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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 met...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768969/ https://www.ncbi.nlm.nih.gov/pubmed/33361084 http://dx.doi.org/10.1136/bmjopen-2020-045335 |
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author | Nava, Chiara Modiano Hedenmalm, Astrid Borys, Franciszek Hooft, Lotty Bruschettini, Matteo Jenniskens, Kevin |
author_facet | Nava, Chiara Modiano Hedenmalm, Astrid Borys, Franciszek Hooft, Lotty Bruschettini, Matteo Jenniskens, Kevin |
author_sort | Nava, Chiara |
collection | PubMed |
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 | Online Article Text |
id | pubmed-7768969 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-77689692021-01-05 Accuracy of continuous glucose monitoring in preterm infants: a systematic review and meta-analysis Nava, Chiara Modiano Hedenmalm, Astrid Borys, Franciszek Hooft, Lotty Bruschettini, Matteo Jenniskens, Kevin BMJ Open Paediatrics 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. BMJ Publishing Group 2020-12-24 /pmc/articles/PMC7768969/ /pubmed/33361084 http://dx.doi.org/10.1136/bmjopen-2020-045335 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Paediatrics Nava, Chiara Modiano Hedenmalm, Astrid Borys, Franciszek Hooft, Lotty Bruschettini, Matteo Jenniskens, Kevin Accuracy of continuous glucose monitoring in preterm infants: a systematic review and meta-analysis |
title | 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_short | 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 |
topic | Paediatrics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768969/ https://www.ncbi.nlm.nih.gov/pubmed/33361084 http://dx.doi.org/10.1136/bmjopen-2020-045335 |
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