Utility of continuous glucose monitoring during pancreatic surgery in patients with congenital hyperinsulinism.

Introduction: Congenital hyperinsulinism [CHI] is a rare disorder characterised by hypoglycaemia secondary to excessive insulin secretion from the pancreas. The aim of management of CHI is to prevent severe and persistent hypoglycaemia which can lead to poor neurodevelopmental outcomes. Pancreatic surgery can play a role in the improvement of glycaemic safety in focal and diffuse CHI. Continuous glucose monitoring [CGM] is increasingly used in diabetes management, yet its application in CHI, particularly during perioperative settings, remains underexplored. Objective: This study aimed to evaluate the utility and accuracy of CGM during pancreatic surgery in CHI patients. Research design and methods: A mixed methods observational study was conducted over three years involving 13 patients undergoing either focal lesionectomy or subtotal pancreatectomy. CGM was performed using the Dexcom G6 device, paired with point-of-care capillary blood glucose measurements to assess accuracy. Qualitative feedback from healthcare professionals and quantitative analysis of CGM data were collected. Results: Hyperglycaemia was observed in 8 patients, influenced by surgical stress and dextrose administration. CGM analysis revealed a median perioperative glucose level of 9.2 mmol/L, with a mean absolute relative difference [MARD] of 19.3% compared to capillary samples. The majority of professionals [94%] reported CGM as helpful in the perioperative period, highlighting its role in guiding prompt adjustment of dextrose infusions and reducing blood sampling frequency. Conclusion: CGM demonstrates utility in monitoring glycaemic trends and managing hyperglycaemia during pancreatic surgery in CHI patients. The integration into perioperative care may further enhance surgical safety, extending the range of clinical applications of CGM.