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New Options for Blood Glucose Monitoring in Cardiac Surgery and ICU Patients

Critically ill or cardiac surgery patients who also have diabetes present unique challenges in the operating room. New blood glucose (BG)-monitoring systems can provide more effective solutions to improve outcomes in these patients, particularly when the monitoring systems are paired with intensive insulin therapy (IIT). According to a presentation at the Annual Meeting of the American Society of Anesthesiologists (ASA), these new techniques address the need for an in-hospital automated system to continuously monitor blood glucose levels of hospitalized patients.

Marc Torjman, PhD, Associate Professor, Department of Anesthesiology, UMDNJ-Robert Wood Johnson Medical School, presented the research on a new generation of in-hospital blood-glucose-monitoring devices.

Dr. Torjman and his team analyzed the effectiveness of the Glucon OPTImus, an automated, programmable, continual blood-glucose-monitoring system for hospitalized patients. The study examined the use of this device among cardiac surgery and ICU patients.

"There is a need for automatic blood glucose measurement in critically ill patients," explained Dr. Torjman. He added, "The purpose of this study was to look at the operational parameters of this monitor."

The study enrolled three cardiac surgery patients and four ICU patients. All had diabetes. Their mean age was 55 years (range: 43-67 years), and mean body mass index (BMI) was 38 kg/m2 (range: 27 to 49).

The OPTImus system works with a central access catheter. Patients were monitored for 96 hours using standard IIT protocol, for a total of 533 blood glucose measurements. The results obtained from the OPTImus device were also referenced against two other blood-glucose-monitoring devices: the Yellow Springs Instruments 2300 (YSI) analyser and the Accu-Check meter. The data were further analyzed according to catheter type, BG concentrations, blood glucose meter errors, blood draw failures, and auto sampler failures.

The blood glucose ranges were found to be from 60 to 248 mg/dL. Results showed that 59 readings were determined to be incorrect — 36 due to meter errors; 14 due to technical problems; nine due to difficulties with catheter use.

In comparing the devices, mean bias for the OPTImus versus YSI was 9.3 +- 21.6 mg/dL. In comparing the OPTImus versus Accu-check, mean bias was 14.7 +- 9.5 mg/dL.

Based on these findings, the researchers concluded that OPTImus was a safe and effective approach to blood glucose measurement in ICU and surgical patients requiring IIT. Accuracy rates were similar to other BG-monitoring devices.

[Presentation title: Evaluation of an Automated Blood Glucose Monitor in Cardiac Surgery and Critically Ill ICU Patients. Abstract A1127]

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Obesity associated with migraines headaches: Headache and obesity are both common and disabling disorders. These US investigators studied the relationship between them including frequency, severity and type of headache. They identified 18,968 individuals with migraine, 7564 with  probable migraine, and 2051 with severe episodic tension-type headache. Among individuals with migraines very frequent headaches occurred in 6.5% of individuals with normal weight and increased to 10.4% of the morbidly obese. Disability related to migraine also was increased among the obese and morbidly obese, 41% of the morbidly obese compared with 32% of those with normal weight. The authors concluded: “These findings support the concept that obesity is an exacerbating factor for migraine but not for other types of episodic headaches.”
  Arch Intern Med 8 October 2007;167:1964-1970.