On the same track Glucose monitoring and treatment strategies in diabetes and critical illness

This thesis focuses on various aspects of glucose monitoring and treatment strategies in both critically ill patients and in diabetes patients. The thesis has three parts. Part 1 of shows that continuous glucose monitoring (CGM) systems can be used safely in critically ill patients. They are promising in terms of efficacy, although accuracy still needs improvement. Moreover, this research supports the use of low-carbohydrate enteral feeding in critically ill patients, since this lowers insulin requirements. Furthermore, the infusion of intravenous glucose as well as insulin should ideally be minimized. Lastly, we found arguments for safe use of liraglutide to better peri-operative glucose control. Part 2 shows that the accuracy assessment of CGM systems is not dependent on chosen reference method. A venous sampling site seems to be preferable, especially from a patient and logistic point of view. Moreover, it confirms that accuracy and reliability of CGM systems in critically ill patients needs improvement. Part 3 shows that the hemoglobin glycation index (HGI) is a predictor for diabetes-related complications, but no better than HbA1c. Since HbA1c is easier and more convenient to use, there seems currently no role for HGI in clinical practice. Eventually, all of this should result in an automated glucose-insulin regulation system, based on accurate CGM systems, uniform reference measures, and the appropriate therapeutic strategies to achieve glycemic control for both critically ill patients and diabetes patients.