Model-Based Glycaemic Control in Multicentre ICUs within Diabetic Patients: In-silico Analysis

Abstract

Sliding-scale insulin therapy has been vastly used for glycaemic control but dysglycaemia remains high. Model-based glycaemic control that incorporates insulin nutrition protocol was proposed as this therapy provides personalized care to avoid dysglycaemia. Thus, this paper aims to implement in-silico simulation and identify which model-based control protocols yield better protocol within ICU diabetic patients based on performance and safety. Multicentre ICU patients of 282 were divided into diabetes mellitus (DM) and non-diabetes mellitus (NDM) cohort where in-silico simulations were done using Specialised Relative Insulin Nutrition Therapy (SPRINT), SPRINT+Glargine and Stochastic Targeted (STAR) protocols. Performance was verified based on the percentage of blood glucose (BG) time in band (TIB) 6.0 – 10.0 mmol/L and safety with number of mild and severe hypoglycaemia episodes. Among the three protocols, STAR protocol showed the highest median and interquartile range % BG TIB 6.0 – 10.0 mmol/L for DM and NDM patients with 71.6 % [57.9 – 79.8] and 77.4 % [62.9 – 88.8]. The number of hypoglycaemia episodes are the lowest in DM and NDM patients too compared to other protocols. These advantages show that STAR protocol can provide better patient outcomes for glycaemic control with personalized care.