Editorial
Towards continuous glucose monitoring in the ICU
¿Hacia una monitorización continua de glucosa en la UCI?
S. Ruiz-Santana
, P. Saavedra
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Situación actual en España a la vista del Estudio EPIPUSE" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "395" "paginaFinal" => "404" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Limitation of life-sustaining treatment in patients with prolonged admission to the ICU. Current situation in Spain as seen from the EPIPUSE Study" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1402 "Ancho" => 2486 "Tamanyo" => 209111 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Día de ingreso en UCI en el que se plantea por primera vez LTSV.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Hernández-Tejedor, M.C. Martín Delgado, L. Cabré Pericas, A. Algora Weber" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Hernández-Tejedor" ] 1 => array:2 [ "nombre" => "M.C." 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Ruiz-Santana, P. Saavedra" "autores" => array:2 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Ruiz-Santana" "email" => array:1 [ 0 => "sruisan@gobiernodecanarias.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Saavedra" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Hacia una monitorización continua de glucosa en la UCI?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">After the two landmark Leuven studies,<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">1,2</span></a> glucose monitoring and control in the ICU were highlighted and opened an innovative research field that is here to stay. After those studies the target glucose control, tight or less stringent, and their related outcomes were not only a matter of cutting-edge investigations<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">3,4</span></a> but also forced a decisive move from glucose control from paper-based to computer-based algorithms and from intermittent to real-time continuous glucose monitoring (CGM) systems in order to better adjust insulin administration. Nearly at the same time research in the field moved towards additional improved clinical outcomes more specifically linked to the prevention of hyperglycemia, hypoglycemia and glycemic variability<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a> and complexity.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a> In addition, requirements and recommendations to measure blood glucose and reporting glycemic control<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> and describing performance characteristics and suggested criteria related to ideal CGM systems have recently been published.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Tight glucose control (TGC) benefit in the ICU is still a matter of intense debate but it has been associated with an increase in the rate of hypoglycemia episodes compared to a conventional glucose control.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">9,10</span></a> The clinicians’ and nurses’ natural fear to iatrogenic hypoglycemia and the necessity to reduce glucose variability, independently of the chosen glucose target range, accelerated the development of computerized decision support systems and CGM devices to manage dysglycemia.</p><p id="par0015" class="elsevierStylePara elsevierViewall">CGM systems sample intermittently and the frequency of actual glucose measurements and the immediate of the data display are the two factors that have to be considered when assessing them. The CGM systems are also able to identify and display trends in blood glucose measurements.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a> Wernerman et al. also summarized the different types of CGM devices as intravascular, transcutaneous and interstitial fluid glucose measuring devices with a sensor inserted subcutaneously.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Subcutaneous CGM devices have been investigated in ICU patients receiving intensive insulin therapy to maintain normoglycemia (80–110<span class="elsevierStyleHsp" style=""></span>mg/dl) and have been shown to have good agreement between the values obtained by this method and those of arterial blood glucose measurements according to an algorithm and also significantly reduced hypoglycemic events.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a> In addition, good glucose measurement correlation has also been shown with arterial blood glucose in 234 pairs of subcutaneous sensor/blood glucose values in ICU patients in circulatory shock requiring norepinephrine therapy.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a> The point accuracy of one of these devices has also recently been shown to be relatively low in critically ill patients.