Tight Glucose Control in Critically Ill Patients: Should Glucose Meters Be Used?

Measurement of blood glucose concentrations using portable, hand-held meters is used widely in patients with diabetes. Clinical settings include self-monitoring of blood glucose by patients, in doctors’ offices, in chronic care facilities, and in hospitals. More recently, evidence has emerged suggesting that tight glycemic control of nondiabetic patients in hospital intensive care units (ICUs)1 improves clinical outcomes. Based on this evidence, lowering blood glucose concentrations with insulin has become the standard of care in many ICUs and other hospital settings. In the vast majority of these patients, frequent measurements of blood glucose are performed with portable glucose meters, and the values are used to determine the dose of insulin. In this Q&A article, 5 experts in the field are asked to comment on the use of glucose meters in tight glycemic control.Greet Van den Berghe2 : This depends on the definition of “tight” and what is meant by “hospitalized.” Although there are numerous studies showing a strong association of both hyperglycemia and hypoglycemia with mortality in hospitalized patients (the nadir of the risk being associated with the “normal for age” fasting blood glucose range), the evidence from randomized controlled studies currently comes from those performed in ICU patients. The 3 studies that we performed in Leuven compared a “normal (fasting) for age” target for blood glucose [80–110 mg/dL (4.4–6.1 mmol/L) for adults, 70–100 mg/dL (3.9–5.6 mmol/L) for children, and 50–80 mg/dL (2.8–4.4 mmol/L) for infants] with a control group in which we assumed hyperglycemia to be a potentially beneficial adaptation. In the control group, we therefore used a “do not touch” approach unless glucose exceeded the renal threshold of 215 mg/dL (11.9 mmol/L). Blood glucose was measured with only 1 device, namely an ABL blood gas analyzer in the surgical and pediatric ICU studies and the HemoCue …