Accuracy of Blood Glucose Measurement and Blood Glucose Targets

Abstract

Background: To summarize new evidence regarding the methodological aspects of blood glucose control in the intensive care unit (ICU).

Methods: We reviewed the literature on blood glucose control in the ICU up to August 2019 through Ovid Medline and Pubmed.

Results: Since the publication of the Leuven studies, the benefits of glycemic control have been recognized. However, the methodology of blood glucose control, notably the blood glucose measurement accuracy and the insulin titration protocol, plays an important but underestimated role. This may partially explain the negative results of the large, pragmatic multicenter trials and made everyone realize that tight glycemic control with less-frequent glucose measurements on less accurate blood glucose meters is neither feasible nor advisable in daily practice. Blood gas analyzers remain the gold standard. New generation point-of-care blood glucose meters may be an alternative when using whole blood of critically ill patients in combination with a clinically validated insulin dosing algorithm.

Conclusion: When implementing blood glucose management in an ICU one needs to take into account the interaction between aimed glycemic target and blood glucose measurement methodology.

Keywords: blood glucose control; blood glucose level; intensive care unit; monitoring; tight glycemic control.

Figure 1.

J-shaped curve showing negative effects for both hypoglycemia and hyperglycemia.