Glucose Monitoring in the ICU
Hyperglycemia and insulin resistance (IR) are common in patients treated in the ICU, and are associated with increased morbidity and mortality in both diabetic and non-diabetic patients.1,2,3 It is estimated that approximately 20 percent of ICU patients have pre-existing diabetes and an additional 40 to 60 percent of ICU patients suffer from “stress hyperglycemia” or a temporary elevation of glucose levels, with all of these patients requiring accurate glucose monitoring to maintain proper glycemic control.
The association of glucose control with morbidity and mortality in ICU patients is especially pronounced in patients recovering from post-cardiac surgery, burns, trauma and sepsis.2,3,7,11
The availability of an accurate, automated, bedside glucose monitoring system would allow for the early detection of incidents of hypoglycemia, hyperglycemia and glycemic variability, enabling clinicians to proactively manage their patients to maintain the right glucose control.
Today’s blood glucose monitoring methods suffer from a variety of error sources that can put ICU patients at risk for insulin titration inaccuracies.4 Measurement of blood glucose concentration in ICUs is generally intermittent, with analysis performed with either point-of-care glucose meters or blood gas analyzers.
Blood gas analyzers are accurate, but take considerable time, limiting the number of samples. Measurements by glucose meters are more rapid and less burdensome on nursing staff, but are often confounded by the use of capillary blood and associated error.5,6 Even the more efficient glucose meters have been shown to be a burden on nursing time.7
Sending samples to the hospital central laboratory provides highly accurate measurements, but the turnaround time makes real-time measurements impossible.
Benefits of Maintaining the Right Level of Glucose Control
Current technology, which can be inaccurate and is time consuming, fundamentally suffers from an inability to provide sufficient measurements to prevent excursions into hypoglycemia, hyperglycemia, or variability.8 Intermittent measurements may fail to detect out-of-control glycemic episodes or glycemic variability.
With the OptiScanner® system, a target range can be entered based on hospital protocol
If the glucose level is trending outside that range, clinicians are alerted, allowing prompt assessment of a patient’s glycemic status and enabling more proactive management.
Most institutions list programs to monitor glucose levels and treat hyperglycemia in the intensive care unit (ICU) setting as a stated patient management goal. An analysis of 1,600 patients showed that improving glycemic control could reduce total length of ICU stay from a median of 4.2 days to 3.4 days among patients requiring ventilation.9
According to a multi-center investigation, even mild hypoglycemia results in increased ICU length of stay, regardless of the severity of the illness or final outcomes. The study concluded that avoiding hypoglycemia has the potential to significantly decrease the cost of care for patients who are critically ill.10