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Near-Continuous Glucose Monitoring Makes Glycemic Control Safer in ICU Patients*

Preiser, Jean-Charles, MD, PhD1; Lheureux, Olivier, MD1; Thooft, Aurelie, MD1; Brimioulle, Serge, MD, PhD1; Goldstein, Jacques, MD2; Vincent, Jean-Louis, MD, PhD, FCCM1

doi: 10.1097/CCM.0000000000003157
Clinical Investigations

Objectives: Tight glycemic control using intermittent blood glucose measurements is associated with a risk of hypoglycemia. Glucose concentrations can now be measured near continuously (every 5–15 min). We assessed the quality and safety of glycemic control guided by a near-continuous glucose monitoring system in ICU patients.

Design: Prospective, cluster-randomized, crossover study.

Setting: Thirty-five–bed medico-surgical department of intensive care with four separate ICUs.

Patients: Adult patients admitted to the department and expected to stay for at least 3 days were considered for inclusion if they had persistent hyperglycemia (blood glucose > 150 mg/dL) up to 6 hours after admission and/or were receiving insulin therapy.

Interventions: A peripheral venous catheter was inserted in all patients and connected to a continuous glucose monitoring sensor (GlucoClear; Edwards Lifesciences, Irvine, CA). The four ICUs were randomized in pairs in a crossover design to glycemic control using unblinded or blinded continuous glucose monitoring monitors. The insulin infusion rate was adjusted to keep blood glucose between 90 and 150 mg/dL using the blood glucose values displayed on the continuous glucose monitor (continuous glucose monitoring group—unblinded units) or according to intermittent blood glucose readings (intermittent glucose monitoring group—blinded units).

Measurements and Main Results: The quality and safety of glycemic control were assessed using the proportion of time in range, the frequency of blood glucose less than 70 mg/dL, and the time spent with blood glucose less than 70 mg/dL (TB70), using blood glucose values measured by the continuous glucose monitoring device. Seventy-seven patients were enrolled: 39 in the continuous glucose monitoring group and 38 in the intermittent glucose monitoring group. A total of 43,107 blood glucose values were recorded. The time in range was similar in the two groups. The incidence of hypoglycemia (8/39 [20.5%] vs 15/38 [39.5%]) and the TB70 (0.4% ± 0.9% vs 1.6% ± 3.4%; p < 0.05) was lower in the continuous glucose monitoring than in the intermittent glucose monitoring group.

Conclusions: Use of a continuous glucose monitoring–based strategy decreased the incidence and severity of hypoglycemia, thus improving the safety of glycemic control.

1Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium.

2Edwards Lifesciences, Irvine, CA.

*See also p. 1372. registration number: NCT 03047824.

Dr. Preiser conceived the study, recruited patients, collected and analyzed the data, drafted the article, and approved the final text. Drs. Lheureux, Thooft, and Brimioulle recruited patients, collected the data, revised the article for critical content, and approved the final text. Drs. Goldstein and Vincent conceived the study, revised the article for critical content, and approved the final text.

Dr. Preiser’s institution received funding from Edwards Lifesciences, and he received honoraria for consultancy from Edwards, Maquet, and Optiscan. Dr. Goldstein received funding from Edwards, and he is a former Edwards Lifesciences employee and reports equity ownership in Edwards Lifesciences. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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