Software-guided versus nurse-directed blood glucose control in critically ill patients: the LOGIC-2 multicenter randomized controlled clinical trial.

Background: Blood glucose control in the intensive care unit (ICU) has the potential to save lives. However, maintaining blood glucose concentrations within a chosen target range is difficult in clinical practice and holds risk of potentially harmful hypoglycemia. Clinically validated computer algorithms to guide insulin dosing by nurses have been advocated for better and safer blood glucose control.

Glucose Control in the ICU: A Continuing Story.

In the present era of near-continuous glucose monitoring (CGM) and automated therapeutic closed-loop systems, measures of accuracy and of quality of glucose control need to be standardized for licensing authorities and to enable comparisons across studies and devices. Adequately powered, good quality, randomized, controlled studies are needed to assess the impact of different CGM devices on the quality of glucose control, workload, and costs. The additional effects of continuing glucose control on the general floor after the ICU stay also need to be investigated.

An Analysis of Reliability and Accuracy of Muscle Thickness Ultrasonography in Critically Ill Children and Adults.

Background: Muscle wasting starts already within the first week in critically patients and is strongly related to poor outcome. Nevertheless, the early detection of muscle wasting is difficult. Therefore, we investigated the reliability and accuracy of ultrasonography to evaluate skeletal muscle wasting in critically ill children and adults.

Modeling of effect of glucose sensor errors on insulin dosage and glucose bolus computed by LOGIC-Insulin.

Background: Effective and safe glycemic control in critically ill patients requires accurate glucose sensors and adequate insulin dosage calculators. The LOGIC-Insulin calculator for glycemic control has recently been validated in the LOGIC-1 randomized controlled trial. In this study, we aimed to determine the allowable error for intermittent and continuous glucose sensors, on the basis of the LOGIC-Insulin calculator.

Continuous glucose control in the ICU: report of a 2013 round table meeting.

Achieving adequate glucose control in critically ill patients is a complex but important part of optimal patient management. Until relatively recently, intermittent measurements of blood glucose have been the only means of monitoring blood glucose levels. With growing interest in the possible beneficial effects of continuous over intermittent monitoring and the development of several continuous glucose monitoring (CGM) systems, a round table conference was convened to discuss and, where possible, reach consensus on the various aspects related to glucose monitoring and management using these systems.

Clinical review: Consensus recommendations on measurement of blood glucose and reporting glycemic control in critically ill adults.

The management reporting and assessment of glycemic control lacks standardization. The use of different methods to measure the blood glucose concentration and to report the performance of insulin treatment yields major disparities and complicates the interpretation and comparison of clinical trials. We convened a meeting of 16 experts plus invited observers from industry to discuss and where possible reach consensus on the most appropriate methods to measure and monitor blood glucose in critically ill patients and on how glycemic control should be assessed and reported.

LOGIC-insulin algorithm-guided versus nurse-directed blood glucose control during critical illness: the LOGIC-1 single-center, randomized, controlled clinical trial.

Objective: Tight blood glucose control (TGC) in critically ill patients is difficult and labor intensive, resulting in poor efficacy of glycemic control and increased hypoglycemia rate. The LOGIC-Insulin computerized algorithm has been developed to assist nurses in titrating insulin to maintain blood glucose levels at 80-110 mg/dL (normoglycemia) and to avoid severe hypoglycemia (<40 mg/dL). The objective was to validate clinically LOGIC-Insulin relative to TGC by experienced nurses.

Blood glucose measurements in critically ill patients.

Studies on tight glycemic control by intensive insulin therapy abruptly changed the climate of limited interest in the problem of hyperglycemia in critically ill patients and reopened the discussion on accuracy and reliability of glucose sensor devices. This article describes important components of blood glucose measurements and their interferences with the focus on the intensive care unit setting. Typical methodologies, organized from analytical accuracy to clinical accuracy, to assess imprecision and bias of a glucose sensor are also discussed.

Glycemic control in the pediatric intensive care unit of Leuven: two years of experience.

Stress hyperglycemia and hypoglycemia are associated with increased mortality and morbidity in critically ill patients. Three randomized controlled trials, in the surgical, medical, and pediatric intensive care unit (PICU) of the Leuven University in Belgium, demonstrated the beneficial response of tightly controlling blood glucose levels within age-adjusted narrow limits by applying intensive insulin therapy. Follow-up studies could not confirm the results obtained in the Leuven studies but revealed the complexity associated with tight glycemic control (TGC).

Assessment of blood glucose control in the pediatric intensive care unit: extension of the glycemic penalty index toward children and infants.

Background: The glycemic penalty index (GPI) is a measure to assess blood glucose (BG) control in critically ill adult patients but needs to be adapted for children and infants.

Method: The squared differences between a clinical expertise penalty function and the corresponding polynomial function are minimized for optimization purposes. The average of all penalties (individually assigned to all BG readings) represents the patient-specific GPI.

Statistical approach of assessing the reliability of glucose sensors: the GLYCENSIT procedure.

Background: In healthcare, patients with diabetes are instructed on how to apply intensified insulin therapy in an optimal manner. Tight blood glucose control is also performed on patients treated in the intensive care unit (ICU). Different blood glucose meters and glucose monitoring systems (GMSs) are used to achieve this goal, and some may lack reliability.

Blood glucose measurements in arterial blood of intensive care unit patients submitted to tight glycemic control: agreement between bedside tests.

Background: Implementing tight glycemic control (TGC) in intensive care unit (ICU) patients requires accurate blood glucose (BG) monitoring. We evaluated the performance of two commercially available bedside glucometers, Accu-Chek and HemoCue, in patients admitted to the ICU and in whom TGC was applied.

Methods: Thirty-seven adult ICU patients were prospectively included.

Towards closed-loop glycaemic control.

Blood glucose control performed by intensive care unit (ICU) nurses is becoming standard practice for critically ill patients. New algorithms, ranging from basic protocols to elementary computerized protocols to advanced computerized protocols, have been presented during the last years aiming to reduce the workload of the medical team. This paper gives an overview of the different types of algorithms and their features.

Ingredients for adequate evaluation of blood glucose algorithms as applied to the critically ill.

The article by Eslami and colleagues provides an overview of the indicators used to measure the quality of blood glucose control in patients admitted to the intensive care unit. Each indicator can be related to one or more of the following categories: blood glucose zones, blood glucose levels, time intervals, and features of the insulin titration algorithm. Some important issues (for instance those concerning the clarity of definitions used for glycaemic thresholds) are raised.

Glycemic penalty index for adequately assessing and comparing different blood glucose control algorithms.

Introduction: Blood glucose (BG) control performed by intensive care unit (ICU) nurses is becoming standard practice for critically ill patients. New (semi-automated) 'BG control' algorithms (or 'insulin titration' algorithms) are under development, but these require stringent validation before they can replace the currently used algorithms. Existing methods for objectively comparing different insulin titration algorithms show weaknesses.

A minimal model for glycemia control in critically ill patients.

In this paper we propose a modified minimal model to be used for glycemia control in critically ill patients. For various reasons the Bergman minimal model is widely used to describe glucose and insulin dynamics. However, since this model is mostly valid in a rather restrictive setting, it might not be suitable to be used in a model predictive controller.

Glycemia prediction in critically ill patients using an adaptive modeling approach.

Background: Strict blood glucose control by applying nurse-driven protocols is common nowadays in intensive care units (ICUs). Implementation of a predictive control system can potentially reduce the workload for medical staff but requires a model for accurately predicting the glycemia signal within a certain time horizon.

Methods: GlucoDay (A.