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Glycemic control

A transformation in critical care patient management

Early interest in tight glycemic control for intensive care patients began in the mid '90s with publication of data from the Portland Diabetic Project showing that post-operative blood glucose levels had an independent effect on the incidence of deep sternal wound infection. This was followed on by data showing post op blood glucose was a highly significant independently predictive variable for mortality.

In 2001 Greet Van den Berghe's landmark prospective trial demonstrated that controlling patient glucose levels in the ICU within tight normal ranges yielded significant improvements in patient outcomes including a 46 per cent reduction in incidence of sepsis, 41 per cent reduction in renal failure, 50 per cent reduction in blood transfusions, and 34 per cent reduction in mortality. This study launched a new field of medical research with over 100 publications in the past decade including two showing a financial benefit to the hospital in savings of $1,580 to €2,638 per patient.

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The paper has revolutionized the clinical practice of intensive care units across the world and has established a new standard in post-surgical care.  The challenge for hospitals is that few ICU's have the resources available to draw blood and perform glucose measurements at the frequency required to safely maintain patients within the target glucose range.

For more information on the challenge and current approach to hospital glycemic control click here.

References

1. Furnary AP, Zerr KJ, Grunkemeier GL, Starr A.
Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures.
Ann Thorac Surg. Feb 1999;67(2):352-60; discussion 360-52.
2. Furnary AP, Zerr KJ, Grunkemeier GL, Heller CA.
Hyperglycemia: A predictor of mortality following CABG in diabetics.
Circulation. 1999;100(18):I-591.
3. Furnary AP, Wu Y, Bookin SO. Effect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: the Portland Diabetic Project.
Endocr Pract. Mar-Apr 2004;10 Suppl 2:21-33.
4. Furnary AP, Gao G, Grunkemeier GL, et al.
Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting.
J Thorac Cardiovasc Surg. May 2003;125(5):1007-21.
5. Furnary AP, Chaugle H, Zerr K, Grunkemeier G.
Postoperative hyperglycemia prolongs length of stay in diabetic CABG patients.
Circulation. 2000;102(18):II-556.
6. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S,
Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations.
Annals of Thoracic Surgery. 1997;63(2):356-61.
7. Van den Berghe G et al. Intensive insulin therapy in critically ill patients. NEJM 2001, 345, 1359-1367.

Platform technology

GlySure's team of scientists and engineers has a combined 150 years' experience of developing in-vivo fiber optic continuous monitoring sensors and systems.

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