Impact of shock requiring norepinephrine on the accuracy and reliability of subcutaneous continuous glucose monitoring.
OBJECTIVE
To evaluate the impact of circulatory shock requiring norepinephrine therapy on the accuracy and reliability of a subcutaneous continuous glucose monitoring system (CGMS) in critically ill patients.


METHODS
A prospective, validation study of a medical intensive care unit at a university hospital was carried out.


METHODS
Continuous glucose monitoring was performed subcutaneously in 50 consecutive patients on intensive insulin therapy (IIT), who were assessed according to the a priori strata of circulatory shock requiring norepinephrine therapy or not.


RESULTS
A total of 736 pairs of sensor glucose (SG)/blood glucose (BG) values were analysed (502 without and 234 with norepinephrine therapy). For all values, repeated measures Bland-Altman analysis showed a mean difference of 0.08 mmol/l (limits of agreement: -1.26 and 1.43 mmol/l). Circulatory shock requiring norepinephrine therapy did not influence the relation of arterial BG with SG in a multivariable random effects linear regression analysis. The covariates norepinephrine dose, body mass index (BMI), glucose level and severity of illness also had no influence. Insulin titration grid analysis showed that 98.6% of the data points were in the acceptable treatment zone. No data were in the life-threatening zone.


CONCLUSIONS
Circulatory shock requiring norepinephrine therapy, as well as other covariates, had no influence on the accuracy and reliability of the CGMS in critically ill patients.
Holzinger
Ulrike
U
Intensive Care Unit 13H1, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. ulrike.holzinger@meduniwien.ac.at
Warszawska
Joanna
J
Kitzberger
Reinhard
R
Herkner
Harald
H
Metnitz
Philipp G H
PG
Madl
Christian
C
D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012769:Shock / Q000188:drug therapy* / Q000503:physiopathology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D001786:Blood Glucose; D014662:Vasoconstrictor Agents; D009638:Norepinephrine