Comparison of adaptive and sliding-scale glycaemic control in critical care and the impact of nutritional inputs

Stress-induced hyperglycaemia is prevalent in critical care. Tight glucose control can reduce mortality up to 43%. An adaptive control algorithm utilising insulin and nutritional feed inputs for targeted glycaemic control in critically ill patients is presented. Validation is performed using retrospective patient data (n=19) in simulated glucoregulatory trials. Conventional sliding-scale and insulin-only methods are compared. Results show a reduction in mean glucose levels, and variability. A 312% increase in time spent in the 46mmol/L normal glucose band compared to slidingscale and a 240% increase compared to the insulinonly protocol is reported. Results are obtained using 60% more insulin and 20% more nutrition across a wide cross-section of ICU patients and patient condition, indicating that the timing of control input administration is more crucial than their absolute amounts. The results show potential in reducing ICU mortality and the risk of severe complications.

[1]  P. Tessari,et al.  Glucose kinetics and splanchnic uptake following mixed meal ingestion in cirrhotic-diabetic subjects. , 2001, Diabetes, nutrition & metabolism.

[2]  Christopher E. Hann,et al.  Integral-based parameter identification for long-term dynamic verification of a glucose-insulin system model , 2005, Comput. Methods Programs Biomed..

[3]  J Geoffrey Chase,et al.  Adaptive bolus-based targeted glucose regulation of hyperglycaemia in critical care. , 2005, Medical engineering & physics.

[4]  J. Patiño,et al.  Hypocaloric Support in the Critically Ill , 1999, World Journal of Surgery.

[5]  James Stephen Krinsley,et al.  Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. , 2003, Mayo Clinic proceedings.

[6]  A. Malhotra,et al.  Stress-induced hyperglycemia. , 2001, Critical care clinics.

[7]  S E Kahn,et al.  The effect of insulin dose on the measurement of insulin sensitivity by the minimal model technique. Evidence for saturable insulin transport in humans. , 1996, The Journal of clinical investigation.

[8]  T. McDonald,et al.  Initial splanchnic extraction of ingested glucose in normal man. , 1978, Metabolism: clinical and experimental.

[9]  B. Ludvik,et al.  Evidence for decreased splanchnic glucose uptake after oral glucose administration in non-insulin-dependent diabetes mellitus. , 1997, The Journal of clinical investigation.

[10]  Miet Schetz,et al.  Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control* , 2003, Critical care medicine.

[11]  Charles Weissman,et al.  Nutrition in the intensive care unit , 1999, Critical care.

[12]  B A Mizock,et al.  Alterations in fuel metabolism in critical illness: hyperglycaemia. , 2001, Best practice & research. Clinical endocrinology & metabolism.