Glicemia

CONTROVERSIES in
Continuous Glucose Monitoring

Journal of Diabetes Science and Technology

Volume 1, Issue 3, May 2007
© Diabetes Technology Society

The Need for Continuous Blood Glucose Monitoring
in the Intensive Care Unit
Ram Weiss, M.D., Ph.D.1 and Isaac Lazar, M.D.2

Abstract
Insulin-based regimens decrease morbidity and mortality among critically ill patients by way ofkeeping glucose
at tight control. Utilizing these regimens involves multiple measurements of glucose by way of finger pricking
or through indwelling vascular catheters in order to adjust insulin doses. The limitations and risks of these
methods of glucose monitoring are related to potential erroneous measurements, increased risk of infection, and a
significant excess workload. An automated bloodglucose monitoring device for glucose monitoring of critically ill
patients is needed to improve patient care while avoiding the disadvantages of currently used glucose monitoring
methodologies.
J Diabetes Sci Technol 2007;1(3):412-414

E

patients except those with a prior diagnosis of diabetes,
yet also carried a greater risk for hypoglycemia.

levated glucose levels in critically illpatients have
been shown to be related to increased mortality and
length of hospital stay in adults and children.1,2 The
impact of tight glycemic control on clinical outcomes of
patients in the intensive care setting has recently gained
recognition. Landmark studies by Van den Berghe et al.3,4
and others demonstrated reduced mortality in patients
who reached target glucose values in the rangeof 80–110
mg/dl and whose stay in the medical intensive care unit
(ICU) was longer than 72 hours and reduced morbidity in
all patients who reached these strict target glucose values.
In a pooled data set analysis,5 the same group showed
that intensive insulin therapy with target blood glucose
20%.12 It is clear
that such discrepancies in glucose levels would surely
have an impact on dosingof insulin regimens. The large
coefficient of variation of finger-prick bedside glucometer
results in comparison to glucose measured from arterial
or venous blood in a reference laboratory is not only due
to operator’s performance. Local perfusion of the site of
measurement may have a major impact on the glucose
levels. Low perfusion states, commonly encountered in
ICU patients, togetherwith increased regional glucose
utilization, may result in a biased capillary glucose
measurement. Atkin and colleagues13 demonstrated that
in patients in shock, capillary glucose was on average
J Diabetes Sci Technol Vol 1, Issue 3, May 2007

413

www.journalofdst.org

The Need for Continuous Blood Glucose Monitoring in the Intensive Care Unit

Weiss

are those in surgical andtrauma intensive care units,
specifically patients with burns, with abdominal trauma,
and/or with surgical interventions that may limit the
utilization of interstitial glucose monitoring.18 The fact
that interstitial glucose may have a certain lag behind
blood glucose in cases of rapid dynamic changes of
systemic glucose levels introduces an additional source of
error and overall further limitsthe use of sensor-derived
glucose levels as a sole means of decision making
regarding the adjustment of intensive insulin protocols.

6. Langley J, Adams G. Insulin-based regimens decrease mortality
rates in critically ill patients: a systematic review. Diabetes Metab
Res Rev. 2006 Nov 6;23(3):184-192.
7. American Diabetes Association. Standards of medical care in
d iabetes. 2006, DiabetesCare 29;(suppl. 1):S4-42.
8. Garber AJ, Moghissi ES, Bransome ED Jr, Clark NG, Clement S,
Cobin RH, Furnary AP, Hirsch IB, Levy P, Roberts R,
Van den Berghe G, Zamudio V; American College of
Endocrinology Task Force on Inpatient Diabetes Metabolic
Control. American College of Endocrinology position statement
on inpatient diabetes and metabolic control. Endocr Pract. 2004
Mar-Apr;10 Suppl...