Glucosafe : a model for glucose control and nutrition advice in the ICU

Hyperglycemia (abnormally high blood glucose concentrations) in hospitalized, critically ill patients has been associated with higher mortality, more frequent complications and prolonged stay in intensive care. As a consequence patients are at risk of acquiring infections, loss of lean body mass, lack of adequate physical activity and, ultimately, weakness and inability to mobilize. Control of blood glucose and optimized nutrition therapy to prevent muscle protein breakdown play an important role for improved chance of survival, reduced length of stay in the intensive care unit and the preservation of muscle strength.
Based on a physiological compartment model, a medical decision support system, Glucosafe, was built for giving clinicians advice on insulin therapy (continuous infusions, boluses) and to recommend nutrition intake (enteral, parenteral) close to the patient’s estimated energy expenditure. In Denmark the system was successfully tested with 22 patients in 2009/2010, where it was shown that use of the system reduced hyperglycemia, and the proportion of time in the “optimal” glycemic range increased from 43% to 84%. Another study with 13 patients in 2011 at the University Hospital in Bruxelles confirmed the previous results. A study with retrospective data from a very large database with over 400 American intensive care patients showed that Glucosafe consistently provided more favorable insulin advice than existing locally installed clinical protocols for insulin.
The project is now entering a new phase where decision support focuses on patient-specific nutrition advice for patients at risk of losing lean muscle from prolonged stay in intensive care. The model will be modified to simulate catabolic and anabolic processes in the body and to recommend adequate levels of calorie and protein intake corresponding to the metabolically dominating phase. This type of advice may be supplemented by protocol-based recommendations on muscle-supporting physiotherapeutic exercises for the ICU patient.