Hospital Glucose Control: Safe and Reliable Glycemic Control Using Enhanced Model Predictive Control Algorithm in Medical Intensive Care Unit Patients

Amrein, Karin; Ellmerer, Martin; Hovorka, Roman; Kachel, Norman; Parcz, Dieter; Korsatko, Stefan; Smolle, Karl-Heinz; Perl, Sabine; Bock, Gerlies; Doll, W.; Köhler, Gerd; Pieber, Thomas R.; Plank, Johannes

doi:10.1089/dia.2009.0147

Cited by 24 publications

(20 citation statements)

References 29 publications

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“…By contrast, SC continuous glucose monitoring (CGM) and CSII devices are smaller, less invasive, and already widely used in ambulatory diabetes care. Thus, CGM and CSII have been used in the development of an AP, and several clinical and in silico evaluations of the AP have been reported (Amrein et al, 2010; Atlas, Nimri, Miller, Grunberg, & Phillip, 2010; Breton et al, 2012; Cobelli et al, 2012; Dassau et al, 2010, 2013; Dua & Pistikopoulos, 2005; Harvey et al, 2014; Hovorka et al, 2011; Kovatchev et al, 2010; Murphy et al, 2011; Parker, Doyle, & Peppas, 1999; Patek et al, 2012; Steil, Rebrin, Darwin, Hariri, & Saad, 2006; Weinzimer et al, 2008; Zisser et al, 2012). However, substantial time delays associated with SC insulin delivery (i.e., the slow absorption peak at 50–60 min and long residence time of 6–8 h, Fig.…”

Section: Introductionmentioning

confidence: 99%

Design and in silico evaluation of an intraperitoneal–subcutaneous (IP–SC) artificial pancreas

Lee

Dassau

Zisser

et al. 2014

Computers & Chemical Engineering

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Prandial glucose regulation is a major challenge for the artificial pancreas using subcutaneous insulin (without a feedforward bolus) due to insulin’s slow absorption-peak (50–60 min). Intraperitoneal insulin, with a fast absorption peak (20–25 min), has been suggested as an alternative to address these limitations. An artificial pancreas using intraperitoneal insulin was designed and evaluated on 100 in silico subjects and compared with two designs using subcutaneous insulin with and without a feedforward bolus, following the three meal (40–70 g-carbohydrates) evaluation protocol. The design using intraperitoneal insulin resulted in a significantly lower postprandial blood glucose peak (38 mg/dL) and longer time in the clinically accepted region (13%) compared to the design using subcutaneous insulin without a feedforward bolus and comparable results to a subcutaneous feedforward bolus design. This superior regulation with minimal user interaction may improve the quality of life for people with type 1 diabetes mellitus.

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Section: Introductionmentioning

confidence: 99%

Design and in silico evaluation of an intraperitoneal–subcutaneous (IP–SC) artificial pancreas

Lee

Dassau

Zisser

et al. 2014

Computers & Chemical Engineering

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“…In the hope of improving the quality of GC and reducing workload, several algorithms have been developed. The enhanced Model Predictive Control (eMPC) algorithm has been studied in several clinical trials where it was found to be efficient and safe [22-27]. It is now implemented in the CE-certified Space GlucoseControl (SGC; B. Braun, Melsungen, Germany) which was the first device on the market available for routine use.…”

Section: Introductionmentioning

confidence: 99%

Glucose control in intensive care: usability, efficacy and safety of Space GlucoseControl in two medical European intensive care units

et al. 2014

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BackgroundThe Space GlucoseControl system (SGC) is a nurse-driven, computer-assisted device for glycemic control combining infusion pumps with the enhanced Model Predictive Control algorithm (B. Braun, Melsungen, Germany). We aimed to investigate the performance of the SGC in medical critically ill patients.MethodsTwo open clinical investigations in tertiary centers in Graz, Austria and Zurich, Switzerland were performed. Efficacy was assessed by percentage of time within the target range (4.4-8.3 mmol/L; primary end point), mean blood glucose, and sampling interval. Safety was assessed by the number of hypoglycemic episodes (≤2.2 mmol/L) and the percentage of time spent below this cutoff level. Usability was analyzed with a standardized questionnaire given to involved nursing staff after the trial.ResultsForty medical critically ill patients (age, 62 ± 15 years; body mass index, 30.0 ± 8.9 kg/m2; APACHE II score, 24.8 ± 5.4; 27 males; 8 with diabetes) were included for a period of 6.5 ± 3.7 days (n = 20 in each center). The primary endpoint (time in target range 4.4 to 8.3 mmol/l) was reached in 88.3% ± 9.3 of the time and mean arterial blood glucose was 6.7 ± 0.4 mmol/l. The sampling interval was 2.2 ± 0.4 hours. The mean daily insulin dose was 87.2 ± 64.6 IU. The adherence to the given insulin dose advice was high (98.2%). While the percentage of time spent in a moderately hypoglycemic range (2.2 to 3.3 mmol/L) was low (0.07 ± 0.26% of the time), one severe hypoglycemic episode (<2.2 mmol/L) occurred (2.5% of patients or 0.03% of glucose readings).ConclusionsSGC is a safe and efficient method to control blood glucose in critically ill patients as assessed in two European medical intensive care units.

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“…Historically, aggressive insulin protocols in cardiac surgery and critical care patients have been associated with considerably higher rates of hypoglycemia. 25,26 Indeed, tight glucose control goals in critical care units have resulted in unacceptably high rates of hypoglycemia 9,12 and increased mortality. 8 Anesthesiologists are especially concerned about hypoglycemia because symptoms are masked by general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Validation of the DeLiT Trial intravenous insulin infusion algorithm for intraoperative glucose control in noncardiac surgery: a randomized controlled trial

Abdelmalak

Maheshwari

Kovaci

et al. 2011

Can J Anesth/J Can Anesth

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Hospital Glucose Control: Safe and Reliable Glycemic Control Using Enhanced Model Predictive Control Algorithm in Medical Intensive Care Unit Patients

Abstract: In our single-center, noncontrolled study the eMPC algorithm was a safe and reliable method to control BG in critically medical ICU patients for the whole length of ICU stay.

Cited by 24 publications

References 29 publications

Design and in silico evaluation of an intraperitoneal–subcutaneous (IP–SC) artificial pancreas

Design and in silico evaluation of an intraperitoneal–subcutaneous (IP–SC) artificial pancreas

Glucose control in intensive care: usability, efficacy and safety of Space GlucoseControl in two medical European intensive care units

Validation of the DeLiT Trial intravenous insulin infusion algorithm for intraoperative glucose control in noncardiac surgery: a randomized controlled trial

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