In silico evaluation of glucose control protocols for critically ill patients.

This letter presents an in silico evaluation method of glucose control protocols for critically ill patients with hyperglycemia. Although various glucose control protocols were introduced and investigated in clinical trials, development and validation of a novel glucose control protocol for critically ill patients require too much time and resources in clinical evaluation. We employed a virtual patient model of the critically ill patient with hyperglycemia and evaluated the clinically investigated glucose control protocols in a computational environment. The three-day simulation results presented the time profiles of glucose and insulin concentrations, the amount of enteral feed and intravenous bolus of glucose, and the intravenous insulin infusion rate. The hyperglycemia and hypoglycemia index, blood glucose concentrations, insulin doses, intravenous glucose infusion rates, and glucose feed rates were compared between different protocols. It is shown that a similar hypoglycemia incidence exists in simulation and clinical results. We concluded that this in silico simulation method using a virtual patient model could be useful for predicting hypoglycemic incidence of novel glucose control protocols for critically ill patients, prior to clinical trials.