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    On the problem of patient specific endogenous glucose production in neonates on stochastic targeted (STAR) glycaemic control (2013)

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    Type of Content
    Journal Article
    UC Permalink
    http://hdl.handle.net/10092/9964
    
    Publisher
    University of Canterbury. Mechanical Engineering
    ISSN
    1932-2968
    Collections
    • Engineering: Journal Articles [1528]
    Authors
    Dickson, J.L.
    Hewett, J.N.
    Gunn, C.A.
    Lynn, A.
    Shaw, Geoff cc
    Chase, Geoff cc
    Dickson, J.L.
    show all
    Abstract

    Background: Stress and prematurity can both induce hyperglycaemia in the neonatal intensive care unit (NICU), which in turn is associated with worsened outcomes. Endogenous glucose production (EGP) is the formation of glucose by the body from substrates, and contributes to blood glucose (BG) levels. Due to the inherent fragility of the extremely low birth weight (ELBW) true fasting EGP cannot be explicitly determined, introducing uncertainty into glycaemic models that rely on quantifying glucose sources. STAR (Stochastic TARgeted) is one such glycaemic control framework. Methods: A literature review was carried out to gather metabolic and EGP values on preterm infants with a gestational age (GA) < 32 weeks and a birth weight (BW) < 2kg. The data was analysed for EGP trends with BW, GA, BG, plasma insulin and glucose infusion rates. Trends were modelled and compared to a literature-derived range of population constant EGP models using clinically validated virtual trials on retrospective clinical data. Results: No clear relationship was found for EGP and BW, GA, or plasma insulin. Some evidence of suppression of EGP with increasing glucose infusion or BG was seen. Virtual trial results showed that population constant EGP models fit clinical data best and gave tighter control performance to a target band in virtual trials. Conclusions: Variation in EGP cannot easily be quantified, and EGP is sufficiently modelled as a population constant in the NICING (Neonatal Intensive Care Insulin-Nutrition-Glucose) model. Analysis of the clinical data and fitting error suggests that ELBW hyperglycaemic preterm neonates have unsuppressed EGP in the higher range than that seen in literature.

    Citation
    Dickson, J.L., Hewett, J.N., Gunn, C.A., Lynn, A., Shaw, G.M., Chase, J.G., Dickson, J.L. (2013) On the problem of patient specific endogenous glucose production in neonates on stochastic targeted (STAR) glycaemic control. Journal of Diabetes Science and Technology (JoDST), 7(4), pp. 913-927.
    This citation is automatically generated and may be unreliable. Use as a guide only.
    Keywords
    endogenous glucose production; extremely preterm infants; glycaemic control; insulin therapy; physiological modelling
    ANZSRC Fields of Research
    32 - Biomedical and clinical sciences::3202 - Clinical sciences::320208 - Endocrinology
    32 - Biomedical and clinical sciences::3202 - Clinical sciences::320212 - Intensive care
    11 - Medical and Health Sciences::1114 - Paediatrics and Reproductive Medicine::111402 - Obstetrics and Gynaecology
    32 - Biomedical and clinical sciences::3208 - Medical physiology::320899 - Medical physiology not elsewhere classified
    Rights
    https://hdl.handle.net/10092/17651

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