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Mathematical Biosciences
Article . 2017 . Peer-reviewed
License: Elsevier TDM
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Article . 2017
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Insulin kinetics and the Neonatal Intensive Care Insulin–Nutrition–Glucose (NICING) model

Insulin kinetics and the Neonatal Intensive Care Insulin-Nutrition-Glucose (NICING) model
Authors: Dickson JL; Pretty CG; Alsweiler J; Lynn A; Chase, Geoff;

Insulin kinetics and the Neonatal Intensive Care Insulin–Nutrition–Glucose (NICING) model

Abstract

Models of human glucose-insulin physiology have been developed for a range of uses, with similarly different levels of complexity and accuracy. STAR (Stochastic Targeted) is a model-based approach to glycaemic control. Elevated blood glucose concentrations (hyperglycaemia) are a common complication of stress and prematurity in very premature infants, and have been associated with worsened outcomes and higher mortality. This research identifies and validates the model parameters for model-based glycaemic control in neonatal intensive care.C-peptide, plasma insulin, and BG from a cohort of 41 extremely pre-term (median age 27.2 [26.2-28.7] weeks) and very low birth weight infants (median birth weight 839 [735-1000] g) are used alongside C-peptide kinetic models to identify model parameters associated with insulin kinetics in the NICING (Neonatal Intensive Care Insulin-Nutrition-Glucose) model. A literature analysis is used to determine models of kidney clearance and body fluid compartment volumes. The full, final NICING model is validated by fitting the model to a cohort of 160 glucose, insulin, and nutrition data records from extremely premature infants from two different NICUs (neonatal intensive care units).Six model parameters related to insulin kinetics were identified. The resulting NICING model is more physiologically descriptive than prior model iterations, including clearance pathways of insulin via the liver and kidney, rather than a lumped parameter. In addition, insulin diffusion between plasma and interstitial spaces is evaluated, with differences in distribution volume taken into consideration for each of these spaces. The NICING model was shown to fit clinical data well, with a low model fit error similar to that of previous model iterations.Insulin kinetic parameters have been identified, and the NICING model is presented for glycaemic control neonatal intensive care. The resulting NICING model is more complex and physiologically relevant, with no loss in bedside-identifiability or ability to capture and predict metabolic dynamics.

Country
New Zealand
Related Organizations
Keywords

Blood Glucose, insulin, 670, Infant, Newborn, physiological modelling, Premature infant, Infant, Low Birth Weight, Models, Biological, premature infant, Fields of Research::32 - Biomedical and clinical sciences::3202 - Clinical sciences::320208 - Endocrinology, Glucose, glycaemic control, Medical applications (general), Fields of Research::32 - Biomedical and clinical sciences::3202 - Clinical sciences::320212 - Intensive care, Infant, Extremely Premature, Glycaemic control, Intensive Care, Neonatal, Humans, Insulin, glucose, Physiological modelling, Kinetics in biochemical problems (pharmacokinetics, enzyme kinetics, etc.)

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    popularity
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    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
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    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
6
Average
Average
Average
bronze