Abstract
Objective: Present a new model-based tight glycaemic control approach using variable insulin and nutrition administration. Background: Hyperglycaemia is prevalent in critical care. Current published protocols use insulin alone to reduce blood glucose levels, require significant added clinical effort, and provide highly variable results. None directly address both the practical clinical difficulties and significant patient variation seen in general critical care, while also providing tight control. Methods: The approach presented manages both nutritional inputs and exogenous insulin infusions using tables simplified from a modelbased, computerised protocol. Unique delivery aspects include bolus insulin delivery for safety and variable enteral nutrition rates. Unique development aspects include the use of simulated virtual patient trials created from retrospective data. The model, protocol development, and first 50 clinical case results are presented. Results: High qualitative correlation to within +/-10% between simulated virtual trials and published clinical results validates the overall approach. Pilot tests covering 7358 patient hours produced an average glucose of 5.9 +/- 1.1 mmol/L. Time in the 4-6.1 mmol/L band was 59%, with 84% in 4.0-7.0 mmol/L, and 92% in 4.0-7.75 mmol/L. The average feed rate was 63% of patient specific goal feed and the average insulin dose was 2.6U/hour. There was one hypoglycaemic measurement of 2.1 mmol/L. No departures from protocol or clinical interventions were required at any time. Summary: Modulating both low dose insulin boluses and nutrition input rates challenges the current practice of using only insulin in larger doses to reduce hyperglycaemic levels. Clinical results show very tight control in safe glycaemic bands. The approach could be readily adopted in any typical ICU.
Keywords: hyperglycaemia, SPRINT Protocol, APACHE II score, Virtual Trial, blood glucose
Current Drug Delivery
Title: Model-Based Insulin and Nutrition Administration for Tight Glycaemic Control in Critical Care
Volume: 4 Issue: 4
Author(s): J. Geoffrey Chase, Geoffrey M. Shaw, Thomas Lotz, Aaron LeCompte, Jason Wong, Jessica Lin, Timothy Lonergan, Michael Willacy and Christopher E. Hann
Affiliation:
Keywords: hyperglycaemia, SPRINT Protocol, APACHE II score, Virtual Trial, blood glucose
Abstract: Objective: Present a new model-based tight glycaemic control approach using variable insulin and nutrition administration. Background: Hyperglycaemia is prevalent in critical care. Current published protocols use insulin alone to reduce blood glucose levels, require significant added clinical effort, and provide highly variable results. None directly address both the practical clinical difficulties and significant patient variation seen in general critical care, while also providing tight control. Methods: The approach presented manages both nutritional inputs and exogenous insulin infusions using tables simplified from a modelbased, computerised protocol. Unique delivery aspects include bolus insulin delivery for safety and variable enteral nutrition rates. Unique development aspects include the use of simulated virtual patient trials created from retrospective data. The model, protocol development, and first 50 clinical case results are presented. Results: High qualitative correlation to within +/-10% between simulated virtual trials and published clinical results validates the overall approach. Pilot tests covering 7358 patient hours produced an average glucose of 5.9 +/- 1.1 mmol/L. Time in the 4-6.1 mmol/L band was 59%, with 84% in 4.0-7.0 mmol/L, and 92% in 4.0-7.75 mmol/L. The average feed rate was 63% of patient specific goal feed and the average insulin dose was 2.6U/hour. There was one hypoglycaemic measurement of 2.1 mmol/L. No departures from protocol or clinical interventions were required at any time. Summary: Modulating both low dose insulin boluses and nutrition input rates challenges the current practice of using only insulin in larger doses to reduce hyperglycaemic levels. Clinical results show very tight control in safe glycaemic bands. The approach could be readily adopted in any typical ICU.
