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LETTER TO THE EDITOR

Thinking Like A Pancreas: A Look Ahead at Diabetes Technology in the Perioperative Setting

TorjmaMC{at}UMDNJ.edu (Torjman) Department of Anesthesiology; Cooper University Hospital; UMDNJ—Robert Wood Johnson Medical School; Camden, NJ (Goldberg, Hirsh, Littman)

To the Editor:

Our preliminary data (1) support the comments in the recent editorial (2) that the anesthesiologist’s management of blood glucose has not changed over the last 5 years. What must be pointed out is the deficiency in current blood glucose monitoring technology when trying to achieve normoglycemia (3–6) with occasional blood glucose measurements during cardiac surgery, especially in diabetics. To "think like a pancreas" requires continuous glucose data much like pulse oximetry and capnography emerged from the need to "think like a lung." The future of "tight" blood glucose control will be with continuous glucose sensors, or other forms of automated blood sampling systems. Those systems will eventually feedback to a controller with algorithms programmed to deliver insulin in a semi-closed or closed-loop technique. The two currently approved glucose monitors measure interstitial glucose but these needle type subcutaneous sensors require equilibration and calibration procedures that make their use less practical in the acute care setting. It is unknown how sensors will perform in surgical patients experiencing rapid fluctuations in blood glucose, changes in blood flow distribution, temperature (7), or various pathologies (i.e., morbid obesity, edema, sepsis). Issues such as calibration drifts from membrane fouling, measurement delays (blood to interstitial fluid), statistical handling of continuous data, and prediction of future glucose information, have not received the needed consideration in the evaluation and approval of these systems. Other technologies classified as intermittent type glucose monitors, specifically designed for the surgical and ICU patient, are currently being developed and tested in the United States. The development of an artificial pancreas is on the horizon with anesthesiology and acute care environments appearing as good testing grounds for early systems with controlled insulin and glucose infusions. Significant progress in this technology will make it possible to "think like a pancreas" as more evidence of hyperglycemia associated adverse outcomes presses for a reduction in the sweetness of blood.

REFERENCES

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This article has been cited by other articles:

				E. A. Martinez and P. J. Pronovost Thinking Like A Pancreas: A Look Ahead at Diabetes Technology in the Perioperative Setting Anesth. Analg., August 1, 2007; 105(2): 545 - 546. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Torjman, M. C. Articles by Littman, J. Search for Related Content PubMed PubMed Citation Articles by Torjman, M. C. Articles by Littman, J.