Near-Continuous Glucose Monitoring Makes Glycemic Control Safer in ICU Patients*

Nekludov

et al. 2020

J Clin Monit Comput

Intensive care unit (ICU) patients develop stress induced insulin resistance causing hyperglycemia, large glucose variability and hypoglycemia. These glucose metrics have all been associated with increased rates of morbidity and mortality. The only way to achieve safe glucose control at a lower glucose range (e.g., 4.4-6.6 mmol/L) will be through use of an autonomous closed loop glucose control system (artificial pancreas). Our goal with the present study was to assess the safety and performance of an artificial pancreas system, composed of the EIRUS (Maquet Critical Care AB) continuous glucose monitor (CGM) and novel artificial intelligence-based glucose control software, in a swine model using unannounced hypo-and hyperglycemia challenges. Fourteen piglets (6 control, 8 treated) underwent sequential unannounced hypoglycemic and hyperglycemic challenges with 3 IU of NovoRapid and a glucose infusion at 17 mg/kg/min over the course of 5 h. In the Control animals an experienced ICU physician used every 30-min blood glucose values to maintain control to a range of 4.4-9 mmol/L. In the Treated group the artificial pancreas system attempted to maintain blood glucose control to a range of 4.4-6.6 mmol/L. Five of six Control animals and none of eight Treated animals experienced severe hypoglycemia (< 2.22 mmol/L). The area under the curve 3.5 mmol/L was 28.9 (21.1-54.2) for Control and 4.8 (3.1-5.2) for the Treated animals. The total percent time within tight glucose control range, 4.4-6.6 mmol/L, was 32.8% (32.4-47.1) for Controls and 55.4% (52.9-59.4) for Treated (p < 0.034). Data are median and quartiles. The artificial pancreas system abolished severe hypoglycemia and outperformed the experienced ICU physician in avoiding clinically significant hypoglycemic excursions.

Section: Discussionmentioning

confidence: 99%

Performance of a closed-loop glucose control system, comprising a continuous glucose monitoring system and an AI-based controller in swine during severe hypo- and hyperglycemic provocations

Nekludov

et al. 2020

J Clin Monit Comput

“…They found that tight control did not reduce the risk of short-term mortality, but lead to severe hypoglycemia (<2.2 mmol/l) more frequently [12]. Preiser J C et al recommended that a continuous glucose monitoring-based strategy may decrease the incidence and severity of hypoglycemia, every 5-15 min may be the best time interval [13]. Many clinical guidelines recommend target blood glucose between 140 and 180 mg/dL (7.8 and 10 mmol/L) for most patients in the intensive care unit (ICU) [14].…”

Section: Discussionmentioning

confidence: 99%

Significance of Blood Glucose Control in Severe Nursing Care of ICU

Huifang¹,

Lu²,

Shan³

2019

To investigate the effect of intensive blood glucose control in Intensive Care Unit (ICU) nursing and analyze its clinical significance. From August 2018 to August 2019, 94 severe patients treated with ICU in our hospital were divided into two groups according to the random digital table method. 47 cases in the control group received routine nursing, and 47 cases in the observation group were treated with blood glucose control and routine nursing management. The sequential organ failure score (SOFA), acute physiological and chronic health status score (APACHE II), hospitalization time in ICU and total hospitalization time were compared between the two groups. After nursing, the APACHE Ⅱ score and SOFA score of the patients in the observation group were significantly lower than those in the control group (P < 0.05); The total hospitalization time of ICU in the observation group was significantly shorter than that in the control group (P < 0.05). Enhanced glycemic control in ICU intensive nursing can improve the clinical therapeutic effect and shorten the rehabilitation time. In addition, tight glycemic control can also optimize the prognosis and shorten hospital stay time. The intensive blood glucose control is worthy to be popularized in ICU.

“…30 Finally, at the time of this study, our institution was not using newer technologies, such as intravascular continuous BG monitoring, and thus we are unable to draw conclusions regarding the impact of vitamin C on this technology. 32 A potential for interference with vitamin C exists because most glucose sensors use the glucose oxidase-based method, but further studies are needed to evaluate the effects using this technology. 33…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Point‐of‐Care Blood Glucose Level Measurements in Critically Ill Patients with Sepsis Receiving High‐Dose Intravenous Vitamin C

Smith

Brown

Manning³

et al. 2018

Pharmacotherapy