Export Options
About this article
Cite this article as:
Chase Geoffrey J., Shaw M. Geoffrey, Lotz Thomas, LeCompte Aaron, Wong Jason, Lin Jessica, Lonergan Timothy, Willacy Michael and Hann E. Christopher, Model-Based Insulin and Nutrition Administration for Tight Glycaemic Control in Critical Care, Current Drug Delivery 2007; 4 (4) . https://dx.doi.org/10.2174/156720107782151223
DOI https://dx.doi.org/10.2174/156720107782151223 |
Print ISSN 1567-2018 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-5704 |
Call for Papers in Thematic Issues
Advancements in Robotic and AI-based Drug Discovery and Delivery for Neurological Disorders
Neurological disorders, including Alzheimer's disease, Parkinson's disease, epilepsy, and brain tumors, pose significant challenges in drug delivery due to the blood-brain barrier's intricate structure and the complexity of neuronal networks. Traditional drug delivery methods often fall short in reaching therapeutic concentrations within the central nervous system, limiting treatment efficacy and ...read more
Electrospun Fibers as Drug Delivery Systems
In recent years, electrospun fibers have attracted considerable attention as potential platforms for drug delivery due to their distinctive properties and adaptability. These fibers feature a notable surface area-to-volume ratio and can be intentionally designed with high porosity, facilitating an increased capacity for drug loading and rendering them suitable for ...read more
Emerging Nanotherapeutics for Mitigation of Neurodegenerative Disorders
Conditions affecting the central nervous system (CNS) present a significant hurdle due to limited access of both treatments and diagnostic tools for the brain. The blood-brain barrier (BBB) acts as a barrier, restricting the passage of molecules from the bloodstream into the brain. The most formidable challenge facing scientists is ...read more
Extracellular vesicles as drug delivery systems
Extracellular vesicles (EVs) are membranous vesicles released from almost all types of cells into extracellular space. EVs are categorized into different types including exosome (~30-150 nm), microvesicle or microparticle (~100-1,000 nm), apoptotic body (~1,000-5,000 nm), and others produced by different mechanisms. Since EVs bear the molecules (e.g., specific lipids, carbohydrates, ...read more
![Wayfinder Image](/images/wayfinder.jpg)
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
Related Articles
-
Overview of Current and Upcoming Strategies Implied for the Therapy of Type 2 Diabetes Mellitus
Current Diabetes Reviews Fatal Lactic Acidosis Precipitated by Nifedipine in a Patient Treated with Disulfiram and Antiretrovirals
Drug Metabolism Letters Erythropoietin and Oxidative Stress
Current Neurovascular Research Disturbance of Inorganic Phosphate Metabolism in Diabetes Mellitus: Its Impact on the Development of Diabetic Late Complications
Current Diabetes Reviews Polyphenols: Potential Future Arsenals in the Treatment of Diabetes
Current Pharmaceutical Design Empagliflozin-A Sodium Glucose Co-transporter-2 Inhibitor: Overview of its Chemistry, Pharmacology, and Toxicology
Current Diabetes Reviews Brain Endothelial Cell-Cell Junctions: How to “Open” the Blood Brain Barrier
Current Neuropharmacology Applications and Limitations of Genetically Modified Mouse Models in Drug Discovery and Development
Current Drug Metabolism Cardio-Protective Effects of Sodium-Glucose Co-Transporter 2 Inhibitors: Focus on Heart Failure
Current Pharmaceutical Design Renoprotective Effects of SGLT2 Inhibitors: Beyond Glucose Reabsorption Inhibition
Current Vascular Pharmacology Clinical and Forensic Signs Related to Opioids Abuse
Current Drug Abuse Reviews Progress in the Diagnosis and Treatment of Pulmonary Aspergillosis
Current Respiratory Medicine Reviews Progress of Oral Insulin and Related Drug Delivery Systems and their Pharmacokinetics
Current Drug Metabolism Catatonia: A Brief Update
Current Psychiatry Reviews Alcoholisms Evolutionary and Cultural Origins
Current Drug Abuse Reviews Pregnancy Complicated by the Most Frequent Forms of Maturity Onset Diabetes of the Young: A Narrative Review on Its Pharmacological Implications
Current Reviews in Clinical and Experimental Pharmacology The Effects of Obesity on Bone Turnover Markers in Diabetic Patients with Diabetic Ketosis or Ketoacidosis
Endocrine, Metabolic & Immune Disorders - Drug Targets The Heme Oxygenase System and Type-1 Diabetes
Current Pharmaceutical Design Clinical Management of Diabetes Mellitus in the Older Adult Patient
Current Diabetes Reviews Exercise and Nutraceuticals: Eminent Approach for Diabetic Neuropathy
Current Molecular Pharmacology