Tight Glycemic Control Can Be Achieved in Adult ICU Patients Safely: Results From a 5-Year Single-Center Observational Study Using the STAR Glycemic Control Framework

Abstract

Background:

Glycemic control (GC) is hard to implement safely in intensive care due to patient variability. GC has been wrongly blamed for increased hypoglycemic risk instead of protocol design, limiting its adoption. Stochastic TARgeted (STAR) is a model-based, patient-specific, risk-based GC framework modulating intravenous (IV) insulin and nutrition, accounting for both inter- and intra-patient variability. This study assesses STAR GC’s ability to provide safe and effective control across a large cohort.

Methods:

This study was performed in Christchurch Hospital Intensive Care Unit, New Zealand. Patients were treated with STAR GC between April 2019 and December 2024. The STAR GC episodes not complying with filtering criteria were excluded. Results are analyzed in terms of performance, safety, and workload.

Results:

Of 1340 adult ICU patients totaling 1958 STAR GC episodes, 1085 patients and 1430 episodes (86 010 h of control) remained after filtering. In total, 71% of blood glucose (BG) measurements were in the target band for a median [interquartile range, IQR] BG of 124 [110-148] mg/dL. Only three (0.21%) severe hypoglycemia events (BG < 40 mg/dL) occurred, two unrelated to the control design. High median [IQR] nutrition delivery (89.0 [17.2-100.0]) %goal feed was achieved with median [IQR] insulin rate of 4.5 [2.0-6.0] U/h. Results were consistent per-patient and improved once in the target band.

Conclusions:

STAR provides safe, effective control for all patients in this large cohort, with minimal hypoglycemia and high nutrition rates. The protocol adapts to patients’ specific needs and tolerances, encouraging STAR’s adoption in other ICUs. The quality of control also enables prospective assessment of the future of GC’s impact on patient outcomes.