Continuous Glucose Monitoring in Intensive Care Unit

Glucose control in ICU patients is challenging and exerts high burden on the nursing staff. Continuous glucose monitors (CGM) are now approved and widely available in the outpatient setting for patients with diabetes mellitus. However, only minimal evidence on CGM performance, reliability and benefit in achieving desired glucose control in the intensive care setting has been gathered so far. The objective of this study is to assess whether the use of CGM helps to maintain blood glucose levels within the time in range recommended for patients in the intensive care. In addition, accuracy of the sensor will be evaluated and compared to measurements of blood glucose by standardized biochemistry methods.

This will be a non-commercial, investigator-driven, active comparator-controlled, randomized, open-label and non-inferiority clinical study to be performed at the Institute for Clinical and Experimental Medicine in Prague. Patients that are being prepared for one of the surgical procedures mentioned below will be asked to participate: 1. pancreas surgery - total or partial pancreas resection 2. orthotopic liver transplantation 3. simultaneous pancreas and kidney transplantation 4. patients with diabetes mellitus undergoing major surgery After obtaining the informed consent, they will be randomized into one of two treatment groups: 1. Study arm with continuous glucose monitor added to standard treatment, where the values obtained by CGM will aid in adjusting the insulin treatment. 2. Control arm with blinded continuous glucose monitor that will be treated according to the standard of care, where the CGM data will be collected in a blind fashion and evaluated after completion of the follow-up. Each surgical group will be randomized and evaluated separately and independently. Continuous glucose monitoring will be initiated after completing the surgical procedure in order to avoid interferences during the procedure. Insulin therapy will be adjusted according to the standard in-house ICU protocol for insulin dose adjustment.