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Journal of Healthcare Engineering
Volume 3, Issue 3, Pages 415-430
http://dx.doi.org/10.1260/2040-2295.3.3.415
Research Article

Improving Safety of Glucose Control in Intensive Care using Virtual Patients and Simulated Clinical Trials

Liam M. Fisk,1 Aaron J. Le Compte,1 Geoffrey M. Shaw,2 and J. Geoffrey Chase1

1Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
2Department of Intensive Care, Christchurch Hospital, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand

Received 1 November 2011; Accepted 1 April 2012

Copyright © 2012 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Despite the potential clinical benefits of normalizing blood glucose in critically ill patients, the risk of hypoglycemia is a major barrier to widespread clinical adoption of accurate glycemic control. To compare five glucose control protocols, a validated insulin-glucose system model was employed to perform simulated clinical trials. STAR, SPRINT, UNC, Yale and Glucontrol protocols were assessed over a medical-surgical intensive care unit patient cohort. Results were interpreted separately for patients with low to high sensitivity to insulin, and low to high variability in metabolic state. STAR and SPRINT provided good glucose control with risk of severe hypoglycemia less than 0.05% across all patient groups. UNC also achieved good control for patients with low and medium levels of insulin sensitivity (SI), but risk of severe hypoglycemia was raised for patients with high SI. Glucontrol showed degradation of performance for patients with high metabolic variability.