Glucose control in the ICU using continuous glucose monitoring: What level of the measurement error is acceptable?
American Association for Clinical Chemistry
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Wilinska, M., & Hovorka, R. (2014). Glucose control in the ICU using continuous glucose monitoring: What level of the measurement error is acceptable?. Clinical Chemistry, 60 1500-1509. https://doi.org/10.1373/clinchem.2014.225326
Background: Accuracy and frequency of glucose measurement is essential to achieve safe and efficacious glucose control in the ICU. Emerging continuous glucose monitors provide frequent measurements, trending information and alarms. The objective of this study was to establish the level of accuracy of continuous glucose monitoring (CGM) associated with safe and efficacious glucose control in the intensive care unit. Methods: Three established glucose control protocols (Yale, University of Washington, and NICE-SUGAR) underwent evaluation using computer simulations. Insulin delivery was informed by intermittent blood glucose (BG) measurements or CGM levels with an increasing level of the measurement error. Measures of glucose control included mean glucose, glucose variability, time glucose was in target range, and hypoglycemia episodes. Results: Apart from Washington protocol, CGM with mean absolute relative deviation (MARD) up to 15% resulted in similar mean glucose as with the use of intermittent BG measurements. Glucose variability was also similar between CGM and BG-informed protocols. Frequency and duration of hypoglycemia were not worse using CGM with MARD at or below 10%. Measures of glucose control varied more between protocols than at different levels of the CGM error. Conclusions: The efficacy of CGM-informed and BG-informed commonly used glucose protocols is similar but the risk of hypoglycemia may be reduced using CGM with MARD at or below 10%. Protocol choice has greater influence on glucose control measures than the glucose measurement method.
glucose control, critical care, insulin titration protocol, continuous glucose monitoring
Edwards Lifesciences provided educational grant to conduct the study but did not play any role in data analysis or interpretation of study results.
External DOI: https://doi.org/10.1373/clinchem.2014.225326
This record's URL: https://www.repository.cam.ac.uk/handle/1810/246109