Continuous glucose sensors for glycaemic control in the ICU: have we arrived?

Dieter Mesotten

doi:10.1186/cc12804

Abstract

Dr Blixt and colleagues show in an elegant pilot study that the continuous measurement of glucose in venous blood by microdialysis in a central venous catheter is feasible in critically ill patients. The performance of this type of continuous glucose monitoring device equals the performance of the commonly used handheld blood glucose meters. But are we, as ICU physicians and nurses, now ready to implement such continuous blood glucose sensors into the daily practice of the ICU? The only yardstick to this is "are these devices truly helping us ...in our critically ill patients".

Highlights

Tight blood glucose control, within the range of fasting blood glucose levels, reduced morbidity in critically ill patients in the setting of well-controlled single-centre studies
The clinical community is eagerly awaiting these randomised controlled trials with the newer continuous blood glucose monitoring (CGM) devices to decide on their applicability
The point accuracy of a near-continuous blood glucose sensor with microdialysis through a central venous line is acceptable for monitoring in the normoglycaemic and hyperglycaemic range

Summary

Introduction

Within the range of fasting blood glucose levels, reduced morbidity in critically ill patients in the setting of well-controlled single-centre studies. For handheld blood glucose meters and the current CGM devices the 95% confidence interval range (36 mg/dl) is larger than the range (30 mg/dl) for tight glycaemic control (80 to 110 mg/dl) These sensors may overestimate blood glucose levels in the hypoglycaemic zone. The presence of continuous data and the embedded trend information may compensate this moderate point accuracy in CGM sensors If this was true, CGM should help us in realising tight glycaemic control while avoiding hypoglycaemia and increased blood glucose variability. The clinical community is eagerly awaiting these randomised controlled trials with the newer CGM devices to decide on their applicability The comparator in these trials should be the current gold standard of glucose measurements in arterial blood by a blood gas analyser. Healthcare payers and society will pass the final judgement: is it worth it? Otherwise, expert nurses [1,14] or computerised protocols [15,16] using intermittent blood glucose measurements may remain the cost-effective gold standard

Conclusion

14. Krinsley JS

17. Haynes B