Real-world Accuracy of CGM in Inpatient Critical and Noncritical Care Settings at a Safety-Net Hospital

Accuracy of Continuous Glucose Monitoring in Adults with Type 1 Diabetes Admitted to Hospital: A Real-World Multicenter Observational Study

Introduction: Continuous glucose monitoring (CGM) use in people with type 1 diabetes (T1D) is revolutionizing management. Use of CGM in hospital is poised to transform care, however routine use is not currently recommended due to lack of accuracy validation in acute care, including in people with T1D. We aimed to determine real-world CGM accuracy in hospitalized adults with T1D. Materials and Methods: In this multicenter retrospective observational study, we compared CGM interstitial fluid glucose with reference blood glucose (capillary/whole-blood point-of-care [POC], blood gas [GAS]) in adults with T1D requiring multiday admissions during 2020-2023 across three health services in Australia. Patients requiring dialysis or admitted under pediatric/obstetric/palliative care/psychiatry units were excluded. CGM accuracy was assessed by comparison with time-matched (±5 min) reference glucose measures, utilizing median absolute relative difference (ARD), mean ARD (MARD), and consensus error grid (CEG) analysis. Results: In total, 2,199 CGM-reference glucose pairs from 214 admissions (146 patients) were assessed. Overall, mean (SD) ARD was 12.8% (13.1) and median (IQR) ARD was 9.4% (3.7-17.7). MARD for CGM-POC pairs was 12.3%; MARD for CGM-GAS pairs was 14.3%. In CEG analysis, 99.3% of glucose pairs were within zones A/B. Accuracy was lower in critical care compared with noncritical care wards (MARD 16.1% vs. 12.0%, P < 0.001). Conclusions: In this real-world multicenter study, CGM glucose agreed well with reference blood glucose, suggesting modern CGM devices could be safely and effectively used in hospitalized adults with T1D. Further prospective studies of CGM accuracy with newer generation devices across different scenarios will further elucidate inpatient CGM accuracy and safety.

Perioperative Fully Closed-loop Versus Usual Care Glucose Management in Adults Undergoing Major Abdominal Surgery: A Two-centre Randomized Controlled Trial

OBJECTIVE

To assess the efficacy and safety of fully closed-loop (FCL) compared with usual care (UC) glucose control in patients experiencing major abdominal surgery-related stress hyperglycemia.

BACKGROUND

Major abdominal surgery-related stress and periprocedural interventions predispose to perioperative hyperglycemia, both in diabetes and non-diabetes patients. Insulin corrects hyperglycemia effectively, but its safe use remains challenging.

METHODS

In this two-centre randomized controlled trial, we contrasted subcutaneous FCL with UC glucose management in patients undergoing major abdominal surgery anticipated to experience prolonged hyperglycemia. FCL (CamAPS HX, Dexcom G6, mylife YpsoPump 1.5x) or UC treatment was used from hospital admission to discharge (max 20 d). Glucose control was assessed using continuous glucose monitoring (masked in the UC group). The primary outcome was the proportion of time with sensor glucose values in a target range of 5.6 to 10.0 mmol/L.

RESULTS

Thirty-seven surgical patients (54% pancreas, 22% liver, 19% upper gastrointestinal, 5% lower gastrointestinal), of whom 18 received FCL and 19 UC glucose management, were included in the analysis. The mean ± SD percentage time with sensor glucose in the target range was 80.1% ± 10.0% in the FCL and 53.7% ± 19.7% in the UC group ( P < 0.001). Mean glucose was 7.5 ± 0.5 mmol/L in the FCL and 9.1 ± 2.4 mmol/L in the UC group ( P = 0.015). Time in hypoglycemia (<3.0 mmol/L) was low in either group. No study-related serious adverse events occurred.

CONCLUSIONS

The FCL approach resulted in significantly better glycemic control compared with UC management, without increasing the risk of hypoglycemia. Automated glucose-responsive insulin delivery is a safe and effective strategy to minimize hyperglycemia in complex surgical populations.

