897-P: Continuous Glucose Monitoring (CGM) in Management of Patients with Severe Traumatic Brain Injury

Hyperglycemia after severe traumatic brain injury patients is frequent finding that has impact on clinical outcome and increases mortality. Management of increased blood glucose but also prevention of hypoglycemic episodes are crucial in those patients. The aim of our observation is to analyze the effect of CGM in management of diabetic patients with severe traumatic brain injury (TBI) Our study included 37 patients (20 men, 17 women, mean age 34.6±9.7 years) hospitalized in Intensive Care Unit. All patients have diabetes with duration 7.3±5.8 years, with severe TBI and Glasgow coma scale of 8 or less. For monitoring of glucose level patients real-time CGM - Paradigm Medtronic Minimed was placed for 5 days period. Simultaneous glucose measurements were performed four times daily. Patients received continuous venous infusion of fast acting insulin for maintaining glucose level below 10mmol/l. Number of CGM measurements was significantly higher compared to conventional monitoring of blood glucose (288 measurements vs. 4 measurements daily, p<0.05). None of the patients showed any problems with CGM-device like technical problems and irritation or allergy at the site of sensor insertion. More than one hypoglycemic episodes (blood glucose below 3.9mmol/) were detected in 37.8% (n=14) based on CGM data and only in 18.9% (n=7) from four-point profiles. CGM defined that patients spent about 54.9±12.2% of observed period in hyperglycemic state (blood glucose above 10mmol/l) while with conventional monitoring this time was 28.7±9.8% (p<0.05). Data from CGM allow more precise adjustment of insulin infusion for maintaining glucose in targets and preventing complications of insulin treatment. Results from real-time CGM has impact on the glycemic control in diabetic patients with severe TBI and should be recommended in protocols for management and used whenever it is possible.