Intensive Insulin Therapy in the Intensive Care Unit
Assessment by continuous glucose monitoring
Article Figures & Tables
Figures
- Figure 1—
Examples of CGM profiles. A: A brittle type 1 diabetic (DM) patient in cardiogenic shock; enteral feeding was started after 36 h. ▪, arterial blood glucose readings. B: A stable nondiabetic patient admitted due to respiratory insufficiency; parenteral nutrition was started after 30 h.
- Figure 2—
EGAs. The Clarke error grid assesses the clinical significance of differences between the GlucoDay and the arterial blood glucose measurements. The method uses a Cartesian diagram, in which the values generated by the continuous monitoring device (GlucoDay) are displayed on the y-axis, and the reference values (arterial blood glucose) are displayed on the x-axis. The diagonal represents the perfect agreement between the two, whereas the points below and above the line indicate overestimation and underestimation of the actual values. Zone A (acceptable) represents the glucose values that deviate from the reference values by ≤20%. These values are clinically exact and are thus characterized by correct clinical treatment. Zone B (benign errors) is located above and below zone A; this zone represents those values that deviate from the reference values, which are incremented by 20%. The values that fall within zones A and B are clinically acceptable, whereas the values included in areas C–E are potentially dangerous, and there is a possibility of making clinically significant mistakes. A: EGA after two-point calibration. B: EGA after six-point calibration. C: Rate EGA. D: Error matrix combining R-EGA and point EGA (P-EGA) zones.
Tables
- Table 1—
Clinical and metabolic parameters of 50 MICU patients according to the insulin regimen used
Insulin regimen Intravenous Subcutaneous Statistics Baseline characteristics Men/women 13/9 18/10 NS Age (years) 60 ± 13 63 ± 18 NS BMI (kg/m2) 27.5 ± 7.1 25.9 ± 7.3 NS Diabetes (no/type 2/type 1) 9/9/4 21/7/0 0.021 APACHE II score 27 ± 7 19 ± 6 <0.0001 SOFA score (at start) 9 ± 4 7 ± 4 0.014 Primary condition Septic shock 13 4 0.002 Cardiogenic shock 3 3 NS Respiratory failure 1 9 0.029 Neurologic event 0 4 NS Cardiopulmonary resuscitation 1 4 NS Clinical outcome Mortality 7 8 NS Corticosteroid therapy 12 3 0.001 Vasopressor therapy 14 10 NS Enteral nutrition 3 11 0.061 Parenteral nutrition 10 1 0.001 Renal failure (CVVH or HD) 9 2 0.006 Mechanical ventilation 16 17 NS Metabolic outcome Insulin dose (day 1) (units/day) 141 ± 100 15 ± 26 <0.0001 Insulin dose (day 2) (units/day) 125 ± 99 19 ± 31 <0.0001 Mean glycaemia (mg/dl) 141 ± 56 149 ± 61 NS % time at glycemia <60 mg/dl 6 ± 9 4 ± 11 NS 80–110 mg/dl 26 ± 21 19 ± 22 NS >110 mg/dl 55 ± 22 71 ± 24 0.016 >140 mg/dl 35 ± 24 42 ± 29 NS >200 mg/dl 13 ± 19 16 ± 23 NS -
Data are means ± SD or number (n). CVVH, continuous venovenous hemofiltration; HD, hemodialysis.
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