Accuracy and Reliability of Intermittent Scanning and Real-Time Continuous Glucose Monitoring Systems in Diabetes Emergencies

BACKGROUND

Diabetes care is a major challenge of patients treated in hospitals. A continuous glucose monitoring system (CGM) provides a more comprehensive assessment of glucose control than capillary blood glucose measurements. Especially in emergencies, data on CGM use in inpatients are limited. To evaluate real-world usability, accuracy of an intermittent scanning and a real-time CGM in patients admitted due to diabetes emergencies was assessed.

METHODS

In 151 patients admitted due to diabetes emergencies, this single-center prospective study investigated the mean absolute relative difference (MARD) in broad glycemic ranges. The CGM accuracy was evaluated by applying a modified version of the Food and Drug Administration (FDA) criteria for CGM use, Clark Error Grid (CEG), and Bland Altman analysis (BAA).

RESULTS

Analysis of 1,498 CGM-/POC-glucose (CGM-/POC-G) pairs revealed a MARD of 10.8% with stepwise improvement from the hypoglycemic to the hyperglycemic range. The CEG analysis showed that 99.1% of all glucose values fell within the optimal or acceptable zones. BAA indicated that 96.0% of CGM-G values fell within the limits of the POC-G values. Day-by-day analysis of overall MARD revealed the highest MARD on the first day of CGM use, followed by consistent and stable MARD levels from day 2 onward until the end of wear time. Applying a modified version of the %20/20 agreement rate of the FDA criteria, 90.7% of CGM-G laid within ±20 mg/dl/±20% agreement rule.

CONCLUSION

This study indicates the usability of CGM for inpatient diabetes care by demonstrating a high accuracy and reliability of CGM measurement.

Real-World Performance of Personal Continuous Glucose Monitors During Hospitalization

Objective: To assess the accuracy of patients' personal continuous glucose monitors (CGMs) worn in the hospital and accuracy correlation with laboratory values and vital signs and to compare CGM glucometric data with data from published literature and guidelines. Method: We enrolled adult patients with diabetes mellitus wearing outpatient-inserted CGMs at the time of hospital admission to a noncritical setting. CGM readings were paired within 5 min with point of care (POC) glucometers and laboratory (Lab) blood glucose levels. CGM accuracy was expressed using mean absolute relative difference (MARD) and Clarke Error Grids. CGM accuracy variation with labs and vital signs was analyzed with Spearman's correlation method. Results: For 188 hospitalizations, we analyzed 3316 CGM-POC pairs from 101 patients (56 with Dexcom® sensors and 45 with Abbott's FreeStyle Libre® sensors) and 771 CGM-Lab pairs for 97 patients. For CGM-POC pairs, MARD was 13.7%, 14.4%, and 11.8% for all sensors, Dexcom, and Libre sensors, respectively. MARD was 22.6% for POC glucose <70 mg/dL. For CGM-Lab pairs, MARD was 13.6%, 12.7%, and 15.4% for all sensors, Dexcom, and Libre sensors, respectively. Of CGM-POC pairs, 98.7% and 98.8% of CGM-Lab pairs were in zones A and B of Error Grid Analysis. There was no correlation between ARD and daily mean arterial blood pressure, hemoglobin level, glomerular filtration rate, and pulse oximetry. CGMs' time below range (TBR), time in range (TIR), and time above range were 2.2% (standard deviation [SD]: 4.7%), 58.7% (SD: 22.5%), and 39.9% (SD: 23.4%), respectively. The coefficient of variation was 31.2%. Conclusion: Except for hypoglycemia ranges, patients' personal CGMs had adequate accuracy for glucose monitoring in the hospital. Vital signs and Lab values did not interfere with CGM accuracy. The TBR and glucose variability were low, better than outpatient recommendations. TIR was in line with inpatient consensus guidelines, and "glucometrics" were comparable with reports for hospital inserted sensors.

Continuous Glucose Monitoring in Hospitalized Adults With Diabetic Ketoacidosis: A Prospective Open-Label Pilot Study

BACKGROUND

Continuous glucose monitoring (CGM) devices are increasingly used in critical and non-critical care hospital units. The efficacy of CGM in assessing glucose control in adults with diabetic ketoacidosis (DKA) is unknown.

