The use of two continuous glucose sensors during and after surgery.
BACKGROUND
Maintaining plasma glucose between 80 and 120 mg/dL is beneficial for patients admitted to a surgical intensive care unit, but requires frequent glucose monitoring to ensure adequacy of treatment and detection of hypoglycemia. We examined whether continuous glucose sensing is feasible and reliable during and after major surgical procedures using two commercially available sensors.


METHODS
Eight patients undergoing abdominal surgery were studied. A CGMS device (Medtronic MiniMed, Northridge, CA) and a GlucoDay device (A. Menarini Diagnostics, Florence, Italy) were placed in the shoulder region, and a second GlucoDay device was placed in the upper leg. Blood glucose was measured every 15 min for a total duration of 12 h.


RESULTS
Technical failure of the CGMS was observed peroperatively more frequently than postoperatively (66% of all time points vs. 18%, P < 0.001). Technical failure of the GlucoDay device occurred most frequently in the GlucoDay placed in the upper leg (64% vs. 17%, P < 0.001). Accuracy of all three sensors was comparable peroperatively (74%, 76%, and 63% of values in Zone A of the Clarke error grid for the CGMS, GlucoDay shoulder, and GlucoDay upper leg, respectively, P = 0.2). Postoperatively, better accuracy was observed in both sensors placed in the shoulder compared with the GlucoDay placed in the upper leg (73%, 69%, and 51% of values in Zone A for the CGMS, GlucoDay shoulder, and GlucoDay upper leg, respectively, P < 0.001).


CONCLUSIONS
Technical performance and accuracy of continuous glucose sensors need improvement before continuous glucose sensors can be used to monitor strict glycemic control during and after surgery.
Vriesendorp
T M
TM
Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands. T.M.Vriesendorp@amc.uva.nl
DeVries
J H
JH
Holleman
F
F
Dzoljic
M
M
Hoekstra
J B L
JB
D000328:Adult; D015374:Biosensing Techniques; D001786:Blood Glucose / Q000032:analysis*; D003422:Critical Care; D004868:Equipment Failure; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis; D008297:Male; D017551:Microdialysis; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D011183:Postoperative Complications / Q000175:diagnosis; D011184:Postoperative Period; D015203:Reproducibility of Results
D001786:Blood Glucose