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On the problem of patient-specific endogenous glucose production in neonates on stochastic targeted glycemic control

Jennifer L Dickson1, James N Hewett, Cameron A Gunn

  • 1Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand. jennifer.dickson@pg.canterbury.ac.nz

Journal of Diabetes Science and Technology
|August 6, 2013
PubMed

Insights

Endogenous glucose production (EGP) in extremely low birth weight (ELBW) neonates is difficult to quantify. Modeling EGP as a population constant improves glycemic control in neonatal intensive care units.

Area of Science:

  • Neonatalogy
  • Endocrinology
  • Metabolic Research

Background:

  • Stress and prematurity can cause hyperglycemia in neonates, worsening outcomes.
  • Endogenous glucose production (EGP) contributes to blood glucose (BG) levels.
  • Quantifying EGP in extremely low birth weight (ELBW) neonates is challenging due to their fragility.

Purpose of the Study:

  • To investigate trends in EGP in preterm infants.
  • To evaluate the impact of EGP variability on glycemic control models.
  • To determine if EGP can be modeled as a population constant.

Main Methods:

  • Literature review for metabolic and EGP data in preterm infants (GA <32 weeks, BW <2 kg).
  • Analysis of EGP trends with birth weight, gestational age, BG, insulin, and glucose infusion (GI) rates.
  • Comparison of population-constant EGP models with virtual trials on retrospective clinical data.

Main Results:

  • No clear EGP relationship found with birth weight, gestational age, or plasma insulin.
  • Evidence suggests EGP suppression with increasing GI or BG.
  • Population-constant EGP models demonstrated the best fit and tighter control in virtual trials.

Conclusions:

  • EGP variation is difficult to quantify and can be modeled as a population constant for neonatal insulin-nutrition-glucose models.
  • ELBW hyperglycemic preterm neonates appear to have unsuppressed EGP in the higher range.
  • Accurate EGP modeling is crucial for optimizing glycemic control in vulnerable neonates.
Abstract

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