Randomized Controlled Trial to Evaluate Blood Glucose Control by the Model Predictive Control Algorithm with Variable Sampling Rate (eMPC) vs. Routine Glucose Management Protocol in Peri- and Post-Operative Period in Cardiac Surgery Patients

Haluzik, Martin; Kremen, Jaromir; Blaha, Jan; Matias, Michal; Kopecky, Petr; Rulisek, Jan; Bosanska, Lenka; Roubicek, Tomas; Anderlova, Katerina; Chassin, Ludovic J.; Hovorka, Roman; Svacina, Stepan
June 2007
Diabetes;Jun2007 Supplement 1, Vol. 56, pA66
Academic Journal
Increased blood glucose levels frequently occur in critically ill patients. Numerous studies have shown that its normalization by intensive insulin treatment markedly improve their outcome. The aim of our study was to compare blood glucose control by the fully automated model predictive control algorithm with variable sampling rate (eMPC) with routine glucose management protocol (RMP) in peri- and postoperative period in cardiac surgery patients. 60 patients (43 men and 17 women; mean age 68±10 years; mean BMI 27.2±4.6 kg/m²) were included into the study, 30 were randomized for treatment using eMPC algorithm and 30 using RMP. All patients underwent elective cardiac surgery and were treated with continuous insulin infusion to maintain euglycemia (target range 4.4 - 6.1 mmol/l). Blood glucose was measured in 1-4 hour intervals depending on request of each algorithm during surgery and post-operation period for 24 hours. Mean blood glucose was 6.15 ± 1.11 mmol/l in eMPC group vs. 7.21 ±1.08 mmol/l in RMP group (p<0.05); percentage of time in target range was 60.4 ± 22.8% for eMPC vs. 27.5 ±16.2% for RMP group (p<0.05). Percentage of time above target range was 30.8 ± 19.6% vs. 69.6 ± 17.1% (p<0,05). No severe hypoglycemia (blood glucose bellow 2.9 mmol/l) was observed during the study. Average insulin infusion rate was 4.67 ± 3.34 in eMPC vs. 2.57 ± 1.66 IU/h in RMP (p<0.05), average sampling interval was 1.46 ± 0.31 vs. 2.10 ± 0.22 hours (p<0.05). We conclude that eMPC algorithm was more effective and comparably safe as compared to RMP in maintaining euglycemia in cardiac surgery patients.


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