Continuous Glucose Monitoring and Hypoglycaemia Risk During Paediatric DKA Treatment in the PICU : A Retrospective Cohort Study

BACKGROUND: Hypoglycaemia is a frequent complication during diabetic ketoacidosis (DKA) treatment. Continuous glucose monitoring (CGM) provides real-time glucose trend information; however, its clinical utility during paediatric DKA management in the intensive care unit (ICU) remains uncertain. We investigated whether CGM insertion during DKA treatment in the paediatric ICU (PICU) is associated with reduced hypoglycaemia and a lower burden of point-of-care (POC) glucose measurements. MATERIALS AND METHODS: We conducted a retrospective single-centre cohort study of paediatric patients (< 20 years) admitted to the PICU with DKA between December 2013 and December 2025 who received continuous intravenous insulin infusion. Patients were categorised based on CGM insertion during their PICU stay. The primary outcome was hypoglycaemia. Secondary outcomes included frequency of POC glucose measurements, ICU length of stay and time to DKA resolution. RESULTS: Seventy-three patients were included; 31 (42.5%) underwent CGM insertion. The incidence of hypoglycaemia was significantly lower in the CGM group (glucose < 70 mg/dL: 6.5% vs. 47.6%, p < 0.001; < 60 mg/dL: 0% vs. 21.4%, p = 0.008). In multivariable analysis, CGM insertion was independently associated with lower hypoglycaemia risk (adjusted OR 0.059, 95% CI 0.011-0.323; p = 0.001). The CGM group also had a significantly lower frequency of POC glucose measurements than the control group. CONCLUSION: Amongst paediatric patients with DKA treated in the PICU, CGM insertion was independently associated with reduced hypoglycaemia and a lower POC testing burden. Prospective studies are warranted to determine whether CGM-guided DKA management improves clinical outcomes in critically ill children.