Diabetes technology & therapeutics
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Diabetes Technol. Ther. · Apr 2006
Comparative Study Clinical TrialA simple insulin-nutrition protocol for tight glycemic control in critical illness: development and protocol comparison.
Hyperglycemia is prevalent in critical care, and tight control can significantly reduce mortality. However, current protocols have been considered taxing to administer and may require extra staff. In addition, increased insulin resistance and saturation effects limit the level of control possible using insulin alone. Thus, regulating both insulin and exogenous nutritional inputs is required to control blood glucose. ⋯ Tight control was achieved in simulation using a protocol that is easy to implement in an intensive care unit. Similarly tight control was also maintained during the two proof-of-concept clinical trials. Measurement frequency of 1-2 h is seen to be critical to achieving and maintaining tight control. The overall SPRINT protocol is easy to use for clinical staff and effective in achieving and maintaining normoglycemia in critical illness.
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Diabetes Technol. Ther. · Apr 2006
Case Reports Clinical TrialA novel, model-based insulin and nutrition delivery controller for glycemic regulation in critically ill patients.
Critically ill patients are often hyperglycemic and insulin resistant, as well as highly dynamic. Tight glucose control has been shown to significantly reduce mortality in critical care. A physiological model of the glucose-insulin regulatory system is improved and used to develop an adaptive control protocol utilizing both nutritional and insulin inputs to control hyperglycemia. The approach is clinically verified in a critical care patient cohort. ⋯ Tight, targeted stepwise regulation was exhibited in all trials. Overall, tight glycemic regulation is achieved in a broad critical care cohort with optimized insulin and nutrition delivery, effectively managing glycemia even with high effective insulin resistance.