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

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 variabili...

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Published in:Critical care (London, England) England), 2012-10, Vol.16 (5), p.R175-R175, Article R175
Main Authors: Brunner, Richard, Adelsmayr, Gabriel, Herkner, Harald, Madl, Christian, Holzinger, Ulrike
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cited_by cdi_FETCH-LOGICAL-c436t-46335a7b74bb86039c8c09c089347f00a31124d052af1221509adf59ad8a496b3
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description 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. 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. 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). 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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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). 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.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>23031322</pmid><doi>10.1186/cc11657</doi><oa>free_for_read</oa></addata></record>
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ispartof Critical care (London, England), 2012-10, Vol.16 (5), p.R175-R175, Article R175
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subjects Aged
Algorithms
Analysis
Blood Glucose - metabolism
Blood sugar
Blood sugar monitoring
Care and treatment
Computer Systems - trends
Critical Illness - mortality
Critical Illness - therapy
Diabetes
Diabetes therapy
Diabetics
Female
Glucose monitors
Glycemic index
Glycemic Index - physiology
Health aspects
Humans
Male
Middle Aged
Mortality
Mortality - trends
Prospective Studies
Retrospective Studies
Statistics as Topic - trends
title Glycemic variability and glucose complexity in critically ill patients: a retrospective analysis of continuous glucose monitoring data
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