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Critical Care

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Open Access 01-10-2012 | Research

Glycemic variability and glucose complexity in critically ill patients: a retrospective analysis of continuous glucose monitoring data

Authors: Richard Brunner, Gabriel Adelsmayr, Harald Herkner, Christian Madl, Ulrike Holzinger

Published in: Critical Care | Issue 5/2012

Abstract

Introduction

Glycemic variability as a marker of endogenous and exogenous factors, and glucose complexity as a marker of endogenous glucose regulation are independent predictors of mortality in critically ill patients. We evaluated the impact of real time continuous glucose monitoring (CGM) on glycemic variability in critically ill patients on intensive insulin therapy (IIT), and investigated glucose complexity - calculated using detrended fluctuation analysis (DFA) - in ICU survivors and non-survivors.

Methods

Retrospective analysis were conducted of two prospective, randomized, controlled trials in which 174 critically ill patients either received IIT according to a real-time CGM system (n = 63) or according to an algorithm (n = 111) guided by selective arterial blood glucose measurements with simultaneously blinded CGM for 72 hours. Standard deviation, glucose lability index and mean daily delta glucose as markers of glycemic variability, as well as glucose complexity and mean glucose were calculated.

Results

Glycemic variability measures were comparable between the real time CGM group (n = 63) and the controls (n = 111). Glucose complexity was significantly lower (higher DFA) in ICU non-survivors (n = 36) compared to survivors (n = 138) (DFA: 1.61 (1.46 to 1.68) versus 1.52 (1.44 to 1.58); P = 0.003). Diabetes mellitus was significantly associated with a loss of complexity (diabetic (n = 33) versus non-diabetic patients (n = 141) (DFA: 1.58 (1.48 to 1.65) versus 1.53 (1.44 to 1.59); P = 0.01).

Conclusions

IIT guided by real time CGM did not result in significantly reduced glycemic variability. Loss of glucose complexity was significantly associated with mortality and with the presence of diabetes mellitus.

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Title: Glycemic variability and glucose complexity in critically ill patients: a retrospective analysis of continuous glucose monitoring data
Authors: Richard Brunner
Gabriel Adelsmayr
Harald Herkner
Christian Madl
Ulrike Holzinger
Publication date: 01-10-2012
Publisher: BioMed Central
Published in: Critical Care / Issue 5/2012
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc11657

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Glycemic variability and glucose complexity in critically ill patients: a retrospective analysis of continuous glucose monitoring data

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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