METHODS

This single-center pilot study compared glycemic control by real-time CGM (Dexcom G6), capillary point-of-care (POC), and basic metabolic panel (BMP) during intravenous (IV) insulin treatment and after the resolution of DKA. We compared the mean absolute relative difference (MARD), median absolute relative difference (ARD) glucose values, and Diabetes Technology Society (DTS) Error Grid analyses.

RESULTS

We recruited 52 patients (49 ± 19 years, admission glucose: 503 ± 239.4 mg/dL) with type 1 diabetes (n = 24) and type 2 diabetes (n = 28). Compared with POC testing, the MARD was 17.4% ± 13.2%, and the median ARD was 14.2% (interquartile range [IQR]: 6.4, 28) during the initial IV insulin period and 19.8% ± 18.7% and 14.3% (7, 26.2) after DKA resolution. The DTS Error Grid analysis showed that 100% of values during the IV insulin treatment and 95% after the DKA resolution were in zones A+B. Compared with BMP glucose values, the MARD and median ARD were 18.5% ± 19.1% and 12.2% (5.4, 23.8) during the IV insulin treatment and 22.5% ± 24.7% and 15.1% (6.6, 27.6) after DKA resolution.

CONCLUSION

This is the first report on the use of real-time CGM in adults with DKA. Our study indicates that CGM technology is a reliable tool for hospital use during acute insulin treatment and after the resolution of DKA. Future multicentre randomized studies are needed to determine the benefits of real-time CGM in facilitating diabetes care in hospitalized patients with hyperglycemic crises.

Continuous Glucose Monitor Accuracy for Diabetes Management in Hospitalized Children

OBJECTIVE

The adoption of continuous glucose monitors (CGMs) in inpatient settings in the pediatric population has been slow because of a scarcity of data on their reliability in hospitalized children.

RESEARCH DESIGN AND METHODS

We retrospectively reviewed the accuracy of the Dexcom G6 CGM system in pediatric patients with diabetes admitted to our academic children's hospital from March 2018 to September 2023. We cross-referenced the Dexcom Clarity database against an internal database of inpatient admissions to identify all children with CGM data admitted to the hospital. We recorded sensor glucose readings from Clarity and values for point-of-care (POC) glucose, blood urea nitrogen (BUN), and pH from the electronic medical record. CGM accuracy and clinical reliability were measured by mean absolute relative difference (MARD) and Clarke error grid (CEG) analyses.

RESULTS

There were 3,200 admissions of children with diabetes in this period, of which 277 (from 202 patients age 2-18 years) had associated CGM data. Paired CGM and POC measurements (n = 2,904) were compared, resulting in an MARD of 15.9%, with 96.6% of the values in zones A and B of the CEG analysis. Approximately 62% of paired values fell within a 15% or 15 mg/dL difference, whichever was larger (15%/15 mg/dL range), 74% within 20%/20, and 88% within 30%/30. Serum pH, sodium, and BUN had no impact on CGM values or absolute relative difference in linear regression analysis.

CONCLUSIONS

CGMs demonstrated acceptable accuracy in hospitalized children with diabetes. CGM data should be integrated into hospital electronic records to optimize management.

Continuous peri-operative glucose monitoring in noncardiac surgery: A systematic review

BACKGROUND

Glucose management is an important component of peri-operative care. The usefulness of continuous glucose monitoring (CGM) in noncardiac surgery is uncertain.

OBJECTIVE

To systematically assess the glycaemic profile and clinical outcome of patients equipped with a CGM device during the peri-operative period in noncardiac surgery.

DESIGN

Systematic review.

DATA SOURCES

Electronic databases were systematically searched up to July 2024.

ELIGIBILITY CRITERIA

Any studies performed in the peri-operative setting using a CGM device were included. Closed-loop systems also administering insulin were excluded. Analyses were stratified according to diabetes mellitus status and covered intra-operative and postoperative data. Outcomes included glycaemic profile (normal range 3.9 to 10.0 mmol l -1 ), complications, adverse events, and device dysfunction.

