Reference : Insulin Sensitivity, Its Variability and Glycemic Outcome: A model-based analysis of ...
Scientific congresses and symposiums : Paper published in a book
Engineering, computing & technology : Multidisciplinary, general & others
http://hdl.handle.net/2268/98708
Insulin Sensitivity, Its Variability and Glycemic Outcome: A model-based analysis of the difficulty in achieving tight glycemic control in critical care
English
Chase, J. Geoffrey [> >]
Le Compte, Aaron J. [> >]
Preiser, Jean-Charles [> >]
Pretty, Christopher G. [> >]
Moorhead, Katherine [Université de Liège - ULg > Département des sciences biomédicales et précliniques > Biochimie et physiologie générales, humaines et path. >]
Penning, Sophie mailto [Université de Liège - ULg > Département d'astrophys., géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles >]
Shaw, Geoffrey M. [> >]
Desaive, Thomas mailto [Université de Liège - ULg > Département d'astrophys., géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles >]
2011
18th World Congress of the International Federation of Automatic Control (IFAC)
Yes
Yes
International
18th World Congress of the International Federation of Automatic Control (IFAC)
28 août 2011 au 2 septembre 2011
Milano
Italy
[en] Insulin Sensitivity ; TGC
[en] Effective tight glycemic control (TGC) can improve outcomes in intensive care unit (ICU)
<br />patients, but is difficult to achieve consistently. Glycemic level and variability, particularly early in a
<br />patient’s stay, are a function of variability in insulin sensitivity/resistance resulting from the level and
<br />evolution of stress response, and are independently associated with mortality. This study examines the
<br />daily evolution of variability of insulin sensitivity in ICU patients using patient data (N = 394 patients,
<br />54019 hours) from the SPRINT TGC study. Model-based insulin sensitivity (SI) was identified each hour
<br />and hour-to-hour percent changes in SI were assessed for Days 1-3 individually and Day 4 Onward, as
<br />well as over all days. Cumulative distribution functions (CDFs), median values, and inter-quartile points
<br />(25th and 75th percentiles) are used to assess differences between groups and their evolution over time.
<br />Compared to the overall (all days) distributions, ICU patients are more variable on Days 1 and 2 (p <
<br />0.0001), and less variable on Days 4 Onward (p < 0.0001). Day 3 is similar to the overall cohort (p = 0.74).
<br />Absolute values of SI start lower and rise for Days 1 and 2, compared to the overall cohort (all days), (p <
<br />0.0001), are similar on Day 3 (p = .72) and are higher on Days 4 Onward (p < 0.0001). ICU patients have
<br />lower insulin sensitivity (greater insulin resistance) and it is more variable on Days 1 and 2, compared to
<br />an overall cohort on all days. This is the first such model-based analysis of its kind. Greater variability
<br />with lower SI early in a patient’s stay greatly increases the difficulty in achieving and safely maintaining
<br />glycemic control, reducing potential positive outcomes. Clinically, the results imply that TGC patients will
<br />require greater measurement frequency, reduced reliance on insulin, and more explicit specification of
<br />carbohydrate nutrition in Days 1-3 to safely minimise glycemic variability for best outcome.
http://hdl.handle.net/2268/98708
also: http://hdl.handle.net/2268/90772

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