Tight Glycemic Control Can Be Achieved in Adult ICU Patients Safely: Results From a 5-Year Single-Center...

Area of Science:

• Intensive Care Medicine
• Endocrinology
• Biomedical Engineering

Background:

• Glycemic control (GC) in intensive care units (ICUs) is challenging due to patient variability.
• Existing GC protocols are often criticized for increased hypoglycemia risk, hindering adoption.
• The Stochastic TARgeted (STAR) framework offers a patient-specific, risk-based approach to GC, integrating insulin and nutrition management.

Purpose of the Study:

• To assess the safety and effectiveness of the STAR GC framework in a large cohort of ICU patients.
• To evaluate STAR GC's ability to manage inter- and intra-patient variability.
• To determine the impact of STAR GC on hypoglycemia rates and nutrition delivery.

Main Methods:

• A prospective study was conducted at Christchurch Hospital ICU, New Zealand.
• Patients were treated with the STAR GC protocol between April 2019 and December 2024.
• Data analysis focused on GC performance, patient safety (hypoglycemia), and nutritional support outcomes.

Main Results:

• 71% of blood glucose measurements fell within the target range across 1430 STAR GC episodes (86,010 hours of control).
• A low rate of severe hypoglycemia (0.21%) was observed, with most events unrelated to the control protocol.
• High median nutrition delivery (89.0% of goal) was achieved concurrently with effective glycemic management.

Conclusions:

• The STAR GC framework demonstrates safe and effective glycemic control in a diverse ICU population.
• The protocol's adaptability to individual patient needs supports its broader implementation in ICUs.
• STAR GC facilitates future research on the clinical outcomes associated with improved glycemic management.