Real-Time Continuous Glucose Monitoring Reduces the Duration of Hypoglycemia Episodes: A Randomized Trial in Very Low Birth Weight Neonates

<div><p>Objectives</p><p>Hypoglycemia is frequent in very low birth weight (VLBW) neonates and compromises their neurological outcome. The aim of this study was to compare real-time continuous glucose monitoring system (RT-CGMS) to standard methods by intermittent capillary blood glucose testing in detecting and managing hypoglycemia.</p><p>Study design</p><p>Forty-eight VLBW neonates were enrolled in this prospective study. During their 3 first days of life, their glucose level was monitored either by RT-CGMS (CGM-group), or by intermittent capillary glucose testing (IGM-group) associated with a blind-CGMS to detect retrospectively missed hypoglycemia. Outcomes were the number and duration of hypoglycemic (≤50mg/dl) episodes per patient detected by CGMS.</p><p>Results</p><p>Forty-three monitorings were analyzed (IGM n = 21, CGM n = 22), with a median recording time of 72 hours. In the IGM group, blind-CGMS revealed a significantly higher number of hypoglycemia episodes than capillary blood glucose testing (1.2±0.4 vs 0.4±0.2 episode/patient, p<0.01). In the CGM-group, the use of RT-CGMS made it possible (i) to detect the same number of hypoglycemia episodes as blind-CGMS (1.2±0.4 episode/patient), (ii) to adapt the glucose supply in neonates with hypoglycemia (increased supply during days 1 and 2), and (iii) to significantly reduce the duration of hypoglycemia episodes per patient (CGM 44[10–140] min versus IGM 95[15–520] min, p<0.05). Furthermore, it reduced the number of blood samples (CGM 16.9±1.0 vs IGM 21.9±1.0 blood sample/patient, p<0.001).</p><p>Conclusion</p><p>RT-CGMS played a beneficial role in managing hypoglycemia in VLBW neonates by adjusting the carbohydrate supply to the individual needs and by reducing the duration of hypoglycemia episodes. The clinical significance of the biological differences observed in our study need to be explored.</p></div

Daily carbohydrate supplies in IGM- and CGM-group.

<p>Results, expressed as mean ± SE, represent daily carbohydrate supplies during the first 4 days of life in IGM versus CGM-group (A), and in patients with (HYPO) versus without (NORMO) hypoglycemia in each group (B and C); *p<0.05.</p

Characteristics of the 48 very low birth weight newborns with intermittent (IGM) or continuous glucose monitoring (CGM).

<p>Results are expressed as number of patients (%) or median [min-max].</p><p>*p<0.05</p><p>Characteristics of the 48 very low birth weight newborns with intermittent (IGM) or continuous glucose monitoring (CGM).</p

Comparison between IGM- and CGM-group: number of heel pricks, number and duration of hypoglycemic episodes per patient.

<p>Number of heel pricks per patient for capillary blood glucose testing (A), number (B) and duration (C) of hypoglycemic episodes per patient. Results are expressed as mean ± SE (A and B) or as median, 25% and 75% percentiles (box) and extreme values (whisker) (C) *p<0.05, ***p<0.001.</p

Additional file 3: of Clinical features of children with enthesitis-related juvenile idiopathic arthritis / juvenile spondyloarthritis followed in a French tertiary care pediatric rheumatology centre

Figure S2. Biological therapy: time to introduction and remission rate. Disease duration before introduction of a first line of biological therapy (years). Remission rate after introduction of a biological therapy (years). Remission was defined as the absence of any articular involvement (both peripheral and axial) and any enthesial involvement for at least six months. (DOCX 104 kb

Additional file 2: of Clinical features of children with enthesitis-related juvenile idiopathic arthritis / juvenile spondyloarthritis followed in a French tertiary care pediatric rheumatology centre

Figure S1. Evolution of the prevalence of inflammatory back pain. Inflammatory back pain was defined as proposed by the ASAS in 2009 [39]. Insidious onset. Improvement with exercise. No improvement with rest. Pain at night. (DOCX 63 kb