Continuous glucose control in the ICU: report of a 2013 round table meeting

Abstract

Achieving adequate glucose control in critically ill patients is a complex but important part of optimal patient management. Until relatively recently, intermittent measurements of blood glucose have been the only means of monitoring blood glucose levels. With growing interest in the possible beneficial effects of continuous over intermittent monitoring and the development of several continuous glucose monitoring (CGM) systems, a round table conference was convened to discuss and, where possible, reach consensus on the various aspects related to glucose monitoring and management using these systems. In this report, we discuss the advantages and limitations of the different types of devices available, the potential advantages of continuous over intermittent testing, the relative importance of trend and point accuracy, the standards necessary for reporting results in clinical trials and for recognition by official bodies, and the changes that may be needed in current glucose management protocols as a result of a move towards increased use of CGM. We close with a list of the research priorities in this field, which will be necessary if CGM is to become a routine part of daily practice in the management of critically ill patients.

Figure 1

Schematic representation of the potential advantages of using trends. (A) If imprecision or noise is random or normally distributed, the trend line will filter it out. (B) If the measurement system has a fixed bias, trend will not be affected but individual values could be. (C) When trying to predict future events, trend may be clinically more important than the current absolute blood glucose value.

Figure 2

The clinical impact of hypo/hyperglycemia varies according to the degree away from normal values.