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Continuous glucose control in the ICU: report of a 2013 round table meeting

Jan Wernerman1, Thomas Desaive2, Simon Finfer3, Luc Foubert4, Anthony Furnary5, Ulrike Holzinger6, Roman Hovorka7, Jeffrey Joseph8, Mikhail Kosiborod9, James Krinsley10, Dieter Mesotten11, Stanley Nasraway12, Olav Rooyackers13, Marcus J Schultz14, Tom Van Herpe1516, Robert A Vigersky17 and Jean-Charles Preiser18*

Author Affiliations

1 Department of Anesthesiology and Intensive Care Medicine, K32, Karolinska University Hospital, Stockholm, Huddinge 14186, Sweden

2 GIGA - Cardiovascular Sciences, University of Liege, Institute of Physics, B5, Allee du 6 aout, 17, Liege 4000, Belgium

3 The George Institute for Global Health and Royal North Shore Hospital, University of Sydney, St Leonards, Sydney, NSW 2065, Australia

4 Department of Anesthesia and Intensive Care Medicine, OLV Clinic, Aalst 9300, Belgium

5 Starr-Wood Cardiac Group, 9155 SW Barnes Road, Portland, OR 97225-6629, USA

6 Department of Medicine III - Division of Gastroenterology and Hepatology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria

7 University of Cambridge Metabolic Research Laboratories, Level 4, Wellcome trust MRC Institute of Metabolic Science, Box 289, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK

8 Jefferson Artificial Pancreas Center and Anesthesiology Program for Translational Research, Department of Anesthesiology, Jefferson Medical College of Thomas Jefferson University, 1020 Walnut Street, Philadelphia, PA 19107, USA

9 Saint-Luke’s Mid America Heart Institute, University of Missouri - Kansas City, 4401 Wornall Road, Kansas City, MO 64111, USA

10 Division of Critical Care, Stamford Hospital and Columbia University College of Physicians and Surgeons, 30 Shelburne Road, Stamford, CT 06904, USA

11 Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, Leuven B-3000, Belgium

12 Surgical Intensive Care Units, Tufts Medical Center, 800 Washington Street, NEMC 4360, Boston, MA 02111, USA

13 Anesthesiology and Intensive Care Clinic, Karolinska Institute and University Hospital, Huddinge 14186, Sweden

14 Department of Intensive Care Medicine, Academic Medical Center at the University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands

15 Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, Leuven B-3000, Belgium

16 Department of Electrical Engineering (STADIUS) - iMinds Future Health Department, Katholieke Universiteit Leuven, Leuven, Heverlee B-3001, Belgium

17 Diabetes Institute, Walter Reed National Military Medical Center, Bethesda, MD 20895, USA

18 Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, 808 route de Lennik, Brussels 1070, Belgium

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Critical Care 2014, 18:226  doi:10.1186/cc13921


See related commentary by Steil and Agus, http://ccforum.com/content/18/3/159

Published: 13 June 2014

Abstract

Achieving adequate glucose control in critically ill patients is a complex but important part of optimal patient management. Until relatively recently, intermittent measurements of blood glucose have been the only means of monitoring blood glucose levels. With growing interest in the possible beneficial effects of continuous over intermittent monitoring and the development of several continuous glucose monitoring (CGM) systems, a round table conference was convened to discuss and, where possible, reach consensus on the various aspects related to glucose monitoring and management using these systems. In this report, we discuss the advantages and limitations of the different types of devices available, the potential advantages of continuous over intermittent testing, the relative importance of trend and point accuracy, the standards necessary for reporting results in clinical trials and for recognition by official bodies, and the changes that may be needed in current glucose management protocols as a result of a move towards increased use of CGM. We close with a list of the research priorities in this field, which will be necessary if CGM is to become a routine part of daily practice in the management of critically ill patients.