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Stochastic targeted (STAR) glycemic control: design, safety, and performance
Alicia Evans1, Aaron Le Compte, Chia-Siong Tan
1Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Christchurch, New Zealand.
Journal of Diabetes Science and Technology
|March 10, 2012
Summary
The Stochastic TARgeted (STAR) approach improves tight glycemic control (TGC) by managing patient variability. This model-based method reduces clinical workload by up to 30% while maintaining safety and efficacy in virtual and pilot trials.
Area of Science:
- Critical care medicine
- Endocrinology
- Biomedical engineering
Background:
- Tight glycemic control (TGC) is beneficial but challenging to achieve consistently.
- STAR (Stochastic TARgeted) is a model-based TGC approach accounting for patient variability.
- STAR aims for a maximum 5% risk of blood glucose (BG) below 72 mg/dl.
Purpose of the Study:
- Assess the safety, efficacy, and clinical burden of the STAR TGC controller.
- Evaluate STAR's performance in modulating insulin and nutrition inputs.
- Validate STAR in virtual and clinical pilot trials.
Main Methods:
- Clinically validated virtual trials using data from 370 patients (SPRINT study).
- STAR protocol designed and tested for safety, performance, and clinical effort.
- Insulin and nutrition interventions administered every 1-3 hours, guided by computer models of metabolism.
Main Results:
- STAR demonstrated similar glycemic control to SPRINT with reduced measurement intervals.
- Improved safety from hypoglycemia observed with STAR.
- STAR reduced clinical burden by up to 30% compared to SPRINT.
Conclusions:
- STAR TGC effectively manages intra- and interpatient variability for tight glycemic control.
- STAR minimizes hypoglycemia risk (max 5%) within a target glycemic band.
- Clinical pilot trials confirmed or surpassed virtual trial results, showing reduced workload and effective control.
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