Skip to main content

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM,volume 2014))

  • 2185 Accesses

Abstract

Many critically ill patients are treated with insulin for shorter or longer periods during their stay in the intensive care unit (ICU) [1]. Intensive monitoring of the blood glucose level is a prerequisite for efficient and safe insulin titration in these patients [2]. Glucose levels are currently monitored manually in the ICU by intermittent measurements of the blood glucose level in central laboratories or using laboratory-based blood gas analyzers and/or glucose strips at the bedside [3]. Intermittent manual glucose monitoring, however, is impractical and expensive, time and blood consuming [4], and could even cause dangerous insulin titration errors in critically ill patients [5].

Glucose monitoring through so-called continuous glucose monitoring (CGM) could overcome some of the shortcomings and drawbacks of intermittent manual glucose monitoring. Specifically, CGM could allow for smoother insulin adjustments based on trends of the glucose level visualized on a monitor [3]. Several CGM devices for use in the ICU are being developed. These all require thorough accuracy testing in diverse cohorts of critically ill patient before they can be implemented in daily ICU practice.

This chapter provides an overview of the diverse CGM techniques and CGM devices intended for use in the ICU. This chapter also deals with how point and trend accuracy of CGM systems could be studied in critically ill patients and how accuracy results could be reported.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Schultz MJ, Spronk PE, van Braam Houckgeest F (2009) Glucontrol, no control, or out of control? Intensive Care Med 36:173–174

    Article  PubMed Central  PubMed  Google Scholar 

  2. Schultz MJ, Harmsen RE, Spronk P (2010) Clinical review: Strict or loose glycemic control in critically ill patients-implementing best available evidence from randomized controlled trials. Crit Care 14:223

    Article  PubMed  Google Scholar 

  3. Finfer S, Wernerman J, Preiser JC et al (2012) Clinical review: Consensus recommendations on measurement of blood glucose and reporting glycemic control in critically ill adults. Crit Care 17:229

    Article  Google Scholar 

  4. Aragon D (2006) Evaluation of nursing work effort and perceptions about blood glucose testing in tight glycemic control. Am J Crit Care 15:370–377

    PubMed  Google Scholar 

  5. Karon BS, Boyd JC, Klee GG (2010) Glucose meter performance criteria for tight glycemic control estimated by simulation modeling. Clin Chem 56:1091–1097

    Article  CAS  PubMed  Google Scholar 

  6. Dungan K, Chapman J, Braithwaite SS, Buse J (2007) Glucose measurement: confounding issues in setting targets for inpatient management. Diabetes Care 30:403–409

    Article  PubMed  Google Scholar 

  7. Klonoff DC (2012) Overview of fluorescence glucose sensing: a technology with a bright future. J Diabetes Sci Technol 6:1242–1250

    Article  PubMed Central  PubMed  Google Scholar 

  8. Magarian P, Sterling B (2009) Plasma-generating glucose monitor accuracy demonstrated in an animal model. J Diabetes Sci Technol 3:1411–1418

    Article  PubMed Central  PubMed  Google Scholar 

  9. D’Orazio P, Burnett RW, Fogh-Andersen N et al (2006) Approved IFCC recommendation on reporting results for blood glucose: International Federation of Clinical Chemistry and Laboratory Medicine Scientific Division, Working Group on Selective Electrodes and Point-of-Care Testing (IFCC-SD-WG-SEPOCT). Clin Chem Lab Med 44:1486–1490

    PubMed  Google Scholar 

  10. Finfer S, Wernerman J, Preiser JC et al (2013) Clinical review: Consensus recommendations on measurement of blood glucose and reporting glycemic control in critically ill adults. Crit Care 17:229

    Article  PubMed  Google Scholar 

  11. Schierenbeck F, Owall A, Franco-Cereceda A, Liska J (2013) Evaluation of a continuous blood glucose monitoring system using a central venous catheter with an integrated microdialysis function. Diabetes Technol Ther 15:26–31

    Article  CAS  PubMed  Google Scholar 

  12. Cengiz E, Tamborlane WV (2009) A tale of two compartments: interstitial versus blood glucose monitoring. Diabetes Technol Ther 11(1):S11–S16

    Article  PubMed  Google Scholar 

  13. Rice MJ, Coursin DB (2012) Continuous measurement of glucose: facts and challenges. Anesthesiology 116:199–204

    Article  PubMed  Google Scholar 

  14. Krouwer JS, Cembrowski GS (2010) A review of standards and statistics used to describe blood glucose monitor performance. J Diabetes Sci Technol 4:75–83