RESULTS

Twenty-six studies (1016 patients) were included. Twenty-four studies were not randomised, and six used a control arm for comparison. In bariatric surgery, diabetes mellitus patients had a mean ± SD glucose of 5.6 ± 0.5 mmol l -1 , with 15.4 ± 8.6% time below range, 75.3 ± 5.5% in range and 9.6 ± 6.7% above range. During major surgery, diabetes mellitus patients showed a mean glucose of 9.6 ± 1.1 mmol l -1 , with 9.5 ± 9.1% of time below range, 56.3 ± 13.5% in range and 30.6 ± 13.9% above range. In comparison, nondiabetes mellitus patients had a mean glucose of 6.4 ± 0.6 mmol l -1 , with 6.7 ± 8.4% time below range, 84.6 ± 15.5% in range and 11.2 ± 4.9% above range. Peri-operative complications were reported in only one comparative study and were similar in CGM and control groups. Device-related adverse events were rare and underreported. In 9.21% of cases, the devices experienced dysfunctions such as accidental removal and issues with sensors or readers.

CONCLUSION

Due to the limited number of controlled studies, the impact of CGM on postoperative glycaemic control and complications compared with point-of-care testing remains unknown. Variability in postoperative glycaemic profiles and a device dysfunction rate of 1 in 10 suggest CGM should be investigated in a targeted surgical group.

A new glucose monitoring system for the intermittent monitoring of interstitial glucose values in patients with diabetes mellitus

Objectives

Glucose monitoring in diabetes is changing overtime with a constant development of new devices for continuous glucose monitoring (CGM). Aim of this observational, prospective study was to evaluate the clinical performance of a novel intermittently scanned CGM system, the Glunovo Flash in a cohort of patients with type 1 diabetes.

Methods

A total of 45 patients with T1D followed at the Endocrinology Unit of the ASST-FBF-Sacco (Milan) were enrolled. All patients were habitual CGM users and were asked to wear simultaneously the Glunovo Flash system and their habitual CGM device for 14 days. A comparison of CGM glucose metrics was performed. Patients' opinions on the new device were also collected.

Results

Thirty-five patients completed the study period of two weeks (7 habitual real time CGM users, 28 habitual intermittently scanned CGM users). Mean Time In Range resulted significantly higher with the novel studied sensor respect to intermittently scanned CGM comparator. No differences were found considering other glucose metrics. A positive correlation was found between the Time In Range recorded by Glunovo Flash and intermittently scanned CGM comparators as well as for Time Above Range, Glucose Management Indicator, Time Below Range and Coefficient of Variation. No correlations were found between glucose metrics recorded by Glunovo Flash and real time CGM comparators. Patients reported a positive experience of use with the new sensor but some elements appeared improvable.

Conclusions

The CGM device Glunovo Flash for patients with diabetes shows similar performance to other intermittently scanned CGM systems.

Accuracy of continuous glucose monitoring in the hospital setting: an observational study

AIMS/HYPOTHESIS

Continuous glucose monitoring (CGM) improves glycaemic outcomes in the outpatient setting; however, there are limited data regarding CGM accuracy in hospital.

METHODS

We conducted a prospective, observational study comparing CGM data from blinded Dexcom G6 Pro sensors with reference point of care and laboratory glucose measurements during participants' hospitalisations. Key accuracy metrics included the proportion of CGM values within ±20% of reference glucose values >5.6 mmol/l or within ±1.1 mmol/l of reference glucose values ≤5.6 mmol/l (%20/20), the mean and median absolute relative difference between CGM and reference value (MARD and median ARD, respectively) and Clarke error grid analysis (CEGA). A retrospective calibration scheme was used to determine whether calibration improved sensor accuracy. Multivariable regression models and subgroup analyses were used to determine the impact of clinical characteristics on accuracy assessments.

