[en] STAR is a glycaemic control (GC) framework using a unique model-based and risk-based dosing approach. STAR modulates both insulin and nutrition inputs to mitigate the risk of hypo- and hyper-glycaemia. This protocol, accounting for both inter- and intra- patient variability successfully manages to provide safe, effective control to all patients, regardless of their condition. In a recent clinical trial in Belgium, workload was pointed as a potential barrier for clinical adoption despite clear benefit for patients. Clinical burden is a key factor in compliance and uptake. This study assesses the impact on GC outcomes when increasing measurement intervals from 1-3 hourly to 1-6 hourly in the STAR GC framework. Retrospective data from 606 critically ill patients totalling over 59,000 hours of control are used to create virtual patients. Insulin sensitivity is identified for each patient using a validated physiological model, and new stochastic predictive models are built to forecast variability up to 6-hourly. Five-fold cross validation is used to build the models on 80% of data and simulate virtual trials on the remaining 20%. Safety, performance, nutrition intake and workload are compared and analysed. Results showed similar, very high safety and performance regardless of the measurement intervals, showing STAR GC framework robustness in controlling patients. However, there was a clear risk and reward tradeoff between the increased risk of hypoglycaemic event (from 12 to 23 patients between 1-3 hourly and 1-6 hourly protocols) and reduced nutrition intake (from 100 [85 - 100] to 85 [70 - 95] % GF) for the benefit of significant lower workload (from 12.1 to 8.3 measurement per day), closer to clinical practice. These promising results should be confirmed in clinical trials but offer possibilities to adapt measurement strategy based on local ICU practice and clinical burden.
Disciplines :
Engineering, computing & technology: Multidisciplinary, general & others Human health sciences: Multidisciplinary, general & others Anesthesia & intensive care
Author, co-author :
Seret, Marie ; Université de Liège - ULiège > GIGA > GIGA Molecular & Computational Biology - Model-based therapeutics
Uyttendaele, Vincent ; Université de Liège - ULiège > GIGA > GIGA Molecular & Computational Biology - Model-based therapeutics
Desaive, Thomas ; Université de Liège - ULiège > GIGA > GIGA Molecular & Computational Biology - Model-based therapeutics
Chase, J. Geoffrey; Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
Language :
English
Title :
Safe and Effective Glycaemic Control for Minimal Workload in Critically Ill Patients: Virtual trials analysis on performance and safety
Publication date :
September 2024
Event name :
12th IFAC Symposium on Biological and Medical Systems BMS 2024
F.R.S.-FNRS - Fund for Scientific Research EU - European Union SPF BOSA - Service Public Fédéral Stratégie et Appui
Funding number :
872488 – DCPM; DIGITWIN4PH
Funding text :
The authors acknowledge the support of the FRS-FNRS – Fund for Scientific Research, the EU H2020 R&I programme (MSCA-RISE-2019 call) agreement #872488 – DCPM, and the Service Public Fédéral Stratégie et Appui (BOSA) – Project DIGITWIN4PH
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