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inpatient hyperglycaemia management

Guillermo Umpierrez, Mary Korytkowski
Diabetic ketoacidosis (DKA), hyperglycaemic hyperosmolar state (HHS) and hypoglycaemia are serious complications of diabetes mellitus that require prompt recognition, diagnosis and treatment. DKA and HHS are characterized by insulinopaenia and severe hyperglycaemia; clinically, these two conditions differ only by the degree of dehydration and the severity of metabolic acidosis. The overall mortality recorded among children and adults with DKA is <1%. Mortality among patients with HHS is ~10-fold higher than that associated with DKA...
April 2016: Nature Reviews. Endocrinology
Kheng Yong Ong, Yu Heng Kwan, Hooi Ching Tay, Doreen Su-Yin Tan, Joanne Yeh Chang
INTRODUCTION: As the effectiveness of intensive glycaemic control is unclear and recommended glycaemic targets are inconsistent, this study aimed to ascertain the prevalence of dysglycaemia among hospitalised patients with diabetes mellitus in an Asian population and evaluate the current standards of inpatient glycaemic control. METHODS: A retrospective observational study was conducted at a secondary hospital. Point-of-care blood glucose (BG) values, demographic data, medical history, glycaemic therapy and clinical characteristics were recorded...
July 2015: Singapore Medical Journal
S George, J Dale, D Stanisstreet
The present paper summarizes the key recommendations in a recent publication produced by the Joint British Diabetes Societies for Inpatient Care on the use of variable rate i.v. insulin infusion in 'medical' inpatients. The full guideline is available at and is designed to be a practical guide that can used by any healthcare professional who manages medical inpatients with hyperglycaemia. Its main aim is to allow variable rate i.v. insulin infusion to be used safely, effectively and efficiently for this specific group of inpatients...
June 2015: Diabetic Medicine: a Journal of the British Diabetic Association
Kalyan Kumar Gangopadhyay, Ganapathi Bantwal, Pradeep G Talwalkar, A Muruganathan, Ashok Kumar Das
Hyperglycaemia is an indicator of poor clinical outcome and mortality in patients with or without a history of diabetes in hospitalised patients in non-critical care condition. A consensus guideline has been developed by a panel of experts based on existing guidelines with specific attention to Indian clinical practice on the management of hyperglycaemia in patients admitted to non-critical care settings. Diagnosis for hyperglycaemia at the time of hospital admission is essential for appropriate treatment during the hospital stay and at the time of discharge...
July 2014: Journal of the Association of Physicians of India
Philippe Le Corvoisier, Sylvie Bastuji-Garin, Bertrand Renaud, Isabelle Mahé, Jean-François Bergmann, Herve Perchet, Elena Paillaud, Dominique Mottier, Olivier Montagne
BACKGROUND: Among patients admitted for acute decompensated heart failure (ADHF), half are aged 75 years or over. The high prevalence of co-morbidities and functional impairments in this age group may affect patient outcomes. OBJECTIVE: To assess the association between co-morbidities, functional status and in-hospital mortality in patients with ADHF aged ≥75 years. DESIGN: A prospective, multicentre cohort study. SETTING: Five French hospitals...
March 2015: Age and Ageing
K Neff, D Donegan, J MacMahon, C O'Hanlon, N Keane, A Agha, C Thompson, D Smith
PN is associated with significant hyperglycaemia, which may be detrimental to clinical outcome. There are few data on the management of this phenomenon outside of intensive care units. In our unit, we studied the efficacy of protocol-based intravenous insulin delivery as compared to subcutaneous insulin prescribed individually outside of the critical care setting. In a retrospective review over a two-year period, we compared patients with PN-associated hyperglycaemia who had received both modes of insulin therapy...
May 2014: Irish Medical Journal
Nicola Townell, David McDougall, E Geoffrey Playford
BACKGROUND: Bloodstream infections (BSIs) are a well-recognized complication of parenteral nutrition (PN). However, their epidemiology and clinical consequences are incompletely described. METHODS: A retrospective cohort study was performed, from 2002 to 2009, of all hospital inpatients who were administered PN, outside the intensive care setting, at a major tertiary hospital in Queensland, Australia. RESULTS: In 780 episodes of PN administration, 120 BSIs occurred, giving an incidence of 10...
