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World J Clin Cases. Oct 16, 2021; 9(29): 8666-8670
Published online Oct 16, 2021. doi: 10.12998/wjcc.v9.i29.8666
Pros and cons of continuous glucose monitoring in the intensive care unit
Ming-Tsung Sun, I-Cheng Li, Wei-Shiang Lin, Gen-Min Lin
Ming-Tsung Sun, I-Cheng Li, Gen-Min Lin, Department of Medicine, Hualien Armed Forces General Hospital, Hualien 971, Taiwan
Wei-Shiang Lin, Department of Medicine, Tri-Service General Hospital, Taipei 114, Taiwan
Author contributions: Sun MT wrote and drafted the article; Li IC and Lin WS made critical revisions related to important intellectual content of the article; Lin GM contributed to conception the study; all authors provided approval of the final version of the article to be published.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gen-Min Lin, FAHA, MD, PhD, Adjunct Professor, Chief Doctor, Department of Medicine, Hualien Armed Forces General Hospital, No. 100 Jinfeng Street, Hualien 971, Taiwan. farmer507@yahoo.com.tw
Received: April 14, 2021
Peer-review started: April 14, 2021
First decision: June 15, 2021
Revised: June 19, 2021
Accepted: August 30, 2021
Article in press: August 30, 2021
Published online: October 16, 2021
Abstract

Diabetes mellitus affects people worldwide, and management of its acute complications or treatment-related adverse events is particularly important in critically ill patients. Previous reports have confirmed that hyperglycemia can increase the risk of mortality in patients cared in the intensive care unit (ICU). In addition, severe and multiple hypoglycemia increases the risk of mortality when using insulin or intensive antidiabetic therapy. The innovation of continuous glucose monitoring (CGM) may help to alert medical caregivers with regard to the development of hyperglycemia and hypoglycemia, which may decrease the potential complications in patients in the ICU. The major limitation of CGM is the measurement of interstitial glucose levels rather than real-time blood glucose levels; thus, there will be a delay in the treatment of hyperglycemia and hypoglycemia in patients. Recently, the European Union approved a state-of-art artificial intelligence directed loop system coordinated by CGM and a continuous insulin pump for diabetes control, which may provide a practical way to prevent acute adverse glycemic events related to antidiabetic therapy in critically ill patients. In this mini-review paper, we describe the application of CGM to patients in the ICU and summarize the pros and cons of CGM.

Keywords: Continuous glucose monitor, Diabetes, Insulin, Intensive care unit, Hypoglycemia

Core Tip: Management of diabetes mellitus induced acute complications or treatment-related adverse events is particularly important in critically ill patients. The innovation of continuous glucose monitoring (CGM) helps medical staffs to alert the emergence hyperglycemia and hypoglycemia, which may decrease potential complications in patients in intensive care unit. The major limitation of CGM is the measurement of interstitial glucose levels rather than the real-time blood glucose levels; thus, there will be a time gap in the appropriate treatment of hyperglycemia and hypoglycemia in patients. The European Union approved a state-of-art artificial intelligence directed loop system coordinated by CGM and a continuous insulin pump for diabetes control, providing a practical way to prevent acute adverse glycemic events related to antidiabetic therapy in critically ill patients.