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hypoglycemia in chronic kidney disease

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https://www.readbyqxmd.com/read/29770308/allo-and-auto-percutaneous-intra-portal-pancreatic-islet-transplantation-pipit-for-diabetes-cure-and-prevention-the-role-of-imaging-and-interventional-radiology
#1
REVIEW
Massimo Venturini, Claudio Sallemi, Paolo Marra, Anna Palmisano, Giulia Agostini, Carolina Lanza, Gianpaolo Balzano, Massimo Falconi, Antonio Secchi, Paolo Fiorina, Lorenzo Piemonti, Paola Maffi, Antonio Esposito, Francesco De Cobelli, Alessandro Del Maschio
Although the life expectancy of patients with type 1 diabetes mellitus (T1DM) has improved since the introduction of insulin therapy, the acute life-threatening and long-term complications from diabetes mellitus are significant causes of both mortality and morbidity. Percutaneous intra-portal pancreatic islet transplantation (PIPIT) is a minimally invasive, repeatable procedure which allows a β-cell replacement therapy through a liver islet engraftment, leading to insulin release and glycaemic control restoration in patients with diabetes...
April 2018: Gland Surgery
https://www.readbyqxmd.com/read/29725636/treatment-of-hyperkalemia-with-a-low-dose-insulin-protocol-is-effective-and-results-in-reduced-hypoglycemia
#2
Bairbre A McNicholas, Mai H Pham, Katrina Carli, Chang Huei Chen, Nancy Colobong-Smith, Arthur Eric Anderson, Hien Pham
Introduction: Complications associated with insulin treatment for hyperkalemia are serious and common. We hypothesize that, in chronic kidney disease (CKD) and end-stage renal disease (ESRD), giving 5 units instead of 10 units of i.v. regular insulin may reduce the risk of causing hypoglycemia when treating hyperkalemia. Methods: A retrospective quality improvement study on hyperkalemia management (K+  ≥ 6 mEq/l) from June 2013 through December 2013 was conducted at an urban emergency department center...
March 2018: KI Reports
https://www.readbyqxmd.com/read/29527311/development-and-validation-of-a-prediction-model-for-insulin-associated-hypoglycemia-in-non-critically-ill-hospitalized-adults
#3
Nestoras Nicolas Mathioudakis, Estelle Everett, Shuvodra Routh, Peter J Pronovost, Hsin-Chieh Yeh, Sherita Hill Golden, Suchi Saria
Objective: To develop and validate a multivariable prediction model for insulin-associated hypoglycemia in non-critically ill hospitalized adults. Research design and methods: We collected pharmacologic, demographic, laboratory, and diagnostic data from 128 657 inpatient days in which at least 1 unit of subcutaneous insulin was administered in the absence of intravenous insulin, total parenteral nutrition, or insulin pump use (index days). These data were used to develop multivariable prediction models for biochemical and clinically significant hypoglycemia (blood glucose (BG) of ≤70 mg/dL and <54 mg/dL, respectively) occurring within 24 hours of the index day...
2018: BMJ Open Diabetes Research & Care
https://www.readbyqxmd.com/read/29453020/2018-consensus-of-the-taiwan-society-of-cardiology-and-the-diabetes-association-of-republic-of-china-taiwan-on-the-pharmacological-management-of-patients-with-type-2-diabetes-and-cardiovascular-diseases
#4
Chern-En Chiang, Shih-Yi Lin, Tsung-Hsien Lin, Tzung-Dau Wang, Hung-I Yeh, Jung-Fu Chen, Chia-Ti Tsai, Yi-Jen Hung, Yi-Heng Li, Ping-Yen Liu, Kuan-Cheng Chang, Kang-Ling Wang, Ting-Hsing Chao, Kou-Gi Shyu, Wei-Shiung Yang, Kwo-Chang Ueng, Pao-Hsien Chu, Wei-Hsian Yin, Yen-Wen Wu, Hao-Min Cheng, Shyi-Jang Shin, Chien-Ning Huang, Lee-Ming Chuang, Shing-Jong Lin, San-Jou Yeh, Wayne Huey-Herng Sheu, Jiunn-Lee Lin
The global incidence and prevalence of type 2 diabetes have been escalating in recent decades. Patients with type 2 diabetes have an increased risk of atherosclerotic cardiovascular disease (ASCVD). About two-thirds of death in type 2 diabetes are due to ASCVD, including 40% from coronary heart disease (CHD), 15% from heart failure (HF), and 10% from stroke. The association between hyperglycemia and elevated CV risk has been demonstrated in multiple cohort studies. However, clinical trials of intensive glucose reduction did not significantly reduce macrovascular outcomes...
