Real-Time Continuous Glucose Monitoring in Critically Ill Patients

A prospective randomized trial

  1. Christian Madl, MD1
  1. 1Department of Medicine III, Intensive Care Unit, Medical University of Vienna, Vienna, Austria;
  2. 2Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
  1. Corresponding author: Ulrike Holzinger, ulrike.holzinger{at}meduniwien.ac.at.

Abstract

OBJECTIVE To evaluate the impact of real-time continuous glucose monitoring (CGM) on glycemic control and risk of hypoglycemia in critically ill patients.

RESEARCH DESIGN AND METHODS A total 124 patients receiving mechanical ventilation were randomly assigned to the real-time CGM group (n = 63; glucose values given every 5 min) or to the control group (n = 61; selective arterial glucose measurements according to an algorithm; simultaneously blinded CGM) for 72 h. Insulin infusion rates were guided according to the same algorithm in both groups. The primary end point was percentage of time at a glucose level <110 mg/dl. Secondary end points were mean glucose levels and rate of severe hypoglycemia (<40 mg/dl).

RESULTS Percentage of time at a glucose level <110 mg/dl (59.0 ± 20 vs. 55.0 ± 18% in the control group, P = 0.245) and the mean glucose level (106 ± 18 vs. 111 ± 10 mg/dl in the control group, P = 0.076) could not be improved using real-time CGM. The rate of severe hypoglycemia was lower in the real-time CGM group (1.6 vs. 11.5% in the control group, P = 0.031). CGM reduced the absolute risk of severe hypoglycemia by 9.9% (95% CI 1.2–18.6) with a number needed to treat of 10.1 (95% CI 5.4–83.3).

CONCLUSIONS In critically ill patients, real-time CGM reduces hypoglycemic events but does not improve glycemic control compared with intensive insulin therapy guided by an algorithm.

Footnotes

  • Clinical trial registry no. NCT00494078, clinicaltrials.gov.

  • This prospective randomized study was investigator initiated and investigator driven. Commercial entities had no role in study design, patient enrollment, data collection, data analysis, data interpretation, or writing of the report.

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received July 23, 2009.
    • Accepted November 17, 2009.
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  1. Diabetes Care vol. 33 no. 3 467-472
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