What is the role of interstitial or transcutaneous glucose measurement?

Continuous glucose monitoring should not be used routinely for the diagnosis and monitoring of neonatal hypoglycaemia. [Conditional recommendation]

In two RCTs in VLBW babies, those with continuous glucose monitoring (CGM) spent more time with blood glucose concentrations in the normal range and underwent fewer blood tests. However, there was little to no effect on the number of hypoglycaemia events.

Current devices are not sufficiently accurate for use in babies (approximately ±1 mmol/L accuracy) and technical difficulties can be time consuming to remedy.

CGM is well tolerated in babies, and insertion may be less painful than heel-prick blood tests.

CGM is cost-effective in adults with diabetes, but its cost-effectiveness in babies is uncertain.

Nil.

This technology is evolving rapidly, so this recommendation should be reviewed frequently.  

Studies are needed on:

1. The potential utility of CGM when a baby is transitioning from intravenous dextrose to breastfeeding.
2. The utility of CGM in late preterm and term babies at risk of hypoglycaemia.
3. The clinical significance of episodes of low glucose concentrations that would not have been detected without CGM, including their association with neurodevelopmental outcomes, and the effect of treatment on these outcomes.
4. The cost-effectiveness of using CGM in babies whose glucose concentrations are very unstable.
5. Whānau perspectives on use of CGM in babies.

The effect on health equity is not known but is likely to depend on access to the devices and the specialist expertise required to use them. Refer to health equity summary below.

Health equity for Māori

Health professionals must apply this guideline equitably to prevent harm and ensure accountability in implementing recommendations for Māori as part of a pro-equity approach. Pākehā benefit from health system privileges, while Māori face systemic racism, leading to reduced health benefits. Health equity can be improved if Māori receive effective interventions.

Ensure Māori whānau are fully informed about their healthcare options as a part of a mana motuhake (self-determination), including prevention, monitoring and treatment options, health benefits and potential risks. Detailed explanations of all interventions, their necessity, and results should also be provided to help achieve equitable health outcomes. Ensure whānau are provided with information in multiple formats (oral, written, online, video) that align with cultural values.

Whānau living in rural areas may face additional financial costs and barriers to accessing specialist services. Proactively support these whānau by informing and supporting them to access available financial assistance and resources to access specialist services.

Health equity for other groups

Health professionals must apply this guideline equitably to prevent harm. Health equity can be improved if all whānau receive effective interventions.
Many groups, including Pacific, Asian, migrant and rural communities, also face significant health inequities. These groups often encounter barriers such as language difficulties, lower health literacy, and challenges in understanding their healthcare options. It is important that all whānau are fully informed about their healthcare options, including prevention, monitoring and treatment options, health benefits and potential risks. Detailed explanations of all interventions, their necessity, and results should also be provided to help achieve equitable health outcomes. Culturally appropriate communication, use of interpreter services where required, along with the use of multiple formats (oral, written, online, video), can help improve engagement with health services.

Rural communities may also experience additional challenges, such as increased travel costs and limited access to specialist care. Providing proactive support, including information about and assistance to access financial and other resources to help access specialist services, is crucial to reducing these inequities and improving health outcomes. Specific additional issues are addressed under the recommendations and EtDs where relevant.