March 2018: Journal of the Chinese Medical Association: JCMA
https://www.readbyqxmd.com/read/29393039/glucagon-treatment-in-type-1-diabetes-with-focus-on-restoring-plasma-glucose-during-mild-hypoglycemia
#5
Ajenthen Ranjan
Type 1 diabetes is a chronic disease caused by an autoimmune destruction of the insulin-producing cells in the pancreas, leading to a condition with insulin deficiency and elevated blood glucose levels. Individuals with type 1 diabetes are therefore recommended to frequently inject insulin subcutaneously to keep near-normal blood glucose levels, preventing the progression and onset of diabetes-related complications, i.e. kidney failure, blindness, amputation, stroke and heart attack. Unfortunately, the intensified insulin therapy is associated with risk of hypoglycemia- impeding individuals from reaching recommended treatment goals...
February 2018: Danish Medical Journal
https://www.readbyqxmd.com/read/29326106/risk-of-hypoglycemia-following-hospital-discharge-in-patients-with-diabetes-and-acute-kidney-injury
#6
Adriana M Hung, Edward D Siew, Otis D Wilson, Amy M Perkins, Robert A Greevy, Jeffrey Horner, Khaled Abdel-Kader, Sharidan K Parr, Christianne L Roumie, Marie R Griffin, T Alp Ikizler, Theodore Speroff, Michael E Matheny
OBJECTIVE: Hypoglycemia is common in patients with diabetes. The risk of hypoglycemia after acute kidney injury (AKI) is not well defined. The purpose of this study was to compare the risk for postdischarge hypoglycemia among hospitalized patients with diabetes who do and do not experience AKI. RESEARCH DESIGN AND METHODS: We performed a propensity-matched analysis of patients with diabetes, with and without AKI, using a retrospective national cohort of veterans hospitalized between 2004 and 2012...
March 2018: Diabetes Care
https://www.readbyqxmd.com/read/29223646/exploring-the-effects-of-dpp-4-inhibitors-on-the-kidney-from-the-bench-to-clinical-trials
#7
REVIEW
Giuseppe Coppolino, Christian Leporini, Laura Rivoli, Francesco Ursini, Eugenio Donato di Paola, Valeria Cernaro, Franco Arturi, Davide Bolignano, Emilio Russo, Giovambattista De Sarro, Michele Andreucci
Dipeptidyl-peptidase-4 (DPP-4) inhibitors are a relatively new class of non-insulin glucose-lowering agents, belonging to the incretin family, which are able to improve glycemic control with a favorable safety profile, since they are associated with a low risk of hypoglycemia, no weight gain, and good tolerability in patients with chronic renal failure. Some experimental and clinical studies suggest that these drugs may exert significant pleiotropic effects, in particular on chronic kidney disease (CKD) progression, but data from clinical trials are still controversial...
March 2018: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/29200897/insulinoma-and-chronic-kidney-disease-an-uncommon-conundrum-not-to-be-overlooked
#8
Luca Foppiani, Serena Panarello, Marco Filauro, Maria Concetta Scirocco, Stefano Cappato, Andrea Parodi, Simona Sola, Giancarlo Antonucci
A hypertensive man with chronic kidney disease (CKD) secondary to polycystic disease was hospitalized for symptoms related to hypoglycemia. Fasting test elicited symptomatic hypoglycemia after 12 hours, which was associated with inappropriately unsuppressed normal insulin and C-peptide levels. Neither ultrasonography (US) nor magnetic resonance imaging detected any pancreatic tumor. Endoscopic ultrasonography (EUS) showed a small isoechogenic nodule suspect for neuroendocrine tumor in the pancreatic head...
2017: Clinical Medicine Insights. Endocrinology and Diabetes
https://www.readbyqxmd.com/read/29159457/ertugliflozin-in-patients-with-stage-3-chronic-kidney-disease-and-type-2-diabetes-mellitus-the-vertis-renal-randomized-study
#9
George Grunberger, Sarah Camp, Jeremy Johnson, Susan Huyck, Steven G Terra, James P Mancuso, Zhi Wei Jiang, Gregory Golm, Samuel S Engel, Brett Lauring
INTRODUCTION: Ertugliflozin is a sodium-glucose cotransporter 2 inhibitor in development for type 2 diabetes mellitus (T2DM). The safety and efficacy of ertugliflozin were evaluated over 52 weeks in patients with chronic kidney disease (CKD). METHODS: In this double-blind randomized study (NCT01986855), patients with glycated hemoglobin (A1C) 7.0-10.5% and stage 3 CKD [estimated glomerular filtration rate (eGFR) ≥ 30 to < 60 mL/min/1.73 m2 ] who were undergoing treatment with standard diabetes therapy (or therapies) including insulin and/or sulfonylureas were randomized to once-daily ertugliflozin 5 mg, 15 mg, or placebo...
