Effects of Continuous Versus Intermittent Glucose Monitoring in Intensive Care Unit Patients: Protocol for a Systematic Review With Meta-Analysis

BACKGROUND: Glucose management in intensive care unit (ICU) patients is challenging, and dysglycemia is associated with increased morbidity and mortality. Continuous glucose monitoring (CGM) could be a potential tool to improve clinical and glycemic outcomes compared with current practice which relies on intermittent glucose measurements.

AIM: The aim of this systematic review and meta-analysis is to assess the effects of CGM compared with point of care (POC) glucose measurements on clinical patient-important and glycemic outcomes in ICU patients.

METHODS: This protocol is based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guideline. We will include all randomized clinical trials in ICU patients. The primary outcome is mortality at the longest follow-up, and the main-secondary outcome is the number of hypoglycemic events. Additional outcomes include both patient-important and glycemic outcomes. We will systematically search: PubMed, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Web of Science Core Collection. We will assess risk of bias using the Cochrane Risk of Bias 2 tool and conduct a Trial Sequential Analysis for the primary and main-secondary outcome. Clinical heterogeneity will be assessed using the Clinical Diversity in meta-analyses tool, and the certainty of evidence will be assessed using the Grading of Recommendation Assessment, Development, and Evaluation approach.

DISCUSSION: This systematic review with meta-analysis will provide an updated overview and synthesis of the effect of CGM versus POC glucose monitoring to inform clinical practice and future trials.