Ongoing clinical studies have shown that good glycemic control is critical, yet difficult to achieve and remains elusive in most hospital settings.1,2
Glycemic control within hospital intensive care has been the subject of numerous research publications, and the importance of in-patient glucose management is well established.
Beginning with the work of Dr. Tony Furnary, which was first presented in 19953, followed by the DIGAMI-1 trial4, Van den Berghe5,6 and Krinsley7, studies over the past two decades have showcased the benefit of tighter glycemic control in reducing both morbidity and mortality.
Better management of blood glucose levels has been linked with:
More recent publications by Egi8, Mackenzie9, Krinsley10 and others11,12, have shown an association between hypoglycemia, hyperglycemia and glycemic variability, and increased mortality, as well as differences in optimal “normal” levels for diabetic versus non-diabetic patients.
In 2013, Krinsley et al. published a paper in Critical Care13 involving 44,964 patients from 23 intensive care units in four continents, in which he summarized the state of glucose control:
“Quite simply, intermittent monitoring is not up to the task… We will be asking our nurses to (a) target a discrete [blood glucose] range by using insulin, (b) avoid hypoglycaemia, and (c) minimize glucose variability. We now have abundant data demonstrating that this cannot be accomplished safely or effectively by using meters, strips, and blood gas analysers… Moreover, we can be certain that these [intermittent] monitoring frequencies do not detect every episode of dysglycaemia that occurs in our patients! Successful management of all three domains of glycaemic control will require the use of continuous or nearly continuous technologies.”
Please click on the links below to review additional literature about the clinical benefits of CGM.
- Cook CB, Elian B, Kongable G, et al. Diabetes and hyperglycemia quality improvement efforts in hospitals in the United States: status, practice variation and barriers to implementation. Endocr Pract. 2010; 16:219-230. Link: http://www.ncbi.nlm.nih.gov/pubmed/20061279
- Swanson CM, Potter DJ, Kongable GL, Cook CB. An update on inpatient glycemic control in US hospitals. Endocr Pract. 2011 Nov-Dec; 17(6) :853-61. Link: http://www.ncbi.nlm.nih.gov/pubmed/21550947
- Zerr KJ et al. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Annals of Thoracic surgery. 1997;63(2)356-61. Link: http://www.ncbi.nlm.nih.gov/pubmed/9033300
- Malberg K et al. Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, insulin Glucose infusion in Acute Myocardial Infarction) Study Group. Bmj. May 24 1997;314(7093):1512-5. Link: http://inpatient.aace.com/sites/all/pdf/Malmberg-1997-314-1512-1515.pdf
- Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Eng J Med. 2001; 345:1359-1367. Link: http://www.ncbi.nlm.nih.gov/pubmed/11794168
- Van den Berghe G, Wilmer A, Hermans G, et al. Intensive Insulin Therapy in the Medical ICU. N Engl J Med. 2006;354:449-461. Link: http://www.ncbi.nlm.nih.gov/pubmed/16452557
- Krinsley J et al. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc. 2004; 79, 992-1000. Link: http://www.ncbi.nlm.nih.gov/pubmed/15301325
- Egi M et al. Variability of blood glucose concentration and short-term mortality in critically ill patients. Anesthesiology. 2006;105(2):244-52. Link: http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1931548
- Mackenzie IM, Whitehouse T, Nightingale PG et al. The metrics of glycaemic control in critical care. Intensive Care Med. 2010; 37:435–443. Link: http://www.ncbi.nlm.nih.gov/pubmed/21210080
- Krinsley JS et al. Glycemic control in the critically ill – 3 domains and diabetic status means one size does not fit all!. Critical Care. 2013; 17:131. Link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672498/
- Hirsch IB et al. Understanding Low Sugar from NICE-SUGAR. NEJM 2012; 367;12. Link: http://www.nejm.org/doi/full/10.1056/NEJMe1208208
- Vincent JL et al. Blood glucose control in 2010: 110 to 150 mg/dL and minimal variability. Crit Care Med 2010; Vol. 38, No 3. Link: http://www.ncbi.nlm.nih.gov/pubmed/20168161
- Krinsley JS, Egi M, Kiss A, et al. Diabetic status and the relationship of the 3 domains of glycemic control to mortality in critically ill patients: an international multi-center cohort study. Crit Care 2013, 17:R37. Link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672498/
- Sechterberger MK, Bosman RJ, Oudemans-van Straaten HM, et al. The effect of diabetes mellitus on the association between measures of glycaemic control and ICU mortality: a retrospective cohort study. Crit Care. 2013;17(2):R52. Link: http://www.ccforum.com/content/17/2/R52
- Furnary AP, Wu Y. Eliminating the diabetic disadvantage: the Portland Diabetic Project. Semin Thorac Cardiovasc Surg. 2006;18(4):302-308. Link: http://www.ncbi.nlm.nih.gov/pubmed/17395026
- Finfer S, Wernerman J, Preiser J-C, et al. Clinical review: Consensus recommendations on measurement of blood glucose and reporting glycemic control in critically ill adults. Crit Care. 2013;17(3):229. Link: http://www.ncbi.nlm.nih.gov/pubmed/23767816
- Ichai C, Preiser J-C. International recommendations for glucose control in adult non diabetic critically ill patients. Crit Care. 2010;14(5):R166. Link: http://www.ncbi.nlm.nih.gov/pubmed/20840773
- Egi M. et al. Hypoglycaemia and outcome in critically ill patients. Mayo Clinic. Proc. 2010, Vol 85, 3,217-224. Link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843109/
- Falciglia M. Hyperglycaemia related mortality in critically ill patients varies with admission diagnosis. Crit Care Med. 2009, Vol 37, 12, 2001-2009. Link: http://www.ncbi.nlm.nih.gov/pubmed/19661802
- Krinsley J. Preiser JC. Time in range 70-140mg/dl >80% is strongly associated with increased survival in non-diabetic critically ill adult patients. Crit Care. 2015 Apr 20;19:179. Link: target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/25927986
- Mesotten D. Glucose management in critically ill adults and children. Lancet Diabetes Endocrinology. 2015 Sep;3(9):723-33. Link: http://www.ncbi.nlm.nih.gov/pubmed/26071884
- Jacobi j. et al. Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Critical Care Med. 2012 40(12): 3251-76. Link: http://www.ncbi.nlm.nih.gov/pubmed/23164767
- Lazaar H. Glycemic control during coronary artery bypass graft surgery. ISRN Cardiology, Article ID 292490. Link: http://www.hindawi.com/journals/isrn/2012/292490/
- Hirsch I. Clinical application of emerging sensor technologies in diabetes: Consensus guidelines for CGM. Diabetes Technology and Therapeutics 2008 Vol 10, No4. Link: http://online.liebertpub.com/doi/abs/10.1089/dia.2008.0016
- Aragon D. Evaluation of nursing work effort and perception about blood glucose control testing in tight glycemic control. Am J Crit Care. 2006 Jul;15(4):370-7. Link: http://www.ncbi.nlm.nih.gov/pubmed/16823014