Real-time continuous glucose monitoring in critically ill patients: a prospective randomized trial.
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.
Holzinger
Ulrike
U
Department of Medicine III, Intensive Care Unit, Medical University of Vienna, Vienna, Austria. ulrike.holzinger@meduniwien.ac.at
Warszawska
Joanna
J
Kitzberger
Reinhard
R
Wewalka
Marlene
M
Miehsler
Wolfgang
W
Herkner
Harald
H
Madl
Christian
C
D000328:Adult; D000368:Aged; D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis* / Q000378:metabolism; D003199:Computer Systems; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D012121:Respiration, Artificial; D012306:Risk
D001786:Blood Glucose