Impact of insulin-stimulated glucose removal saturation on dynamic modelling and control of hyperglycaemia

Abstract

Reported insulin-stimulated glucose removal saturation levels vary widely between individuals and trade off with insulin sensitivity in model-based control methods. A non-linear model and adaptive insulin infusion protocol enabled high-precision blood glucose control in critically ill patients using a constant insulin-stimulated glucose removal saturation parameter. Analysis of clinical trial results with and without saturation modelling indicates the significant impact of this saturation parameter on controller efficacy. Without accounting for saturation, the time-average prediction error during a five-hour trial was up to 17.6%. The average prediction error between the four patients examined in this study was reduced to 5.8% by approximating the saturation parameter. Hence, saturation is an important dynamic that requires good methods of estimation or identification to enable tight glycemic control.

A physiological Intensive Control Insulin-Nutrition-Glucose (ICING) model validated in critically ill patients

“…Simulation studies had been carried out to investigate the impact of these parameters, namely "effective" insulin half life and insulin-stimulated glucose removal saturation [44,79]. Both variables have direct impact on S I .…”

Modeling the glucose regulatory system in extreme preterm infants

“…Therefore, the parameter representing saturation of insulin mediated glucose uptake, α G , was set to zero in this study. This lack of saturation effect is significantly different to the adult case, where the significant glucose uptake saturation can occur [38,[50][51][52].…”

The Impact of Model-based Therapeutics on Glucose Control in an Intensive Care Unit

“…The mean glucose and standard deviation of 5.58 ± 1.03 mmol/L with 67.57% of glucose values lying in the 4.0 to 6.1 mmol/L band. The reason for this decrease in performance is that there are significant periods in Figure 14 where the insulin has reached the maximum of 6 Units/hour so effectively no added, but necessary, control is being applied in these periods and insulin effect is saturated [1,12]. The solution to this problem has been to vary the nutrition, as well as the insulin [10,11].…”