Clinical performance and practical implications of continuous glucose monitoring in very preterm infants: a cohort study
In brief
Continuous glucose monitors placed 98% to 99% of readings in low-risk zones
In 155 very preterm infants, 98% to 99% of continuous glucose readings fell in clinically acceptable error zones, despite an average 11.9% difference from blood tests. Monitoring also detected glucose problems missed by intermittent sampling, but readings were less accurate at extremes. The findings support using monitors to track trends, not replace blood tests.
- Journal
- Archives of disease in childhood. Fetal and neonatal edition (Q1)
- Published
- 29 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Gordon Xin Hua Liu, Loredana Marcovecchio, Kathryn Beardsall
- PMID
- 42810838
- DOI
- 10.1136/archdischild-2026-330804
Why clinicians should know about it
- Picked for Neonatology (paper of the day, 1 October 2026): CGM performance study in very preterm infants
Abstract
OBJECTIVE: To explore the clinical performance of continuous glucose monitoring (CGM) in very preterm infants during the first week of life, using data from the multicentre Real time continuous glucose monitoring (REACT) randomised controlled trial (RCT) and to consider how CGM can best support neonatal glucose management. DESIGN: Prespecified secondary analysis of paired sensor glucose (SG) and blood glucose (BG) measurements from the REACT RCT. SETTING: 13 neonatal intensive care units (NICUs) in the UK, Spain and the Netherlands. PATIENTS: 155 very preterm infants (≤1200 g birth weight or <34 weeks' gestation) with CGM data collected during the first week of life. MAIN OUTCOME MEASURES: Mean absolute relative difference (MARD), ISO 15197:2013 system agreement, Bland-Altman bias, error grid analysis and clinical contextualisation of CGM performance. RESULTS: Across 2223 SG-BG pairs, overall MARD was 11.9%, and 98%-99% of values fell within clinically acceptable error grid zones. SG tended to be less accurate at BG extremes, although error grid analyses show that clinical risk from discrepancies was low. CGM detected episodes of dysglycaemia not captured by intermittent sampling. Glucose variability did not materially influence accuracy. CONCLUSIONS: CGM can provide clinically meaningful information in very preterm infants despite modest analytical inaccuracy when compared with single point-of-care values. Its greatest utility lies in continuous trend monitoring, early detection of silent dysglycaemia and reduced invasive sampling, rather than replacement of diagnostic blood testing. Clinicians should interpret SG values in context, confirm unexpected extremes with BG and focus on patterns rather than single values.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.