Publication
Title
Randomized evaluation of glycemic control in the medical intensive care unit using real-time continuous glucose monitoring (REGIMEN Trial)
Author
Abstract
Background and Objective: Hyperglycemia occurs commonly in patients admitted to medical intensive care units (MICUs). Whether real-time (RT) continuous glucose monitoring (CGM) improves glycemic control and variability and reduces hypoglycemia in severely ill MICU patients with an Acute Physiology and Chronic Health Evaluation II (APACHE-II) score of 20 has not been studied. Subjects and Methods: Thirty-five patients (6610 years of age; APACHE-II score, 286) were randomly assigned to RT-CGM (n=16) using the GlucoDay((R))S (A. Menarini Diagnostics, Florence, Italy) device or to blinded CGM. Insulin was infused using a modified Yale protocol targeting a blood glucose level between 80 and 120mg/dL. Outcome measures were percentage of time in normoglycemia (80-110mg/dL) and in hypoglycemia (<60mg/dL), glycemic variability (SD, coefficient of variation, mean amplitude of glucose excursions, and mean of daily differences), and CGM accuracy (error grid analyses, Bland-Altman bias plot, and mean absolute relative deviation). Results: During 96h of monitoring, glycemia reached target (80-110mg/dL) in 37 +/- 15%, was between 70 and 180mg/dL in 91 +/- 10%, and <60mg/dL in 2 +/- 2% of the time. In the RT-CGM group glycemia averaged 119 +/- 17mg/dL versus 122 +/- 11mg/dL in the control group. Parameters of glucose variability and percentages of time at target glycemia and in hypoglycemia were similar between groups. GlucoDayS values and arterial glycemia correlated well, with 98.6% of data falling in Zones A and B of the error grid analysis. Mean absolute relative devation was 11.2%. Conclusions: RT-CGM did not ameliorate glucose control or variability; neither did it reduce the number of hypoglycemic events, but our insulin infusion protocol led to overall good glucose control without a significant hypoglycemia risk, making further improvement difficult.
Language
English
Source (journal)
Diabetes technology and therapeutics. - -
Publication
2015
ISSN
1520-9156
Volume/pages
17:12(2015), p. 889-898
ISI
000365647500008
Full text (Publishers DOI)
Full text (publishers version - intranet only)
UAntwerpen
Faculty/Department
Research group
Publication type
Subject
Affiliation
Publications with a UAntwerp address
External links
Web of Science
Record
Identification
Creation 15.01.2016
Last edited 18.05.2017
To cite this reference