Multicentric, Randomized, Controlled Trial to Evaluate Blood Glucose Control by the Model Predictive Control Algorithm Versus Routine Glucose Management Protocols in Intensive Care Unit Patients

Multicentric, Randomized, Controlled Trial to Evaluate Blood Glucose Control by the Model Predictive Control Algorithm Versus Routine Glucose Management Protocols in Intensive Care Unit Patients Johannes Plank , MD 1 , Jan Blaha , MD 2 , Jeremy Cordingley , MBBS 3 , Malgorzata E. Wilinska , PHD 4 , Ludovic J. Chassin , PHD 4 , Cliff Morgan , PHD 3 , Stephen Squire , BSC 3 , Martin Haluzik , PHD 2 , Jaromir Kremen , MD 2 , Stepan Svacina , PHD 2 , Wolfgang Toller , MD 5 , Andreas Plasnik , MD 1 , Martin Ellmerer , PHD 1 , Roman Hovorka , PHD 4 and Thomas R. Pieber , MD 1 1 Department of Internal Medicine, Medical University Hospital, Graz, Austria 2 Faculty of Medicine, Charles University, Prague, Czech Republic 3 Adult Intensive Care Unit, Royal Brompton Hospital, London, U.K. 4 Department of Paediatrics, Cambridge University, Cambridge, U.K. 5 Department of Anaesthesiology and Intensive Care Medicine, Medical University Hospital, Graz, Austria Address correspondence and reprint requests to Johannes Plank, Department of Internal Medicine, Medical University Graz, Auenbruggerplatz 15, 8036 Graz, Austria. E-mail: johannes.plank{at}klinikum-graz.at Abstract OBJECTIVE —To evaluate a fully automated algorithm for the establishment of tight glycemic control in critically ill patients and to compare the results with different routine glucose management protocols of three intensive care units (ICUs) across Europe (Graz, Prague, and London). RESEARCH DESIGN AND METHODS —Sixty patients undergoing cardiac surgery (age 67 ± 9 years, BMI 27.7 ± 4.9 kg/m 2 , 17 women) with postsurgery blood glucose levels >120 mg/dl (6.7 mmol/l) were investigated in three different ICUs (20 per center). Patients were randomized to either blood glucose management (target range 80–110 mg/dl [4.4–6.1 mmol/l]) by the fully automated model predictive control (MPC) algorithm ( n = 30, 10 per center) or implemented routine glucose management protocols ( n = 30, 10 per center). In all patients, arterial glucose was measured hourly to describe the glucose profile until the end of the ICU stay but for a maximum period of 48 h. RESULTS —Compared with routine protocols, MPC treatment resulted in a significantly higher percentage of time within the target glycemic range (% median [min–max]: 52 [17–92] vs. 19 [0–71]) over 0–24 h ( P < 0.01). Improved glycemic control with MPC treatment was confirmed in patients remaining in the ICU for 48 h (0–24 h: 50 [17–71] vs. 21 [4–67], P < 0.05, and 24–48 h: 65