Use of continuous glucose monitoring systems in pediatric patients in the perioperative environment: Challenges and machine learning opportunities

Table 3 Summary of International Society for Pediatric and Adolescent Diabetes recommendations

ISPAD 2022 clinical practice guidelines for management of children with diabetes having surgery
Glycemic goals for surgery
BG should be maintained between 90-180 mg/dL
Prevent perioperative hypoglycemia and DKA
Assessment of pediatric T1D prior to surgery/or anesthesia
Preoperative endocrine consultation: Thorough assessment of glycemia, assess for ketones (blood and urine) formalize perioperative glycemic plan
Preoperative care
If patient expected to receive GA, can be admitted to hospital or same-day clinic
Insulin is required, even in fasting state, to avoid DKA
POC BG should be checked and recorded every hour
Intraoperative care
Monitor POC BG every hour and continue in recovery
CGM can be continued intraoperatively but validated with POC BG levels
Postoperative care
Give short or rapid acting insulin (based upon insulin: Carbohydrate ratio or correction factor)
More frequent CGM/POC BG levels recommended for 24-48 hours after surgery due to surgical stressors
Validate CGM readings after exposure to anesthetic agents with POC BG
Target BG levels in postoperative period between 140-180 mg/dL

ISPAD: International Society for Pediatric and Adolescent Diabetes; CGM: Continuous glucose monitors; BG: Blood glucose; POC: Point-of-care; T1D: Type 1 diabetes; DKA: Diabetic ketoacidosis.