Continuous determination of blood glucose in children admitted with malaria in a rural hospital in Mozambique

Abstract

Background: Hypoglycaemia is a frequent complication among admitted children, particularly in malaria-endemic areas. This study aimed to estimate the occurrence of hypoglycaemia not only upon admission but throughout the first 72 h of hospitalization in children admitted with malaria.

Methods: A simple pilot study to continuously monitor glycaemia in children aged 0-10 years, admitted with malaria in a rural hospital was conducted in Southern Mozambique by inserting continuous glucose monitors (CGMs) in subcutaneous tissue of the abdominal area, producing glycaemia readings every 5 min.

Results: Glucose was continuously monitored during a mean of 48 h, in 74 children. Continuous measurements of blood glucose were available for 72/74 children (97.3%). Sixty-five of them were admitted with density-specific malaria diagnosis criteria (17 severe, 48 uncomplicated). Five children (7.7%) had hypoglycaemia (<54 mg/dL) on admission as detected by routine capillary determination. Analysing the data collected by the CGMs, hypoglycaemia episodes (<54 mg/dL) were detected in 10/65 (15.4%) of the children, of which 7 (10.8%) could be classified as severe (≤45 mg/dL). No risk factors were independently associated with the presence of at least one episode of hypoglycaemia (<54 mg/dL) during hospitalization. Only one death occurred among a normoglycaemic child. All episodes of hypoglycaemia detected by CGMs were subclinical episodes or not perceived by caregivers or clinical staff.

Conclusions: Hypoglycaemia beyond admission in children with malaria appears to be much more frequent than what had been previously described. The clinical relevance of these episodes of hypoglycaemia in the medium or long term remains to be determined.

Keywords: Blood glucose; Continuous glucose monitor; Hyperglycaemia; Hypoglycaemia; Malaria.

Fig. 1

Study profile

Fig. 2

Continuous glucose monitor inserted in a child participating in our study

Fig. 3

Clarke error grid analysis comparing measures of continuous glucose monitors vs capillary blood glucometer measures. The figure is divided in the following 5 regions: Region A values within 20% of the reference sensor; Region B values outside 20% of the reference sensor, but that would not lead to an inappropriate treatment, Region C values leading to an unnecessary treatment; Region D values indicating a potentially dangerous failure to detect hypo- or hyper-glycaemia; Region E values that would confuse treatment of hypoglycaemia for hyperglycaemia, and vice versa. CGM glucose levels measured by continuous glucose monitors, CBG capillary glucose levels measured by a glucometer

Fig. 4

Bland–Altman plot of the difference between glucose levels measured by continuous glucose monitors (CGM) against those measured by capillar determination using a glucometer (CBG). The within-subject variance is estimated by a random effects model. The 95% limits of agreement (−37.0, 40.0 mg/dL) contained 95% of the difference scores