Continuous glucose monitoring as a tool to identify hyperglycaemia in non‐diabetic patients with acute coronary syndromes

Radermecker, Régis; Sultan, Ashraf Uddin; Piot, C.; Remy, A. Saint; Avignon, A.; Renard, Éric

doi:10.1111/j.1464-5491.2008.02643.x

Cited by 10 publications

(10 citation statements)

References 7 publications

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“…The development of continuous glucose monitoring system (CGMS) with a subcutaneous sensor device has provided a novel tool to record interstitial glycaemic kinetics [33]. GGMS revealed that normoglycaemia was only achieved 22% of the time in diabetic/non diabetic ICU patients [34] and that early and frequent hyperglycaemia occurred in non-diabetic patients with acute coronary syndromes [35]. Recent evidence suggests that continuous monitoring of glucose levels may help to signal glycaemic excursions and eventually to optimize insulin titration in the ICU [36].…”

Section: Lessons From Continuous Glucose Monitoringmentioning

confidence: 99%

“…Ideally, clinicians should not infuse any glucose solution during the management of such patients (except to correct hypoglycaemia) in order to avoid acute hyperglycaemia, which may be deleterious for the injured brain [7]. Even if CGMS has only been used to carefully evaluate post-stroke hyperglycaemia yet, this technology will probably be interesting in the future to manage hyperglycaemia in stroke unit in a more effective and safer manner [33], as in other critically ill patients [34][35][36].…”

Section: Practical Implications Regarding Glucose Management During Smentioning

confidence: 99%

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Management of blood glucose in patients with stroke

Radermecker

Scheen

2010

Diabetes & Metabolism

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SUMMARYStroke is a leading cause of death worldwide and the commonest cause of long-term disability amongst adults, more particularly in patients with diabetes mellitus and arterial hypertension.Increasing evidence suggests that disordered physiological variables following acute ischaemic stroke, especially hyperglycaemia, adversely affect outcomes. Post-stroke hyperglycaemia is common (up to 50 % of patients) and may be rather prolonged, regardless of diabetes status. A substantial body of evidence has demonstrated that hyperglycaemia has a deleterious effect upon clinical and morphological stroke outcomes. Therefore, hyperglycaemia represents an attractive physiological target for acute stroke therapies.However, whether intensive glycaemic manipulation positively influences the fate of ischaemic tissue remains unknown. One major adverse event of management of hyperglycaemia with insulin (either glucose-potassium-insulin infusions or intensive insulin therapy) is the occurrence of hypoglycaemia, which can also induce cerebral damages. Novel insights into post-stroke hyperglycaemia management are derived from continuous glucose monitoring systems (CGMS). This article aims to describe the adverse effects of hyperglycaemia following acute ischaemic stroke and the risk associated to iatrogenic hypoglycaemia, to summarise the evidence from current glucose-lowering treatment trials and to show the usefulness of CGMS in both nondiabetic and diabetic patients with acute stroke. Key-words Mots-clé :Accident vasculaire cérébral -Diabète -Hyperglycémie -Hypoglycémie - Insulinothérapie -CGMS

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Section: Lessons From Continuous Glucose Monitoringmentioning

confidence: 99%

Section: Practical Implications Regarding Glucose Management During Smentioning

confidence: 99%

Management of blood glucose in patients with stroke

Radermecker

Scheen

2010

Diabetes & Metabolism

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“…In particular, these devices were highly sensitive in detecting rapid glucose excursions (12). Recently, these CGM techniques have also been evaluated in critically ill patients and have yielded similar positive results (13–17). Mainly, subcutaneous CGM devices have been intensely investigated (13–17).…”

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confidence: 92%

Real-Time Continuous Glucose Monitoring in Critically Ill Patients

et al. 2009

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OBJECTIVETo evaluate the impact of real-time continuous glucose monitoring (CGM) on glycemic control and risk of hypoglycemia in critically ill patients.RESEARCH DESIGN AND METHODSA total 124 patients receiving mechanical ventilation were randomly assigned to the real-time CGM group (n = 63; glucose values given every 5 min) or to the control group (n = 61; selective arterial glucose measurements according to an algorithm; simultaneously blinded CGM) for 72 h. Insulin infusion rates were guided according to the same algorithm in both groups. The primary end point was percentage of time at a glucose level <110 mg/dl. Secondary end points were mean glucose levels and rate of severe hypoglycemia (<40 mg/dl).RESULTSPercentage of time at a glucose level <110 mg/dl (59.0 ± 20 vs. 55.0 ± 18% in the control group, P = 0.245) and the mean glucose level (106 ± 18 vs. 111 ± 10 mg/dl in the control group, P = 0.076) could not be improved using real-time CGM. The rate of severe hypoglycemia was lower in the real-time CGM group (1.6 vs. 11.5% in the control group, P = 0.031). CGM reduced the absolute risk of severe hypoglycemia by 9.9% (95% CI 1.2–18.6) with a number needed to treat of 10.1 (95% CI 5.4–83.3).CONCLUSIONSIn critically ill patients, real-time CGM reduces hypoglycemic events but does not improve glycemic control compared with intensive insulin therapy guided by an algorithm.

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“…Radermecker et al ., studied the occurrence and the distribution of glucose excursions >7.8 mmol/l by CGMS in 21 non-diabetic patients admitted with acute coronary syndrome (ACS) without baseline hyperglycaemia. [49] CGMS data disclosed time spent >7.8 mmol/l in 17 patients, whereas only seven of them showed at least one capillary blood glucose test value above the threshold for the same time period. Glucose excursions were detectable earlier from CGMS data.…”

Section: Introductionmentioning

confidence: 99%

Continuous glucose monitoring system and new era of early diagnosis of diabetes in high risk groups

Soliman

Desanctis

Yassin

et al. 2014

Indian J Endocr Metab

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Continuous glucose monitoring (CGM) systems are an emerging technology that allows frequent glucose measurements to monitor glucose trends in real time. Their use as a diagnostic tool is still developing and appears to be promising. Combining intermittent glucose self-monitoring (SGM) and CGM combines the benefits of both. Significant improvement in the treatment modalities that may prevent the progress of prediabetes to diabetes have been achieved recently and dictates screening of high risk patients for early diagnosis and management of glycemic abnormalities. The use of CGMS in the diagnosis of early dysglycemia (prediabetes) especially in high risk patients appears to be an attractive approach. In this review we searched the literature to investigate the value of using CGMS as a diagnostic tool compared to other known tools, namely oral glucose tolerance test (OGTT) and measurement of glycated hemoglobin (HbA1C) in high risk groups. Those categories of patients include adolescents and adults with obesity especially those with family history of type 2 diabetes mellitus, polycystic ovary syndrome (PCO), gestational diabetes, cystic fibrosis, thalassemia major, acute coronary syndrome (ACS), and after renal transplantation. It appears that the ability of the CGMS for frequently monitoring (every 5 min) glucose changes during real-life settings for 3 to 5 days stretches the chance to detect more glycemic abnormalities during basal and postprandial conditions compared to other short-timed methods.

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Continuous glucose monitoring as a tool to identify hyperglycaemia in non‐diabetic patients with acute coronary syndromes

Cited by 10 publications

References 7 publications

Management of blood glucose in patients with stroke

Management of blood glucose in patients with stroke

Real-Time Continuous Glucose Monitoring in Critically Ill Patients

Continuous glucose monitoring system and new era of early diagnosis of diabetes in high risk groups

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