Insulin Sensitivity and Patient Variability Aspects Towards a Successful Glycemic Control Protocol

Insulin infusion protocol based on the sliding scale is the standard protocol implemented in Malaysia's Intensive Care Unit (ICU) for controlling the patient's glycemic level. However, patients have a different dynamic and sensitivity toward insulin infusion, which needs close monitoring. The objective of this study is to compare the performance of two sliding scale-based glycemic control protocols (Protocols X and Y) on two different cohorts (cohorts A and B). Insulin sensitivity and patient variability of the patients were modelled using retrospective data, and an established glucose-insulin model. The sliding scale-based was further compared with a model-based glycemic control, Stochastic TARgeted (STAR) to investigate the patient variability and dynamic factors. The results obtained from this study showed that cohort A had more dynamics metabolism with lower mean of insulin sensitivity (50.0 L/mU.min) than cohort B. Protocol X had highest blood glucose (BG) measurements within their target range (6.0-10.0 mmol/L). However, there is no significant mean difference ( ) in BG level between Protocol X and Protocol Y. The median Acute Physiology and Chronic Health II (APACHE II) score showed the cohort A (26) had more severe patients than cohort B (20) that possibly not responding well towards the insulin therapy. The findings of this study show that the sliding scale-based results in a better BG level than the model-based. Nevertheless, patient variability and dynamics play an essential role in achieving a blood glucose target.