A 3D insulin sensitivity prediction model enables more patient-specific prediction and model-based glycaemic control

Uyttendaele, Vincent; Knopp, Jennifer L.; Stewart, Kent W.; Desaive, Thomas; Balazs, Benyo; Szabo-Nemedi, Noemi; Illyes, Attila; Shaw, Geoffrey M.; Chase, J Geoffrey

doi:10.1016/j.bspc.2018.05.032

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A 3D insulin sensitivity prediction model enables more patient-specific prediction and model-based glycaemic control

Uyttendaele, Vincent; Knopp, Jennifer L.; Stewart, Kent W. et al.

2018 • In Biomedical Signal Processing and Control, 45, p. 192-200

Peer Reviewed verified by ORBi

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https://hdl.handle.net/2268/227186

DOI
10.1016/j.bspc.2018.05.032

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Keywords :

Critical Care; Glycaemic control; Insulin Sensitivity

Abstract :

[en] Background Insulin therapy for glycaemic control (GC) in critically ill patients may improve outcomes by reducing hyperglycaemia and glycaemic variability, which are both associated with increased morbidity and mortality. However, initial positive results have proven difficult to repeat or achieve safely. STAR (Stochastic TARgeted) is a model-based glycaemic control protocol using a risk-based dosing approach. STAR uses a 2D stochastic model to predict distributions of likely future changes in model-based insulin sensitivity (SI) based on its current value, and determines the optimal intervention. Objectives This study investigates the impact of a new 3D stochastic model on the ability to predict more accurate future SI distributions, which would allow more aggressive insulin dosing and improved glycaemic control. Methods The new 3D stochastic model is built using both current SI and its prior variation to predict future SI distribution from 68,629 h of clinical data (819 GC episodes). The 5th-95th percentile range of predicted SI distribution are calculated and compared with the 2D model. Results Results show the 2D model is over-conservative compared to the 3D case for more than 77% of the data, predominantly where SI is stable (|%ΔSI| ≤ 25%). These formerly conservative prediction ranges are now ~30% narrower with the 3D model, which safely enables more aggressive insulin dosing for these patient hours. In addition, distributions of predicted SI within the 5th-95th percentile range are much closer to the ideal value of 90% for more patients with the 3D model. Conclusions The new 3D model better characterises patient specific metabolic variability and patient specific response to insulin, allowing more optimal insulin dosing to increase performance and safety.

Research Center/Unit :

Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
GIGA-In Silico Medicine, Université de Liège, Belgique

Disciplines :

Engineering, computing & technology: Multidisciplinary, general & others
Endocrinology, metabolism & nutrition

Author, co-author :

Uyttendaele, Vincent ; Université de Liège - ULiège > Form. doct. sc. ingé. & techno. (aéro. & mécan. - Paysage)

Knopp, Jennifer L.

Stewart, Kent W.

Desaive, Thomas ; Université de Liège - ULiège > Département d'astrophys., géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles

Balazs, Benyo

Szabo-Nemedi, Noemi

Illyes, Attila

Shaw, Geoffrey M.

Chase, J Geoffrey ; Université de Liège - ULiège > Département d'astrophys., géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles

Language :

English

Title :

A 3D insulin sensitivity prediction model enables more patient-specific prediction and model-based glycaemic control

Publication date :

September 2018

Journal title :

Biomedical Signal Processing and Control

ISSN :

1746-8094

eISSN :

1746-8108

Publisher :

Elsevier, Netherlands

Volume :

Pages :

192-200

Peer reviewed :

Peer Reviewed verified by ORBi

Funders :

FRIA - Fonds pour la Formation à la Recherche dans l'Industrie et dans l'Agriculture
NZ National Science Challenge 7, Science for Technology and Innovation
MedTech CoRE
Erasmus+

Available on ORBi :

since 20 August 2018

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