OBJECTIVE: Hyperglycemia occurs in most critically ill patients. Using continuous glucose monitoring (CGM), we investigated whether intensive insulin therapy based on discontinuous glucose monitoring can achieve normoglycemia (80-110 mg/dl) in a medical intensive care unit (MICU). RESEARCH DESIGN AND METHODS: Fifty adults (men/women 31/19, age 62 +/- 16 years, nondiabetic/diabetic 30/20, intravenous/subcutaneous insulin 22/28, and Acute Physiology and Chronic Health Evaluation II score 22 +/- 7) were prospectively recruited. Forty-eight-hour CGM was performed using a subcutaneous glucose sensor (GlucoDay) and compared with arterial glycemia. Main outcome measures were percent of time in normoglycemia and accuracy/applicability of CGM. RESULTS: During 48-h CGM, glycemia reached target (80-110 mg/dl) in only 22 +/- 18%, was >140 mg/dl in 39 +/- 27%, and was <60 mg/dl in 5 +/- 10% of the time. Patients on subcutaneous versus intravenous insulin had more glycemia readings >110 mg/dl (P = 0.016). Glycemia was higher in diabetic patients (170 +/- 77 vs. 129 +/- 35 mg/dl, P = 0.013). BMI was an independent determinant for bad glycemic control (beta = 0.73, P < 0.0001). Diabetic state (beta = 0.47, P < 0.0001), septic shock (beta = 0.22, P = 0.045), sequential organ failure assessment score (beta = 0.40, P = 0.001), and use of corticoids (beta = 0.28, P = 0.014) and inotropics (beta = -0.24, P = 0.035) were independent determinants of insulin dose. GlucoDay values and arterial glycemia correlated well (r = 0.85, P < 0.0001, n = 555 after six-point calibration), with 97% of data falling in regions A and B of error grid analysis. There were no adverse events using GlucoDay. CONCLUSIONS: GlucoDay, a well-tolerated 48-h CGM system, revealed that normoglycemia was only achieved 22% of the time in MICU patients. Further studies should investigate whether application of CGM to titrate insulin therapy can improve patient outcome.
OBJECTIVE:Hyperglycemia occurs in most critically illpatients. Using continuous glucose monitoring (CGM), we investigated whether intensive insulin therapy based on discontinuous glucose monitoring can achieve normoglycemia (80-110 mg/dl) in a medical intensive care unit (MICU). RESEARCH DESIGN AND METHODS: Fifty adults (men/women 31/19, age 62 +/- 16 years, nondiabetic/diabetic 30/20, intravenous/subcutaneous insulin 22/28, and Acute Physiology and Chronic Health Evaluation II score 22 +/- 7) were prospectively recruited. Forty-eight-hour CGM was performed using a subcutaneous glucose sensor (GlucoDay) and compared with arterial glycemia. Main outcome measures were percent of time in normoglycemia and accuracy/applicability of CGM. RESULTS: During 48-h CGM, glycemia reached target (80-110 mg/dl) in only 22 +/- 18%, was >140 mg/dl in 39 +/- 27%, and was <60 mg/dl in 5 +/- 10% of the time. Patients on subcutaneous versus intravenous insulin had more glycemia readings >110 mg/dl (P = 0.016). Glycemia was higher in diabeticpatients (170 +/- 77 vs. 129 +/- 35 mg/dl, P = 0.013). BMI was an independent determinant for bad glycemic control (beta = 0.73, P < 0.0001). Diabetic state (beta = 0.47, P < 0.0001), septic shock (beta = 0.22, P = 0.045), sequential organ failure assessment score (beta = 0.40, P = 0.001), and use of corticoids (beta = 0.28, P = 0.014) and inotropics (beta = -0.24, P = 0.035) were independent determinants of insulin dose. GlucoDay values and arterial glycemia correlated well (r = 0.85, P < 0.0001, n = 555 after six-point calibration), with 97% of data falling in regions A and B of error grid analysis. There were no adverse events using GlucoDay. CONCLUSIONS:GlucoDay, a well-tolerated 48-h CGM system, revealed that normoglycemia was only achieved 22% of the time in MICU patients. Further studies should investigate whether application of CGM to titrate insulin therapy can improve patient outcome.
Authors: Ulrike Holzinger; Joanna Warszawska; Reinhard Kitzberger; Harald Herkner; Philipp G H Metnitz; Christian Madl Journal: Intensive Care Med Date: 2009-04-07 Impact factor: 17.440
Authors: Thomas R Campion; Addison K May; Lemuel R Waitman; Asli Ozdas; Cynthia S Gadd Journal: Intensive Care Med Date: 2010-03-30 Impact factor: 17.440
Authors: Amisha Wallia; Guillermo E Umpierrez; Robert J Rushakoff; David C Klonoff; Daniel J Rubin; Sherita Hill Golden; Curtiss B Cook; Bithika Thompson Journal: J Diabetes Sci Technol Date: 2017-04-21
Authors: Martin Ellmerer; Martin Haluzik; Jan Blaha; Jaromir Kremen; Stepan Svacina; Andreas Plasnik; Dimas Ikeoka; Manfred Bodenlenz; Lukas Schaupp; Johannes Plank; Thomas R Pieber Journal: Int J Endocrinol Date: 2009-05-26 Impact factor: 3.257