Utilization of a Computerized Intravenous Insulin Infusion Program to Control Blood Glucose in the Intensive Care Unit

Juneja, Rattan; Roudebush, Corbin P.; Kumar, Nilay; Macy, Ashley; Golas, Adam; Wall, Donna A.; Wolverton, Cheryl; Nelson, Dallas; Carroll, Joni C.; Flanders, Samuel

doi:10.1089/dia.2006.0015

Cited by 99 publications

(80 citation statements)

References 14 publications

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“…Other protocols, adjust based on a surrogate response to insulin decreases (e.g. resistance increases) [116,117], but do so in fixed multiples, rather than via an explicit or patient-specific algorithm.…”

Section: The Impact Of Insulin Sensitivity and Its Variation And Impmentioning

confidence: 99%

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Chase

Compte

Suhaimi

et al. 2011

Computer Methods and Programs in Biomedicine

123

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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 mortality and other outcomes has proven difficult with more failures than successes. Hence, there has been growing debate over the necessity of TGC, its goals, the risk of severe hypoglycemia, and target cohorts.This paper provides a review of TGC via new analyses of data from several clinical trials, including SPRINT, Glucontrol and a recent NICU study. It thus provides both a review of the problem and major background factors driving it, as well as a novel model-based analysis designed to examine these dynamics from a new perspective. Using these clinical results and analysis, the goal is to develop new insights that shed greater light on the leading factors that make TGC difficult and inconsistent, as well as the requirements they thus impose on the design and implementation of TGC protocols.A model-based analysis of insulin sensitivity using data from three different critical care units, comprising over 75,000 hours of clinical data, is used to analyse variability in metabolic dynamics using a clinically validated model-based insulin sensitivity metric (S I ). Variation in S I provides a new interpretation and explanation for the variable results seen (across cohorts and studies) in applying TGC. In particular, significant intra-and inter-patient variability in insulin resistance (1/ S I ) is seen be a major confounder that makes TGC difficult over diverse cohorts, yielding variable results over many published studies and protocols. Further factors that exacerbate this variability in glycemic outcome are found to include measurement frequency and whether a protocol is blind to carbohydrate administration.

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Section: The Impact Of Insulin Sensitivity and Its Variation And Impmentioning

confidence: 99%

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Chase

Compte

Suhaimi

et al. 2011

Computer Methods and Programs in Biomedicine

123

View full text Add to dashboard Cite

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“…Multiple IV insulin protocols exist for rapid hyperglycemia correction developed for patients in intensive care units. Some protocols have trade names [39,40] and some do not [28•]. Some academic institutions use protocols developed by local experts, some of them are available on their institutional websites, and many are readily publicly accessible on the Web [41].…”

Section: Methods To Lower Hyperglycemiamentioning

confidence: 99%

Management of hyperglycemia during acute stroke

Bruno

2008

Curr Cardiol Rep

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Long-term complications of hyperglycemia are well known, but short-term complications are not. Because hyperglycemia and hypoglycemia can be corrected relatively rapidly, it seems important to determine if such interventions during acute illnesses improve patient outcomes. In most animal stroke studies, animals with hyperglycemia before or during brain ischemia have worse outcomes than those with normoglycemia. In humans, hyperglycemia during acute stroke has been associated with worse clinical outcomes than normoglycemia, but it remains to be established if rapid correction of the hyperglycemia will improve patient outcomes. Intravenous insulin infusion protocols are the only currently established methods to effectively lower and control hyperglycemia during acute illness. Recent pilot clinical trials demonstrate feasibility and safety of such interventions. One randomized effi cacy trial has been reported and additional trials are needed. In the meantime, an intermediate approach to managing acute stroke hyperglycemia with subcutaneous insulin seems reasonable.

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“…Development of CGM technology 74,77 is underway to provide realtime near-continuous BG quantification, minimizing a concomitant increase in nursing workload requirements. 78 Several CDSS applications for insulin management are currently commercially available, [79][80][81][82] demonstrating reduced glycemic excursion and significantly fewer hypoglycemic events.…”

Section: Glycemic Control Challengesmentioning

confidence: 99%

Glycemic Control in the Burn Intensive Care Unit: Focus on the Role of Anemia in Glucose Measurement

Mann

Mora

Pidcoke

et al. 2009

J Diabetes Sci Technol

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Glycemic control with intensive insulin therapy (IIT) has received widespread adoption secondary to findings of improved clinical outcomes and survival in the burn population. Severe burn as a model for trauma is characterized by a hypermetabolic state, hyperglycemia, and insulin resistance. In this article, we review the findings of a burn center research facility in terms of understanding glucose management. The conferred benefits from IIT, our findings of poor outcomes associated with glycemic variability, advantages from preserved diurnal variation of glucose and insulin, and impacts of glucometer error and hematocrit correction factor are discussed. We conclude with direction for further study and the need for a reliable continuous glucose monitoring system. Such efforts will further the endeavor for achieving adequate glycemic control in order to assess the efficacy of target ranges and use of IIT.

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Utilization of a Computerized Intravenous Insulin Infusion Program to Control Blood Glucose in the Intensive Care Unit

Abstract: Use of the GlucoStabilizer program in the ICU resulted in improved glycemic control compared to the previous manually calculated glycemic control protocols.

Cited by 99 publications

References 14 publications

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Management of hyperglycemia during acute stroke

Glycemic Control in the Burn Intensive Care Unit: Focus on the Role of Anemia in Glucose Measurement

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