Glucose control and use of continuous glucose monitoring in the intensive care unit: a critical review.
Stress hyperglycemia recently became a major therapeutic target in the Intensive Care Unit (ICU) since it occurs in most critically ill patients and is associated with adverse outcome, including increased mortality. Intensive insulin therapy to achieve normoglycemia may reduce mortality, morbidity and the length of ICU and in-hospital stay. However, obtaining normoglycemia requires extensive efforts from the medical staff, including frequent glucose monitoring and adjustment of insulin dose. Current insulin titration is based upon discrete glucose measurements, which may miss fast changes in glycemia and which does not give a full picture of overall glycemic control. Recent evidence suggests that continuous monitoring of glucose levels may help to signal glycemic excursions and eventually to optimize insulin titration in the ICU. In this review we will summarise monitoring and treatment strategies to achieve normoglycemia in the ICU, with special emphasis on the possible advantages of continuous glucose monitoring.
De Block
Christophe
C
Department of Endocrinology-Diabetology, Antwerp University Hospital (UZA), Wilrijkstraat 10, B-2650 Edegem, Belgium. christophe.deblock@ua.ac.be
Manuel-y-Keenoy
Begoña
B
Rogiers
Peter
P
Jorens
Philippe
P
Van Gaal
Luc
L
D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects; D002648:Child; D016638:Critical Illness; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D007231:Infant, Newborn; D007328:Insulin / Q000627:therapeutic use; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data; D007363:Intensive Care Units, Neonatal / Q000592:standards / Q000706:statistics & numerical data; D015278:Intensive Care Units, Pediatric / Q000592:standards / Q000706:statistics & numerical data; D018670:Monitoring, Ambulatory / Q000379:methods*; D015995:Prevalence; D013312:Stress, Physiological / Q000502:physiology
D001786:Blood Glucose; D007328:Insulin