Abstract
Glucose measurement in intensive care medicine is performed intermittently with the risk of undetected hypoglycemia. The workload for the ICU nursing staff is substantial. Subcutaneous continuous glucose monitoring (CGM) systems are available and may be able to solve some of these issues in critically ill patients. In a randomized controlled design in a mixed ICU in a teaching hospital we compared the use of subcutaneous CGM with frequent point of care (POC) to guide insulin treatment. Adult critically ill patients with an expected stay of more than 24 hours and in need of insulin therapy were included. All patients received subcutaneous CGM. CGM data were blinded in the control group, whereas in the intervention group these data were used to feed a computerized glucose regulation algorithm. The same algorithm was used in the control group fed by intermittent POC glucose measurements. Safety was assessed with the incidence of severe hypoglycemia (<2.2 mmol/L), efficacy with the percentage time in target range (5.0 to 9.0 mmol/L). In addition, we assessed nursing workload and costs. In this study, 87 patients were randomized to the intervention and 90 to the control group. CGM device failure resulted in 78 and 78 patients for analysis. The incidence of severe glycemia and percentage of time within target range was similar in both groups. A significant reduction in daily nursing workload for glucose control was found in the intervention group (17 versus 36 minutes; P <0.001). Mean daily costs per patient were significantly reduced with EUR 12 (95% CI −32 to −18, P = 0.02) in the intervention group. Subcutaneous CGM to guide insulin treatment in critically ill patients is as safe and effective as intermittent point-of-care measurements and reduces nursing workload and daily costs. A new algorithm designed for frequent measurements may lead to improved performance and should precede clinical implementation. Clinicaltrials.gov, NCT01526044 . Registered 1 February 2012.
Highlights
Glucose measurement in intensive care medicine is performed intermittently with the risk of undetected hypoglycemia
The present study showed that a subcutaneous continuous glucose monitoring (CGM) system to guide blood glucose regulation was effective and safe in glycemic control compared to frequent point of care (POC)-guided blood glucose regulation
Subcutaneous CGM to guide blood glucose regulation in critically ill patients was shown to be safe in terms of hypoglycemia incidence
Summary
Glucose measurement in intensive care medicine is performed intermittently with the risk of undetected hypoglycemia. Subcutaneous continuous glucose monitoring (CGM) systems are available and may be able to solve some of these issues in critically ill patients. Stress-induced hyperglycemia is common and relates to adverse outcomes in critically ill patients [1,2]. The outcomes of two large intervention studies are in some way contradictory but the consensus is that hyperglycemia should be corrected, while avoiding hypoglycemia and Glucose regulation regimens require frequent monitoring of glucose, which leads to a considerable workload for the intensive care (IC) nurses. Previous studies have indicated an acceptable accuracy and reliability for subcutaneous CGM devices in critically ill patients [11,12,13,14,15]. An improvement of the mean glucose concentration by using realtime CGM was not found [16]
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