Insulin Sensitivity, Its Variability and Glycemic Outcome: A model-based analysis of the difficulty in achieving tight glycemic control in critical care - 2011
Paper published in a book (Scientific congresses and symposiums)
Insulin Sensitivity, Its Variability and Glycemic Outcome: A model-based analysis of the difficulty in achieving tight glycemic control in critical care
Chase, J. Geoffrey; Le Compte, Aaron J.; PREISER, Jean-Charleset al.
2011 • In 18th World Congress of the International Federation of Automatic Control (IFAC)
[en] Effective tight glycemic control (TGC) can improve outcomes in intensive care unit (ICU)
patients, but is difficult to achieve consistently. Glycemic level and variability, particularly early in a
patient’s stay, are a function of variability in insulin sensitivity/resistance resulting from the level and
evolution of stress response, and are independently associated with mortality. This study examines the
daily evolution of variability of insulin sensitivity in ICU patients using patient data (N = 394 patients,
54019 hours) from the SPRINT TGC study. Model-based insulin sensitivity (SI) was identified each hour
and hour-to-hour percent changes in SI were assessed for Days 1-3 individually and Day 4 Onward, as
well as over all days. Cumulative distribution functions (CDFs), median values, and inter-quartile points
(25th and 75th percentiles) are used to assess differences between groups and their evolution over time.
Compared to the overall (all days) distributions, ICU patients are more variable on Days 1 and 2 (p <
0.0001), and less variable on Days 4 Onward (p < 0.0001). Day 3 is similar to the overall cohort (p = 0.74).
Absolute values of SI start lower and rise for Days 1 and 2, compared to the overall cohort (all days), (p <
0.0001), are similar on Day 3 (p = .72) and are higher on Days 4 Onward (p < 0.0001). ICU patients have
lower insulin sensitivity (greater insulin resistance) and it is more variable on Days 1 and 2, compared to
an overall cohort on all days. This is the first such model-based analysis of its kind. Greater variability
with lower SI early in a patient’s stay greatly increases the difficulty in achieving and safely maintaining
glycemic control, reducing potential positive outcomes. Clinically, the results imply that TGC patients will
require greater measurement frequency, reduced reliance on insulin, and more explicit specification of
carbohydrate nutrition in Days 1-3 to safely minimise glycemic variability for best outcome.
Disciplines :
Engineering, computing & technology: Multidisciplinary, general & others
Moorhead, Katherine ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Biochimie et physiologie générales, humaines et path.
Penning, Sophie ; Université de Liège - ULiège > Département d'astrophys., géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles
Shaw, Geoffrey M.
Desaive, Thomas ; Université de Liège - ULiège > Département d'astrophys., géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles
Language :
English
Title :
Insulin Sensitivity, Its Variability and Glycemic Outcome: A model-based analysis of the difficulty in achieving tight glycemic control in critical care
Publication date :
2011
Event name :
18th World Congress of the International Federation of Automatic Control (IFAC)
Event place :
Milano, Italy
Event date :
28 août 2011 au 2 septembre 2011
By request :
Yes
Audience :
International
Main work title :
18th World Congress of the International Federation of Automatic Control (IFAC)
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