Poster (Scientific congresses and symposiums)
When NICE is Not Nice: Performance of Two ICU Glycaemic Control Protocols
Uyttendaele, Vincent; Dickson, Jennifer; Stewart, Kent et al.
201616th Annual Diabetes Technology Meeting (DTM)
 

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Keywords :
Glycaemic Control; Insulin sensitivity; Insulin
Abstract :
[en] Objective: Hypoglycemia, hyperglycemia and blood glucose (BG) variability are associated with worsened outcomes in critical care. However, NICE-SUGAR trial (unexpectedly?) showed no clinical benefit from intensive insulin therapy. This study compares the table-based NICE-SUGAR and model-based STAR protocols to assess their relative capability to achieve safe, effective control for all patients. Method: Validated virtual patients (n=443) were used to simulate glycemic outcomes of the NICE-SUGAR and STAR protocols. Key outcomes assess tightness and safety of control for all patients: %BG in 80–144 mg/dL range (PTR); Per-Patient Mean BG (PPM_BG); and Incidence Hypoglycemia (BG<40 mg/dL). These metrics assess performance overall, for each patient, and safety. Results are assessed for NICE-SUGAR measuring per-protocol (~24/day) and at reported average rate (~3-hourly; ~8/day). STAR measures 1-3-hourly, averaging 12/day. Result: Per-protocol, STAR provided tight control, with higher PTR (90.7% vs. 78.3%) and tighter median [IQR] PPM_BG (112[106-119] vs. 117[106–137] mg/dL), and greater safety from hypoglycemia (5 (1%) vs. 10 patients (2.5%)). The 5-95th percentile range PPM_BG for NICE-SUGAR (97–185 mg/dL) shows ~5% of NICE-SUGAR patients had mean BG above 180mg/dL matching clinically reported performance. STAR’s 90th percentile PPM_BG range was (97–146 mg/dL). Measuring as recorded clinically, NICE-SUGAR had PTR of 77%, PPM_BG of 122 [110-140] mg/dL and 24(6%) of patients experienced hypoglycemia. These results match clinically reported values well (mean BG 115 vs. 118 mg/dL clinically vs. simulation, clinically 7% of patients had a hypoglycemic event) Conclusions: Glycemic control protocols need to be both safe and effective for all patients before potential clinical benefits can be assessed. NICE-SUGAR (measured ~24/day or as reported ~8/day) was unable to achieve this outcome for all patients.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Uyttendaele, Vincent ;  Université de Liège - ULiège > Form. doct. sc. ingé. & techno. (aéro. & mécan. - Paysage)
Dickson, Jennifer
Stewart, Kent
Shaw, Geoff
Desaive, Thomas  ;  Université de Liège > Département d'astrophys., géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles
Chase, Geoffrey
Language :
English
Title :
When NICE is Not Nice: Performance of Two ICU Glycaemic Control Protocols
Publication date :
2016
Event name :
16th Annual Diabetes Technology Meeting (DTM)
Event place :
Bethesda, United States
Event date :
November 10-12 2016
Audience :
International
Available on ORBi :
since 04 February 2017

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