Glycemic control in ICU stays tough due to patient differences. The STAR protocol changes that with a smart, patient-specific approach. It uses models to adjust insulin and nutrition safely. The results of the trial were published in the Journal of Diabetes Science and Technology.
Protocol and Patient Details
This study ran at Christchurch Hospital ICU in New Zealand from April 2019 to December 2024. It covered 1340 adult patients in 1958 STAR episodes. After filters, 1085 patients and 1430 episodes remained, totaling 86 010 h of control. Teams measured performance, safety, and workload.
Strong Time-in-Target Results
71% of blood glucose readings hit the target band. Median BG stayed at 124 [110-148] mg/dL. Control worked well across all patients. Once in target, results got even better.
Top Safety with Low Hypoglycemia
Severe hypoglycemia (BG < 40 mg/dL) struck only three times (0.21%). Two cases had no link to the protocol. Median insulin rate held at 4.5 [2.0-6.0] U/h.
High Nutrition Without Compromise
Patients reached 89.0 [17.2-100.0] % of goal feed rate. STAR handles inter- and intra-patient variability. This supports its use in busy ICUs everywhere.
Path Forward for GC Protocols
STAR proves safe and effective in large groups. Low risks and high nutrition encourage wider adoption. It sets up studies on long-term patient outcomes.
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Key highlights
- STAR achieves 71% blood glucose measurements in the target band across 86,010 hours in 1085 ICU patients.
- Median blood glucose level remains stable at 124 [110-148] mg/dL during STAR control.
- Severe hypoglycemia occurs in only 0.21% of cases, with most unrelated to protocol design.
- Nutrition delivery hits 89.0 [17.2-100.0] % of goal feed alongside median insulin of 4.5 [2.0-6.0] U/h.
- STAR adapts to individual patient variability, supporting its rollout in other ICUs for better glycemic management.
Source
Seret M, Uyttendaele V, Chase JG, Shaw GM, Desaive T. Tight Glycemic Control Can Be Achieved in Adult ICU Patients Safely: Results From a 5-Year Single-Center Observational Study Using the STAR Glycemic Control Framework. J Diabetes Sci Technol. Published online January 22, 2026. doi:10.1177/19322968251412857
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STAR glycemic control in 1085 ICU patients achieves 71% target blood glucose with just 0.21% severe hypoglycemia over 86,010 hours. It boosts nutrition delivery safely.
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