Impact of variation in patient response on model-based control of glycaemia in critically ill patients (2013)
Type of ContentJournal Article
PublisherUniversity of Canterbury. Mechanical Engineering
Critically ill patients commonly experience stress-induced hyperglycaemia, and several studies have shown tight glycaemic control (TGC) can reduce patient mortality. However, tight control is often difficult to achieve due to conflicting drug therapies and evolving patient condition. Thus, a number of studies have failed to achieve consistently safe and effective TGC possibly due to the use of fixed insulin dosing protocols over adaptive patient-specific methods. Model-based targeted glucose control can adapt insulin and dextrose interventions to match identified patient insulin sensitivity. This study explores the impact on glycemic control of assuming patient response to insulin is constant, as many protocols do, versus time-varying. Validated virtual trial simulations of glucose control were performed on adult and neonatal virtual patient cohorts. Results indicate assumptions of constant insulin sensitivity can lead to six-fold increases in incidence of hypoglycaemia, similar to literature reports and a commonly cited issue preventing increased adoption of TGC in critical care. It is clear that adaptive, patient-specific, approaches are better able to manage inter- and intra- patient variability than typical, fixed protocols.
CitationLe Compte, A.J., Pretty, C.G., Lin, J., Shaw, G.M., Lynn, A., Chase, J.G. (2013) Impact of variation in patient response on model-based control of glycaemia in critically ill patients. Computer Methods and Programs in Biomedicine, 109(2), pp. 211-219.
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Keywordscritical care; glycaemic control; simulation; modelling; insulin sensitivity
ANZSRC Fields of Research40 - Engineering::4003 - Biomedical engineering::400303 - Biomechanical engineering
32 - Biomedical and clinical sciences::3202 - Clinical sciences::320208 - Endocrinology
32 - Biomedical and clinical sciences::3202 - Clinical sciences::320212 - Intensive care
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Tight Glycemic Control in Critical Care - The leading role of insulin sensitivity and patient variability – A review and model-based analysis Chase, Geoff; Le Compte, A.J.; Suhaimi, F.; Shaw, Geoff; Lynn, A.; Lin, J.; Pretty, Christopher; Razak, N.N.; Parente, J.D.; Hann, C.E.; Preiser, J-C.; Desaive, T. (University of Canterbury. Electrical and Computer EngineeringUniversity of Canterbury. Mathematics and StatisticsUniversity of Canterbury. Mechanical Engineering, 2011)Tight glycemic control (TGC) has emerged as a major research focus in critical care due to its potential to simultaneously reduce both mortality and costs. However, repeating initial successful TGC trials that reduced ...
Insulin Sensitivity, Its Variability and Glycemic Outcome: A model-based analysis of the difficulty in achieving tight glycemic control in critical care Chase, Geoff; Le Compte, A.J.; Preiser, J.C.; Pretty, C.G.; Moorhead, K.T.; Penning, S.; Shaw, Geoff; Desaive, T. (University of Canterbury. Mechanical Engineering, 2011)Effective tight glycemic control (TGC) can improve outcomes in intensive care unit (ICU) patients, but is difficult to achieve consistently. Glycemic level and variability, particularly early in a patient’s stay, are a ...
Variability of insulin sensitivity during the first 4 days of critical illness: Implications for tight glycaemic control Pretty, C.G.; Le Compte, A.J.; Chase, Geoff; Shaw, Geoff; Preiser, J-C.; Penning, S.; Desaive, T. (University of Canterbury. Mechanical Engineering, 2012)Background: Effective tight glycemic control (TGC) can improve outcomes in critical care patients, but it is difficult to achieve consistently. Insulin sensitivity defines the metabolic balance between insulin concentration ...