Cumulative time in band (cTIB): glycemic level, variability and patient outcome all in one

Conference (2012, October 15)

Second pilot trials of the STAR-Liege protocol for tight glycemic control in critically ill patients

in BioMedical Engineering OnLine (2012)

Impact of sensor and measurement timing errors on model-based insulin sensitivity

Conference (2012, August)

Impact of sensor and measurement timing errors on model-based insulin sensitivity

in Proceedings of the 8th IFAC Symposium on Biological and Medical Systems (2012, August)

Variability of insulin sensitivity during the first 4 days of critical illness: implications for tight glycemic control

in Annals of Intensive Care (2012)

Introduction: Effective tight glycaemic control (TGC) can improve outcomes in critical care patients, but is difficult to achieve consistently. Insulin sensitivity defines the metabolic balance between ... [more ▼]

Introduction: Effective tight glycaemic control (TGC) can improve outcomes in critical care patients, but is difficult to achieve consistently. Insulin sensitivity defines the metabolic balance between insulin concentration and insulin mediated glucose disposal. Hence, variability of insulin sensitivity can cause variable glycaemia. This study quantifies and compares the daily evolution of insulin sensitivity level and variability for critical care patients receiving TGC. <br /> <br />Methods: A retrospective analysis of data from the SPRINT TGC study involving patients admitted to a mixed medical-surgical ICU between August 2005 and May 2007. Only patients who commenced TGC within 12 hours of ICU admission and spent at least 24 hours on the SPRINT protocol were included (N=164). Model-based insulin sensitivity (SI) was identified each hour. Absolute level and hour-to-hour percent changes in SI were assessed on cohort and per-patient bases. Levels and variability of SI were compared over time on 24-hour and 6-hour timescales for the first 4 days of ICU stay. <br /> <br />Results: Cohort and per-patient median SI levels increased by 34% and 33% (p<0.001) between days 1 and 2 of ICU stay. Concomitantly, cohort and per-patient SI variability decreased by 32% and 36% (p<0.001). For 72% of the cohort, median SI on day 2 was higher than on day 1. The day 1-2 results are the only clear, statistically significant trends across both analyses. <br /> <br />Analysis of the first 24 hours using 6-hour blocks of SI data showed that most of the improvement in insulin sensitivity level and variability seen between days 1 and 2 occurred during the first 12-18 hours of day 1. <br /> <br />Conclusions: Critically ill patients have significantly lower and more variable insulin sensitivity on day 1 than later in their ICU stay and particularly during the first 12 hours. This rapid improvement is likely due to the decline of counter-regulatory hormones as the acute phase of critical illness progresses. Clinically, these results suggest that while using TGC protocols with patients during their first few days of ICU stay, extra care should be afforded. Increased measurement frequency, higher target glycaemic bands, conservative insulin dosing and modulation of carbohydrate nutrition should be considered to safely minimize outcome glycaemic variability and reduce the risk of hypoglycaemia. [less ▲]

Does Tight Glycemic Control positively impact on patient mortality?

in Critical Care (2012, March 20)

STAR Development and Protocol Comparison

in IEEE Transactions on Biomedical Engineering (2012)

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)

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

in Critical Care (2011, March)