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Clinical impact of sample interference on intensive insulin therapy in severely burned patients: a pilot study.
J Burn Care Res. 2014 Jan-Feb; 35(1):72-9.JB

Abstract

Severely burned patients benefit from intensive insulin therapy (IIT) for tight glycemic control (TGC). The authors evaluated the clinical impact of automatic correction of hematocrit and ascorbic acid interference for bedside glucose monitoring performance in critically ill burn patients. The performance of two point-of-care glucose monitoring systems (GMSs): 1) GMS1, an autocorrecting device, and 2) GMS2, a noncorrecting device were compared. Sixty remnant arterial blood samples were collected in a prospective observational study to evaluate hematocrit and ascorbic acid effects on GMS1 vs GMS2 accuracy paired against a plasma glucose reference. Next, we enrolled 12 patients in a pilot randomized controlled trial. Patients were randomized 1:1 to receive IIT targeting a TGC interval of 111 to 151 mg/dl and guided by either GMS1 or GMS2. GMS bias, mean insulin rate, and glycemic variability were calculated. In the prospective study, GMS1 results were similar to plasma glucose results (mean bias, -0.75 [4.0] mg/dl; n = 60; P = .214). GMS2 results significantly differed from paired plasma glucose results (mean bias, -5.66 [18.7] mg/dl; n = 60; P = .048). Ascorbic acid therapy elicited significant GMS2 performance bias (29.2 [27.2]; P < .001). Randomized controlled trial results reported lower mean bias (P < .001), glycemic variability (P < .05), mean insulin rate (P < .001), and frequency of hypoglycemia (P < .001) in the GMS1 group than in the GMS2 group. Anemia and high-dose ascorbic acid therapy negatively impact GMS accuracy and TGC in burn patients. Automatic correction of confounding factors improves glycemic control. Further studies are warranted to determine outcomes associated with accurate glucose monitoring during IIT.

Authors+Show Affiliations

From the *Department of Pathology and Laboratory Medicine, School of Medicine, and †Department of Biomedical Engineering, University of California, Davis.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Observational Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

23884048

Citation

Tran, Nam K., et al. "Clinical Impact of Sample Interference On Intensive Insulin Therapy in Severely Burned Patients: a Pilot Study." Journal of Burn Care & Research : Official Publication of the American Burn Association, vol. 35, no. 1, 2014, pp. 72-9.
Tran NK, Godwin ZR, Bockhold JC, et al. Clinical impact of sample interference on intensive insulin therapy in severely burned patients: a pilot study. J Burn Care Res. 2014;35(1):72-9.
Tran, N. K., Godwin, Z. R., Bockhold, J. C., Passerini, A. G., Cheng, J., & Ingemason, M. (2014). Clinical impact of sample interference on intensive insulin therapy in severely burned patients: a pilot study. Journal of Burn Care & Research : Official Publication of the American Burn Association, 35(1), 72-9. https://doi.org/10.1097/BCR.0b013e31829b3700
Tran NK, et al. Clinical Impact of Sample Interference On Intensive Insulin Therapy in Severely Burned Patients: a Pilot Study. J Burn Care Res. 2014 Jan-Feb;35(1):72-9. PubMed PMID: 23884048.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical impact of sample interference on intensive insulin therapy in severely burned patients: a pilot study. AU - Tran,Nam K, AU - Godwin,Zachary R, AU - Bockhold,Jennifer C, AU - Passerini,Anthony G, AU - Cheng,Julian, AU - Ingemason,Morgan, PY - 2013/7/26/entrez PY - 2013/7/26/pubmed PY - 2014/9/30/medline SP - 72 EP - 9 JF - Journal of burn care & research : official publication of the American Burn Association JO - J Burn Care Res VL - 35 IS - 1 N2 - Severely burned patients benefit from intensive insulin therapy (IIT) for tight glycemic control (TGC). The authors evaluated the clinical impact of automatic correction of hematocrit and ascorbic acid interference for bedside glucose monitoring performance in critically ill burn patients. The performance of two point-of-care glucose monitoring systems (GMSs): 1) GMS1, an autocorrecting device, and 2) GMS2, a noncorrecting device were compared. Sixty remnant arterial blood samples were collected in a prospective observational study to evaluate hematocrit and ascorbic acid effects on GMS1 vs GMS2 accuracy paired against a plasma glucose reference. Next, we enrolled 12 patients in a pilot randomized controlled trial. Patients were randomized 1:1 to receive IIT targeting a TGC interval of 111 to 151 mg/dl and guided by either GMS1 or GMS2. GMS bias, mean insulin rate, and glycemic variability were calculated. In the prospective study, GMS1 results were similar to plasma glucose results (mean bias, -0.75 [4.0] mg/dl; n = 60; P = .214). GMS2 results significantly differed from paired plasma glucose results (mean bias, -5.66 [18.7] mg/dl; n = 60; P = .048). Ascorbic acid therapy elicited significant GMS2 performance bias (29.2 [27.2]; P < .001). Randomized controlled trial results reported lower mean bias (P < .001), glycemic variability (P < .05), mean insulin rate (P < .001), and frequency of hypoglycemia (P < .001) in the GMS1 group than in the GMS2 group. Anemia and high-dose ascorbic acid therapy negatively impact GMS accuracy and TGC in burn patients. Automatic correction of confounding factors improves glycemic control. Further studies are warranted to determine outcomes associated with accurate glucose monitoring during IIT. SN - 1559-0488 UR - https://www.unboundmedicine.com/medline/citation/23884048/Clinical_impact_of_sample_interference_on_intensive_insulin_therapy_in_severely_burned_patients:_a_pilot_study_ L2 - https://academic.oup.com/jbcr/article-lookup/doi/10.1097/BCR.0b013e31829b3700 DB - PRIME DP - Unbound Medicine ER -