Accuracy of a Continuous Glucose Monitor in the Intensive Care Unit: A Proposed Accuracy Standard and Calibration Protocol for Inpatient Use.

Background and Aims: Guidelines now recommend inpatient continuous glucose monitor (CGM) use with confirmatory blood glucose measurements. However, the Food and Drug Administration has not yet officially approved CGM for inpatient use in large part because its accuracy has not been established in this setting. We tested the accuracy of the Dexcom G6 (G6) in 28 adults on an insulin infusion in a medical-surgical intensive care unit with 1064 matched CGM and arterial point-of-care pairs. Methods: The participants were on average 57.29 (SD 2.39) years, of whom 13 had a prior diagnosis of diabetes and 14 were admitted for a surgical diagnosis. The first 19 participants received the G6 without calibration and had a mean absolute relative difference (MARD) of 13.19% (IQR 5.11, 19.03) across 659 matched pairs, which just meets the critical care expert recommendation of MARD <14%. We then aimed to improve accuracy for the subsequent 9 participants using a calibration protocol. Results: The MARD for calibrated participants was 9.65% (3.03, 13.33), significantly lower than for uncalibrated participants (P < 0.001). Calibration also demonstrated excellent safety with 100% of values within the Clarke Error Grid zones A and B compared with 99.07% without calibration. Our protocol achieved the lowest MARD and safest CEG profile in the critical care setting and well exceeds the critical care expert recommendations. Our large sample of heterogenous critically ill patients also reached comparable accuracy to the MARD of 9% for G6 in outpatients. We believe our calibration protocol will allow G6 to be used with sufficient accuracy in inpatients.

Event Related Potentials Reveal Early Phonological and Orthographic Processing of Single Letters in Letter-Detection and Letter-Rhyme Paradigms.

INTRODUCTION: When and where phonological processing occurs in the brain is still under some debate. Most paired-rhyme and phonological priming studies used word stimuli, which involve complex neural networks for word recognition and semantics. This study investigates early (<300 ms) and late (>300 ms) orthographic and phonological processing of letters. METHODS: Fifteen participants aged 20-35 engaged in three two-forced choice experiments, one letter-detection (LetterID) and two letter-rhyme (Paired-Rhyme and Letter-Rhyme) tasks. From the EEG recordings, event related potential (ERP) differences within and across task stimuli were found. We also calculated the global field power (GFP) for each participant. Accuracies and reaction times were also measured from their button presses for each task. RESULTS: Behavioral: Reaction times were 18 ms faster to letter than pseudoletter stimuli, and 27 ms faster to rhyme than nonrhyme stimuli. ERP/GFP: In the LetterID task, grand-mean evoked potentials (EPs) showed typical P1, N1, P2, and P3 waveform morphologies to letter and pseudoletter stimuli, with GFPs to pseudoletters being greater than letters from 160-600 ms. Across both rhyme tasks, there were greater negativities for nonrhyme than for rhyme stimuli at 145 ms and 426 ms. The P2 effect for rhyme stimuli was smaller than letter stimuli when compared across tasks. CONCLUSION: Differences in early processing of letters vs. pseudoletters between 130-190 ms suggest that letters are processed earlier and perhaps faster in the brain than pseudoletters. The P2 effect between letter and rhyme stimuli likely reflect sublexical phonological processing. Together, findings from our study fill in evidence for the temporal dynamics of orthographic and phonological processing of single letters.