Related Experiment Video
Updated: May 20, 2025
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
In-silico assessment of longer measurement intervals in glycaemic control to match clinical practice
Marie Seret1, Vincent Uyttendaele1, J Geoffrey Chase2
1Model-based therapeutics, GIGA Institute, University of Liège, Allée Du 6 Août 19, Bât. B5a, 4000 Liège, Belgium.
Background And Objective:
STAR is a patient-specific glycaemic control (GC) framework accounting for both inter- and intra- patient variability to modulate insulin and nutrition in ICU patients. While providing safe, effective control to all patient, the workload induced by STAR represents a clinical burden in some ICUs. This study aims at extending the treatment interval of STAR from 1-3 hourly to 1-6 hourly to reduce the workload associated with STAR and assessing the impact on GC outcomes using virtual trials.
Methods:
Retrospective data form 606 patients are used to create virtual patients. Insulin sensitivity is identified for each patient using a physiological model and used to build and validate the new stochastic models to provide up to 6-hourly predictions using five-fold cross-validation. Virtual trials are performed and safety, performance, nutrition intake and workload are compared and analysed.
Results:
The extended STAR protocol 1-6 hourly measurement interval still provided high control safety and efficacy. Results showed slightly reduced %BG within the safe target band 4.4-8.0 mmol/L (from 83.8 to 81.4 %) as the measurement interval increased. It also resulted in an increased risk of hyper- (from 14.5 to 16.9 %BG > 8.0 mmol/L) and severe hypo- (from 0.03 to 0.05 %BG < 2.2 mmol/L) glycaemia. Insulin and nutrition rates decreased (from 3.5 [2.0 5.0] to 2.5 [1.7 3.0] U/h and from 100 [85 100] to 89 [71 100] % goal feed (GF) respectively). The workload was significantly reduced from 12 to 8 measurements per day.
Conclusions:
The workload was successfully reduced by extending the measurement interval, approaching clinical practice. High performance and safety are achieved. However, the results also highlight a clear risk and reward trade-off in glycaemic control with the increased risk of hyper- and hypo- glycaemia and the reduced nutrition rates. Choosing an intermediate measurement interval could be an interesting solution. Clinical trials should be conducted to further confirm those results and consider the adoption of longer treatment intervals in STAR GC framework.
