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Randomized Controlled Trial
. 2007 Aug;92(8):2960-4.
doi: 10.1210/jc.2007-0434. Epub 2007 Jun 5.

Blood glucose control by a model predictive control algorithm with variable sampling rate versus a routine glucose management protocol in cardiac surgery patients: a randomized controlled trial

Roman Hovorka  1 , Jaromir Kremen, Jan Blaha, Michal Matias, Katerina Anderlova, Lenka Bosanska, Tomas Roubicek, Malgorzata E Wilinska, Ludovic J Chassin, Stepan Svacina, Martin Haluzik
Affiliations
Randomized Controlled Trial

Blood glucose control by a model predictive control algorithm with variable sampling rate versus a routine glucose management protocol in cardiac surgery patients: a randomized controlled trial

Roman Hovorka et al. J Clin Endocrinol Metab. 2007 Aug.

Abstract

Context: Elevated blood glucose levels occur frequently in the critically ill. Tight glucose control by intensive insulin treatment markedly improves clinical outcome.

Objective and design: This is a randomized controlled trial comparing blood glucose control by a laptop-based model predictive control algorithm with a variable sampling rate [enhanced model predictive control (eMPC); version 1.04.03] against a routine glucose management protocol (RMP) during the peri- and postoperative periods.

Setting: The study was performed at the Department of Cardiac Surgery, University Hospital.

Patients: A total of 60 elective cardiac surgery patients were included in the study.

Interventions: Elective cardiac surgery and treatment with continuous insulin infusion (eMPC) or continuous insulin infusion combined with iv insulin boluses (RMP) to maintain euglycemia (target range 4.4-6.1 mmol/liter) were performed. There were 30 patients randomized for eMPC and 30 for RMP treatment. Blood glucose was measured in 1- to 4-h intervals as requested by each algorithm during surgery and postoperatively over 24 h.

Main outcome measures: Mean blood glucose, percentage of time in target range, and hypoglycemia events were used.

Results: Mean blood glucose was 6.2 +/- 1.1 mmol/liter in the eMPC vs. 7.2 +/- 1.1 mmol/liter in the RMP group (P < 0.05); percentage of time in the target range was 60.4 +/- 22.8% for the eMPC vs. 27.5 +/- 16.2% for the RMP group (P < 0.05). No severe hypoglycemia (blood glucose < 2.9 mmol/liter) occurred during the study. Mean insulin infusion rate was 4.7 +/- 3.3 IU/h in the eMPC vs. 2.6 +/- 1.7 IU/h in the RMP group (P < 0.05). Mean sampling interval was 1.5 +/- 0.3 h in the eMPC vs. 2.1 +/- 0.2 h in the RMP group (P < 0.05).

Conclusions: Compared with RMP, the eMPC algorithm was more effective and comparably safe in maintaining euglycemia in cardiac surgery patients.

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