May 2014: Scandinavian Journal of Infectious Diseases
H Thabit, R Hovorka
Inpatient glycaemic control remains an important issue due to the increasing number of patients with diabetes admitted to hospital. Morbidity and mortality in hospital are associated with poor glucose control, and cost of hospitalization is higher compared to non-diabetes patients. Guidelines for inpatient glycaemic control in the non-critical care setting have been published. Current recommendations include basal-bolus insulin therapy, regular glucose monitoring, as well as enhancing healthcare provider's role and knowledge...
June 2014: Diabetes, Obesity & Metabolism
R Tamler, A S Dunn, D E Green, M Skamagas, T L Breen, H C Looker, D LeRoith
AIM: An online diabetes course for medical residents led to lower patient blood glucose, but also increased hypoglycaemia despite improved trainee confidence and knowledge. Based on these findings, we determined whether an optimized educational intervention delivered to hospitalists (corresponding to an Acute Physician or Specialist in Acute Hospital Medicine in the UK) improved inpatient glycaemia without concomitant hypoglycaemia. METHODS: All 22 hospitalists at an academic medical centre were asked to participate in an online curriculum on the management of inpatient dysglycaemia in autumn 2009 and a refresher course in spring 2010...
August 2013: Diabetic Medicine: a Journal of the British Diabetic Association
J A Edge, F Ackland, S Payne, A McAulay, E Hind, C Burren, J Burditt, D Sims
AIM: Hospital inpatient care for children with diabetes is frequently mentioned by parents as unsatisfactory. The aim of this study was to examine the reasons for inpatient admission of children with diabetes and to understand patient and carer experience in order to improve services. METHODS: Questionnaires were given to medical teams, parents and children during admissions of children with diabetes under 16 years of age in three regions of England. RESULTS: There were 401 admissions over 6 months from 3247 patients: 334 (83%) emergency admissions and 59 (15%) elective; the reason is unknown in eight (2%)...
March 2013: Diabetic Medicine: a Journal of the British Diabetic Association
R Herring, D L Russell-Jones, C Pengilley, H Hopkins, B Tuthill, J Wright, S V Hordern, S Davidson
OBJECTIVE: To assess whether the introduction of a management of raised glucose clinical decision tool could improve assessment of patients with hyperglycaemia by non-specialist physicians, leading to early discharge and improved quality of inpatient care. METHODS: Participants were adults aged 18 years or over presenting to the Medical Assessment Unit with a capillary blood glucose level > 11.1 mmol/l. Phase 1 of the study (phase 1) evaluated current clinical practice and potential impact of the clinical decision tool...
January 2013: Diabetic Medicine: a Journal of the British Diabetic Association
Daniela Sofrà, Sylvie Masmont Berwart, Marc Egli, Juan Ruiz
The report of significant decrease of the inpatient hospital mortality and morbidity with an efficient insulin therapy has demonstrated the need of a good glycaemic control for patients hospitalised in acute care. However, one is faced with numerous difficulties in the hospital management of patients with hyperglycaemia, errors often occur when prescribing insulin, and the management skills are insufficient. Our goal is to change the medical and nursing practices to evolve towards an efficient and safe management of the hospitalised patient...
June 6, 2012: Revue Médicale Suisse
E A Mitchell, V E Coates, A A Ryan, M O McCarron, D Lyttle, E McCrum-Gardner
AIM: To evaluate the extent to which hyperglycaemia was monitored and managed among patients admitted to hospital with acute stroke and transient ischaemic attack. METHODS: We conducted a retrospective cohort study involving a review of the records of 112 patients consecutively admitted with acute stroke or transient ischaemic attack to all three district general hospitals in one Health and Social Care Trust in Northern Ireland from 1 January to 15 April 2008. Glucose results for each of the first 5 days of hospital admission were ascertained...
September 2012: Diabetic Medicine: a Journal of the British Diabetic Association
Michelle Curll, Monica Dinardo, Michelle Noschese, Mary T Korytkowski
PROBLEM: Medical nutrition therapy is an important component of glycaemic management in hospitalised patients with diabetes; however, there is a lack of information guiding the ordering of specific meal plans in this setting. SETTING: University-affiliated academic medical centre. METHODS: An administrative decision to gradually replace standard consistent-carbohydrate (CCMP) (standard group) with patient-controlled meal plans (patient-controlled group) presented the opportunity to compare menu selection, adherence to CCMP, glycaemic control and satisfaction as a quality-improvement initiative...
