Inpatient continuous glucose monitoring halves the risk of hypoglycemia in patients with hyperinsulinism
- 1Faculty of Biology, Medicine and Health, University of Manchester
- 2Royal Manchester Children’s Hospital, Department of Pediatric Endocrinology, Manchester University NHS Foundation Trust
Abstract
Introduction: Patients with congenital hyperinsulinism (HI) face recurrent and unpredictable hypoglycemia. Conventional inpatient monitoring relies on intermittent fingerprick glucose testing, which is burdensome for pediatric patients and risks missing hypoglycemic episodes between tests.
Continuous glucose monitoring (CGM) provides high granularity, complimentary monitoring but with unproven efficacy to detect and reduce hypoglycemia in the inpatient setting. This study evaluates whether CGM can improve inpatient safety through the early detection, and subsequent treatment, of hypoglycemic episodes.
Methods: Thirteen inpatients with HI were monitored using Dexcom G7 or G6 device. Finger-prick glucose monitoring was performed at the expert clinician’s discretion and to verify CGM-prompted hypoglycemia alerts. All CGM data were retrospectively searched for hypoglycemia episodes. Fingerprick glucose data were concurrently analysed, alongside electronic health records, to quantify early hypoglycemia detection and subsequent hypoglycemia saved. CGM accuracy was analysed using established metrics, including hypoglycemia sensitivity and error grid analysis, in Python 3.1.1.
Results: From 3504 paired CGM and fingerprick values, hypoglycemia sensitivity was 56.7%, with CGM devices tending to overread, by a mean of +0.43mmol/L. On Hypoglycemia Error Grid analysis, 6.2% of values were classed as moderate or severe risk.
Patient data, from 627 days of monitoring, showed 721 CGM-detected hypoglycemia events (<3.5 mmol/L). Of these, 448 (62.1%) were refuted as false positives and 273 (37.9%) were confirmed as true hypoglycemia, by fingerprick glucose monitoring. Patients spent a mean of 16 minutes/day (1.1% time) in hypoglycemia. CGM alerts saved an estimated mean of 21 minutes/day of hypoglycemia; a more than halving of total hypoglycemia experienced per patient.
Discussion: The use of CGM within the inpatient setting, for those with HI, allows for a significant reduction in hypoglycemia; potentially halving hypoglycemic time. Sensor accuracy remains poor in the inpatient setting, resulting in high false negatives and suboptimal hypoglycemia sensitivity.
However, the overall burden of CGM use is relatively low in the inpatient setting, when healthcare professionals can share the work with parents.
Related
- Continuous glucose monitoring reveals thyroid feedback-related residual glycemic variability and hypoglycemia during inpatient glucose optimization in euthyroid adults with type 2 diabetes: a CGM-based observational study.
- Prevention of exercise-induced hypoglycemia in 12 patients with type 1 diabetes running the Paris Marathon using continuous glucose monitoring: A prospective, single-center observational study
- Pediatric Inpatient Continuous Glucose Monitoring: Development and Implementation of a Hospital Policy for Accuracy-Validated Insulin Dosing
- An international position statement on practical approaches for inpatient continuous glucose monitoring, insulin pumps and automated insulin delivery systems in adults
- What are the experiences, perceptions and training needs of inpatient general nursing staff on Continuous Glucose Monitoring?
BibTeX
@article{chandra2026inpatient,
title = {{Inpatient continuous glucose monitoring halves the risk of hypoglycemia in patients with hyperinsulinism}},
author = {Chloe Chandra and Shamani De Silva and Sarah Worthington and Indraneel Banerjee and Chris Worth},
journal = {Frontiers in Endocrinology},
year = {2026},
month = oct,
doi = {10.3389/fendo.2026.1943475},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1943475/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Inpatient continuous glucose monitoring halves the risk of hypoglycemia in patients with hyperinsulinism
AU - Chloe Chandra
AU - Shamani De Silva
AU - Sarah Worthington
AU - Indraneel Banerjee
AU - Chris Worth
PY - 2026
DA - 2026/10/15
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1943475
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1943475/full
AB - Introduction: Patients with congenital hyperinsulinism (HI) face recurrent and unpredictable hypoglycemia. Conventional inpatient monitoring relies on intermittent fingerprick glucose testing, which is burdensome for pediatric patients and risks missing hypoglycemic episodes between tests. Continuous glucose monitoring (CGM) provides high granularity, complimentary monitoring but with unproven efficacy to detect and reduce hypoglycemia in the inpatient setting. This study evaluates whether CGM can improve inpatient safety through the early detection, and subsequent treatment, of hypoglycemic episodes. Methods: Thirteen inpatients with HI were monitored using Dexcom G7 or G6 device. Finger-prick glucose monitoring was performed at the expert clinician’s discretion and to verify CGM-prompted hypoglycemia alerts. All CGM data were retrospectively searched for hypoglycemia episodes. Fingerprick glucose data were concurrently analysed, alongside electronic health records, to quantify early hypoglycemia detection and subsequent hypoglycemia saved. CGM accuracy was analysed using established metrics, including hypoglycemia sensitivity and error grid analysis, in Python 3.1.1. Results: From 3504 paired CGM and fingerprick values, hypoglycemia sensitivity was 56.7%, with CGM devices tending to overread, by a mean of +0.43mmol/L. On Hypoglycemia Error Grid analysis, 6.2% of values were classed as moderate or severe risk. Patient data, from 627 days of monitoring, showed 721 CGM-detected hypoglycemia events (<3.5 mmol/L). Of these, 448 (62.1%) were refuted as false positives and 273 (37.9%) were confirmed as true hypoglycemia, by fingerprick glucose monitoring. Patients spent a mean of 16 minutes/day (1.1% time) in hypoglycemia. CGM alerts saved an estimated mean of 21 minutes/day of hypoglycemia; a more than halving of total hypoglycemia experienced per patient. Discussion: The use of CGM within the inpatient setting, for those with HI, allows for a significant reduction in hypoglycemia; potentially halving hypoglycemic time. Sensor accuracy remains poor in the inpatient setting, resulting in high false negatives and suboptimal hypoglycemia sensitivity. However, the overall burden of CGM use is relatively low in the inpatient setting, when healthcare professionals can share the work with parents.
SN - 1664-2392
ER -