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Impact of shock requiring norepinephrine on the accuracy and reliability of subcutaneous continuous glucose monitoring

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Abstract

Objective

To evaluate the impact of circulatory shock requiring norepinephrine therapy on the accuracy and reliability of a subcutaneous continuous glucose monitoring system (CGMS) in critically ill patients.

Design and setting

A prospective, validation study of a medical intensive care unit at a university hospital was carried out.

Methods

Continuous glucose monitoring was performed subcutaneously in 50 consecutive patients on intensive insulin therapy (IIT), who were assessed according to the a priori strata of circulatory shock requiring norepinephrine therapy or not.

Results

A total of 736 pairs of sensor glucose (SG)/blood glucose (BG) values were analysed (502 without and 234 with norepinephrine therapy). For all values, repeated measures Bland–Altman analysis showed a mean difference of 0.08 mmol/l (limits of agreement: −1.26 and 1.43 mmol/l). Circulatory shock requiring norepinephrine therapy did not influence the relation of arterial BG with SG in a multivariable random effects linear regression analysis. The covariates norepinephrine dose, body mass index (BMI), glucose level and severity of illness also had no influence. Insulin titration grid analysis showed that 98.6% of the data points were in the acceptable treatment zone. No data were in the life-threatening zone.

Conclusions

Circulatory shock requiring norepinephrine therapy, as well as other covariates, had no influence on the accuracy and reliability of the CGMS in critically ill patients.

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Acknowledgements

The CGMS® System Gold™ apparatus and sensors were provided at no charge by Medtronic, Austria. No financial support was received for this work.

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Authors and Affiliations

  1. Intensive Care Unit 13H1, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18–20, 1090, Vienna, Austria

    Ulrike Holzinger, Joanna Warszawska, Reinhard Kitzberger & Christian Madl

  2. Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria

    Harald Herkner

  3. Department of Anaesthesiology and General Intensive Care, Medical University of Vienna, Vienna, Austria

    Philipp G. H. Metnitz

Authors
  1. Ulrike Holzinger
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  2. Joanna Warszawska
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  3. Reinhard Kitzberger
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  4. Harald Herkner
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  5. Philipp G. H. Metnitz
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  6. Christian Madl
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Corresponding author

Correspondence to Ulrike Holzinger.

Additional information

http://clinicaltrials.gov/archive/NCT00494455

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Holzinger, U., Warszawska, J., Kitzberger, R. et al. Impact of shock requiring norepinephrine on the accuracy and reliability of subcutaneous continuous glucose monitoring. Intensive Care Med 35, 1383–1389 (2009). https://doi.org/10.1007/s00134-009-1471-y

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  • DOI: https://doi.org/10.1007/s00134-009-1471-y

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