Therapeutic impact on intravenous insulin dosing with three new point-of-care glucose meters in an adult ICU

Introduction

Glycemic control is mandatory in the critically ill, because hypoglycemia and hyperglycemia are associated with increased mortality [1]. We compared in a prospective observational study three new point-of-care devices with the hexokinase reference method and we evaluated whether their results would modify insulin titration.

Methods

Arterial blood glucose was simultaneously measured by the blood gas analyser RapidLab 1265, by three glucose meters (Accu-Chek performa, Precision XceedPro, Nova StatStrip), and with the hexokinase reference method. All values were duplicated and the average value of each was computed. Bland-Altman, Passing Bablok, Kanji [2] and modified Kanji approaches were performed. Biases were expressed as the glucose result of the point-of-care method minus the reference method. We evaluated the theoretical impact on insulin titration by comparing glucose meter results with the hexokinase reference method on a dynamic sliding scale targeting a glycemia of 80 to 130 mg/dl.

Results

A total of 156 matched analyses were done in 80 patients. The mean flash SOFA score was 4.5. The range of the reference glucose was 25 to 327 mg/dl. The numbers of discrepancies of dosing insulin were respectively 8-5-6-14 at 0.1 U/hour, 0-6-3-6 at 0.2 U/hour and 2-3-0-0 at 0.3 U/hour. None was greater than 0.3 U/hour. Regarding the point-of-care results, total theoretical insulin dose changes were respectively: -11.7 U, -19.2 U, -22.2 U, +4.9 U for all these measurements (devices order as in Methods). Table 1 presents the standard comparisons.

Table 1

Conclusions

Glucose monitoring with new glucose meters results has minor impact on intravenous insulin dose titration compared with the reference method.