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In the very low birthweight (VLBW) infant population, high glucose concentrations have been associated with increased mortality, brain injury, retinopathy of prematurity and worse neurodevelopmental outcomes. However, trials to prevent or treat hyperglycaemia in this population with continuous insulin infusions or a combination of insulin and/or reductions in the glucose infusion rate have been complicated by more frequent episodes of low glucose concentrations. While the long-term significance of these episodes is unknown, most would agree that they should be avoided during treatment of hyperglycaemia with insulin. Emerging data further associate increased glycaemic variability with impaired long-term outcomes. Use of continuous (interstitial) glucose monitoring (CGM) in very preterm, VLBW infants has the potential to minimise the incidence and severity of hypoglycaemia and hyperglycaemia and increase glycaemic stability during critical developmental periods, providing new opportunities to improve long-term neurocognitive outcomes in these children by preventing these common but potentially harmful metabolic disorders.
Thomson et al 1 report the results of a single-centre study in which feasibility of CGM for very preterm infants was assessed. The study was divided into two phases. In the first phase, accuracy was assessed by comparison of real-time (RT) CGM (Paradigm Veo, Medtronic MiniMed) to point-of-care (POC) blood glucose concentrations (Statstrip, Nova Biomedical) in 20 infants. In the second phase, a pilot study was conducted in which 20 infants were randomised to unblinded RT-CGM in conjunction with a clinical guideline dictating care decisions based on the CGM values versus standard neonatal care. In the standard care arm, infant interstitial glucose concentrations were measured with a blinded retrospective recording CGM (iPro2, Medtronic MiniMed) while glucose was managed using the standard of care hospital protocol. The goal of these studies was to generate data to inform a randomised trial evaluating the impact of unblinded RT-CGM in the care …
Contributors WWH and PJR had the idea for the article. TLH, WWH and PJR performed the literature search. TLH and PJR wrote the first draft of the article. TLH, WWH and PJR revised. PJR is the guarantor of the work.
Funding TLH is supported by the National Institute of Diabetes and Digestive and Kidney Disease, R01 DK101659 and NIH National Centers for Advancing Translational Sciences UL1 TR002535. WWH is supported by NIH grants T32 HD007186, K12 HD068372, and UL1TR001082. PJR is supported by NIH R01 DK088139 and R01 HD093701.
Competing interests PJR has received a Nova Statstrip for use in his animal laboratory studies. TLH has received support for clinical trials in pregnancy from Dexcom and has a collaborative relationship that includes clinical trial support from Jansson Research and Development.
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Provenance and peer review Commissioned; internally peer reviewed.