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Model-based glycemic control in a Malaysian intensive care unit: performance and safety study

Authors Abu-Samah A, Knopp JL, Abdul Razak NN, Razak AA, Jamaludin UK, Mohamad Suhaimi F, Md Ralib A, Mat Nor MB, Chase JG, Pretty CG

Received 17 September 2018

Accepted for publication 30 January 2019

Published 31 May 2019 Volume 2019:12 Pages 215—226


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Asma Abu-Samah,1 Jennifer Launa Knopp,2 Normy Norfiza Abdul Razak,3 Athirah Abdul Razak,3 Ummu Kulthum Jamaludin,3 Fatanah Mohamad Suhaimi,4 Azrina Md Ralib,5 Mohd Basri Mat Nor,6 James Geoffrey Chase,2 Christopher Grant Pretty2

1Institute of Energy Infrastructure, Universiti Tenaga Nasional, Kajang, 43000, Malaysia; 2Department of Mechanical Engineering, University of Canterbury, Christchurch, 8041, New Zealand; 3College of Engineering, Universiti Tenaga Nasional, Kajang, 43000, Malaysia; 4Faculty of Mechanical Engineering, Universiti Malaysia Pahang, Pekan, 26600, Malaysia; 5Advanced Medical and Dental Institute, Universiti Sains Islam Malaysia, Kepala Batas, 13200, Malaysia; 6Kulliyah of Medicine, International Islamic University Malaysia, Kuantan, 25200, Malaysia

Background: Stress-induced hyperglycemia is common in critically ill patients. A few forms of model-based glycemic control have been introduced to reduce this phenomena and among them is the automated STAR protocol which has been used in the Christchurch and Gyulá hospitals’ intensive care units (ICUs) since 2010.
Methods: This article presents the pilot trial assessment of STAR protocol which has been implemented in the International Islamic University Malaysia Medical Centre (IIUMMC) Hospital ICU since December 2017. One hundred and forty-two patients who received STAR treatment for more than 20 hours were used in the assessment. The initial results are presented to discuss the ability to adopt and adapt the model-based control framework in a Malaysian environment by analyzing its performance and safety.
Results: Overall, 60.7% of blood glucose measurements were in the target band. Only 0.78% and 0.02% of cohort measurements were below 4.0 mmol/L and 2.2 mmol/L (the limitsfor mild and severe hypoglycemia, respectively). Treatment preference-wise, the clinical staff were favorable of longer intervention options when available. However, 1 hourly treatments were still used in 73.7% of cases.
Conclusion: The protocol succeeded in achieving patient-specific glycemic control while maintaining safety and was trusted by nurses to reduce workload. Its lower performance results, however, give the indication for modification in some of the control settings to better fit the Malaysian environment.

Keywords: glycemic control, intensive care unit, model-based control, pilot trial, Malaysian hospital

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