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Subcutaneous glucose monitoring in patients with severe sepsis

Introduction

Tight glycemic control (TGC) to improve mortality and morbidity in ICU patients requires frequent blood glucose measurements and thus increases the workload for medical staff. TGC could be simplified by subcutaneous glucose monitoring as suggested for diabetes care. Due to altered tissue perfusion as often seen in critically ill patients, it remains unclear whether subcutaneous adipose tissue (SAT) is a reliable measurement site. In this study we evaluated clinically whether SAT can be used as safe, alternative site to establish TGC in patients with severe sepsis.

Methods

For 26 hours, arterial blood and SAT microdialysis samples were taken from 10 patients with severe sepsis. Hourly SAT glucose concentrations were calibrated to arterial blood glucose (Bg) by one-point calibration either 1 hour (BgSAT1h) or 6 hours (BgSAT6h) after catheter insertion. The relation between Bg and calibrated SAT glucose readings was clinically evaluated applying a well-established insulin titration error grid analysis.

Results

Arterial and SAT glucose readings were comparable (Bg: 143 (122–167) mg/dl; BgSAT1h: 147 (130–177) mg/dl; BgSAT6h: 146 (117–181) mg/dl; median (IQR)). Relative differences between Bg vs BgSAT1h and BgSAT6h indicated -2 (-193 to 30)% and -4 (-42 to 25)%; median (5th and 95th percentiles)), respectively. Clinical evaluation of the data indicated that 86% (BgSAT1h) and 95% (BgSAT6h) of the glucose readings from SAT would allow correct treatment according to an insulin-titration guideline. Fourteen percent of the data for BgSAT1h and 5% of the data for BgSAT6h would cause a violation of the guideline and thus unwanted glucose excursions and a possible risk for the patient.

Conclusion

Clinical evaluation of subcutaneous glucose monitoring to establish TGC indicated that only 86% of the readings would allow acceptable treatment according to a titration guideline. Although this result could be substantially improved by introducing a 6-hour stabilisation period for the trauma caused by catheter insertion, the clinical applicability of subcutaneous glucose monitoring for patients with sepsis has to be considered with care.

Acknowledgements

Funded by the European Commission as part of CLINICIP FP6 IST 506965.

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Mader, J., Korsatko, S., Ikeoka, D. et al. Subcutaneous glucose monitoring in patients with severe sepsis. Crit Care 11, P144 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5304

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Keywords

  • Severe Sepsis
  • Diabetes Care
  • Subcutaneous Adipose Tissue
  • Catheter Insertion
  • Blood Glucose Measurement