Feasibility of Blood Glucose Management Using Intra-Arterial Glucose Monitoring in Combination with an Automated Insulin Titration Algorithm in Critically Ill Patients

2019 ◽  
Vol 21 (10) ◽  
pp. 581-588
Author(s):  
Julia K. Mader ◽  
Melanie Motschnig ◽  
Verena Theiler-Schwetz ◽  
Karin Eibel-Reisz ◽  
Alexander C. Reisinger ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Glucose Monitoring ◽  
Titration Algorithm ◽  
Glucose Management ◽  
Arterial Glucose

scholarly journals Glucose Management Technologies for the Critically Ill

2019 ◽  
Vol 13 (4) ◽  
pp. 682-690 ◽  
Author(s):  
Pedro D. Salinas ◽  
Carlos E. Mendez
Keyword(s):  
Insulin Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
New Technologies ◽  
Point Of Care ◽  
Glucose Monitoring ◽  
Standard Of Care ◽  
Optimal Method ◽  
Intravenous Insulin ◽  
Glucose Management

Hyperglycemia is common in the intensive care unit (ICU) both in patients with and without a previous diagnosis of diabetes. The optimal glucose range in the ICU population is still a matter of debate. Given the risk of hypoglycemia associated with intensive insulin therapy, current recommendations include treating hyperglycemia after two consecutive glucose >180 mg/dL with target levels of 140-180 mg/dL for most patients. The optimal method of sampling glucose and delivery of insulin in critically ill patients remains elusive. While point of care glucose meters are not consistently accurate and have to be used with caution, continuous glucose monitoring (CGM) is not standard of care, nor is it generally recommended for inpatient use. Intravenous insulin therapy using paper or electronic protocols remains the preferred approach for critically ill patients. The advent of new technologies, such as electronic glucose management, CGM, and closed-loop systems, promises to improve inpatient glycemic control in the critically ill with lower rates of hypoglycemia.

scholarly journals Continuous Glucose Monitoring in Critically Ill Patients With COVID-19: Results of an Emergent Pilot Study

2020 ◽  
Vol 14 (6) ◽  
pp. 1065-1073
Author(s):  
Archana R. Sadhu ◽  
Ivan Alexander Serrano ◽  
Jiaqiong Xu ◽  
Tariq Nisar ◽  
Jessica Lucier ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Pilot Study ◽  
Insulin Therapy ◽  
Critically Ill ◽  
Continuous Glucose Monitoring ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Target Range

Background: Amidst the coronavirus disease 2019 (COVID-19) pandemic, continuous glucose monitoring (CGM) has emerged as an alternative for inpatient point-of-care blood glucose (POC-BG) monitoring. We performed a feasibility pilot study using CGM in critically ill patients with COVID-19 in the intensive care unit (ICU). Methods: Single-center, retrospective study of glucose monitoring in critically ill patients with COVID-19 on insulin therapy using Medtronic Guardian Connect and Dexcom G6 CGM systems. Primary outcomes were feasibility and accuracy for trending POC-BG. Secondary outcomes included reliability and nurse acceptance. Sensor glucose (SG) was used for trends between POC-BG with nursing guidance to reduce POC-BG frequency from one to two hours to four hours when the SG was in the target range. Mean absolute relative difference (MARD), Clarke error grids analysis (EGA), and Bland-Altman (B&A) plots were calculated for accuracy of paired SG and POC-BG measurements. Results: CGM devices were placed on 11 patients: Medtronic ( n = 6) and Dexcom G6 ( n = 5). Both systems were feasible and reliable with good nurse acceptance. To determine accuracy, 437 paired SG and POC-BG readings were analyzed. For Medtronic, the MARD was 13.1% with 100% of readings in zones A and B on Clarke EGA. For Dexcom, MARD was 11.1% with 98% of readings in zones A and B. B&A plots had a mean bias of −17.76 mg/dL (Medtronic) and −1.94 mg/dL (Dexcom), with wide 95% limits of agreement. Conclusions: During the COVID-19 pandemic, CGM is feasible in critically ill patients and has acceptable accuracy to identify trends and guide intermittent blood glucose monitoring with insulin therapy.

Glycaemic control in critical illness

2016 ◽  
Author(s):  
Simon Finfer
Keyword(s):  
Blood Glucose ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Glucose Concentration ◽  
Point Of Care ◽  
Glucose Variability ◽  
Severe Illness ◽  
Loop Control ◽  
Considerable Uncertainty ◽  
Glucose Management

Hyperglycaemia is a near universal occurrence in critically-ill patients. In the last 10 years, control of blood glucose has been one of the most intensively studied areas of critical care medicine. It has become clear that control of blood glucose has the potential to affect both morbidity and mortality, and considerable uncertainty remains over many aspects of blood glucose management. Both hyperglycaemia and hypoglycaemia are associated with increased mortality and should be avoided wherever possible. Wide fluctuations in blood glucose concentration (referred to as increased glucose variability) are also associated with increased mortality, but may indicate more severe illness. Increased interest in blood glucose management has demonstrated that point-of-care glucose meters designed for ambulatory use by patient with diabetes are not sufficiently accurate for use in critically-ill patients. More accurate analysers should be used in the intensive care unit and management guided by computerized. Future developments may see the introduction of accurate continuous or near continuous blood glucose analysers, but safe and effective closed loop control of blood glucose remains an elusive goal.

