Departmental Papers (CIS)

Date of this Version

9-9-2013

Document Type

Conference Paper

Comments

IEEE International Conference on Healthcare Informatics (ICHI 2013), Philadelphia, PA, September 9 - 11, 2013.

Abstract

Intraoperative glycemic control, particularly in cardiac surgical patients, remains challenging. Patients with impaired insulin sensitivity and/or secretion (i.e., type 1 diabetes mellitus) often manifest extremely labile blood glucose measurements during periods of stress and inflammation. Most current insulin infusion protocols are developed based on clinical experiences and consensus among a local group of physicians. Recent advances in human glucose metabolism modeling have established a computer model that invokes algorithms representing many of the pathways involved in glucose dysregulation for patients with diabetes. In this study, we used an FDA approved glucose metabolism model to evaluate an existing institutional intraoperative insulin infusion protocol via closedloop simulation on the virtual diabetic population that comes with the computer model. A comparison of simulated responses to actual retrospective clinical data from 57 type 1 diabetic patients undergoing cardiac surgery managed by the institutional protocol was performed. We then designed a proportional-derivative controller that overcomes the weaknesses exhibited by our old protocol while preserving its strengths. In-silico evaluation results show that our proportional-derivative controller more effectively manages intraoperative hyperglycemia while simultaneously reducing hypoglycemia and glycemic variability. By performing insilico simulation on intraoperative glucose and insulin responses, robust and seemingly efficacious algorithms can be generated that warrant prospective evaluation in human subjects.

Subject Area

CPS Medical

Publication Source

IEEE International Conference on Healthcare Informatics (ICHI 2013)

Start Page

307

Last Page

316

DOI

10.1109/ICHI.2013.43

Copyright/Permission Statement

© 2013 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.

Keywords

Intraoperative glycemic control, in-silico evaluation, proportional-derivative controller, insulin infusion protocol, computer model

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Date Posted: 06 September 2013

This document has been peer reviewed.