August 2010: Quality & Safety in Health Care
Kathleen M Dungan, Susan S Braithwaite, Jean-Charles Preiser
Results of randomised controlled trials of tight glycaemic control in hospital inpatients might vary with population and disease state. Individualised therapy for different hospital inpatient populations and identification of patients at risk of hyperglycaemia might be needed. One risk factor that has received much attention is the presence of pre-existing diabetes. So-called stress hyperglycaemia is usually defined as hyperglycaemia resolving spontaneously after dissipation of acute illness. The term generally refers to patients without known diabetes, although patients with diabetes might also develop stress hyperglycaemia-a fact overlooked in many studies comparing hospital inpatients with or without diabetes...
May 23, 2009: Lancet
Sandy Middleton, Christopher Levi, Jeanette Ward, Jeremy Grimshaw, Rhonda Griffiths, Catherine D'Este, Simeon Dale, N Wah Cheung, Clare Quinn, Malcolm Evans, Dominique Cadilhac
BACKGROUND: Hyperglycaemia, fever, and swallowing dysfunction are poorly managed in the admission phase of acute stroke, and patient outcomes are compromised. Use of evidence-based guidelines could improve care but have not been effectively implemented. Our study aims to develop and trial an intervention based on multidisciplinary team-building to improve management of fever, hyperglycaemia, and swallowing dysfunction in patients following acute stroke. METHODS AND DESIGN: Metropolitan acute stroke units (ASUs) located in New South Wales, Australia will be stratified by service category (A or B) and, within strata, by baseline patient recruitment numbers (high or low) in this prospective, multicentre, single-blind, cluster randomised controlled trial (CRCT)...
2009: Implementation Science: IS
M Noschese, A C Donihi, G Koerbel, E Karslioglu, M Dinardo, M Curll, M T Korytkowski
PROBLEM: Insulin can have favourable effects on patient outcomes when used appropriately; however, it is considered among the top five medications associated with errors in the hospital setting. SETTING: Tertiary care centre. METHODS: A diabetes order set with prescribing guidelines was developed by a multidisciplinary diabetes patient safety committee, and introduced on an inpatient unit (the order set unit) following educational sessions with doctors/nurses...
December 2008: Quality & Safety in Health Care
Yan Bi, Jin-hua Yan, Zhi-hong Liao, Yan-bing Li, Long-yi Zeng, Kuan-xiao Tang, Yao-ming Xue, Hua-zhang Yang, Lu Li, De-hong Cai, Ge Wu, Fan Zhang, Shao-da Lin, Zheng-hua Xiao, Da-long Zhu, Jian-ping Weng
BACKGROUND: Diabetes mellitus has become epidemic in recent years in China. We investigated the prevalence of hyperglycaemia and inadequate glycaemic control among type 2 diabetic inpatients from ten university teaching hospitals in Guangdong Province, China. METHODS: Inadequate glycaemic control in diabetic patients was defined as HbA1c = 6.5%. Therapeutic regimens included no-intervention, lifestyle only, oral antiglycemic agents (OA), insulin plus OA (insulin + OA), or insulin only...
April 20, 2008: Chinese Medical Journal
Peter Langhorne, Alex Pollock
BACKGROUND: The effectiveness of organized inpatient (stroke unit) care has been demonstrated in systematic reviews of clinical trials. However, the key components of stroke unit care are poorly understood. METHODS: We conducted a survey of recent trials (published 1985-2000) of a stroke unit/ward which had demonstrated a beneficial effect consistent with the stroke unit systematic review. RESULTS: We identified 11 eligible stroke unit trials of which the majority described similar approaches to i) assessment procedures (medical, nursing and therapy assessments), ii) early management policies (e...
September 2002: Age and Ageing
A Bhattacharyya, C Christodoulides, K Kaushal, J P New, R J Young
AIMS: To devise a system for assessing in-patient glycaemic control and care satisfaction in diabetic patients admitted to hospital for reasons other than their diabetes. METHODS: Consecutive January to March 2001 case-notes were reviewed. Admissions with acute metabolic complications, acute myocardial infarction and pregestational or gestational diabetes were excluded. Glycaemic control, frequency of blood monitoring and management of hyperglycaemia were recorded...
May 2002: Diabetic Medicine: a Journal of the British Diabetic Association
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