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Clinical review: Consensus recommendations on measurement of blood glucose and reporting glycemic control in critically ill adults

Simon Finfer1, Jan Wernerman2, Jean-Charles Preiser3*, Tony Cass4, Thomas Desaive5, Roman Hovorka6, Jeffrey I Joseph7, Mikhail Kosiborod8, James Krinsley9, Iain Mackenzie10, Dieter Mesotten11, Marcus J Schultz12, Mitchell G Scott13, Robbert Slingerland14, Greet Van den Berghe11 and Tom Van Herpe1115

Author Affiliations

1 The George Institute for Global Health and Royal North Shore Hospital, University of Sydney, St Leonards, Sydney, NSW 2065, Australia

2 Department of Anestesiology & Intensive Care Medicine, Karolinska University Hospital, Solnav├Ągen 1, 171 77 Solna, Sweden

3 Department of Intensive Care, Erasme University Hospital, 808 route de Lennik, B-1070 Brussels, Belgium

4 Institute of Biomedical Engineering, Imperial College, South Kensington Campus, Exhibition Rd, London SW7 2AZ, UK

5 GIGA - Cardiovascular Sciences, University of Liege, Institute of Physics, B5, Allee du 6 aout, 17, 4000 Liege, Belgium

6 Institute of Metabolic Science, University of Cambridge Metabolic Research Laboratories, Level 4, Institute of Metabolic Science, Box 289, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0QQ, UK

7 Jefferson Artificial Pancreas Center & Anesthesiology Program for Translational Research, Department of Anesthesiology, Jefferson Medical College of Thomas Jefferson University, 1020 Walnut Street, Philadelphia, PA 19107, USA

8 Saint-Luke's Mid America Heart Institute, University of Missouri - Kansas City, 4401 Wornall Road, Kansas City, MO 64111, USA

9 Division of Critical Care, Stamford Hospital and Columbia University College of Physicians and Surgeons, 30 Shelburne Road, Stamford, CT 06904, USA

10 Department of Anaesthesia and Intensive Care Medicine, Queen Elizabeth Hospital Birmingham, Queen Elizabeth Medical Centre, Birmingham, B15 2TH, UK

11 Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium

12 Department of Intensive Care Medicine, Academic Medical Center at the University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

13 Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA

14 Isala Klinieken, Department of Clinical Chemistry, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands

15 Department of Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven, Leuven, Belgium

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Critical Care 2013, 17:229  doi:10.1186/cc12537

Published: 14 June 2013


The management reporting and assessment of glycemic control lacks standardization. The use of different methods to measure the blood glucose concentration and to report the performance of insulin treatment yields major disparities and complicates the interpretation and comparison of clinical trials. We convened a meeting of 16 experts plus invited observers from industry to discuss and where possible reach consensus on the most appropriate methods to measure and monitor blood glucose in critically ill patients and on how glycemic control should be assessed and reported. Where consensus could not be reached, recommendations on further research and data needed to reach consensus in the future were suggested. Recognizing their clear conflict of interest, industry observers played no role in developing the consensus or recommendations from the meeting. Consensus recommendations were agreed for the measurement and reporting of glycemic control in clinical trials and for the measurement of blood glucose in clinical practice. Recommendations covered the following areas: How should we measure and report glucose control when intermittent blood glucose measurements are used? What are the appropriate performance standards for intermittent blood glucose monitors in the ICU? Continuous or automated intermittent glucose monitoring - methods and technology: can we use the same measures for assessment of glucose control with continuous and intermittent monitoring? What is acceptable performance for continuous glucose monitoring systems? If implemented, these recommendations have the potential to minimize the discrepancies in the conduct and reporting of clinical trials and to improve glucose control in clinical practice. Furthermore, to be fit for use, glucose meters and continuous monitoring systems must match their performance to fit the needs of patients and clinicians in the intensive care setting.

See related commentary by Soto-Rivera and Agus, http://ccforum.com/content/17/3/155 webcite