Stress hyperglycaemia and endocrine emergencies

2021 ◽  
pp. 912-925
Author(s):  
Jan Gunst ◽  
Yves Debaveye ◽  
Greet Van den Berghe
Keyword(s):  
Blood Glucose ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Glucose Monitoring ◽  
Specific Treatment ◽  
Thyroid Storm ◽  
Adrenal Crisis ◽  
Electrolyte Disturbances ◽  
Life Threatening ◽  
Unclear Etiology

Although endocrine pathology is usually treated in an outpatient clinic, intensive care may be required when endocrinopathies are associated with other medical illnesses or reach a state of decompensation. Although endocrine emergencies are quite rare, they are potentially life-threatening if not recognised promptly and managed effectively. Therefore, every clinician should always be attentive to a possible diagnosis of these complex disorders. The three major diabetic emergencies comprise diabetic ketoacidosis, hyperglycaemic hyperosmolar state, and prolonged hypoglycaemia. Hyperglycaemic crises are characterised by hypovolaemia and electrolyte disturbances, and may be triggered by potentially life-threatening conditions. Hence, airway-breathing-circulation securement, early fluid resuscitation, and adequate diagnosis and treatment of the underlying condition are the cornerstones of acute management. Subsequently, monitoring and correction of electrolyte disturbances and insulin treatment are initiated. Profound hypoglycaemia should be suspected in every patient with coma of unclear etiology, especially if the patient has an indistinct history or was treated with insulin or sulfonylurea/meglitinide. This condition warrants an immediate administration of glucose, followed by regular blood glucose monitoring. Alternatively, glucagon may be injected subcutaneously, or preferably intramuscularly. Hyperglycaemia in critically ill patients is associated with adverse outcome. The optimal blood glucose target for critically ill patients remains unclear, however. In any case, clinicians should prevent severe hyperglycaemia, hypoglycaemia and large glucose fluctuations. The classical non-diabetic endocrine emergencies comprise thyroid storm, myxoedema coma, acute adrenal crisis, and phaeochromocytoma. They all pose diagnostic and therapeutic challenges and require specific treatment such as endocrine replacement or blockage therapy, apart from supportive care and treatment of the inciting event. It is important to note that such conditions are occasionally the first manifestation of an endocrine disorder. This chapter also briefly discusses amiodarone-induced thyroid dysfunction.

scholarly journals Study on the blood glucose management with controlled goal feed in Malaysian critically ill patients

2019 ◽  
Vol 469 ◽  
pp. 012097
Author(s):  
R C Zafirah ◽  
J Ummu K. ◽  
K Khalijah ◽  
H M. Luqman ◽  
A F Q A Aishah ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Glucose Management

scholarly journals Dysglycemia in Critically Ill Patients: Common Problems and Future Direction

2017 ◽  
Vol 5 (3) ◽  
pp. 1
Author(s):  
Sarvin Sanaie ◽  
Ata Mahmoodpoor
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Critically Ill ◽  
Treatment Effect ◽  
Critically Ill Patients ◽  
Local Treatment ◽  
Critically Ill Children ◽  
Target Range ◽  
Glucose Management ◽  
Time In Target Range

The management of blood glucose (BG) in the critically ill became a topic of great interest following the publication of the landmark single-center surgical ICU study targeting euglycemia (80 to 110 mg/dL) in Leuven, Belgium, in 2001 (1). This study resulted in thousands of protocols and guidelines promoting 'tight' BG control . The failure to show the same results and high incidence of hypoglycemia in following trials have resulted in controversy in blood glucose management in critically ill patients. Analysis of dysglycemia in critically ill patients should include markers of three domains: hyperglycemia, hypoglycemia, and glycemic variability (2,3). Thus, hyperglycemia, hypoglycemia, and blood glucose variability should all be regarded as independent predictors of adverse outcomes in critically ill patients. Agus et al., in their multicenter study (4), showed that critically ill children with hyperglycemia did not benefit from strict glycemic control to a target glucose of 80-110 mg/dL compared to 150-180 mg/dL and patients in lower treatment target showed an insignificant 90-day mortally rate compared to other group. There are so many reasons to describe these controversies: In LEUVEN III study (5), despite a 25% hypoglycemia incidence, tight glycemic control had a significant treatment effect; nevertheless, in Agus et al. study, despite a lower incidence of hypoglycemia, treatment effect was not significant. The reasons can be explained with the fact that first trials were single centered open label studies which were terminated at early stages of the study because of observed benefits which may have exaggerated the treatment effect. Also, the observed difference was found in subgroup analysis which could have been due to chance factor. Findings from RCTs conducted on critically ill adults and children strongly suggest that the largest benefit for blood glucose control can be expected if the difference in blood glucose concentrations between the study groups is large and if the study is done in a single-centre setting where the blood glucose management is tailored to the local treatment habits. Consequently, we could not compare those single centered trials which are not externally validated with high level of adherence to protocols, lower time to target range, higher time in target range with multi centered trials with a low level of adherence to protocol higher time to target range, lower time in target range and a totally different method of energy supplementation. Finally, the era of 'one size fits all' in regard to glycemic targets in the critically ill seems to be over. We should also consider the correct and earlier diagnosis of patients, their glycemic status and preadmission glycemic control individually (6). Future trials should consider the discrepancies accounting for controversial points like nutritional status of patients, glucose monitoring methods (7) and insulin titration method. 

Sign in / Sign up

Export Citation Format

Share Document