Interface Design and Human Factors Consideration for Model-Based Tight Glycemic Control in Critical Care

in Journal of Diabetes Science and Technology (2012)

Data Entry Errors and Design for Model-Based Tight Glycemic Control in Critical Care

in Journal of Diabetes Science and Technology (2012)

Validation of a virtual patient and virtual trials method for accurate prediction of TGC protocol performance

in Critical Care (2011, March)

Enhanced insulin sensitivity variability in the first 3 days of ICU stay: Implications for TGC

Poster (2011, March)

Pilot Trials of STAR Target to Range Glycemic Control

in Intensive Care Medicine (2011), 37 (Suppl 1)

Variability of insulin sensitivity for diabetics and non-diabetics during the first 3 days of ICU stay

Poster (2011)

Safety and Performance of Stochastic Targeted (STAR) Glycemic Control of Insulin and Nutrition – First Pilot Results

in Intensive Care Medicine (2011)

Pilot proof of concept clinical trials of Stochastic Targeted (STAR) glycemic control.

in Annals of intensive care (2011), 1

ABSTRACT: INTRODUCTION: Tight glycemic control (TGC) has shown benefits but has been difficult to achieve consistently. STAR (Stochastic TARgeted) is a flexible, model-based TGC approach directly ... [more ▼]

ABSTRACT: INTRODUCTION: Tight glycemic control (TGC) has shown benefits but has been difficult to achieve consistently. STAR (Stochastic TARgeted) is a flexible, model-based TGC approach directly accounting for intra- and inter- patient variability with a stochastically derived maximum 5% risk of blood glucose (BG) < 4.0 mmol/L. This research assesses the safety, efficacy, and clinical burden of a STAR TGC controller modulating both insulin and nutrition inputs in pilot trials. METHODS: Seven patients covering 660 hours. Insulin and nutrition interventions are given 1-3 hourly as chosen by the nurse to allow them to manage workload. Interventions are calculated by using clinically validated computer models of human metabolism and its variability in critical illness to maximize the overlap of the model-predicted (5-95th percentile) range of BG outcomes with the 4.0-6.5 mmol/L band while ensuring a maximum 5% risk of BG < 4.0 mmol/L. Carbohydrate intake (all sources) was selected to maximize intake up to 100% of SCCM/ACCP goal (25 kg/kcal/h). Maximum insulin doses and dose changes were limited for safety. Measurements were made with glucometers. Results are compared to those for the SPRINT study, which reduced mortality 25-40% for length of stay >/=3 days. Written informed consent was obtained for all patients, and approval was granted by the NZ Upper South A Regional Ethics Committee. RESULTS: A total of 402 measurements were taken over 660 hours (~14/day), because nurses showed a preference for 2-hourly measurements. Median [interquartile range, (IQR)] cohort BG was 5.9 mmol/L [5.2-6.8]. Overall, 63.2%, 75.9%, and 89.8% of measurements were in the 4.0-6.5, 4.0-7.0, and 4.0-8.0 mmol/L bands. There were no hypoglycemic events (BG < 2.2 mmol/L), and the minimum BG was 3.5 mmol/L with 4.5% < 4.4 mmol/L. Per patient, the median [IQR] hours of TGC was 92 h [29-113] using 53 [19-62] measurements (median, ~13/day). Median [IQR] results: BG, 5.9 mmol/L [5.8-6.3]; carbohydrate nutrition, 6.8 g/h [5.5-8.7] (~70% goal feed median); insulin, 2.5 U/h [0.1-5.1]. All patients achieved BG < 6.1 mmol/L. These results match or exceed SPRINT and clinical workload is reduced more than 20%. CONCLUSIONS: STAR TGC modulating insulin and nutrition inputs provided very tight control with minimal variability by managing intra- and inter- patient variability. Performance and safety exceed that of SPRINT, which reduced mortality and cost in the Christchurch ICU. The use of glucometers did not appear to impact the quality of TGC. Finally, clinical workload was self-managed and reduced 20% compared with SPRINT. [less ▲]

Tight Glycemic Control Models for Critically Ill Patients in Intensive Care Units

in 9th Belgian Day on Biomedical Engineering, "Bridging the gap between medicine and engineering', Friday November 26th 2010 in the Academy Palace, Hertogstraat 1, 1000 Brussels (2010, November 26)

Critically ill patients often present stress-induced hyperglycemia and low insulin sensitivity. Recent studies have shown that high blood glucose (BG) levels are linked to worsened patient outcomes and ... [more ▼]

Critically ill patients often present stress-induced hyperglycemia and low insulin sensitivity. Recent studies have shown that high blood glucose (BG) levels are linked to worsened patient outcomes and increased mortality. Tight glycemic control (TGC) aims at reducing BG levels taking into account inter-patient variability, evolving physiological patient conditions and minimizing hypoglycemic risks. Clinical protocols are used to specify insulin and nutrition rates and BG measurement time interval during control. This research compares different protocols to determine the best one to use at the CHU of Liege. [less ▲]