Real-time CGM Deemed Feasible, Accurate for Managing DKA in Pediatric T1D

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Serum bicarbonate level also did not appear to affect the accuracy of real-time continuous glucose monitoring (rtCGM) in pediatric diabetic ketoacidosis (DKA).

The use of real-time continuous glucose monitoring (rtCGM) in managing diabetic ketoacidosis (DKA) in children with type 1 diabetes (T1D) is both feasible and accurate, according to research published in Journal of Diabetes Science and Technology.

According to the authors, serum bicarbonate level did not seem to affect rtCGM accuracy in the setting of DKA, but further research assessing the use and cost-effectiveness of rtCGM in treatment decisions is necessary. While the use of rtCGM in ambulatory settings has been shown to improve overall glycemic control and reduce DKA incidence in both adults and children with T1D, its use in children with DKA has not been well researched, they added.

The prospective, single-arm, single-center study included data from 35 children hospitalized with DKA, with a mean (SD) age of 11.9 (4.1) years.

Accuracy, reliability, and feasibility of a commercially available rtCGM device was compared with that of point-of-care (POC) capillary and serum glucose values in these pediatric patients and was evaluated by Clarke Error Grid (CEG) analysis. Average length of hospital stay (LOS) and the relationship between rtCGM readings and degree of acidosis were also assessed.


Among the 35 children in the study, the authors collected 524 time-matched glucose values between serum glucose and rtCGM and 91 time-matched glucose values between POC capillary glucose and rtCGM. CEG analysis showed more than 95% of each of these pairs were clinically acceptable.

The average (SD) LOS was 1.32 (0.73 days).

When compared with serum bicarbonate level, there was a negative correlation (−0.27) between serum glucose and rtCGM delta (P < .01), but a positive correlation between POC capillary glucose and rtCGM delta (P = .06).

“Analyses of serum bicarbonate levels demonstrated that the degree of acidosis and impaired perfusion during an episode of DKA does not impact the accuracy or reliability of rtCGM values,” the authors noted.

They also measured a mean duration of rtCGM use of 18.6 (9.7) hours, correlating to more than 18 fingerstick POC tests that may not have been needed if rtCGM data were used to make treatment decisions.

No adverse events were reported. However, the authors noted multiple limitations, including time delays between DKA diagnosis and rtCGM readings and the lack of patients presenting extreme acidosis or hyperglycemia

“These extremes are the factors that are of most clinical interest because the functionality and accuracy of rtCGM are potentially most affected within these extreme ranges,” the authors noted. “A final limitation was the inability to provide a blinded evaluation; however, because the study protocol prohibited nursing staff and physicians to act upon the results of the rtCGM, we do not feel this impacted our findings.”


Pott T, Jimenez-Vega J, Parker J, Fitzgerald R. Continuous glucose monitoring in pediatric diabetic ketoacidosis. J Diabetes Sci Technol. Published online November 23, 2022. doi:10.1177/19322968221140430