CGM Could Help Management of Diabetic Ketoacidosis

Patients with diabetic ketoacidosis (DKA) can benefit from using a continuous glucose monitor (CGM) due to their ability to provide accurate blood glucose measurements and identify missed opportunities for earlier intervention, according to data published in the journal CHEST Critical Care.¹ Authors of the study said that future trials should assess the impact of CGM on patient outcomes, experiences, and resource use.

CGM Could Help Management of Diabetic Ketoacidosis / sudok1 - stock.adobe.com

DKA is a life-threatening complication of diabetes and is typically seen in patients with type 1 diabetes (T1D).² There are numerous triggers for DKA, including new-onset diabetes, infections, or lack of compliance with treatment. Although the mortality rate of DKA is low—between 0.2% and 2.5%—complications can include hypoglycemia, hypokalemia, cerebral edema, and acute respiratory failure.

“The use of a CGM is a promising strategy for optimizing DKA management by allowing real-time continuous glucose level-based titrations in therapies, promoting faster response time in titrating treatments, eliminating the nursing burden of hourly POCBG monitoring, promoting patient comfort, and preventing the need for ICU admission in some cases,” the authors wrote. “However, major barriers are the lack of published data on the analytical accuracy of CGMs during DKA and how associated metabolic derangements affect accuracy.”

Investigators from the University of Michigan conducted a study to determine the clinical and analytical accuracy of CGM in adult patients with DKA. The prospective, observational study was conducted at an academic medical center emergency department (ED) and ED-ICU in the United States from March to August 2023. The study cohort included 20 patients with DKA, of which the mean age was 42 years, 60% were female, and 70% had type 1 diabetes.

Patients entering the ED had a CGM applied within 12 hours and interstitial glucose readings were collected with a Dexcom G6 CGM until the resolution of DKA. The CGM readings were compared to glucose readings from capillary whole blood (POCBG) and serum (BMP and VBG) obtained during routine clinical care. The primary study outcome was the proportion of paired glucose measurements from CGM and POCBG in Clarke error grid zones A and B.

During the study, 334 paired glucose measurements from CGM and POCBG were analyzed. The study found that 97% of paired readings fell in Clarke error grid zones A and B. For 71.9% of the paired observations, the CGM measurement was higher than the POCBG measurement. The average difference was 26.0 mg/dL. The first incidence of POCBG of less than 150 mg/dL and POCBG of less than 100 mg/dL was detected 28.9 minutes and 13.8 minutes earlier by the CGM, respectively.

Additionally, there were no complications related to the CGM device during the study and CGM application and removal were well tolerated by all patients. The authors said that CGM-guided DKA management could help improve patient comfort by avoiding repeated fingersticks, reduce resource use, and improve patient outcomes by reducing the risk of severe hypoglycemia.

“This is the first step in improving patient outcomes, patient experience, and reducing resource utilization for the common, costly condition of DKA,” Nate Haas, MD, clinical assistant professor of emergency medicine at the University of Michigan and author on the study, said in a release.³ “By using this tool, we can reduce the number of fingersticks needed, simplify management, and prevent the need for ICU admission for DKA in the future.”

References

1. Haas NL, Ang L, Esfandiara NH, et al. Analytical Accuracy of a Continuous Glucose Monitor in Adult Diabetic Ketoacidosis. CHEST Critical Care, Volume 3, Issue 1, 100109. DOI: 10.1016/j.chstcc.2024.100109

2. Lizzo JM, Goyal A, Gupta V. Adult Diabetic Ketoacidosis. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560723/

3. Continuous glucose monitors can optimize diabetic ketoacidosis management. News Release. Michigan Medicine. March 18, 2025. Accessed March 15, 2025. https://www.michiganmedicine.org/health-lab/continuous-glucose-monitors-can-optimize-diabetic-ketoacidosis-management