Abstract
Introduction
Hypoglycemia is a frequent and feared complication of insulin therapy on the intensive care unit (ICU). Sedated patients in particular are at risk for hypoglycemia due to the absence of clinical symptoms. Furthermore, recent studies point to a correlation between the variability of blood glucose and mortality. Therefore, continuous glucose monitoring has the potential to influence outcome due to a better control of blood glucose in critically ill patients.
Materials and methods
We evaluated the efficacy, accuracy and safety of a new commercially available subcutaneous continuous glucose monitoring system (sCGM; Sentrino®, Medtronic) in a pilot study in critically ill adult patients. sCGM data were recorded for up to 72 h and values were compared with blood glucose values measured by cassette-based blood gas analyzer (BGA).
Results
A total of 14 patients (eight male, six female), with a mean age of 62.1 ± 9.8 years, referred to the ICU after major abdominal surgery were studied. The average simplified acute physiology score (SAPS II) was 35 ± 9. Three patients had known type II diabetes. The average runtime of sensors was 44.1 ± 22.1 h. In comparison to BGA, measurement of blood glucose by sCGM revealed an accuracy of 1.5 mg/dl, and a precision of + 34.2 mg/dl to − 31.2 mg/dl. Linn’s concordance correlation coefficient yielded 0.74 with a 95 % confidence interval of 0.68–0.78. No hypoglycemic events, defined as a blood glucose level below 70 mg/dl, occurred during treatment.
Conclusions
sCGM monitoring via a subcutaneous sensor demonstrated high accuracy and considerable variability compared to blood gas samples, even in critically ill patients.
Zusammenfassung
Hintergrund
Die Hypoglykämie stellt eine häufige und gefürchtete Komplikation der Insulintherapie auf der Intensivstation dar. Insbesondere bei sedierten Patienten besteht aufgrund fehlender klinischer Symptome das Risiko einer Hypoglykämie. Außerdem weisen aktuelle Studien auf eine Korrelation zwischen der Variabilität von Blutzucker und Mortalität hin. Daher hat das kontinuierliche Glukosemonitoring das Potenzial, den Verlauf durch eine bessere Blutzuckereinstellung bei kritisch kranken Patienten zu beeinflussen.
Material und Methoden
Untersucht wurden die Wirksamkeit, Genauigkeit und Sicherheit eines neuen, kommerziell verfügbaren, subkutanen kontinuierlichen Glukosemonitoringsystems (sCGM; Sentrino®, Fa. Medtronic) in einer Pilotstudie an kritisch kranken erwachsenen Patienten. Die sCGM-Daten wurden für bis zu 72 h aufgezeichnet und die Werte mit den Blutzuckerwerten verglichen, die mittels eines kassettenbasierten Blutgasanalysators (BGA) gemessen wurden.
Ergebnisse
Es wurden insgesamt 14 Patienten (8 m, 6 w) mit einem Durchschnittsalter von 62,1 ± 9,8 Jahren untersucht, die nach einer großen Bauchoperation auf die Intensivstation verlegt wurden. Der durchschnittliche SAPS II („simplified acute physiology score“) betrug 35 ± 9. Bei 3 Patienten war ein Typ-2-Diabetes bekannt. Die durchschnittliche Nutzungsdauer der Sensoren lag bei 44,1 ± 22,1 h. Im Vergleich zur BGA ergab die Messung des Blutzuckers mit dem sCGM eine Genauigkeit von 1,5 mg/dl und eine Variabilität von + 34,2 mg/dl bis − 31,2 mg/dl. Der Konkordanz-Korrelationskoeffizient nach Linn ergab 0,74 bei einem 95 %-Konfidenzintervall von 0,68–0,78. Es traten keine Hypoglykämien, definiert als Blutzuckerspiegel unter 70 mg/dl, während der Behandlung auf.
Schlussfolgerungen
Das sCGM-Monitoring über einen subkutanen Sensor wies eine hohe Genauigkeit und eine beträchtliche Variabilität im Vergleich zu den Blutgasanalysen auf, selbst bei kritisch kranken Patienten.
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Acknowledgements
We would like to thank the nursing staff of the surgical ICU (1 F) Department of Intensive Care Medicine, Center of Anesthesiology and Intensive Care Medicine, Hamburg-Eppendorf University Medical Center, Hamburg, Germany for helping us to perform the study.
Compliance with ethical guidelines
Conflict of interest. M. A. Punke, C. Decker, K. Wodack, D. A. Reuter and S. Kluge declare that there are no conflicts of interest. We received sensors and monitors from Medtronic free of charge.
All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.
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Punke, M., Decker, C., Wodack, K. et al. Continuous glucose monitoring on the ICU using a subcutaneous sensor . Med Klin Intensivmed Notfmed 110, 360–363 (2015). https://doi.org/10.1007/s00063-014-0453-1
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DOI: https://doi.org/10.1007/s00063-014-0453-1