O021 - PERSONALISED NUTRITION DELIVERY DURING GLYCAEMIC CONTROL IN INTENSIVE CARE

O021

PERSONALISED NUTRITION DELIVERY DURING GLYCAEMIC CONTROL IN INTENSIVE CARE

M. Seret^1,*, V. Uyttendaele¹, J. G. Chase², G. M. Shaw³, T. Desaive¹

¹Model-based therapeutics, GIGA Institute, University of Liège, Liège, Belgium, ²Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, ³Department of Intensive Care, Christchurch Hospital, Christchurch, New Zealand

Rationale: Safe, effective glycaemic control (GC) in critically ill patients is directly linked to nutrition. Variable nutrition delivery protocols interact with patient-specific, variability in nutrition tolerance and insulin sensitivity to reduce GC safety and performance, whereas personalised nutrition delivery in conjunction with insulin delivery could enable safer, more effective GC and optimise patient outcomes.

Methods: The Stochastic TARgeted (STAR) model-based GC framework is the first protocol modulating both insulin and nutrition to control glycaemia. Insulin-nutrition interventions are based on identified patient-specific insulin sensitivity, accounting for the interplay between glycaemia, nutrition, and patient variability. GC commences after 2 consecutive blood glucose (BG) measurements over 145 mg/dL. STAR was implemented as the standard of care in the Christchurch Hospital Intensive Care Unit, New Zealand in 2010. This study analyses nutrition delivery and GC metrics for 5.5 years of data from April 2019 to December 2024.

Results: N= 734 patients and 1009 episodes of > 10 hours GC and being fed are analysed in this study. GC was safe and effective, with 72.4% of BG in normoglycaemic range (80-145 mg/dL) and only 2 (0.2%) events of severe hypoglycaemia (BG < 40 mg/dL), with 1 while receiving insulin. Nutrition delivery had high median [IQR] rates (93.7 [54.1– 100.0] % goal feed), corresponding to 1584 [960 – 1920] kcal/day at cohort level. Nutrition delivery increases over time with the lowest rates in the first 12-24 hours and most acute phase.

Image:

Conclusion: STAR provided safe, effective GC modulating insulin and nutrition in concert, achieving high time in range and extremely low incidence of severe hypoglycaemia. The large variability in nutrition rates achieved reflect high personalisation in nutrition management. These outcomes support STAR’s ability to provide personalised nutrition therapy as part of GC.

Disclosure of Interest: None declared