Evaluating glycemic control algorithms by computer simulations.
Abstract Background: Numerous guidelines and algorithms exist to achieve glycemic control. Their strengths and weaknesses are difficult to assess without head-to-head comparison in time-consuming clinical trials. We hypothesized that computer simulations may be useful. Methods: Two open-label random...
| Publicado en: | Diabetes Technology & Therapeutics Vol. 13; no. 7; pp. 713 - 723 |
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| Autores principales: | , , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
2011 Jul
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108233401&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 108233401 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15209156 N3C jtl: Diabetes Technology & Therapeutics issn: 15209156 maglogo: N pubinfo: dt: 2011 Jul vid: 13 iid: 7 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 108233401 108233401 2011187252 10.1089/dia.2011.0016 NLM21488803 108233401 ppf: 713 ppct: 10 formats: tig: atl: Evaluating glycemic control algorithms by computer simulations. aug: au: Wilinska ME Blaha J Chassin LJ Cordingley JJ Dormand NC Ellmerer M Haluzik M Plank J Vlasselaers D Wouters PJ Hovorka R affil: Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom sug: subj: Algorithms Computer Simulation Critical Illness Therapy Diabetes Mellitus Complications Diabetes Mellitus Drug Therapy Hyperglycemia Prevention and Control Hypoglycemia Prevention and Control Adult Aged Aged, 80 and Over Blood Glucose Analysis Clinical Trials Diabetes Mellitus Diet Therapy Female Human Hypoglycemic Agents Administration and Dosage Hypoglycemic Agents Adverse Effects Hypoglycemic Agents Therapeutic Use Insulin Administration and Dosage Insulin Adverse Effects Insulin Therapeutic Use Intensive Care Units Male Middle Age Research, Medical Methods Retrospective Design Risk Assessment Methods Adult: 19-44 years Aged: 65+ years Aged, 80 & over Middle Aged: 45-64 years Female Male ab: Abstract Background: Numerous guidelines and algorithms exist to achieve glycemic control. Their strengths and weaknesses are difficult to assess without head-to-head comparison in time-consuming clinical trials. We hypothesized that computer simulations may be useful. Methods: Two open-label randomized clinical trials were replicated using computer simulations. One study compared performance of the enhanced model predictive control (eMPC) algorithm at two intensive care units in the United Kingdom and Belgium. The other study compared three glucose control algorithms-eMPC, Matias (the absolute glucose protocol), and Bath (the relative glucose change protocol)-in a single intensive care unit. Computer simulations utilized a virtual population of 56 critically ill subjects derived from routine data collected at four European surgical and medical intensive care units. Results: In agreement with the first clinical study, computer simulations reproduced the main finding and discriminated between the two intensive care units in terms of the sampling interval (1.3 h vs. 1.8 h, United Kingdom vs. Belgium; P < 0.01). Other glucose control metrics were comparable between simulations and clinical results. The principal outcome of the second study was also reproduced. The eMPC demonstrated better performance compared with the Matias and Bath algorithms as assessed by the time when plasma glucose was in the target range between 4.4 and 6.1 mmol/L (65% vs. 43% vs. 42% [P < 0.001], eMPC vs. Matias vs. Bath) without increasing the risk of severe hypoglycemia. Conclusions: Computer simulations may provide resource-efficient means for preclinical evaluation of algorithms for glycemic control in the critically ill. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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