Christophe E M De Block1, Jens Gios2, Nina Verheyen1, Begoña Manuel-y-Keenoy3, Peter Rogiers4, Philippe G Jorens5, Cosimo Scuffi6, Luc F Van Gaal1. 1. 1 Department of Endocrinology, Diabetology & Metabolism, University of Antwerp , Edegem, Belgium . 2. 2 Department of Anesthesiology, Antwerp University Hospital , Edegem, Belgium . 3. 3 Laboratory of Endocrinology, University of Antwerp , Wilrijk, Belgium . 4. 4 Department of Critical Care Medicine, General Hospital Middelheim , Antwerp, Belgium . 5. 5 Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp , Edegem, Belgium . 6. 6 A. Menarini Diagnostics, Scientific and Technology Affairs , Florence, Italy .
Abstract
BACKGROUND AND OBJECTIVE:Hyperglycemia occurs commonly in patients admitted to medical intensive care units (MICUs). Whether real-time (RT) continuous glucose monitoring (CGM) improves glycemic control and variability and reduces hypoglycemia in severely ill MICU patients with an Acute Physiology and Chronic Health Evaluation II (APACHE-II) score of ≥20 has not been studied. SUBJECTS AND METHODS: Thirty-five patients (66 ± 10 years of age; APACHE-II score, 28 ± 6) were randomly assigned to RT-CGM (n = 16) using the GlucoDay(®)S (A. Menarini Diagnostics, Florence, Italy) device or to blinded CGM. Insulin was infused using a modified Yale protocol targeting a blood glucose level between 80 and 120 mg/dL. Outcome measures were percentage of time in normoglycemia (80-110 mg/dL) and in hypoglycemia (<60 mg/dL), glycemic variability (SD, coefficient of variation, mean amplitude of glucose excursions, and mean of daily differences), and CGM accuracy (error grid analyses, Bland-Altman bias plot, and mean absolute relative deviation). RESULTS: During 96 h of monitoring, glycemia reached target (80-110 mg/dL) in 37 ± 15%, was between 70 and 180 mg/dL in 91 ± 10%, and <60 mg/dL in 2 ± 2% of the time. In the RT-CGM group glycemia averaged 119 ± 17 mg/dLversus 122 ± 11 mg/dL in the control group. Parameters of glucose variability and percentages of time at target glycemia and in hypoglycemia were similar between groups. GlucoDayS values and arterial glycemia correlated well, with 98.6% of data falling in Zones A and B of the error grid analysis. Mean absolute relative devation was 11.2%. CONCLUSIONS:RT-CGM did not ameliorate glucose control or variability; neither did it reduce the number of hypoglycemic events, but our insulin infusion protocol led to overall good glucose control without a significant hypoglycemia risk, making further improvement difficult.
RCT Entities:
BACKGROUND AND OBJECTIVE:Hyperglycemia occurs commonly in patients admitted to medical intensive care units (MICUs). Whether real-time (RT) continuous glucose monitoring (CGM) improves glycemic control and variability and reduces hypoglycemia in severely ill MICU patients with an Acute Physiology and Chronic Health Evaluation II (APACHE-II) score of ≥20 has not been studied. SUBJECTS AND METHODS: Thirty-five patients (66 ± 10 years of age; APACHE-II score, 28 ± 6) were randomly assigned to RT-CGM (n = 16) using the GlucoDay(®)S (A. Menarini Diagnostics, Florence, Italy) device or to blinded CGM. Insulin was infused using a modified Yale protocol targeting a blood glucose level between 80 and 120 mg/dL. Outcome measures were percentage of time in normoglycemia (80-110 mg/dL) and in hypoglycemia (<60 mg/dL), glycemic variability (SD, coefficient of variation, mean amplitude of glucose excursions, and mean of daily differences), and CGM accuracy (error grid analyses, Bland-Altman bias plot, and mean absolute relative deviation). RESULTS: During 96 h of monitoring, glycemia reached target (80-110 mg/dL) in 37 ± 15%, was between 70 and 180 mg/dL in 91 ± 10%, and <60 mg/dL in 2 ± 2% of the time. In the RT-CGM group glycemia averaged 119 ± 17 mg/dL versus 122 ± 11 mg/dL in the control group. Parameters of glucose variability and percentages of time at target glycemia and in hypoglycemia were similar between groups. GlucoDayS values and arterial glycemia correlated well, with 98.6% of data falling in Zones A and B of the error grid analysis. Mean absolute relative devation was 11.2%. CONCLUSIONS: RT-CGM did not ameliorate glucose control or variability; neither did it reduce the number of hypoglycemic events, but our insulin infusion protocol led to overall good glucose control without a significant hypoglycemia risk, making further improvement difficult.
Authors: Georgia M Davis; Rodolfo J Galindo; Alexandra L Migdal; Guillermo E Umpierrez Journal: Endocrinol Metab Clin North Am Date: 2020-03 Impact factor: 4.741
Authors: Jenna Sopfe; Laura Pyle; Amy K Keating; Kristen Campbell; Arthur K Liu; R Paul Wadwa; Michael R Verneris; Roger H Giller; Gregory P Forlenza Journal: Blood Adv Date: 2019-02-12
Authors: Rodolfo J Galindo; Guillermo E Umpierrez; Robert J Rushakoff; Ananda Basu; Suzanne Lohnes; James H Nichols; Elias K Spanakis; Juan Espinoza; Nadine E Palermo; Dessa Garnett Awadjie; Leigh Bak; Bruce Buckingham; Curtiss B Cook; Guido Freckmann; Lutz Heinemann; Roman Hovorka; Nestoras Mathioudakis; Tonya Newman; David N O'Neal; Michaela Rickert; David B Sacks; Jane Jeffrie Seley; Amisha Wallia; Trisha Shang; Jennifer Y Zhang; Julia Han; David C Klonoff Journal: J Diabetes Sci Technol Date: 2020-09-28