Abstract
Objective
To investigate the effectiveness of an enhanced software Model Predictive Control (eMPC) algorithm for intravenous insulin infusion, targeted at tight glucose control in critically ill patients, over 72 h, in two intensive care units with different management protocols.
Design
Comparison with standard care in a two center open randomized clinical trial.
Setting
Two adult intensive care units in University Hospitals.
Patients and participants
Thirty-four critically ill patients with hyperglycaemia (glucose >120 mg/dL) or already receiving insulin infusion.
Interventions
Patients were randomized, within each ICU, to intravenous insulin infusion advised by eMPC algorithm or the ICU’s standard insulin infusion administration regimen.
Measurements and results
Arterial glucose concentration was measured at study entry and when advised by eMPC or measured as part of standard care. Time-weighted average glucose concentrations in patients receiving eMPC advised insulin infusions were similar [104 mg/dL (5.8 mmol/L)] in both ICUs. eMPC advised glucose measurement interval was significantly different between ICUs (1.1 vs. 1.8 h, P < 0.01). The standard care insulin algorithms resulted in significantly different time-weighted average glucose concentrations between ICUs [128 vs. 99 mg/dL (7.1 vs. 5.5 mmol/L), P < 0.01].
Conclusions
In this feasibility study the eMPC algorithm provided similar, effective and safe tight glucose control over 72 h in critically ill patients in two different ICUs. Further development is required to reduce glucose sampling interval while maintaining a low risk of hypoglycaemia.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345:1359–1367
Van den Berghe G, Wouters PJ, Bouillon R, Weekers F, Verwaest C, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P (2003) Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med 31:359–366
Krinsley JS (2004) Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc 79:992–1000 (Erratum 80:1101)
Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, Van Wijngaerden E, Bobbaers H, Bouillon R (2006) Intensive insulin therapy in the medical ICU. N Engl J Med 354:449–461
Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A (2003) Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 125:1007–1021
Pittas AG, Siegel RD, Lau J (2006) Insulin therapy and in-hospital mortality in critically ill patients: systematic review and meta-analysis of randomized controlled trials. JPEN 30:164–172
Cheung NW, Wong VW, McLean M (2006) The hyperglycemia: intensive insulin infusion in infarction (HI-5) study: a randomized controlled trial of insulin infusion therapy for myocardial infarction. Diabetes Care 29:765–770
CLINICIP. Available online at: http://www.clinicip.org. Accessed 12 March 2007
Plank J, Blaha J, Cordingley J, Wilinska ME, Chassin LJ, Morgan C, Squire S, Haluzik M, Svacina S, Toller W, Plasnik A, Ellmerer M, Hovorka R, Pieber TR (2006) Multicentric, randomized, controlled trial to evaluate blood glucose control by the model predictive control algorithm versus routine glucose management protocols in intensive care unit patients. Diabetes Care 29:271–276
Cordingley J, Vlaselaers D, Hovorka R, Dormand N, Wouters P, Chassin L, Squire S, Wilinska M, Morgan C, Van den Berghe G (2007) Tight glycaemic control in critically ill patients: two centre trial of enhanced model predictive algorithm versus standard care. Intensive Care Med 33(Suppl 2):190
Hovorka R, Chassin LJ, Wilinska ME, Canonico V, Akwi JA, Federici MO, Massi-Benedetti M, Hutzli I, Zaugg C, Kaufmann H, Both M, Vering T, Schaller HC, Schaupp L, Bodenlenx M, Pieber TR (2004) Closing the loop: the Adicol experience. Diabetes Technol Ther 6:307–318
Hovorka R (2006) Continuous glucose monitoring and closed-loop systems. Diabet Med 23:1–12
Vogelzang M, van der Horst IC, Nijsten MW (2004) Hyperglycaemic index as a tool to assess glucose control: a retrospective study. Crit Care 8:R122–R127
Van den Berghe G (2004) How to compare adequacy of algorithms to control blood glucose in the intensive care unit? Crit Care 8:151–152
Rood E, Bosman RJ, van der Spoel JI, Taylor P, Zandstra DF (2005) Use of a computerized guideline for glucose regulation in the intensive care unit improved both guideline adherence and glucose regulation. J Am Med Inform Assoc 12:172–180
Thomas AN, Marchant AE, Ogden MC, Collin S (2005) Implementation of a tight glycaemic control protocol using a web-based insulin dose calculator. Anaesthesia 60:1093–1100
Davidson PC, Steed RD, Bode BW (2005) Glucomander. Diabetes Care 28:2418–2423
Vogelzang M, Zijlstra F, Nijsten W (2005) Design and implementation of GRIP: a computerized glucose control system at a surgical intensive care unit. BMC Med Inform Decis Mak 5:38
Wong XW, Chase JG, Shaw JM, Hann CE, Lotz T, Singh-Levett I, Hollingsworth LJ, Wong OS, Andreassen S (2006) Model predictive glycaemic regulation in critical illness using insulin and nutrition input: a pilot study. Med Eng Phys 28:665–681
Acknowledgments
The authors wish to thank the patients, nurses, doctors, clinical engineers and allied health professionals in both ICUs for their support in undertaking this study. The CLINICIP project is supported by an EC 6th Framework Programme grant.
Author information
Authors and Affiliations
Corresponding author
Additional information
An erratum to this article can be found at http://dx.doi.org/10.1007/s00134-008-1342-y
Rights and permissions
About this article
Cite this article
Cordingley, J.J., Vlasselaers, D., Dormand, N.C. et al. Intensive insulin therapy: enhanced Model Predictive Control algorithm versus standard care. Intensive Care Med 35, 123–128 (2009). https://doi.org/10.1007/s00134-008-1236-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-008-1236-z