Continuous Glucose Monitoring in the Intensive Care Unit
Hyperglycemia (high blood sugar) in intensive care (ICU) patients is strongly associated with increased morbidity and mortality. In addition to the fact that stress-induced hyperglycemia occurs due to being seriously ill, the frequent use of corticosteroids in the ICU can have hyperglycemia as a side effect. According to current insights, efforts should be made to keep glucose levels within the so-called glucose target range in order to reduce the risk of morbidity and mortality. To counteract hyperglycemia, patients are therefore treated with intensive intravenous insulin therapy.
Glucose monitoring is currently often performed by measuring glucose levels in blood several times a day (every four to six hours), obtained via a finger prick or from the invasive line (venous or arterial) using Point-of-Care (POC) sensors. However, this approach results in a high burden on medical staff and causes discomfort in patients. Despite strict protocols, it can still happen that blood sugar levels do not remain within the required target range. In addition, intensive insulin therapy increases the risk of hypoglycemia (low blood sugar), which in itself is a predictor of increased morbidity and mortality in ICU patients. Furthermore, large fluctuations in blood glucose are also associated with increased mortality. For these reasons, accurate and timely glucose measurement is crucial in this population in order to adequately adjust insulin accordingly.
Continuous glucose monitoring (CGM) is increasingly being used in the treatment of diabetes patients to monitor glucose, with studies showing significantly lower HbA1c values (a measure of the average blood sugar level over the past 2-3 months) when using CGM, because insulin administration is better adjusted/regulated. A CGM sensor measures blood glucose levels in the interstitial fluid 24 hours a day. The CGM is hardly used in the ICU, while some studies show that this is a promising application that needs to be further investigated. Since the measurements are interstitial, the CGM measurement lags behind the POC measurement appr. ten minutes, as it is already known from studies in diabetes patients. The advantage of the CGM, however, is that based on the trend of the measurement, it can already be predicted whether hypo- or hyperglycemia is likely to occur, which allows intervention at an earlier stage.
The aim of this project is to investigate (1) the discrepancy between the CGM and POC measurements in patients in the ICU, and (2) whether this is the same for all patient groups/characteristics. During this project, the student will study the difference and/or agreement between the POC and CGM measurements with regard to the sensitivity, specificity and accuracy of clinically relevant glucose concentrations. In addition, the influence of the used medication, such as paracetamol, to the measurement results of CGM sensors, will be explored.
Project duration:
Spring 24/25 (February 2025 – July 2025)
Educational programs:
– Biology and Medical Lab (BML)
Interested, please send your motivation letter and CV before the 8th of December 2024 to Aurel Ymeti (a.ymeti@saxion.nl)