Blood glucose control and monitoring in the critically ill

This thesis deals with blood glucose control and blood glucose monitoring in intensive care unit (ICU) patients: two important aspects of care for and monitoring of critically ill patients. While the precise targets of blood glucose control in ICU patients remain a matter of debate, currently many, if not all, critically ill patients are treated with insulin at some point during their stay in the ICU. Although many patients are currently treated with insulin, it could be that certain patient groups benefit more from blood glucose control than other patient groups. Several quality and safety metrics for blood glucose control are proposed to be used, among others the mean blood glucose level, the proportion of patients developing or samples showing dysglycemia, and glycemic variability. However, these metrics of quality and safety for blood glucose control are only partly, and frequently inconsistently used. Blood glucose levels are still monitored manually using point-of-care devices with significant inaccuracies. Manual blood glucose monitoring is not only time-and blood-consuming, but also bears the risk of incorrect adjustments of the insulin infusion rate. The three key aims of this thesis are: To discuss practical aspects of and metrics for blood glucose control in critically ill patients (Part I of this thesis); To investigate factors that could affect quality and safety of blood glucose control (Part II of this thesis); To study blood glucose monitoring, in particular new devices for automatic and continuous blood glucose monitoring (Part III of this thesis)