Estimating Increased EGP During Stress Response in Critically Ill Patients
Jennifer J Ormsbee1, Jennifer L Knopp1, J Geoffrey Chase1
1Department of Mechanical Engineering, Centre for Bioengineering, University of Canterbury, Christchurch, New Zealand.
Journal of Diabetes Science and Technology
|June 2, 2020
Summary
Critically ill patients with stress hyperglycemia benefit from glycemic control (GC). This study shows a population EGP value is sufficient for most patients, but some need adjusted models due to extreme stress responses.
Area of Science:
- Critical Care Medicine
- Endocrinology
- Pharmacokinetics
Background:
- Stress-induced hyperglycemia is common in critically ill patients.
- Effective glycemic control (GC) improves outcomes in intensive care units (ICUs).
- Model-based GC requires accurate parameter assumptions, including endogenous glucose production (EGP).
Purpose of the Study:
- To explore endogenous glucose production (EGP) variability in critically ill patients.
- To assess the adequacy of a population-based parameter for EGP in ICU glycemic control models.
- To investigate the impact of stress response on EGP.
Main Methods:
- Hourly insulin sensitivity (SI) was calculated from clinical data of 145 ICU patients.
- Lower bounds were imposed on SI to estimate EGP during potential stress responses.
- Minimum EGP and event durations were analyzed.
Main Results:
- Constrained EGP events occurred in 1.6% of patient hours, primarily within the first 12 hours and without nutrition.
- Estimated EGP ranged from 1.16 to 2.75 mmol/min, with most below 1.5 mmol/min.
- The current population EGP value of 1.16 mmol/min was sufficient for over 98% of patient hours.
Conclusions:
- A population EGP value is generally adequate for ICU glycemic control.
- A small subset of patients exhibits significantly elevated EGP, likely due to severe early-stage stress responses.
- Further investigation into EGP variability in extreme stress is warranted.
Keywords:
EGPcritical illnessendogenous glucose productionglycemic controlhyperglycemiainsulin resistanceinsulin sensitivityphysiological stressMore Related Videos
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