STAR-Liège: Modulating Insulin AND Nutrition Improves Glycaemic Control

Introduction:
Stress-induced hyperglycaemia is a common complication associated with higher morbidity and mortality in ICU
patients. The Stochastic TARgeted (STAR) glycaemic control (GC) framework provides consistent, safe,
effective control in different ICUs and countries. It is a patient-specific, risk-based protocol controlling both
insulin and nutrition dosing. This study analyses safety and efficacy of STAR at the University Hospital of
Liège, Belgium, and assesses the impact of also modulating nutrition on GC outcomes.
Methods:
Patients are included after 2 blood glucose (BG) > 145 mg/dL. The study compares STAR (N=14; modulating
insulin and nutrition) and STAR-IO (N=15; controlling insulin only, leaving nutrition at clinical discretion). STAR
controls nutrition between 30-100% of goal feed if insulin alone cannot safely reduce BG. The target band is 80-
145 mg/dL for both arms. GC was stopped after 72h or if BG in target at insulin rate ≤2U/h for 6 hours.
Performance is assessed by %BG in target and the median [IQR] BG, and safety by %BG below (<80 mg/dL) and
above (>145 mg/dL) target. Ethics approval was granted by the University Hospital of Liège Ethics Committee.
Results:
Table 1 shows better performance for STAR (83% vs 78% BG in target), and better safety from hypoglycaemia
(0.7% vs 1.5%) and hyperglycaemia (17% vs 21%). Median [IQR] BG are similar (STAR: 121 [110 135] mg/dL vs
STAR-IO: 119 [106 137] mg/dL). Despite controlling nutrition, STAR provided higher median [IQR] nutrition than
STAR-IO (98 [67 109] vs 93 [53 103] %Goal) and required lower workload (13.6 vs 15.5 assays per day).
Conclusion:
STAR outperforms STAR-IO. Both STAR and STAR-IO provide safe, effective control for all patients. GC safety
and performance can be improved by patient-specific control of nutrition, in addition to insulin, for highly insulin
resistant patients.