Safety and efficacy of continuous glucose monitoring devices in individuals with diabetes undergoing hyperbaric oxygen therapy: a scoping review

Introduction: Continuous glucose monitoring devices (CGMs) have emerged as an effective approach to optimise glycaemic control for individuals living with diabetes mellitus. Despite CGMs offering improved patient satisfaction and quality of life, they have been primarily validated for outpatient and home use. This has posed a challenge for patients and providers who wish to incorporate CGMs into clinical settings such as hyperbaric oxygen therapy (HBOT). Those with advanced diabetes mellitus who have diabetic foot ulcers that are refractory to treatment are among the most prevalent users of HBOT. However, those who prefer to use their CGM during HBOT face uncertainty regarding the accuracy and safety of their device under hyperbaric conditions. Methods: The product specifications of commonly used CGMs were collated. In addition, a scoping review of the literature was conducted where Medline, Embase, and Scopus were searched for reports that assess the accuracy or safety of CGMs in hyperbaric conditions. Results: The product specifications of commonly used CGMs by Dexcom, Abbott, Medtronic, and Senseonics demonstrate a maximum validated pressure of approximately 106 kPa (1.06 atmospheres absolute). Our literature search identified five reports, of which four focused on accuracy and one focused on safety of CGMs in hyperbaric conditions. Treatments were conducted in multiplace chambers and cumulatively described 39 participants, of whom 12 have diabetes. Although heterogeneous in nature, the reports generally supported the safety and accuracy of CGMs in hyperbaric conditions. Conclusions: The safety and accuracy of using CGMs during HBOT warrants further investigation. CGMs have not been validated for repeated exposure to hyperbaric conditions and should not be used in oxygen pressurised monoplace chambers until further safety data is available. We provide practical recommendations for use of CGMs in multiplace chambers.