    Article  PubMed Central  PubMed  Google Scholar 

  15. Clarke WL, Kovatchev B (2007) Continuous glucose sensors: Continuing questions about clinical accuracy. J Diabetes Sci Technol 1:669–675

    Article  PubMed Central  PubMed  Google Scholar 

  16. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    Article  CAS  PubMed  Google Scholar 

  17. Clarke WL, Cox D, Gonder-Frederick LA, Carter W, Pohl SL (1987) Evaluating clinical accuracy of systems for self-monitoring of blood glucose. Diabetes Care 10:622–628

    Article  CAS  PubMed  Google Scholar 

  18. Ellmerer M, Haluzik M, Blaha J et al (2006) Clinical evaluation of alternative-site glucose measurements in patients after major cardiac surgery. Diabetes Care 29:1275–1281

    Article  CAS  PubMed  Google Scholar 

  19. Kovatchev BP, Gonder-Frederick LA, Cox DJ, Clarke WL (2004) Evaluating the accuracy of continuous glucose-monitoring sensors: continuous glucose-error grid analysis illustrated by TheraSense Freestyle Navigator data. Diabetes Care 27:1922–1928

    Article  CAS  PubMed  Google Scholar 

  20. Wentholt IM, Hoekstra JB, Devries JH (2006) A critical appraisal of the continuous glucose-error grid analysis. Diabetes Care 29:1805–1811

    Article  PubMed  Google Scholar 

  21. Critchley LA, Lee A, Ho AM (2010) A critical review of the ability of continuous cardiac output monitors to measure trends in cardiac output. Anesth Analg 111:1180–1192

    Article  PubMed  Google Scholar 

  22. De Block C, Manuel YKB, Van Gaal L, Rogiers P (2006) Intensive insulin therapy in the intensive care unit: assessment by continuous glucose monitoring. Diabetes Care 29:1750–1756

    Article  PubMed  Google Scholar 

  23. Mulavisala K, Gopal P, Crane B, Mackenzie A (2012) Preliminary ICU experience of a novel intravascular blood glucose sensor. Crit Care 16:P175 (abst)

    Article  Google Scholar 

  24. Bird S, Macken L, Flower O et al (2013) Continuous arterial and venous glucose monitoring by quenched chemical fluorescence in ICU patients after cardiac surgery. Critical Care 17:P461 (abst)

    Article  Google Scholar 

  25. Nasraway SA, Ehsan A, Melanson AM et al (2012) Accuracy of a novel non-invasive transdermal continuous glucose monitor in critically ill patients. Crit Care Med 40:S305 (abst)

    Article  Google Scholar 

  26. Kosiborod M, Gottlieb R, Sekella J et al (2013) Performance of the Medtronic Sentrino(R) continuous glucose management system in the cardiac ICU. Crit Care 17:P462 (abst)

    Article  Google Scholar 

  27. Optiscan (2013) OptiScan Biomedical presents study results demonstrating optiscanner’s excellent glucose monitoring accuracy in critically ill ICU patients. Available at: http://www.optiscancorp.com/OptiScan%20MANAGE%20Study%20Data%20Press%20Release%20-%20FINAL.pdf. Accessed Nov 2013

  28. Flowsion. http://www.flowsionmedical.com/ Accessed Nov 2013

  29. Foubert L (2012) Clinical experience with the GluCoclear continuous glucose monitoring system. Available at: http://www.esicm.org/flash-conferences-sponsorised/lisbon-2012 Accessed Nov 2013

  30. Miller M, Skladany MJ, Ludwig CR, Guthermann JS (2007) Convergence of continuous glucose monitoring and in-hospital tight glycemic control: closing the gap between caregivers and industry. J Diabetes Sci Technol 1:903–906

    Article  PubMed Central  PubMed  Google Scholar 

  31. Holzinger U, Warszawska J, Kitzberger R et al (2010) Real-time continuous glucose monitoring in critically ill patients: a prospective randomized trial. Diabetes Care 33:467–472

    Article  CAS  PubMed  Google Scholar 

  32. Leelarathna L, English S, Thabit H et al (2013) Feasibility of fully automated closed-loop glucose control utilizing continuous subcutaneous glucose measurements in critical illness: a randomised controlled trial. Crit Care 17:R159

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R. T. M. van Hooijdonk .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer International Publishing Switzerland

About this chapter

Cite this chapter

van Hooijdonk, R.T.M., Leopold, J.H., Schultz, M.J. (2014). Continuous Glucose Monitoring Devices for Use in the ICU. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2014. Annual Update in Intensive Care and Emergency Medicine, vol 2014. Springer, Cham. https://doi.org/10.1007/978-3-319-03746-2_45

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-03746-2_45

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-03745-5

  • Online ISBN: 978-3-319-03746-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics