Publication: Estimating Enhanced Endogenous Glucose Production in Intensive Care Unit Patients with Severe Insulin Resistance
Date
2022
Authors
Yahia A.
Szl�vecz �.
Knopp J.L.
Norfiza Abdul Razak N.
Abu Samah A.
Shaw G.
Chase J.G.
Benyo B.
Journal Title
Journal ISSN
Volume Title
Publisher
SAGE Publications Inc.
Abstract
Background: Critically ill ICU patients frequently experience acute insulin resistance and increased endogenous glucose production, manifesting as stress-induced hyperglycemia and hyperinsulinemia. STAR (Stochastic TARgeted) is a glycemic control protocol, which directly manages inter- and intra- patient variability using model-based insulin sensitivity (SI). The model behind STAR assumes a population constant for endogenous glucose production (EGP), which is not otherwise identifiable. Objective: This study analyses the effect of estimating EGP for ICU patients with very low SI (severe insulin resistance) and its impact on identified, model-based insulin sensitivity identification, modeling accuracy, and model-based glycemic clinical control. Methods: Using clinical data from 717 STAR patients in 3 independent cohorts (Hungary, New Zealand, and Malaysia), insulin sensitivity, time of insulin resistance, and EGP values are analyzed. A method is presented to estimate EGP in the presence of non-physiologically low SI. Performance is assessed via model accuracy. Results: Results show 22%-62% of patients experience 1+ episodes of severe insulin resistance, representing 0.87%-9.00% of hours. Episodes primarily occur in the first 24 h, matching clinical expectations. The Malaysian cohort is most affected. In this subset of hours, constant model-based EGP values can bias identified SI and increase blood glucose (BG) fitting error. Using the EGP estimation method presented in these constrained hours significantly reduced BG fitting errors. Conclusions: Patients early in ICU stay may have significantly increased EGP. Increasing modeled EGP in model-based glycemic control can improve control accuracy in these hours. The results provide new insight into the frequency and level of significantly increased EGP in critical illness. � 2021 Diabetes Technology Society.
Description
glucose; glucose; insulin; adult; Article; blood glucose monitoring; cohort analysis; critically ill patient; disease simulation; female; finite element analysis; gluconeogenesis; glucose blood level; glycemic control; human; Hungary; hyperglycemia; hyperinsulinemia; insulin resistance; insulin sensitivity; intensive care unit; major clinical study; Malaysia; male; New Zealand; physiological stress; simulation; critical illness; hyperglycemia; intensive care; intensive care unit; procedures; Blood Glucose; Critical Care; Critical Illness; Glucose; Humans; Hyperglycemia; Insulin; Insulin Resistance; Intensive Care Units