February 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/29100450/meglitinides-increase-the-risk-of-hypoglycemia-in-diabetic-patients-with-advanced-chronic-kidney-disease-a-nationwide-population-based-study
#10
Pei-Chen Wu, Vin-Cent Wu, Cheng-Jui Lin, Chi-Feng Pan, Chih-Yang Chen, Tao-Min Huang, Che-Hsiung Wu, Likwang Chen, Chih-Jen Wu
The safety of short-acting meglitinides in diabetic patients with advanced chronic kidney disease (CKD) has not been widely reported. Diabetic patients with advanced CKD who had a serum creatinine level of > 6 mg/dL a hematocrit level of ≦ 28% and received erythropoiesis-stimulating agent treatment between 2000 and 2010, were included in this nationwide study in Taiwan. The outcomes of interest were defined as hypoglycemia and long-term mortality. The risks of hypoglycemia and death were analyzed using Cox proportional hazards models, with end-stage renal disease and anti-diabetic drugs as time-dependent variables...
September 29, 2017: Oncotarget
https://www.readbyqxmd.com/read/29098423/hypoglycemia-reduction-strategies-in-the-icu
#11
REVIEW
Susan Shapiro Braithwaite, Dharmesh B Bavda, Thaer Idrees, Faisal Qureshi, Oluwakemi T Soetan
PURPOSE OF REVIEW: We reviewed the strategies associated with hypoglycemia risk reduction among critically ill non-pregnant adult patients. RECENT FINDINGS: Hypoglycemia in the ICU has been associated with increased mortality in a number of studies. Insulin dosing and glucose monitoring rules, response to impending hypoglycemia, use of computerization, and attention to modifiable factors extrinsic to insulin algorithms may affect the risk for hypoglycemia. Recurring use of intravenous (IV) bolus doses of insulin in insulin-resistant cases may reduce reliance upon higher IV infusion rates...
November 2, 2017: Current Diabetes Reports
https://www.readbyqxmd.com/read/28983844/the-role-of-vildagliptin-in-the-therapy-of-type-2-diabetic-patients-with-renal-dysfunction
#12
REVIEW
Roberto Trevisan
Diabetes is the leading cause of chronic kidney disease, and even in the absence of albuminuria, decreased renal function in type 2 diabetes mellitus (T2DM) patients increases the risk for major adverse cardiovascular events and death. The evidence derived from recent studies suggests that intensive glucose control not only reduces the risk for microalbuminuria and macroalbuminuria but may also decrease the rate of decline of glomerular filtration rate (GFR). Although insulin therapy is widely used in patients with T2DM and renal disease, metabolic control is particularly difficult to achieve and manage because of the limited therapeutic options and the frequent comorbidities seen in this population...
December 2017: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/28977090/use-of-sglt-2-inhibitors-in-the-treatment-of-type-2-diabetes-mellitus
#13
REVIEW
Leyna Leite Santos, Fernando José Camello de Lima, Célio Fernando de Sousa-Rodrigues, Fabiano Timbó Barbosa
INTRODUCTION: Diabetes mellitus is one of the most common chronic diseases in the world, with high morbidity and mortality rates, resulting in a greatly negative socioeconomic impact. Although there are several classes of oral antidiabetic agents, most of the patients are outside the therapeutic goal range. OBJECTIVE: To review the use of SGLT-2 inhibitors in the treatment of type 2 diabetes mellitus, focusing on their favorable and unfavorable effects, as well as on cardiovascular profile...
July 2017: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/28842165/chronic-kidney-disease-basal-insulin-glargine-and-health-outcomes-in-people-with-dysglycemia-the-origin-study
#14
RANDOMIZED CONTROLLED TRIAL
Vasilios Papademetriou, Eric S Nylen, Michael Doumas, Jeff Probstfield, Johannes F E Mann, Richard E Gilbert, Hertzel C Gerstein
BACKGROUND: Early stages of chronic kidney disease are associated with an increased cardiovascular risk in patients with established type 2 diabetes and macrovascular disease. The role of early stages of chronic kidney disease on macrovascular outcomes in prediabetes and early type 2 diabetes mellitus is not known. In the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial, the introduction of insulin had no effect on cardiovascular outcomes compared with standard therapy...
