Continuous intravenous glucose measurements in Intensive and Medium Care patients, treated with Intensive Insulin Therapy (IIT)

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J. van Dam- Kastelein, E.A. Vlot, H.S. Moeniralam

Voorzitter(s): prof. dr. R.P. Koopmans, MUMC, Maastricht & dr. C.J.A.M. Konings, Catharina Ziekenhuis, Eindhoven

Woensdag 22 april 2015

15:00 - 16:00u in Zaal 2.1

Categorieën: parallelsessie (case reports/research)

Parallel sessie: Parallelsessie 5: Case reports/research

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Background:
The majority of critically ill patients is hyperglycemic. Lower glucose levels in a very narrow range reduces mortality and morbidity. However, the low frequency and manual blood glucose monitoring limits the safety of intensive insulin therapy (IIT). The higher incidence of hypoglycemia and strong fluctuations in glucose levels induced by IIT are also associated with a higher mortality. Undoubtedly, intensive glucose monitoring is a prerequisite for safe IIT.

The aim of the Glucose Level at the Intensive Care (GLIC) study is to evaluate if continuous glucose monitoring (CGM) in critically ill patients treated with IIT is useful to reach and maintain the glucose target-range of 4.4-6.1 mmol/L, to prevent hypoglycemic events, to decrease blood glucose coefficient of variation (CV), and to reduce nurse staff workload.

Methods:
CGM with an intravenous glucose sensor (GlucoClear, Edwards Lifesciences) was performed on consenting critically ill patients in a mixed adult ICU/ MCU unit. Blinded CGM guided by intermittent glucose measurements were compared with non-blinded CGM, according to a novel nurse-driven protocol with a target-range of 4.4-6.1 mmol/L. 

Results:
22 intermittently guided and 29 CGM-guided patients were included. In both groups severe hypoglycemia was no longer prevalent. In the CGM group the mean glucose level significant decreased (p= 0.005) along with a significant increase of time in target glycemic range (from 38% to 59%) and a decrease of CV.

Conclusion:
CGM enables safe IIT by reducing dysglycemia and preventing hypoglycemia. More experience with CGM may be needed to reach a lower CV.