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Current approach

Since the Van den Berghe NEJM paper the practice of glycemic control has been widely adopted in hospitals worldwide. Glucose monitoring is generally done manually by nursing staff, mainly using finger sticks and hand-held glucose meters. This practice is time consuming (up to 15 minutes per sample, including therapy adjustment) and greatly increases nurse workload.

A study conducted by Daleen Aragon* on the impact of TGC implementation on nursing concluded: "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."

For many intensive care units TGC/IIT causes significant cost and resource problems and maintaining a patient's glucose level within a tight target range is difficult using current clinical practice.  As a result, glucose monitoring is often performed at a frequency that significantly reduces patient care benefits while increasing the risk of hypoglycaemia.  Multiple studies over the past few years have shown an association between even one mild hypoglycemic event and increased mortality.

To date, the single greatest barrier to adopting TGC/IIT is the absence of an appropriate technology on the market to meet the need for tight control, ease of use, and automated monitoring. 

See Clinical demand to read what the experts say.

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Kosiborod et al, Circulation. 2005;111(23):3078-86
U-shaped mortality curve showing increased risk of mortality at both hyper and hypoglycemic levels.  Fear of increasing hypoglycemia due to the limitations of current intermittent technology has resulted in a majority of clinicians opting for looser or higher target ranges.

* Daleen Aragon, RN, PhD, CCRN,   Evaluation of Nursing Work Effort and Perceptions About Blood Glucose Testing in Tight Glycemic Control, American Journal of Critical Care, July 2006, Volume 15, No. 4

Platform technology

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