy over extremes of blood sugar may be a concern. We recommend larger studies to evaluate its use for the early detection of hypoglycemia and hyperglycemia.
authors.affiliation: Royal Manchester Children's Hospital, Manchester, UK.
authors.forename: Sumant
authors.initials: S
authors.lastname: Prabhudesai
authors.affiliation: Columbia Asia Hospital, Ahmedebad, Gujrat, India.
authors.forename: Amruta
authors.initials: A
authors.lastname: Kanjani
authors.affiliation: PD Hinduja National Hospital and Medical Research Centre, Mumbai, India.
authors.forename: Isha
authors.initials: I
authors.lastname: Bhagat
authors.affiliation: Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India.
authors.forename: Karnam G
authors.initials: KG
authors.lastname: Ravikumar
authors.affiliation: Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India.
authors.forename: Bala
authors.initials: B
authors.lastname: Ramachandran
keywords: Children; continuous glucose monitoring system; septic shock