RESULTS

A total of 326 adults hospitalised on 19 medical or surgical non-intensive care hospital floors were enrolled, providing 6648 matched glucose pairs. The %20/20 was 59.5%, the MARD was 19.2% and the median ARD was 16.8%. CEGA showed that 98.2% of values were in zone A (clinically accurate) and zone B (benign). Subgroups with lower accuracy metrics included those with severe anaemia, renal dysfunction and oedema. Application of a once-daily morning calibration schedule improved accuracy (MARD 11.4%).

CONCLUSIONS/INTERPRETATION

The CGM accuracy when used in hospital may be lower than that reported in the outpatient setting, but this may be improved with appropriate patient selection and daily calibration. Further research is needed to understand the role of CGM in inpatient settings.

Accuracy of continuous glucose monitoring systems in intensive care unit patients: a scoping review

PURPOSE

Glycemic control poses a challenge in intensive care unit (ICU) patients and dysglycemia is associated with poor outcomes. Continuous glucose monitoring (CGM) has been successfully implemented in the type 1 diabetes out-patient setting and renewed interest has been directed into the transition of CGM into the ICU. This scoping review aimed to provide an overview of CGM accuracy in ICU patients to inform future research and CGM implementation.

METHODS

We systematically searched PubMed and EMBASE between 5th of December 2023 and 21st of May 2024 and reported findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline for scoping reviews (PRISMA-ScR). We assessed studies reporting the accuracy of CGM in the ICU and report study characteristics and accuracy outcomes.

RESULTS

We identified 2133 studies, of which 96 were included. Most studies were observational (91.7%), conducted in adult patients (74%), in mixed ICUs (47.9%), from 2014 and onward, and assessed subcutaneous CGM systems (80%) using arterial blood samples as reference test (40.6%). Half of the studies (56.3%) mention the use of a prespecified reference test protocol. The mean absolute relative difference (MARD) ranged from 6.6 to 30.5% for all subcutaneous CGM studies. For newer factory calibrated CGM, MARD ranged from 9.7 to 20.6%. MARD for intravenous CGM was 5-14.2% and 6.4-13% for intraarterial CGM.

CONCLUSIONS

In this scoping review of CGM accuracy in the ICU, we found great diversity in accuracy reporting. Accuracy varied depending on CGM and comparator, and may be better for intravascular CGM and potentially lower during hypoglycemia.

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.

Empowering Hospitalized Patients With Diabetes: Implementation of a Hospital-wide CGM Policy With EHR-Integrated Validation for Dosing Insulin

OBJECTIVE

We aimed to assess the feasibility, clinical accuracy, and acceptance of a hospital-wide continuous glucose monitoring (CGM) policy with electronic health record (EHR)-integrated validation for insulin dosing.

RESEARCH DESIGN AND METHODS

A hospital policy was developed and implemented at Stanford Health Care for using personal CGMs in lieu of fingerstick blood glucose (FSBG) monitoring. It included requirements specific to each CGM, accuracy monitoring protocols, and EHR integration. User experience surveys were conducted among a subset of patients and nurses.

RESULTS

From November 2022 to August 2023, 135 patients used the CGM protocol in 185 inpatient encounters. This group included 27% with type 1 diabetes and 24% with automated insulin delivery systems. The most-used CGMs were Dexcom G6 (44%) and FreeStyle Libre 2 (43%). Of 1,506 CGM validation attempts, 87.8% met the 20% or 20 mg/dL (%20/20) criterion for CGM-based insulin dosing and 99.3% fell within Clarke zones A or B. User experience surveys were completed by 27 nurses and 46 patients. Most nurses found glucose management under the protocol effective (74%), easy to use (67%), and efficient (63%); 80% of nurses preferred inpatient CGM to FSBG. Most patients liked the CGM protocol (63%), reported positive CGM interactions with nursing staff (63%), and felt no significant interruptions to their diabetes management (63%).

CONCLUSIONS

Implementation of a hospital-wide inpatient CGM policy supporting multiple CGM types with real-time accuracy monitoring and integration into the EHR is feasible. Initial feedback from nurses and patients was favorable, and further investigation toward broader use and sustainability is needed.

