To safely target normoglycaemia in ICU, patients, intensivists and ICU nurses alike, anxiously await accurate continuous blood glucose sensors.

A post hoc cost analysis of the original Van den Berghe prospective study showed the excess cost of intensive care unit hospitalization in the conventional vs. intensive treatment group was 2638 Euros per patient.

Van den Berghe G. et al, Analysis of healthcare resource utilization with intensive insulin therapy in critically ill patients. Critical Care Medicine March 2006; 34(3):612-6

These devices (continuous or near continuous glucose monitors) offer the promise of a reduction in severe hypoglycemia, glycemic variability and the nursing work burden, and will probably become a cornerstone of SEGC.

A commentary raising concerns about the risk of increased hypoglycemia when tight glycemic targets are implemented with existing glucome measurement techology.

Krinsley, J.S. and Preiser J-C., Moving beyond tight glucose control to safe effective glucose control. Critical Care 2008; 12:149

We need better methods to monitor blood glucose levels at the bedside.

Letter discussing research showing link between glucose variability and mortality and calling for better CGM systems that will "facilitate the maintenance of optimal, steady blood glucose levels at all times in all our ICU patients."

Vincent, J. L., Blood glucose control in 2010: 110 to 150 mg/dL and minimal variability. Critical Care Medicine March 2010; 38(3):993-5

Most importantly, we need to improve the monitoring of blood glucose, from what is the primitive standard of once every 1-2 hrs. We must transition to continuous or near-continuous blood glucometry through a technology breakthrough.

Editorial arguing for more frequent and better blood glucose monitoring to allow implementation of Tight Glycemic Control without increasing risk of hypoglycemia.

Nasraway, S.A., Sitting on the horns of a dilemma: Avoiding severe hypoglycemia while practicing tight glycemic control. Critical Care Medicine October 2007; 35(10):2435-7

Although most nurses endorse tight glycemic control, the work associated with it is burdensome and costly. Because up to 2 hours might be required for tight glycemic control for a single patient in a 24-hour period, the costs in time and money are high. Easier clinical methods for monitoring blood glucose levels are needed.

Time-in-motion study showing high burden on nursing staff of implementing TGC with intermittent manual testing.

Aragon, D., Evaluation of nursing work effort and perceptions about blood glucose testing in tight glycemic control. American Journal of Critical Care. 2006 Jul;15(4):370-7.

…better technology that would allow accurate glucose monitoring with minimal effort is required.

Most recent editorial discussing risk of hypoglycaemia and need for better glucose monitoring in intensive care

Irl Hirsch, NEJM 367;12 nejm.org september 20, 2012