Many critically ill patients receive insulin and therefore require close blood glucose monitoring. This usually takes place by intermittent point-of-care (POC) testing, resulting in considerable workload. Subcutaneous continuous glucose monitoring (CGM) systems may therefore be of benefit.
Researchers conducted a randomised controlled trial comparing the use of subcutaneous CGM to frequent POC testing in guiding glucose regulation. Both groups received a subcutaneous CGM system. In the intervention group this was used to guide insulin administration, whereas in the control group staff were blinded to these readings and glucose regulation was guided by frequent POC measurements.
The primary safety outcome was the incidence of severe hypoglycaemia (<2.2 mmol/L). Primary efficacy outcomes were the percentage of time that blood glucose levels were within the target range (5.0/9.0 mmol/L).
Episodes of severe hypoglycaemia and time within the target range were similar for the two groups, but there was a reduction in daily nursing workload for glucose control in the intervention group.
This study suggests that subcutaneous CGM is as safe and effective as POC testing for guiding insulin treatment in critically ill patients, but leads to reduced nursing workload for blood glucose monitoring.
Written by Stephanie Harriman, Deputy Medical Editor for BioMed Central.
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Daphne T Boom, Marjolein K Sechterberger, Saskia Rijkenberg, Susanne Kreder, Rob J Bosman, Jos PJ Wester, Ilse van Stijn, J Hans DeVries and Peter HJ van der Voort
Critical Care 2014, 18:453