Accuracy of continuous glucose monitoring in preterm infants: a systematic review and meta-analysis

Background and objectives Continuous glucose monitoring (CGM) could be a valuable instrument for measurement of glucose concentration in preterm neonate. We undertook a systematic review and meta-analysis to compare the diagnostic accuracy of CGM devices to intermittent blood glucose evaluation meth...

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Autores principales:	Chiara Nava, Astrid Modiano Hedenmalm, Franciszek Borys, Matteo Bruschettini, Kevin Jenniskens
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2020
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/abad06ef0a9243b99abaf4a97e2cc387
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spelling	oai:doaj.org-article:abad06ef0a9243b99abaf4a97e2cc3872021-11-20T16:00:06ZAccuracy of continuous glucose monitoring in preterm infants: a systematic review and meta-analysis10.1136/bmjopen-2020-0453352044-6055https://doaj.org/article/abad06ef0a9243b99abaf4a97e2cc3872020-12-01T00:00:00Zhttps://bmjopen.bmj.com/content/10/12/e045335.fullhttps://doaj.org/toc/2044-6055Background and objectives Continuous glucose monitoring (CGM) could be a valuable instrument for measurement of glucose concentration in preterm neonate. We undertook a systematic review and meta-analysis to compare the diagnostic accuracy of CGM devices to intermittent blood glucose evaluation methods for the detection of hypoglycaemic or hypoglycaemic events in preterm infants.Data sources A structured electronic database search was performed for studies that assessed the accuracy of CGM against any intermittent blood glucose testing methods in detecting episodes of altered glycaemia in preterm infants. No restrictions were used. Three review authors screened records and included studies.Data extraction Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. From individual patient data (IPD), sensitivity and specificity were determined using predefined thresholds. The mean absolute relative difference (MARD) of the studied CGM devices was assessed and if those satisfied the accuracy requirements (EN ISO 15197). IPD datasets were meta-analysed using a logistic mixed-effects model. A bivariate model was used to estimate the summary receiver operating characteristic curve (ROC) curve and extract the area under the curve (AUC). The overall level of certainty of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation.Results Among 4481 records, 11 were included. IPD datasets were obtained for five studies. Only two of the studies showed an MARD lower than 10%, with none of the five CGM devices studied satisfying the European Union (EU) ISO 15197 requirements. Pooled sensitivity and specificity of CGM devices for hypoglycaemia were 0.39 and 0.99, whereas for hyperglycaemia were 0.87 and 0.99, respectively. The AUC was 0.70 and 0.86, respectively. The certainty of the evidence was considered as low to moderate. Limitations primarily related to the lack of representative population, reference standard and CGM device.Conclusions CGM devices demonstrated low sensitivity for detecting hypoglycaemia in preterm infants, however, provided high accuracy for detection of hyperglycaemia.PROSPERO registration number CRD42020152248.Chiara NavaAstrid Modiano HedenmalmFranciszek BorysMatteo BruschettiniKevin JenniskensBMJ Publishing GrouparticleMedicineRENBMJ Open, Vol 10, Iss 12 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Chiara Nava Astrid Modiano Hedenmalm Franciszek Borys Matteo Bruschettini Kevin Jenniskens Accuracy of continuous glucose monitoring in preterm infants: a systematic review and meta-analysis
description	Background and objectives Continuous glucose monitoring (CGM) could be a valuable instrument for measurement of glucose concentration in preterm neonate. We undertook a systematic review and meta-analysis to compare the diagnostic accuracy of CGM devices to intermittent blood glucose evaluation methods for the detection of hypoglycaemic or hypoglycaemic events in preterm infants.Data sources A structured electronic database search was performed for studies that assessed the accuracy of CGM against any intermittent blood glucose testing methods in detecting episodes of altered glycaemia in preterm infants. No restrictions were used. Three review authors screened records and included studies.Data extraction Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. From individual patient data (IPD), sensitivity and specificity were determined using predefined thresholds. The mean absolute relative difference (MARD) of the studied CGM devices was assessed and if those satisfied the accuracy requirements (EN ISO 15197). IPD datasets were meta-analysed using a logistic mixed-effects model. A bivariate model was used to estimate the summary receiver operating characteristic curve (ROC) curve and extract the area under the curve (AUC). The overall level of certainty of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation.Results Among 4481 records, 11 were included. IPD datasets were obtained for five studies. Only two of the studies showed an MARD lower than 10%, with none of the five CGM devices studied satisfying the European Union (EU) ISO 15197 requirements. Pooled sensitivity and specificity of CGM devices for hypoglycaemia were 0.39 and 0.99, whereas for hyperglycaemia were 0.87 and 0.99, respectively. The AUC was 0.70 and 0.86, respectively. The certainty of the evidence was considered as low to moderate. Limitations primarily related to the lack of representative population, reference standard and CGM device.Conclusions CGM devices demonstrated low sensitivity for detecting hypoglycaemia in preterm infants, however, provided high accuracy for detection of hyperglycaemia.PROSPERO registration number CRD42020152248.
format	article
author	Chiara Nava Astrid Modiano Hedenmalm Franciszek Borys Matteo Bruschettini Kevin Jenniskens
author_facet	Chiara Nava Astrid Modiano Hedenmalm Franciszek Borys Matteo Bruschettini Kevin Jenniskens
author_sort	Chiara Nava
title	Accuracy of continuous glucose monitoring in preterm infants: a systematic review and meta-analysis
title_short	Accuracy of continuous glucose monitoring in preterm infants: a systematic review and meta-analysis
title_full	Accuracy of continuous glucose monitoring in preterm infants: a systematic review and meta-analysis
title_fullStr	Accuracy of continuous glucose monitoring in preterm infants: a systematic review and meta-analysis
title_full_unstemmed	Accuracy of continuous glucose monitoring in preterm infants: a systematic review and meta-analysis
title_sort	accuracy of continuous glucose monitoring in preterm infants: a systematic review and meta-analysis
publisher	BMJ Publishing Group
publishDate	2020
url	https://doaj.org/article/abad06ef0a9243b99abaf4a97e2cc387
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Accuracy of continuous glucose monitoring in preterm infants: a systematic review and meta-analysis

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