Model-based glycemic control in a Malaysian intensive care unit: performance and safety study

Area of Science:

• Critical Care Medicine
• Endocrinology
• Health Informatics

Background:

• Stress-induced hyperglycemia is a frequent complication in critically ill patients.
• Model-based glycemic control, such as the STAR protocol, offers a potential solution.
• The STAR protocol has been utilized in intensive care units (ICUs) internationally since 2010.

Purpose of the Study:

• To pilot test the STAR protocol's performance and safety in a Malaysian ICU.
• To assess the adaptability of the model-based glycemic control framework in a new healthcare environment.
• To evaluate the feasibility of implementing automated glycemic control in the International Islamic University Malaysia Medical Centre (IIUMMC) Hospital ICU.

Main Methods:

• A pilot trial involving 142 patients who underwent STAR protocol treatment for over 20 hours.
• Analysis of blood glucose measurements to assess performance within target bands and incidence of hypoglycemia.
• Evaluation of clinical staff preferences and treatment intervention frequency.

Main Results:

• 60.7% of blood glucose measurements fell within the target range.
• Hypoglycemia rates were low, with 0.78% below 4.0 mmol/L and 0.02% below 2.2 mmol/L.
• While nurses found the protocol beneficial for workload reduction, performance indicated a need for control setting adjustments.

Conclusions:

• The STAR protocol demonstrated success in achieving patient-specific glycemic control and ensuring safety.
• The protocol was well-received by nursing staff, contributing to reduced workload.
• Performance data suggests that modifications to the control settings are necessary for optimal adaptation to the Malaysian context.