Nur Jihan Mohd Zukhi
@usm.my
Advanced Medical and Dental Institute
Universiti Sains Malaysia
Scopus Publications
Scopus Publications
J. Zukhi, F. Suhaimi, Mohd Zulfakar Mazlan, Ummu K. Jamaludin, Normy N. Razak and Nizuwan Azman
Insulin infusion protocol based on the sliding scale is the standard protocol implemented in Malaysia's Intensive Care Unit (ICU) for controlling the patient's glycemic level. However, patients have a different dynamic and sensitivity toward insulin infusion, which needs close monitoring. The objective of this study is to compare the performance of two sliding scale-based glycemic control protocols (Protocols X and Y) on two different cohorts (cohorts A and B). Insulin sensitivity and patient variability of the patients were modelled using retrospective data, and an established glucose-insulin model. The sliding scale-based was further compared with a model-based glycemic control, Stochastic TARgeted (STAR) to investigate the patient variability and dynamic factors. The results obtained from this study showed that cohort A had more dynamics metabolism with lower mean of insulin sensitivity (50.0 L/mU.min) than cohort B. Protocol X had highest blood glucose (BG) measurements within their target range (6.0-10.0 mmol/L). However, there is no significant mean difference ($\\mathrm{p} > 0.05$) in BG level between Protocol X and Protocol Y. The median Acute Physiology and Chronic Health II (APACHE II) score showed the cohort A (26) had more severe patients than cohort B (20) that possibly not responding well towards the insulin therapy. The findings of this study show that the sliding scale-based results in a better BG level than the model-based. Nevertheless, patient variability and dynamics play an essential role in achieving a blood glucose target.
Fatanah M Suhaimi, Syatirah Mat Zin, Seniz Ertugrul, Mohd Zulfakar Mazlan, and Nur Jihan M Zukhi
IEEE
Type II diabetes mellitus (T2DM) is one of severe and common chronic disease, affecting almost all populations in many countries. T2DM and its complications constitute a major worldwide public health problem and associated with high rates of diabetes-related morbidity and mortality. In this study, a retrospective clinical data was collected from three patients receiving insulin therapy in the ICU of HUSM. The autoregressive moving average with exogenous (ARMAX) model structure techniques were used to generate a model converter that best describes the glucose and insulin relationship of the subject. Several combinations of model order were tested and simulated on the subjects. The best model fit criterion and the corresponding time-delay were identified. The estimated peak value was also compared to the real peak value. The finding shows that different patient can be represented with different model structure and different time-delay. However, there is a need to categorize the patients according to their appropriate model structure, particularly on the time-delay unit. Additional clinical parameter and a more extensive data set may be required to ensure the structure of the model precisely describe the glucose-insulin interaction of the patient.
Jihan Zukhi, Fatanah M. Suhaimi, Mohd Zulfakar Mazlan, Ummu K. Jamaludin, Normy Razak, and Mastura Mohd Sopian
Elsevier BV
Abstract Insulin infusion protocol is the standard protocol that has been practiced in Malaysia’s intensive care unit (ICU) for controlling the hyperglycemia. Multiple sliding scale method of the insulin infusion protocol may drive conflict in selecting an appropriate scale to be applied to the patient. The objective of this paper is to analyse the blood glucose outcome of eight sliding scales insulin infusion protocol adopted in the Universiti Sains Malaysia Hospital (HUSM). A retrospective data of 78 ICU patients of HUSM were fitted using a validated glucose-insulin system to identify insulin sensitivity profiles of the patients. Then, these SI profiles were simulated on various scale protocols. The results obtained from this study showed that among eight scales, Scale 4 had the highest percentage of BG within the HUSM’s target of 6.0–10.0 mmol/L. Scale 1 had the highest percentage of BG for the BG measurement more than 10.0 mmol/L while Scale 8 had the highest percentage of BG measurement of less than 6.0 mmol/L. However, none of the scale shown better performance than the current clinical practice. Furthermore, all of the eight scales had a more substantial number of BG measurement compared to the clinical. This study shows that Scale 2 and Scale 3 result in a similar outcome. Similarly, Scale 5 is almost the same as Scale 6. Thus, at least two sets of scale can be combined to reduce the number of scales. The reduction of scales consequently avoid confusion and helps the clinician in selecting the appropriate scale to be applied to the patients. From this study, it can be concluded that the HUSM protocol is a combination of scales. The scales may be shifted from one to another scale depending on patient condition and clinician judgement. A proper guideline for the scale shifting seems necessary to allow optimum glycemic management in the ICU.
J. Zukhi, D. Yusob, A. A. Tajuddin, and R. Zainon
Springer Singapore
D. Yusob, J. Zukhi, A. A. Tajuddin, and R. Zainon
Springer Singapore
Diana Yusob, Jihan Zukhi, Abd Aziz Tajuddin, and Rafidah Zainon
IOP Publishing
Noorfatin Aida B. Amin, J Zukhi, N. A. Kabir, and R. Zainon
IOP Publishing
J Zukhi, D Yusob, A A Tajuddin, L Vuanghao, and R Zainon
IOP Publishing
Norain Yusoff, Jihan Zukhi, Awatif Rusli, and Rafidah Zainon
IOP Publishing