December 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28828479/development-and-validation-of-a-tool-to-identify-patients-with-type-2-diabetes-at-high-risk-of-hypoglycemia-related-emergency-department-or-hospital-use
#15
MULTICENTER STUDY
Andrew J Karter, E Margaret Warton, Kasia J Lipska, James D Ralston, Howard H Moffet, Geoffrey G Jackson, Elbert S Huang, Donald R Miller
Importance: Hypoglycemia-related emergency department (ED) or hospital use among patients with type 2 diabetes (T2D) is clinically significant and possibly preventable. Objective: To develop and validate a tool to categorize risk of hypoglycemic-related utilization in patients with T2D. Design, Setting, and Participants: Using recursive partitioning with a split-sample design, we created a classification tree based on potential predictors of hypoglycemia-related ED or hospital use...
October 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28758978/dietary-approaches-in-the-management-of-diabetic-patients-with-kidney-disease
#16
REVIEW
Gang Jee Ko, Kamyar Kalantar-Zadeh, Jordi Goldstein-Fuchs, Connie M Rhee
Chronic kidney disease (CKD) is one of the most prevalent complications of diabetes, and patients with diabetic kidney disease (DKD) have a substantially higher risk of cardiovascular disease and death compared to their non-diabetic CKD counterparts. In addition to pharmacologic management strategies, nutritional and dietary interventions in DKD are an essential aspect of management with the potential for ameliorating kidney function decline and preventing the development of other end-organ complications. Among DKD patients with non-dialysis dependent CKD, expert panels recommend lower dietary protein intake of 0...
July 31, 2017: Nutrients
https://www.readbyqxmd.com/read/28721081/insulin-glargine-300-u-ml-for-basal-insulin-therapy-in-type-1-and-type-2-diabetes-mellitus
#17
REVIEW
Ip Tim Lau, Ka Fai Lee, Wing Yee So, Kathryn Tan, Vincent Tok Fai Yeung
OBJECTIVE: To review published clinical studies on the efficacy and safety of new insulin glargine 300 units/mL (Gla-300), a new long-acting insulin analog, for the treatment of type 1 and type 2 diabetes mellitus (T1DM, T2DM). MATERIALS AND METHODS: Data sources comprised primary research articles on Gla-300, including pharmacodynamic, pharmacokinetic, and clinical studies. RESULTS: In pharmacodynamic and pharmacokinetic studies, Gla-300 showed a flatter time-action profile and longer duration of action than Gla-100...
2017: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
https://www.readbyqxmd.com/read/28686322/characteristics-of-frequent-emergency-department-users-with-type-2-diabetes-mellitus-in-korea
#18
Morena Ustulin, Junghoon Woo, Jeong-Taek Woo, Sang Youl Rhee
AIMS/INTRODUCTION: Frequent emergency department (ED) visitors are medically vulnerable individuals. We identified the characteristics of "frequent ED users" among Korean patients with type 2 diabetes mellitus. MATERIALS AND METHODS: We used the Health Insurance Review and Assessment Service National Patient Sample, which is a nationally representative sample. Patients (n = 109,412) with type 2 diabetes mellitus as a primary or secondary diagnosis at one of their visits were included...
March 2018: Journal of Diabetes Investigation
https://www.readbyqxmd.com/read/28616207/changes-in-metformin-use-in-chronic-kidney-disease
#19
Talha H Imam
Metformin is one of the oldest and most widely prescribed antidiabetic medicines worldwide. It is the only such medicine that has shown a reduction of cardiovascular mortality in diabetes mellitus type 2. Since many diabetic patients have chronic kidney disease, its use is often curtailed by practitioners due to fear of lactic acidosis and the US Food and Drug Administration (FDA) warnings that, until recently, had been in place for decades. Current guidelines, though somewhat vague regarding dosages, clearly pave the way for spreading the use of metformin in patients with lower glomerular filtration rates...
June 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28605603/efficacy-and-safety-of-degludec-versus-glargine-in-type-2-diabetes
#20
RANDOMIZED CONTROLLED TRIAL
Steven P Marso, Darren K McGuire, Bernard Zinman, Neil R Poulter, Scott S Emerson, Thomas R Pieber, Richard E Pratley, Poul-Martin Haahr, Martin Lange, Kirstine Brown-Frandsen, Alan Moses, Simon Skibsted, Kajsa Kvist, John B Buse
BACKGROUND: Degludec is an ultralong-acting, once-daily basal insulin that is approved for use in adults, adolescents, and children with diabetes. Previous open-label studies have shown lower day-to-day variability in the glucose-lowering effect and lower rates of hypoglycemia among patients who received degludec than among those who received basal insulin glargine. However, data are lacking on the cardiovascular safety of degludec. METHODS: We randomly assigned 7637 patients with type 2 diabetes to receive either insulin degludec (3818 patients) or insulin glargine U100 (3819 patients) once daily between dinner and bedtime in a double-blind, treat-to-target, event-driven cardiovascular outcomes trial...
August 24, 2017: New England Journal of Medicine
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