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 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 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
1Fahy, BG, Sheehy AM, Coursin DB. Glucose control in the intensive care unit. Crit Care Med 2009;37:1769-1776.
2Krinsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. May Clin Proc 2003;78:1471-1478.
3Falciglia M, Freyberg R, Almenoff P, D’Alessio D, Render M. Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis. Crit Care Med 2009;37(12):3001-3009.
4Dungan K, et al. Glucose measurement: confounding issues in setting targets for inpatient management. Diabetes Care 2007;30:403-409.
5Finfer S, Wernerman J, Preiser JC, et al. Clinical review: Consensus recommendations on measurement of blood glucose and reporting glycemic control in critically ill adults. Critical Care 2013;17:229
6Kanji S, Buffie J, Hutton B, Bunting PS, Singh A, McDonald K, Fergusson D, McIntyre LA, Hebert PC. Reliability of point-of-care testing for glucose measurement in critically ill adults. Crit Care Med. 2005 Dec;33(12):2778-85.
7Aragon, Daleen. Evaluation of Nursing Work Effort and Perceptions About Blood Glucose Testing in Tight Glycemic Control. Am J Crit Care 2006;15:4:370-377.
8Juneja R, Roudebush C, Nasraway S, Golas A, Jacobi J, Carroll J, Nelson D, Abad V, Flanders S. Computerized intensive insulin dosing can mitigate hypoglycemia and achieve tight glycemic control when glucose measurement is performed frequently and on time. Critical Care 2009, 13:R163.
9Krinsley, J and Jones R. Cost Analysis of Intensive Glycemic Control in Critically Ill Adult Patients. Chest 2006;129: 644-650).
10Krinsley J et al. Mild hypoglycemia is strongly associated with increased intensive care unit length of stay. Annals of Intensive Care 2011, 1:49.
11Hsu, Chien-Wei. Glycemic control in critically ill patients. World J Crit Care Med. 2012 Feb 4; 1(1): 31–39.
OptiScan Biomedical has received CE Mark certification for the OptiScanner 5000/6000 system.