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- Title
Continuous Glucose Monitoring Highlights Stress Hyperglycemia at the Intensive Care Unit: Need for Expert Diabetes Supervision?
- Authors
de Block, Christophe; Manuel-Y-Keenoy, Begoñl;a; Rogiers, Peter; van Gaal, Luc
- Abstract
Stress hyperglycemia occurs in most ICU patients and negatively affects outcome. Achieving normoglycemia is crucial to obtain morbidity/mortality benefits of insulin therapy, but is labor-intensive. Insulin needs vary depending on nutritional delivery, fluctuating disease severity and drug administration. Current insulin therapy is based upon intermittent glucose measurements, which may miss fast glycemic changes. Continuous glucose monitoring (CGM) may help to signal glycemic excursions. We evaluated the applicability/accuracy of a CGM system in the ICU, and assessed the quality of glucose control in ICU patients, hypothesizing that diabetic patients would do worse. 60 adult patients (age 63±15 y, non-diabetic/diabetic: 36/24, APACHE-II score: 24±8, SOFA score: 8±4) were prospectively recruited in an observational study. The GlucoDay® device (MenariniDiagnostics) was used for 48h-CGM. GlucoDay® data correlated linearly with arterial glycemia (r=0.85,p<0.0001, 6-pt calibration); 97% of data fell in regions A and B of the Error Grid. Hemodynamic changes (hypotension, shock, vasopressor need) did not affect accuracy. GlucoDay® noted changes in glycemia immediately, and caused no adverse events. During 48h-CGM, normoglycemia (60-110 mg/dl) was reached in only 32± 18% of the time. Glycemia was >140 mg/dl in 38±25 % and <60 mg/dl in 5± 9% of time. More hypoglycemic episodes were noted in diabetic than in non-diabetic patients (3 vs 1, p=0.015). Diabetic patients had a mean insulin dose/day of 122± 102 units (vs 35±62 U in non-DM patients, p<0.0001) for a mean glycemia of 145± 67 mg/dl (vs 140±49 mg/dl in non-DM patients). Conclusion: GlucoDay®, an accurate and well-tolerated CGM system, showed that normoglycemia was reached in only 32±18% of time. Glucose control must be improved in all, including non-DM, ICU patients. Thus, the endocrinologist may be a useful member of the ICU team. In the future, implementation of strict glycemic control in ICU may be facilitated by "real-time" CGM signalling impending glycemic excursions, rendering intensive insulin therapy easier and safer.
- Publication
Diabetes, 2007, Vol 56, pA118
- ISSN
0012-1797
- Publication type
Academic Journal