Variability of insulin sensitivity during the first 4 days of critical illness: Implications for tight glycaemic control

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dc.contributor.authorPretty, C.G.
dc.contributor.authorLe Compte, A.J.
dc.contributor.authorChase, Geoff
dc.contributor.authorShaw, Geoff
dc.contributor.authorPreiser, J-C.
dc.contributor.authorPenning, S.
dc.contributor.authorDesaive, T.
dc.date.accessioned2012-08-28T21:52:30Z
dc.date.available2012-08-28T21:52:30Z
dc.date.issued2012en
dc.description.abstractBackground: 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 and insulin-mediated glucose disposal. Hence, variability of insulin sensitivity can cause variable glycemia. This study quantifies and compares the daily evolution of insulin sensitivity level and variability for critical care patients receiving TGC. Methods: This is a retrospective analysis of data from the SPRINT TGC study involving patients admitted to a mixed medical-surgical ICU between August 2005 and May 2007. Only patients who commenced TGC within 12 hours of ICU admission and spent at least 24 hours on the SPRINT protocol were included (N = 164). Model-based insulin sensitivity (SI) was identified each hour. Absolute level and hour-to-hour percent changes in SI were assessed on cohort and per-patient bases. Levels and variability of SI were compared over time on 24-hour and 6-hour timescales for the first 4 days of ICU stay. Results: Cohort and per-patient median SI levels increased by 34% and 33% (p<0.001) between days 1 and 2 of ICU stay. Concomitantly, cohort and per-patient SI variability decreased by 32% and 36% (p<0.001). For 72% of the cohort, median SI on day 2 was higher than on day 1. The day 1–2 results are the only clear, statistically significant trends across both analyses. Analysis of the first 24 hours using 6-hour blocks of SI data showed that most of the improvement in insulin sensitivity level and variability seen between days 1 and 2 occurred during the first 12–18 hours of day 1. Conclusions: Critically ill patients have significantly lower and more variable insulin sensitivity on day 1 than later in their ICU stay and particularly during the first 12 hours. This rapid improvement is likely due to the decline of counter-regulatory hormones as the acute phase of critical illness progresses. Clinically, these results suggest that while using TGC protocols with patients during their first few days of ICU stay, extra care should be afforded. Increased measurement frequency, higher target glycemic bands, conservative insulin dosing, and modulation of carbohydrate nutrition should be considered to minimize safely the outcome glycemic variability and reduce the risk of hypoglycemia.en
dc.identifier.citationPretty, C.G., Le Compte, A.J., Chase, J.G., Shaw, G.M., Preiser, J-C., Penning, S., Desaive, T. (2012) Variability of insulin sensitivity during the first 4 days of critical illness: Implications for tight glycaemic control. Annals of Intensive Care, 2(17), pp. Online.en
dc.identifier.doihttps://doi.org/10.1186/2110-5820-2-17
dc.identifier.issn2110-5820
dc.identifier.urihttp://hdl.handle.net/10092/6919
dc.language.isoen
dc.publisherUniversity of Canterbury. Mechanical Engineeringen
dc.rights.urihttps://hdl.handle.net/10092/17651en
dc.subjectcritical careen
dc.subjecthyperglycemiaen
dc.subjectinsulin resistanceen
dc.subjectMathematical modelen
dc.subjectalgorithmsen
dc.subject.anzsrcFields of Research::40 - Engineering::4003 - Biomedical engineering::400303 - Biomechanical engineeringen
dc.subject.anzsrcFields of Research::32 - Biomedical and clinical sciences::3202 - Clinical sciences::320208 - Endocrinologyen
dc.subject.anzsrcFields of Research::32 - Biomedical and clinical sciences::3202 - Clinical sciences::320212 - Intensive careen
dc.titleVariability of insulin sensitivity during the first 4 days of critical illness: Implications for tight glycaemic controlen
dc.typeJournal Article
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