Abstract
This pilot prospective study reports the feasibility, management and cost of the use of a continuous glucose monitoring (CGM) system in critically ill adult horses and foals. We compared the glucose measurements obtained by the CGM device with blood glucose (BG) concentrations. Neonatal foals (0-2 weeks of age) and adult horses (> 1 year old) admitted in the period of March-May 2016 with clinical and laboratory parameters compatible with systemic inflammatory response syndrome (SIRS) were included. Glucose concentration was monitored every 4 hours on blood samples with a point-of-care (POC) glucometer and with a blood gas analyzer. A CGM system was also placed on six adults and four foals but recordings were successfully obtained only in four adults and one foal. Glucose concentrations corresponded fairly well between BG and CGM, however, there appeared to be a lag time for interstitial glucose levels. Fluctuations of glucose in the interstitial fluid did not always follow the same trend as BG. CGM identified peaks and drops that would have been missed with conventional glucose monitoring. The use of CGM system is feasible in ill horses and may provide clinically relevant information on glucose levels, but there are several challenges that need to be resolved for the system to gain more widespread usability.
Highlights
Derangements of blood glucose (BG) concentration are relatively common in critically ill horses [1] Hyperglycemia in horses with acute abdominal pain has been linked to non-survival [2, 3], and in neonatal foals hypoglycemia and hyperglycemia occur with approximately equal frequency and are associated with decreased survival [1]
The objectives of this study was, 1) to test and report the feasibility, management and cost of the use of a continuous glucose monitoring (CGM) system in adult horses and foals hospitalized and undergoing intensive care, 2) to compare the glucose measurements obtained by the CGM device with BG concentrations measured by blood gas analysis and a handheld glucometer, and 3) to determine whether the CGM system provided additional clinically relevant information that would remain undetected by conventional glucose monitoring
The study was performed to investigate the feasibility of using a CGM system in critically ill patients
Summary
Derangements of blood glucose (BG) concentration are relatively common in critically ill horses [1] Hyperglycemia in horses with acute abdominal pain has been linked to non-survival [2, 3], and in neonatal foals hypoglycemia and hyperglycemia occur with approximately equal frequency and are associated with decreased survival [1]. A strong positive correlation between plasma L-lactate, a marker of systemic disease severity, and glucose concentrations has been detected both in humans and animals [4] as they are interconnected metabolites in carbohydrate metabolism, and each can lead to the generation of the other [5]. For those reasons, close monitoring of BG concentrations may be useful in critically ill horses.
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