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)
<br />patients, but is difficult to achieve consistently. Glycemic level and variability, particularly early in a
<br />patient’s stay, are a function of variability in insulin sensitivity/resistance resulting from the level and
<br />evolution of stress response, and are independently associated with mortality. This study examines the
<br />daily evolution of variability of insulin sensitivity in ICU patients using patient data (N = 394 patients,
<br />54019 hours) from the SPRINT TGC study. Model-based insulin sensitivity (SI) was identified each hour
<br />and hour-to-hour percent changes in SI were assessed for Days 1-3 individually and Day 4 Onward, as
<br />well as over all days. Cumulative distribution functions (CDFs), median values, and inter-quartile points
<br />(25th and 75th percentiles) are used to assess differences between groups and their evolution over time.
<br />Compared to the overall (all days) distributions, ICU patients are more variable on Days 1 and 2 (p <
<br />0.0001), and less variable on Days 4 Onward (p < 0.0001). Day 3 is similar to the overall cohort (p = 0.74).
<br />Absolute values of SI start lower and rise for Days 1 and 2, compared to the overall cohort (all days), (p <
<br />0.0001), are similar on Day 3 (p = .72) and are higher on Days 4 Onward (p < 0.0001). ICU patients have
<br />lower insulin sensitivity (greater insulin resistance) and it is more variable on Days 1 and 2, compared to
<br />an overall cohort on all days. This is the first such model-based analysis of its kind. Greater variability
<br />with lower SI early in a patient’s stay greatly increases the difficulty in achieving and safely maintaining
<br />glycemic control, reducing potential positive outcomes. Clinically, the results imply that TGC patients will
<br />require greater measurement frequency, reduced reliance on insulin, and more explicit specification of
<br />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)
BAGSHAW, S. M., BELLOMO, R., JACKA, M. J., EGI, M., HART, G. K. & GEORGE, C. 2009. The impact of early hypoglycemia and blood glucose variability on outcome in critical illness. Crit Care, 13, R91.
BLAKEMORE, A., WANG, S., LECOMPTE, A., WONG, X., SHAW, G., LIN, J., LOTZ, T., HANN, C. & CHASE, J. 2008. Model-based Insulin Sensitivity as a Sepsis Diagnostic in Critical Care. Journal of Diabetes Science and Technology (JoDST), 2, 468-477.
CERRA, F. B., BENITEZ, M. R., BLACKBURN, G. L., IRWIN, R. S., JEEJEEBHOY, K., KATZ, D. P., PINGLETON, S. K., POMPOSELLI, J., ROMBEAU, J. L., SHRONTS, E., WOLFE, R. R. & ZALOGA, G. P. 1997. Applied nutrition in ICU patients. A consensus statement of the American College of Chest Physicians. Chest, 111, 769-78.
CHASE, J. G., SHAW, G., LE COMPTE, A., LONERGAN, T., WILLACY, M., WONG, X. W., LIN, J., LOTZ, T., LEE, D. & HANN, C. 2008. Implementation and evaluation of the SPRINT protocol for tight glycaemic control in critically ill patients: a clinical practice change. Crit Care, 12, R49.
CHASE, J. G., SHAW, G. M., LOTZ, T., LECOMPTE, A., WONG, J., LIN, J., LONERGAN, T., WILLACY, M. & HANN, C. E. 2007. Model-based insulin and nutrition administration for tight glycaemic control in critical care. Curr Drug Deliv, 4, 283-96.
DOIG, G. S., SIMPSON, F., FINFER, S., DELANEY, A., DAVIES, A. R., MITCHELL, I. & DOBB, G. 2008. Effect of evidence-based feeding guidelines on mortality of critically ill adults: a cluster randomized controlled trial. JAMA, 300, 2731-41.
EGI, M., BELLOMO, R., STACHOWSKI, E., FRENCH, C. J. & HART, G. 2006. Variability of blood glucose concentration and short-term mortality in critically ill patients. Anesthesiology, 105, 244-52.
FINFER, S., CHITTOCK, D. R., SU, S. Y., BLAIR, D., FOSTER, D., DHINGRA, V., BELLOMO, R., COOK, D., DODEK, P., HENDERSON, W. R., HEBERT, P. C., HERITIER, S., HEYLAND, D. K., MCARTHUR, C., MCDONALD, E., MITCHELL, I., MYBURGH, J. A., NORTON, R., POTTER, J., ROBINSON, B. G. & RONCO, J. J. 2009. Intensive versus conventional glucose control in critically ill patients. N Engl J Med, 360, 1283-97.
GRIESDALE, D. E., DE SOUZA, R. J., VAN DAM, R. M., HEYLAND, D. K., COOK, D. J., MALHOTRA, A., DHALIWAL, R., HENDERSON, W. R., CHITTOCK, D. R., FINFER, S. & TALMOR, D. 2009. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. Cmaj.
HANN, C. E., CHASE, J. G., LIN, J., LOTZ, T., DORAN, C. V. & SHAW, G. M. 2005. Integral-based parameter identification for long-term dynamic verification of a glucose-insulin system model. Comput Methods Programs Biomed, 77, 259-270.
