Intensive Insulin Therapy in the Intensive Care Unit: Assessment by Continuous Glucose Monitoring.
From: Department of Diabetology, Metabolism and Clinical Nutrition, Antwerp University Hospital, Belgium. christophe.deblock@ua.ac.be
Diabetes care
- Publish Date: Aug 2006
- ISSN: 0149-5992
- Volume: 29
- Issue: 8
- Pages: 1750-6
- Medium: Print
- Language: English
- Citation (JAMA): De Block Christophe, Manuel-Y-Keenoy Begoña, Van Gaal Luc, et al. Intensive Insulin Therapy in the Intensive Care Unit: Assessment by Continuous Glucose Monitoring.. Diabetes Care Aug 2006;29:1750-6
Abstract
OBJECTIVE: Hyperglycemia occurs in most critically ill patients. Using continuous glucose monitoring (CGM), we investigated whether intensive insulin therapy based on discontinuous glucose monitoring can achieve normoglycemia (80-110 mg/dl) in a medical intensive care unit (MICU). RESEARCH DESIGN AND METHODS: Fifty adults (men/women 31/19, age 62 +/- 16 years, nondiabetic/diabetic 30/20, intravenous/subcutaneous insulin 22/28, and Acute Physiology and Chronic Health Evaluation II score 22 +/- 7) were prospectively recruited. Forty-eight-hour CGM was performed using a subcutaneous glucose sensor (GlucoDay) and compared with arterial glycemia. Main outcome measures were percent of time in normoglycemia and accuracy/applicability of CGM. RESULTS: During 48-h CGM, glycemia reached target (80-110 mg/dl) in only 22 +/- 18%, was >140 mg/dl in 39 +/- 27%, and was <60 mg/dl in 5 +/- 10% of the time. Patients on subcutaneous versus intravenous insulin had more glycemia readings >110 mg/dl (P = 0.016). Glycemia was higher in diabetic patients (170 +/- 77 vs. 129 +/- 35 mg/dl, P = 0.013). BMI was an independent determinant for bad glycemic control (beta = 0.73, P < 0.0001). Diabetic state (beta = 0.47, P < 0.0001), septic shock (beta = 0.22, P = 0.045), sequential organ failure assessment score (beta = 0.40, P = 0.001), and use of corticoids (beta = 0.28, P = 0.014) and inotropics (beta = -0.24, P = 0.035) were independent determinants of insulin dose. GlucoDay values and arterial glycemia correlated well (r = 0.85, P < 0.0001, n = 555 after six-point calibration), with 97% of data falling in regions A and B of error grid analysis. There were no adverse events using GlucoDay. CONCLUSIONS: GlucoDay, a well-tolerated 48-h CGM system, revealed that normoglycemia was only achieved 22% of the time in MICU patients. Further studies should investigate whether application of CGM to titrate insulin therapy can improve patient outcome.
Mesh Headings (Keywords): Blood Glucose, Diabetes Mellitus, Female, Humans, Hyperglycemia, Injections, Intravenous, Injections, Subcutaneous, Insulin, Intensive Care Units, Male, Middle Aged, Monitoring, Physiologic
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