Glucose Control and Use of Continuous Glucose Monitoring in the Intensive Care Unit: A Critical Review

Abstract

Stress hyperglycemia recently became a major therapeutic target in the Intensive Care Unit (ICU) since it occurs in most critically ill patients and is associated with adverse outcome, including increased mortality. Intensive insulin therapy to achieve normoglycemia may reduce mortality, morbidity and the length of ICU and in-hospital stay. However, obtaining normoglycemia requires extensive efforts from the medical staff, including frequent glucose monitoring and adjustment of insulin dose. Current insulin titration is based upon discrete glucose measurements, which may miss fast changes in glycemia and which does not give a full picture of overall glycemic control. Recent evidence suggests that continuous monitoring of glucose levels may help to signal glycemic excursions and eventually to optimize insulin titration in the ICU. In this review we will summarise monitoring and treatment strategies to achieve normoglycemia in the ICU, with special emphasis on the possible advantages of continuous glucose monitoring.

Adverse Drug Events in Intensive Care Units: A Cross-Sectional Study of Prevalence and Risk Factors

“…Strict glucose control via intravenously administered insulin was used in more than 70% of our patients to achieve target blood glucose levels by using a strategy based on intensive insulin therapy (Leuven protocol) 19 and many other studies. 20 Because of the high percentage of patients treated with insulin, our finding that hypoglycemia was the most prevalent ADE was not unexpected. This observation illustrates the clear need for careful monitoring of glucose levels, particularly because insulin-related hypoglycemia has been reported as a marker of poor outcomes.…”

Management of blood glucose in patients with stroke

“…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].…”

“…Treatment protocols with frequent glucose measurement and intensive glucose-lowering therapy for a minimum of 72 h post-stroke need to be evaluated. With the recent improvement of glucose monitoring system [36], it will be probably easier to manage post-stroke hyperglycaemia in a more effective and safe manner in a near future [33].…”

“…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].…”

Вплив Різних Хірургічних Доступів При Протезуванні Аортального Клапана На Ступінь Вираженості Операційного Стресу І системної Запальної Реакції

“…Незважаючи на відсут-ність статистично значимої різниці, значення р да-них показників наближено до граничного значення 0,05, що вказує на наявність тенденції до підвищен-ня. Дані результати свідчать про наявність стресової гормональної перебудови основного обміну речо-вин у прооперованих пацієнтів у вигляді стресової стимуляції продукції тиреотропного гормона та гі-перглікемії [5,[14][15][16].…”