Hospitals & Services

Glycaemic Control (STAR)

The department of Intensive Care uses a method of controlling blood glucose by adjusting both the nutrition (carbohydrate load) and insulin in order to provide tight and safe control.  This system is called STAR, Stochastic TARgeted Glycaemic control).  This results from 10 years research at the Centre for Bioengineering, University of Canterbury.  The models developed have produced tighter and safer control.

 

There is good evidence that hypoglycaemia and hyperglycaemia contribute to organ failure and mortality.  However, it is difficult to control these parameters well with a one-size fits all protocol.  Specifically, when simple (heuristic) protocols have been implemented, patient centred outcome improvements have not been realised.  Since the introduction of model-based glycaemic control in September 2005, the mortality of patients who have spent more than three days in Intensive Care, has been reduced by 30%.

 

The STAR protocol uses an android tablet with simple instructions that guide both the feed and insulin inputs.  These are calculated every one to three hours.

 

As a general rule, all patients who are hyperglycaemic (glucose > 8mmol/l) and who are expected to remain in ICU for at least 24 hours should be commenced on STAR.

 

STAR is designed to be used in critically ill patients.  This method uses one to three hourly boluses of insulin, which is determined by the likelihood of developing hypoglycaemia.  Where a patient is particularly insulin resistant, a background infusion started may be recommended at 1-2 units per hour.  The background infusion must be stopped if glucose levels are less that 4.0 mmol/L.  STAR should be ceased after at least 6 consecutive hours, without insulin administration.

 

STAR is highly customisable:

  • Target range:  this can be altered if the patient has type II diabetes.  Here the recommended target range is increased from 5.0-8.0mmol/L to 6.0-9.0mmol/L.  Patients with type II diabetes have a higher mortality if their blood glucose is constrained to lower euglycaemic levels.  This is likely due to the risk of hypoglycaemia, an independent mortality risk.

 

  • Nutrition:  Both enteral and parental nutrition rates are taken into account when calculating the next insulin dose.  However, it is possible to override variable nutrition recommendations by setting a constant nutrition rate.  Please ensure the nutrition rate is correctly entered into the programme.  STAR may be used without nutrition running and during peri-operative periods when nutrition is stopped.

 

Please ask for help if you are uncertain about the application of STAR to Intensive Care patients.

Page last reviewed: 13 May 2014
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