Two Glycemic Control Algorithms Compared

Dr. T. Chon

The comparison of two glycemic control algorithms for postoperative surgical patients

  

A Novel Computerized Fading Memory Algorithm for Glycemic Control in Postoperative Surgical Patients

Mayumi Horibe, MD,*† Bala G. Nair, PhD,* Gary Yurina, CRNA,† Moni B. Neradilek, MS,‡ and Irene Rozet, MD*†

Anesthesia & Analgesia June 2012

Hyperglycemia is an important predictor of morbidity and mortality, especially in critically ill patients. This study compared the use of a “Fading Memory” algorithm (FM) and an established algorithm (VA) used at their institution. The innovative FM algorithm was designed to mimic the pancreatic cell response of an initial, transient/rapid increase in insulin, then a slower increase of insulin that remains elevated for the duration of hyperglycemia. The study used Regular Insulin infusion and used target goals as 140 +/- 20mg/dl. Four comparisons were made between the two algorithms; the 1) time to reach the target glucose level and, 2) glucose level within target range during maintenance were not statistically significant; whereas the 3) the ability to maintain glucose levels with minimal variability and, 4) mean insulin dosage used in the maintenance phase was found to be statistically significant. The use of the FM algorithm is a helpful addition to the various debates/studies with glucose control. One of the strengths of this study is selecting a target glucose range that was not too low, avoiding hypoglycemia. In the future, the FM algorithm should be studied during the intraoperative setting and applied to patients with other co-morbidities such as end-stage renal disease and/or patients with greater insulin resistance, such that is seen in our county population.