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Research Article: Inpatient continuous glucose monitoring halves the risk of hypoglycemia in patients with hyperinsulinism

Date Published: 2026-10-15

Abstract:
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. 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. 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. 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.

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…

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