Assessment of Glycemic Control Protocol (STAR) Through Compliance Analysis Amongst Malaysian ICU Patients

Figures & data

Table 1 Patient’s Demographic

Demographic Parameter	Statistics
Years of Data	2017	2018	2019*
Total patients (Total patients with only 1 episode)	136 (66)
Total episodes	271
Per-cohort episodes (Total patients)	100 (37)	135 (76)	36 (23)
Age (years old) [Median (Interquartile Range)]	62 [57–66]	63 [54–72]	63 [59–71]
Weight (kilograms) [Median (Interquartile Range)]	64 [55–71]	61 [53–72]	65 [58–74]
Total number of patients by gender (Female:Male)	18:19	34:42	17:6
Overall LGC (hours) [Median (Interquartile Range)]	28 [14–57]
Per-cohort LGC (hours) [Median (Interquartile Range)]	25 [11–52]	28 [14–56]	38 [19–71]
Acute Physiological and Chronic Health (APACHE) II [Median (Interquartile Range)]	16 [11–23]	15 [11–20]	Not available

Note: *Indicates that the available data used were until April, a quarter of 2019 unlike in the year of 2017 and 2018. 

Table 2 Results of Compliance and Clinical Trials of IIUMMC Patients

Parameter	Overall	2017	2018	2019	P-value Test
Insulin compliance (%)	98.8	97.2	99.7	99.7	P<0.05
Nb. of times for insulin non-compliance	109	96	10	3
Nb. episodes with insulin non-compliance	32	22	7	3
Total amount of recommended insulin (U)	24097.8	9390.6	10903.7	3485	No significant
Total amount insulin given (U)	23533.0	9162.6	10878.8	3475.7
Absolute amount of insulin non-compliance (U)	277.8	227.1	41.1	9.3
Feed compliance (%)	97.7	98.6	96.7	98.8	P<0.05
Nb. of times for feed non-compliance	200	50	136	14
Nb. episodes with feed non-compliance	66	22	39	5
Total amount of recommended feed (mL)	282493.3	122342.0	128537.0	31614.3	No significant
Total amount feed given (mL)	281142.3	121880.0	127911.0	31351.3
Absolute amount of feed non-compliance (mL)	6124.2	715	3755.1	303.0
Clinical BG in median [IQR] (mmol/L)	8.7 [7.0–11.0]	8.8 [7.0–11.0]	8.6 [6.9–10.9]	8.8 [7.1–11.0]	<0.05
Clinical insulin in median [IQR] (U/hr)	1.5 [0.4–3.1]	1.6 [0.5–3.2]	1.5 [0.2–3.0]	1.5 [0.4–3.2]	<0.05
Clinical feed in median [IQR] (g/hr)	5.2 [3.7–6.9]	5.2 [3.8–6.3]	5.1 [2.4–7.1]	5.2 [4.3–6.1]	<0.05
Nb. of BG measurement	8777	3498	4070	1209	No significant
Average BG measurement per day	17	18	17	17	–
Hourly Resampled Measurements
%BG within 4.4–8.0 mmol/L (79–144 mg/dL)	45.0 [26.3–62.5]	50.0 [29.7–68.7]	42.7 [23.2–58.8]	43.1 [29.3–61.8]	No significant
%BG within 6.0–10.0 mmol/L (108–180 mg/dL)	65.0 [50.0–78.4]	64.2 [51.1–77.7]	65.6 [47.2–78.4]	68.9 [50.6–77.6]	No significant
%BG >10.0 mmol/L (180 mg/dL)	19.0 [10.6–33.9]	16.9 [10.0–30.1]	20.0 [10.7–36.4]	21.4 [15.5–38.9]	No significant
%BG <4.4 mmol/L (79 mg/dL)	0.0 [0.0–1.4]	0.0 [0.0–3.7]	0.0 [0.0–0.9]	0.0 [0.0–0.0]	<0.05
%BG <4.0 mmol/L (72 mg/dL) mild hypoglycemia	0.830	1.313	0.530	0.574	<0.05
%BG <2.2 mmol/L (39 mg/dL)	0.0 [0.0–0.0]				No significant
Nb. episodes of mild hypoglycemia	93	38	45	10	–
Nb. episodes of severe hypoglycemia	2	1	1	0	–

Abbreviations: Nb, number; BG, blood glucose.

Figure 1 BG cumulative distribution frequency (CDF) for (A) Overall (B) 2017 (C) 2018 and (D) 2019*.

Figure 2 Profile figures of (A) compliant episode (patient 68), and (B) non-compliant episode (Patient 8) under STAR protocol. The first panel represents blood glucose (BG) mmol/L. The cross (x) is the BG clinical reading and the line is fitted BG using integral fitting method. The dashed line represents the BG limit target of 6–10.0 mmol/L (108–180 mg/dL). The second panel shows the plasma insulin (I) mU/L (dashed line) and interstitial insulin (Q) mU/L (straight line). The third panel is patient’s insulin sensitivity and the last panel represents insulin administered and feed given, straight line for insulin (U/hr), dashed line for Enteral feed (g/hr), and dashed dotted line for Parenteral feed (g/hr).

Figure 3 Non-compliance nutrition amount (mL) per episode for each year. It is clear non-compliance occurs primarily in 2017–18 .

Figure 4 Non-compliance in total recommended insulin amount (U) per episode for each year. It is clear non-compliance occurs primarily in 2017 .

Table 3 The Availability and Number of Times 1-, 2-, and 3-Hour Interval Interventions Chosen

BG Treatment Recommended	Total BG Treatment Recommended	Number of Chosen/Available BG Treatment
		1-Hour	2-Hours	3-Hours
Only Option 1 Recommended	277	277/277
Only Options 1 and 2 Recommended	710	432/571	136/139
Options 1, 2, and 3 Recommended	11919	5676/7930	818/2353	1395/1636
Total and Overall Percentage	12906	6385/8778	954/2492	1395/1636