title: Value of continuous glucose monitoring for minimizing severe hypoglycemia during tight glycemic control.
abstract: OBJECTIVE
  Tight glycemic control can potentially reduce morbidity and mortality in the intensive care unit but increases the risk of hypoglycemia. The most effective means to avoid hypoglycemia is to obtain frequent blood glucose samples, but this increases the burden to nursing staff. The objective of this study was to assess the ability of a real-time continuous glucose monitor to reduce hypoglycemia (blood glucose <60 mg/dL [3.3 mmol/L]) during standard care or tight glycemic control effected with a proportional integral derivative insulin titration algorithm.
  
  
  METHODS
  Real-time continuous glucose monitor profiles obtained from an ongoing prospective randomized trial of tight glycemic control were retrospectively analyzed to determine whether the continuous glucose measure had prevented instances of hypoglycemia.
  
  
  METHODS
  Cardiac intensive care unit.
  
  
  METHODS
  Children 3 yrs of age or younger undergoing cardiac surgery were studied.
  
  
  METHODS
  Intravenous insulin infusion and rescue glucose guided by the real-time continuous glucose monitor and the proportional integral derivative algorithm in the tight glycemic control arm (n = 155; target glucose 80-110 mg/dL [4.4-6.1 mmol/L]) and the real-time continuous glucose monitor in the standard care arm (n = 156).
  
  
  RESULTS
  No reduction in hypoglycemia was observed with real-time continuous glucose monitor alarms set at 60 mg/dL (3.3 mmol/L) (zero of 19 occurrences of blood glucose <60 mg/dL [3.3 mmol/L] detected); 18 of 40 subsequent incidences of hypoglycemia were detected after the alarm threshold was increased to 70 mg/dL (3.9 mmol/L). In the tight glycemic control arm, eight incidences were reduced in duration and an additional eight events were prevented with intravenous glucose. In the standard care arm, three of nine occurrences of hypoglycemia were detected with the duration reduced in all cases. On average, one to two false hypoglycemia alarms were observed in each patient.
  
  
  CONCLUSIONS
  The real-time continuous glucose monitor in combination with proportional integral derivative control can reduce hypoglycemia during tight glycemic control. The real-time continuous glucose monitor can also reduce hypoglycemia during standard care. However, false alarms increase the overall nursing workload.
authors.affiliation: Department of Surgery and Medicine, Children's Hospital, Boston, MA, USA.
authors.forename: Garry M
authors.initials: GM
authors.lastname: Steil
authors.forename: Monica
authors.initials: M
authors.lastname: Langer
authors.forename: Karen
authors.initials: K
authors.lastname: Jaeger
authors.forename: Jamin
authors.initials: J
authors.lastname: Alexander
authors.forename: Michael
authors.initials: M
authors.lastname: Gaies
authors.forename: Michael S D
authors.initials: MS
authors.lastname: Agus
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D002675:Child, Preschool; D006801:Humans; D007003:Hypoglycemia / Q000503:physiopathology* / Q000517:prevention & control*; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008991:Monitoring, Physiologic / Q000379:methods; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D001786:Blood Glucose