Improving glycemic control in critically ill patients: personalized care to mimic the endocrine pancreas

  title={Improving glycemic control in critically ill patients: personalized care to mimic the endocrine pancreas},
  author={J. Geoffrey Chase and Thomas Desaive and Julien Boh{\'e} and Miriam Cnop and Christophe E M De Block and Jan Gunst and Roman Hovorka and Pierre Kalfon and James S. Krinsley and Eric Renard and Jean-Charles Preiser},
  journal={Critical Care},
There is considerable physiological and clinical evidence of harm and increased risk of death associated with dysglycemia in critical care. However, glycemic control (GC) currently leads to increased hypoglycemia, independently associated with a greater risk of death. Indeed, recent evidence suggests GC is difficult to safely and effectively achieve for all patients. In this review, leading experts in the field discuss this evidence and relevant data in diabetology, including the artificial… 

The Long and Winding Road to Personalized Glycemic Control in the Intensive Care Unit.

  • M. Tickoo
  • Medicine
    Seminars in respiratory and critical care medicine
  • 2019
The pathophysiology and downstream effects of altered glycemic response in critical illness, management of glycemic control in the ICU, and future strategies toward personalization of critical care glycemic management are discussed.

Glucose control in the ICU.

Tight glucose control is well tolerated and effective in patients receiving early parenteral nutrition when provided with a protocol that includes frequent, accurate glucose measurements and avoids large glucose fluctuations.

STAR-Liège Clinical Trial Interim Results: Safe and Effective Glycemic Control for All

Interim results of the fully computerized model-based Stochastic TARgeted (STAR) glycemic control framework at the University Hospital of Liège, Belgium show the possibility to achieve safe, effective control for all patients using STAR, and suggest gly glucose control to lower targets could be beneficial.

Insulin sensitivity in critically ill patients: are women more insulin resistant?

Given equivalent intra-patient variability and significantly greater insulin resistance, females can receive the same benefit from safe, effective GC as males, but may require higher insulin doses to achieve the same glycaemia.

Estimating Enhanced Endogenous Glucose Production in Intensive Care Unit Patients with Severe Insulin Resistance

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 and provides new insight into the frequency and level of significantly increased EGP in critical illness.


The results points at the feasibility of the network to act as an effective classifier using intensive care units data, and glycemic control performance to be the basis of a probabilistic, personalized, and automated decision support in theintensive care units.



Safety, efficacy and clinical generalization of the STAR protocol: a retrospective analysis

STAR outperformed its predecessor, SPRINT, by providing higher nutrition and equally safe, effective control for all the days of patient stay, while lowering the number of measurements and interventions required.

Continuous glucose monitoring in the ICU: clinical considerations and consensus

Some of the evidence supporting different glucose targets in various groups of patients are considered, focusing on those with and without diabetes and neurological ICU patients.

Technical Challenges and Clinical Outcomes of Using a Closed-Loop Glycemic Control System in the Hospital

The goal of the team was to use the STG closed-loop glycemic control system for perioperative TGC in surgical patients to solve the complications of IIT and reduce risk of hypoglycemia.

A simple insulin-nutrition protocol for tight glycemic control in critical illness: development and protocol comparison.

Tight control was achieved in simulation using a protocol that is easy to implement in an intensive care unit and effective in achieving and maintaining normoglycemia in critical illness.

Physiological modeling, tight glycemic control, and the ICU clinician: what are models and how can they affect practice?

The concept of model-based therapeutics, the use of computational models in clinical medicine and critical care in specific, as well as its potential clinical advantages, are presented in a format designed for the clinical perspective.

Pilot proof of concept clinical trials of Stochastic Targeted (STAR) glycemic control

Performance and safety exceed that of SPRINT, which reduced mortality and cost in the Christchurch ICU, and clinical workload is reduced more than 20% compared with SPRINT.

Computerization of the Yale insulin infusion protocol and potential insights into causes of hypoglycemia with intravenous insulin.

The incidence of hypoglycemia in this study was lower than the control group of the NICE-SUGAR study and are supportive of the new Society of Critical Care guidelines to target BG levels of 100-150 mg/dL in critically ill patients.