Myths and methodologies: Assessing glycaemic control and associated regulatory mechanisms in human physiology research

Accurate measurements of glycaemic control and the underpinning regulatory mechanisms are vital in human physiology research. Glycaemic control is the maintenance of blood glucose concentrations within optimal levels and is governed by physiological variables including insulin sensitivity, glucose tolerance and β-cell function. These can be measured with a plethora of methods, all with their own benefits and limitations. Deciding on the best method to use is challenging and depends on the specific research question(s). This review therefore discusses the theory and procedure, validity and reliability and any special considerations of a range common methods used to measure glycaemic control, insulin sensitivity, glucose tolerance and β-cell function. Methods reviewed include glycosylated haemoglobin, continuous glucose monitors, the oral glucose tolerance test, mixed meal tolerance test, hyperinsulinaemic euglycaemic clamp, hyperglycaemic clamp, intravenous glucose tolerance test and indices derived from both fasting concentrations and the oral glucose tolerance test. This review aims to help direct understanding, assessment and decisions regarding which method to use based on specific physiology-related research questions.

Perspective of Continuous Glucose Monitoring-Based Interventions at the Various Stages of Type 2 Diabetes

Continuous glucose monitoring (CGM) is now advocated for the clinical management of individuals with type 1 diabetes (T1D). However, this glucose monitoring strategy is not routinely used in type 2 diabetes (T2D), given the large population, significant cost implications and relatively limited supporting evidence. T2D is a more heterogenous condition compared with T1D with various glucose lowering therapies that do not necessarily require CGM to ensure within target glucose levels. While all individuals with T2D may benefit from CGM at certain time points, the whole T2D population does not necessarily require this technology continuously, which should be prioritized based on patient benefit and cost effectiveness. In this pragmatic opinion piece, we describe the rationale and evidence for CGM use in different subgroups of individuals with T2d, divided according to the stage of the condition, glycemic therapies, presence of diabetes complications, or associated co-morbidities. We discuss a total of 16 T2D subgroups and provide a clinical view on CGM use in each, based on current evidence while also highlighting areas of knowledge gaps. This work provides health care professionals with a simple guide to CGM use in different T2D groups and gives suggestion for future studies to justify expansion of this technology.

Feasibility and Performance of Continuous Glucose Monitoring to Guide Computerized Insulin Infusion Therapy in Cardiovascular Intensive Care Unit

BACKGROUND

We evaluated the feasibility of real-time continuous glucose monitoring (CGM) for titrating continuous intravenous insulin infusion (CII) to manage hyperglycemia in postoperative individuals in the cardiovascular intensive care unit and assessed their accuracy, nursing acceptance, and postoperative individual satisfaction.

METHODS

Dexcom G6 CGM devices were applied to 59 postsurgical patients with hyperglycemia receiving CII. A hybrid approach combining CGM with periodic point-of-care blood glucose (POC-BG) tests with two phases (initial-ongoing) of validation was used to determine CGM accuracy. Mean and median absolute relative differences and Clarke Error Grid were plotted to evaluate the CGM accuracy. Surveys of nurses and patients on the use of CGMs experience were conducted and results were analyzed.

RESULTS

In this cohort (mean age 64, 32% female, 32% with diabetes) with 864 paired POC-BG and CGM values analyzed, mean and median absolute relative difference between POC-BG and CGM values were 13.2% and 9.8%, respectively. 99.7% of paired CGM and POC-BG were in Zones A and B of the Clarke Error Grid. Responses from nurses reported CGMs being very or quite convenient (n = 28; 93%) and it was favored over POC-BG testing (n = 28; 93%). Majority of patients (n = 42; 93%) reported their care process using CGM as being good or very good.

CONCLUSION

This pilot study demonstrates the feasibility, accuracy, and nursing convenience of adopting CGM via a hybrid approach for insulin titration in postoperative settings. These findings provide robust rationale for larger confirmatory studies to evaluate the benefit of CGM in postoperative care to improve workflow, enhance health outcomes, and cost-effectiveness.