KRINSLEY, J. S. 2004. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc, 79, 992-1000.
KRISHNAN, J. A., PARCE, P. B., MARTINEZ, A., DIETTE, G. B. & BROWER, R. G. 2003. Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes. Chest, 124, 297-305.
KROGH-MADSEN, R., PLOMGAARD, P., KELLER, P., KELLER, C. & PEDERSEN, B. K. 2004. Insulin stimulates interleukin-6 and tumor necrosis factor-alpha gene expression in human subcutaneous adipose tissue. American journal of physiology, 286, E234-8.
LANGOUCHE, L., VANDER PERRE, S., WOUTERS, P. J., D'HOORE, A., HANSEN, T. K. & VAN DEN BERGHE, G. 2007. Effect of intensive insulin therapy on insulin sensitivity in the critically ill. J Clin Endocrinol Metab, 92, 3890-7.
LE COMPTE, A., CHASE, J., LYNN, A., HANN, C., SHAW, G., WONG, X. & LIN, J. 2009. Blood Glucose Controller for Neonatal Intensive Care: Virtual trials development and 1st clinical trials. Journal of Diabetes Science and Technology (JoDST), 3, 1066-1081.
LIN, J., LEE, D., CHASE, J. G., SHAW, G. M., LE COMPTE, A., LOTZ, T., WONG, J., LONERGAN, T. & HANN, C. E. 2008. Stochastic modelling of insulin sensitivity and adaptive glycemic control for critical care. Comput Methods Programs Biomed, 89, 141-52.
LONERGAN, T., LECOMPTE, A., WILLACY, M., CHASE, J. G., SHAW, G. M., WONG, X. W., LOTZ, T., LIN, J. & HANN, C. E. 2006. A Simple Insulin-Nutrition Protocol for Tight Glycemic Control in Critical Illness: Development and Protocol Comparison. Diabetes Technol Ther, 8, 191-206.
LOTZ, T. F., CHASE, J. G., MCAULEY, K. A., LEE, D. S., LIN, J., HANN, C. E. & MANN, J. I. 2006. Transient and steady-state euglycemic clamp validation of a model for glycemic control and insulin sensitivity testing. Diabetes Technol Ther, 8, 338-46.
MARIK, P. E. & RAGHAVAN, M. 2004. Stresshyperglycemia, insulin and immunomodulation in sepsis. Intensive Care Medicine, 30, 748-756.
MARTIN, C. M., DOIG, G. S., HEYLAND, D. K., MORRISON, T. & SIBBALD, W. J. 2004. Multicentre, cluster-randomized clinical trial of algorithms for critical-care enteral and parenteral therapy (ACCEPT). CMAJ, 170, 197-204.
NATALI, A., GASTALDELLI, A., CAMASTRA, S., SIRONI, A. M., TOSCHI, E., MASONI, A., FERRANNINI, E. & MARI, A. 2000. Dose-response characteristics of insulin action on glucose metabolism: a non-steady-state approach. Am J Physiol Endocrinol Metab, 278, E794-801.
PREISER, J. C., DEVOS, P., RUIZ-SANTANA, S., MELOT, C., ANNANE, D., GROENEVELD, J., IAPICHINO, G., LEVERVE, X., NITENBERG, G., SINGER, P., WERNERMAN, J., JOANNIDIS, M., STECHER, A. & CHIOLERO, R. 2009. A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study. Intensive Care Med, 35, 1738-1748.
QUANIERS, J. M., LERUTH, J., ALBERT, A., LIMET, R. R. & DEFRAIGNE, J. O. 2006. Comparison of inflammatory responses after off-pump and on-pump coronary surgery using surface modifying additives circuit. Ann Thorac Surg, 81, 1683-90.
SUHAIMI, F., LE COMPTE, A., PREISER, J. C., SHAW, G. M., MASSION, P., RADERMECKER, R., PRETTY, C., LIN, J., DESAIVE, T. & CHASE, J. G. 2010. What Makes Tight Glycemic Control (TGC) Tight? The impact of variability and nutrition in 2 clinical studies. Journal of Diabetes Science and Technology, 4, 284-298.
VAN DEN BERGHE, G., WOUTERS, P., WEEKERS, F., VERWAEST, C., BRUYNINCKX, F., SCHETZ, M., VLASSELAERS, D., FERDINANDE, P., LAUWERS, P. & BOUILLON, R. 2001. Intensive insulin therapy in the critically ill patients. N Engl J Med, 345, 1359-1367.
WEEKERS, F., GIULIETTI, A. P., MICHALAKI, M., COOPMANS, W., VAN HERCK, E., MATHIEU, C. & VAN DEN BERGHE, G. 2003. Metabolic, endocrine, and immune effects of stress hyperglycemia in a rabbit model of prolonged critical illness. Endocrinology, 144, 5329-38.
WILSON, M., WEINREB, J. & HOO, G. W. 2007. Intensive insulin therapy in critical care: a review of 12 protocols. Diabetes Care, 30, 1005-11.
