DOI: 10.1097/01.CCM.0000262541.71678.8E

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Issn Print: 0090-3493

Publication Date: 2007/05/01


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Subcutaneous continuous glucose monitoring in severe burn patients

David C. Klonoff

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I read with interest the article by Samuelsson and colleagues titled “Microdialysis shows metabolic effects in skin during fluid resuscitation in burn-injured patients” (1). In this article, dermal interstitial fluid (ISF) was reported to contain statistically significantly different glucose concentrations in burn patients than in controls. The blood glucose concentrations in the burn patients rose after their burns and peaked on day 2, but the ISF glucose concentrations were climbing as of day 4. The disparity was attributed to local dermal insulin resistance occurring even when the systemic situation insulin resistance due to the burns was beginning to normalize.
Intensive insulin therapy is increasingly accepted as the appropriate treatment for acutely ill critical care patients (2). This therapy requires hourly glucose monitoring and frequent adjustments of insulin dosages. This approach, compared with traditional loose glucose control, increases the risk of hypoglycemia (3). Continuous glucose monitoring has been proposed as a tool for following glucose levels in critical care patients both to provide frequent glucose readings automatically to assist in adjustment of insulin dosing and to sound an alarm in the case of hypoglycemia.
Currently approved subcutaneous continuous glucose monitoring instruments measure the concentrations of glucose in ISF. Good correlation between ISF glucose and blood glucose has been demonstrated in critically ill adults (4) and children (5). The effects of severe burns on the metabolism of skin (including not only involved but also uninvolved areas) could render continuous glucose monitoring inaccurate in this setting.
The investigators placed the microdialysis catheter in uninjured skin only 5–10 cm away from a severe burn area. Might a catheter placed much further away have demonstrated less of a metabolic difference between uninjured skin and control skin in severe burn patients? Might effective intensive insulin therapy have lessened the metabolic disparities between uninjured skin and control skin? Based on the observations in the article by Samuelsson and colleagues, unless additional investigations are conducted, it is not currently appropriate to use subcutaneous continuous glucose monitoring as a clinical tool for following glucose levels in severely burned critical care patients.
The author has not disclosed any potential conflicts of interest.
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