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Assessment of Glycemic Control Protocol (STAR) Through Compliance Analysis Amongst Malaysian ICU Patients

Authors Abdul Razak A, Abu-Samah A, Abdul Razak NN, Jamaludin U, Suhaimi F, Ralib A, Mat Nor MB, Pretty C, Knopp JL, Chase JG

Received 20 September 2019

Accepted for publication 15 January 2020

Published 4 June 2020 Volume 2020:13 Pages 139—149


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Athirah Abdul Razak,1 Asma Abu-Samah,2 Normy Norfiza Abdul Razak,1 Ummu Jamaludin,3 Fatanah Suhaimi,4 Azrina Ralib,5 Mohd Basri Mat Nor,6 Christopher Pretty,7 Jennifer Laura Knopp,7 James Geoffrey Chase7

1College of Engineering, Universiti Tenaga Nasional, Kajang, Malaysia; 2Department of Electrical, Electronics and Systems, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, Bangi, Malaysia; 3Department of Mechanical Engineering, Universiti Malaysia Pahang, Kuantan, Malaysia; 4Advanced Medical and Dental Institute, Universiti Sains Malaysia, Pulau Pinang, Malaysia; 5Department of Anesthesiology, International Islamic University Malaysia, Kuantan, Malaysia; 6Intensive Care Unit, International Islamic University Medical Centre, Kuantan, Malaysia; 7Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand

Correspondence: Normy Norfiza Abdul Razak; Athirah Abdul Razak Email;

Purpose: This paper presents an assessment of an automated and personalized stochastic targeted (STAR) glycemic control protocol compliance in Malaysian intensive care unit (ICU) patients to ensure an optimized usage.
Patients and Methods: STAR proposes 1– 3 hours treatment based on individual insulin sensitivity variation and history of blood glucose, insulin, and nutrition. A total of 136 patients recorded data from STAR pilot trial in Malaysia (2017–quarter of 2019*) were used in the study to identify the gap between chosen administered insulin and nutrition intervention as recommended by STAR, and the real intervention performed.
Results: The results show the percentage of insulin compliance increased from 2017 to first quarter of 2019* and fluctuated in feed administrations. Overall compliance amounted to 98.8% and 97.7% for administered insulin and feed, respectively. There was higher average of 17 blood glucose measurements per day than in other centres that have been using STAR, but longer intervals were selected when recommended. Control safety and performance were similar for all periods showing no obvious correlation to compliance.
Conclusion: The results indicate that STAR, an automated model-based protocol is positively accepted among the Malaysian ICU clinicians to automate glycemic control and the usage can be extended to other hospitals already. Performance could be improved with several propositions.

Keywords: compliance, glycemic control, diabetes, stochastic targeted prediction, model-based control

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