Original article Performance assessment of a glucose control protocol in septic patients with an automated intermittent plasma glucose monitoring device q M. Umbrello a, * , V. Salice b , P. Spanu a , P. Formenti a , A. Barassi c , G.V. Melzi d’Eril c , G. Iapichino a, b a Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo e Polo Universitario, Italy b Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Italy c Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy article info Article history: Received 8 October 2013 Accepted 10 October 2013 Keywords: Blood glucose Glucose control protocol Sepsis Automated glucose control Critically ill patients summary Background & aims: The optimal level and modality of glucose control in critically ill patients is still debated. A protocolized approach and the use of nearly-continuous technologies are recommended to manage hyperglycemia, hypoglycemia and glycemic variability. We recently proposed a pato-physiology- based glucose control protocol which takes into account patient glucose/carbohydrate intake and insulin resistance. Aim of the present investigation was to assess the performance of our protocol with an automated intermittent plasma glucose monitoring device (OptiScannerÔ 5000). Methods: OptiScannerÔ was used in 6 septic patients, providing glucose measurement every 15 0 from a side-port of an indwelling central venous catheter. Target level of glucose was 80e150 mg/dL. Insulin infusion and kcal with nutritional support were also recorded. Results: 6 septic patients were studied for 319 h (1277 measurements); 58 [45e65] hours for each pa- tient (measurements/patient: 231 [172e265]). Blood glucose was at target for 93 [90e98]% of study time. Mean plasma glucose was 126  11 mg/dL. Only 3 hypoglycemic episodes (78, 78, 69 mg/dL) were recorded. Glucose variability was limited: plasma glucose coefficient of variation was 11.7  4.0% and plasma glucose standard deviation was 14.3  5.5 mg/dL. Conclusions: The local glucose control protocol achieved satisfactory glucose control in septic patients along with a high degree of safeness. Automated intermittent plasma glucose monitoring seemed useful to assess the performance of the protocol. Ó 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. 1. Introduction An increase in blood glucose level is a commonly recognized feature of critically ill patients 1 ; this condition is the consequence of increased hepatic neoglucogenesis, as well as the development of muscle insulin resistance. Numerous studies have demonstrated a strong association between hyperglycaemia and poor clinical outcomes such as mortality, increased length of stay, infectious complications. 2 This association has a solid rationale and consistent pato-physiological mechanisms have been identified that may explain better outcomes with glucose control both in clinical 3 and in pre-clinical studies. 4 Indeed, two large single-center RCT showed a significant reduction in morbidity and mortality when critically ill patients were treated according to a tight glucose control. 5,6 Nevertheless, this result was not replicated in more recent, large, multicenter trials, which showed no effect of such a tight control, 7,8 or even a significant worsening of the outcome. 9 These apparently conflicting results led to the ongoing heavy debate about the optimal level and modality of glucose control. 10 What is generally considered a possible explanation for the diverging results is the significant incidence of severe hypoglyce- mia experienced by patients in the interventional arms of RCT, 6e9 which has been associated to unfavorable outcomes even at milder thresholds such as <70 mg/100 mL. 11 Another factor, not Non-standard abbreviations: NS, nutrition support; G/CHO, glucose/ carbohydrate. q Conference presentation: This work was presented in part at the 24th SMART Congress, Milan, Italy, May 8e10th 2013. * Corresponding author. Unità Operativa di Anestesia e Rianimazione, A.O. San Paolo e Polo Universitario, Via A. Di Rudinì, 8, 20142 Milano, Italy. Tel.: þ39 02 50323134; fax: þ39 02 50323137. E-mail address: michele.umbrello@ao-sanpaolo.it (M. Umbrello). Contents lists available at ScienceDirect Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu 0261-5614/$ e see front matter Ó 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. http://dx.doi.org/10.1016/j.clnu.2013.10.007 Clinical Nutrition xxx (2013) 1e5 Please cite this article in press as: Umbrello M, et al., Performance assessment of a glucose control protocol in septic patients with an automated intermittent plasma glucose monitoring device, Clinical Nutrition (2013), http://dx.doi.org/10.1016/j.clnu.2013.10.007