Model predictive glycaemic regulation in critical illness using insulin and nutrition input: a pilot study

Abstract

This paper develops and presents a pilot study of a long-term controller for safe regulation of glycaemia under elevated insulin resistance and glucose intolerance in critically ill patients by modulating enteral nutrition inputs in addition to conventional basal-bolus intravenous insulin therapy. Clinical proof-of-concept pilot trials of the algorithm are performed which show the algorithm adaptability to time-varying intraas well as inter-patient variability in condition while requiring relatively infrequent glucose measurement. This research is a step towards randomized, comparative cohort studies of clinical outcomes using the developed protocol. Previous blood glucose control research includes controlled experiments in insulin infusion by Hovorka et al. [26], Chee et al. [27], and Chase et al. [18, 28]. Adaptive bolus-based control using insulin-alone by Chase et al. [18], is the basis of this work. The primary difference in this research is the improvement in control under elevated insulin resistance by modulation of nutritional support in addition to insulin input