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this issue, Ballesteros Ortega et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a> performed a study in 18 critically ill patients in distributive shock, admitted to their ICU between September 2010 and September 2011, to whom a subcutaneous CGM sensor was inserted in their abdominal wall and glucose values were recorded every 5<span class="elsevierStyleHsp" style=""></span>minutes. In five additional patients the sensor was unable to detect tissue glucose. Capillary glucose (CG) was also monitored, to adjust insulin perfusion, according to their ICU protocol aimed to maintain a range of blood glucose of the studied patients between 100 and 140<span class="elsevierStyleHsp" style=""></span>mg/dl. The authors obtained 11,673 CGM and 348 CG values which obviously imply that repeated observations were collected in every particular patient. They eventually compared 295 pairs of apparently simultaneous measurements obtained with both methods of glucose measurement, procured in the first 72<span class="elsevierStyleHsp" style=""></span>h after the placement of the subcutaneous CGM system sensor. Their main conclusion was that when the CGM device is able to obtain data there is correlation between the values obtained by both methods in patients with distributive shock. However, in the statistical analysis performed by the authors they did not consider the real nature of the obtained data: pairs of repeated CGM and CG measurements, with an average of 16 pairs per patient. This fact in our opinion eventually questions the reliability of the results.</p><p id="par0030" class="elsevierStylePara elsevierViewall">While ultimate researches clarify the clinical advantages or disadvantages in addition to the cost-effectiveness of intravascular, transcutaneous or subcutaneous interstitial fluid CGM devices and validated closed loop systems for glucose control and eventually may be incorporated to our ICUs. In the meantime, let us optimize and update our routine blood glucose sample sites and analysis in addition to our currently used insulin administration algorithms to further improve the safety of our ICU patients and the quality of the given assistance.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-05-04" "fechaAceptado" => "2015-05-06" "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0075" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive insulin therapy in critically ill patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Van den Berghe" 1 => "P. Wouters" 2 => "F. Weekers" 3 => "C. Verwaest" 4 => "F. Bruyninckx" 5 => "M. 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| 2024 Enero | 48 | 39 | 87 |
| 2023 Diciembre | 45 | 32 | 77 |
| 2023 Noviembre | 48 | 42 | 90 |
| 2023 Octubre | 39 | 28 | 67 |
| 2023 Septiembre | 42 | 37 | 79 |
| 2023 Agosto | 26 | 12 | 38 |
| 2023 Julio | 41 | 29 | 70 |
| 2023 Junio | 38 | 20 | 58 |
| 2023 Mayo | 45 | 41 | 86 |
| 2023 Abril | 43 | 25 | 68 |
| 2023 Marzo | 75 | 29 | 104 |
| 2023 Febrero | 66 | 35 | 101 |
| 2023 Enero | 53 | 34 | 87 |
| 2022 Diciembre | 74 | 31 | 105 |
| 2022 Noviembre | 55 | 44 | 99 |
| 2022 Octubre | 54 | 49 | 103 |
| 2022 Septiembre | 37 | 36 | 73 |
| 2022 Agosto | 53 | 44 | 97 |
| 2022 Julio | 48 | 56 | 104 |
| 2022 Junio | 50 | 35 | 85 |
| 2022 Mayo | 65 | 40 | 105 |
| 2022 Abril | 88 | 47 | 135 |
| 2022 Marzo | 73 | 62 | 135 |
| 2022 Febrero | 75 | 39 | 114 |
| 2022 Enero | 66 | 41 | 107 |
| 2021 Diciembre | 65 | 58 | 123 |
| 2021 Noviembre | 86 | 49 | 135 |
| 2021 Octubre | 56 | 79 | 135 |
| 2021 Septiembre | 55 | 38 | 93 |
| 2021 Agosto | 42 | 43 | 85 |
| 2021 Julio | 36 | 46 | 82 |
| 2021 Junio | 45 | 32 | 77 |
| 2021 Mayo | 54 | 43 | 97 |
| 2021 Abril | 127 | 80 | 207 |
| 2021 Marzo | 109 | 39 | 148 |
| 2021 Febrero | 89 | 37 | 126 |
| 2021 Enero | 76 | 28 | 104 |
| 2020 Diciembre | 84 | 27 | 111 |
| 2020 Noviembre | 72 | 28 | 100 |
| 2020 Octubre | 59 | 40 | 99 |
| 2020 Septiembre | 59 | 25 | 84 |
| 2020 Agosto | 39 | 24 | 63 |
| 2020 Julio | 37 | 36 | 73 |
| 2020 Junio | 43 | 12 | 55 |
| 2020 Mayo | 57 | 21 | 78 |
| 2020 Abril | 28 | 17 | 45 |
| 2020 Marzo | 35 | 15 | 50 |
| 2020 Febrero | 107 | 33 | 140 |
| 2020 Enero | 46 | 24 | 70 |
| 2019 Diciembre | 56 | 18 | 74 |
| 2019 Noviembre | 44 | 31 | 75 |
| 2019 Octubre | 40 | 31 | 71 |
| 2019 Septiembre | 43 | 26 | 69 |
| 2019 Agosto | 59 | 25 | 84 |
| 2019 Julio | 39 | 18 | 57 |
| 2019 Junio | 32 | 13 | 45 |
| 2019 Mayo | 37 | 33 | 70 |
| 2019 Abril | 33 | 25 | 58 |
| 2019 Marzo | 26 | 37 | 63 |
| 2019 Febrero | 31 | 30 | 61 |
| 2019 Enero | 36 | 39 | 75 |
| 2018 Diciembre | 47 | 44 | 91 |
| 2018 Noviembre | 54 | 35 | 89 |
| 2018 Octubre | 62 | 21 | 83 |
| 2018 Septiembre | 44 | 16 | 60 |
| 2018 Agosto | 31 | 13 | 44 |
| 2018 Julio | 26 | 21 | 47 |
| 2018 Junio | 50 | 15 | 65 |
| 2018 Mayo | 24 | 6 | 30 |
| 2018 Abril | 36 | 7 | 43 |
| 2018 Marzo | 62 | 8 | 70 |
| 2018 Febrero | 33 | 7 | 40 |
| 2018 Enero | 61 | 19 | 80 |
| 2017 Diciembre | 19 | 6 | 25 |
| 2017 Noviembre | 36 | 11 | 47 |
| 2017 Octubre | 52 | 10 | 62 |
| 2017 Septiembre | 30 | 7 | 37 |
| 2017 Agosto | 28 | 11 | 39 |
| 2017 Julio | 20 | 7 | 27 |
| 2017 Junio | 24 | 17 | 41 |
| 2017 Mayo | 30 | 8 | 38 |
| 2017 Abril | 27 | 13 | 40 |
| 2017 Marzo | 16 | 16 | 32 |
| 2017 Febrero | 11 | 6 | 17 |
| 2017 Enero | 11 | 8 | 19 |
| 2016 Diciembre | 30 | 14 | 44 |
| 2016 Noviembre | 40 | 29 | 69 |
| 2016 Octubre | 40 | 23 | 63 |
| 2016 Septiembre | 39 | 16 | 55 |
| 2016 Agosto | 15 | 8 | 23 |
| 2016 Julio | 17 | 21 | 38 |
| 2016 Junio | 1 | 0 | 1 |
| 2016 Febrero | 1 | 0 | 1 |
| 2016 Enero | 2 | 0 | 2 |
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