Project Details

Evaluation of malgylcemia in the pediatric hematopoietic stem cell transplant population

Jenna Sopfe, MD

Summary

Background: Pediatric patients undergoing hematopoietic stem cell transplant (HSCT) may be at risk for malglycemia and adverse outcomes including infection, prolonged hospital stays, organ dysfunction, graft-versus-host-disease, delayed hematopoietic recovery, and increased mortality. Continuous glucose monitoring (CGM) may aid in describing and treating malglycemia in this population. However, no studies have demonstrated safety, tolerability or accuracy of CGM in this uniquely immunocompromised population. Methods: A prospective observational study was conducted, employing the Abbott Freestyle Libre Pro in patients age 2-30 undergoing HSCT at Children’s Hospital Colorado. Patients with pre-existing diabetes mellitus or insulin requirements, or on chronic steroids, at the time of HSCT, were excluded. CGM occurred up to 7 days prior to, and 60 days after, HSCT during hospitalization only. Blood glucoses collected as during routine HSCT care were compared with CGM values to evaluate accuracy. Adverse events and patient refusal to wear CGM device were monitored to assess safety and tolerability. Results: Participants (n=29; median age 13.1 years, [IQR] [4.7, 16.6] years) wore 84 sensors for an average of 25 [21.5, 30.0] days per participant. Paired serum-sensor values (n=893) demonstrated a mean absolute relative difference of 20±14% with Clarke Error Grid analysis showing 99% of pairs in the clinically acceptable zones (A+B). There were 4 episodes of self-limited bleeding (4.8% of sensors); no other adverse events occurred. Six patients (20.7%) refused subsequent CGM placements. Conclusions: CGM is feasible with acceptable accuracy in the hospitalized pediatric HSCT population. Few adverse events occurred, all of which were low grade.

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