Real-Time Continuous Glucose Monitoring in Critically Ill Patients A prospective randomized trial

OBJECTIVE - To evaluate the impact of real-time continuous glucose monitoring (CGM) on glycemic control and risk of hypoglycemia in critically ill patients. RESEARCH DESIGN AND METHODS - A total 124 patients receiving mechanical ventilation were randomly assigned to the real-time CGM group (it = 63; glucose values given every 5 min) or to the control group (n = 61; selective arterial glucose measurements according to an algorithm; Simultaneously blinded CGM) for 72 h. Insulin infusion rates were guided according to the same algorithm in both groups. The primary end point was percentage of time at a glucose level < 110 mg/dl. Secondary end points were mean glucose levels and rate of severe hypoglycemia (<40 mg/dl). RESULTS - Percentage of time at a glucose level < 110 mg/dl (59.0 +/- 20 vs. 55.0 +/- 18% in the control group, P = 0.245) and the mean glucose level (106 +/- 18 vs. 111 +/- 10 mg/dl in the control group, P = 0.076) could not be improved using real-time CGM. The rate of severe hypoglycemia was lower in the real-time CGM group (1.6 vs. 11.5% in the control group, P = 0.031). CGM reduced the absolute risk of severe hypoglycemia by 9.9% (95% Cl 1.2-18.6) with a number needed to treat of 10.1 (95% Cl 5.4-83.3). CONCLUSIONS - In critically ill patients, real-time CGM reduces hypoglycemic events but does not improve glycemic control compared With intensive insulin therapy guided by an algorithm.