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Inpatient hyperglycemia

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https://www.readbyqxmd.com/read/27903614/association-between-inpatient-sleep-loss-and-hyperglycemia-of-hospitalization
#1
Regina H DePietro, Kristen L Knutson, Lisa Spampinato, Samantha L Anderson, David O Meltzer, Eve Van Cauter, Vineet M Arora
OBJECTIVE: To determine whether inpatient sleep duration and efficiency are associated with a greater risk of hyperglycemia in hospitalized patients with and without diabetes. RESEARCH DESIGN AND METHODS: In this retrospective analysis of a prospective cohort study, medical inpatients ≥50 years of age were interviewed, and their charts were reviewed to obtain demographic data and diagnosis. Using World Health Organization criteria, patients were categorized as having normal blood glucose, impaired fasting blood glucose, or hyperglycemia based on morning glucose from the electronic health record...
November 30, 2016: Diabetes Care
https://www.readbyqxmd.com/read/27864238/outcomes-of-a-pharmacist-managed-glucose-collaborative-practice-agreement
#2
Vidya Pugazhenthi, Travis B Dick, Matthew Call
PURPOSE: The impact of a pharmacist-managed glucose collaborative practice agreement (CPA) on glycemic control at a tertiary medical center was investigated. METHODS: A retrospective data analysis was performed on hospitalized, noncritically ill patients admitted between December 2012 and June 2014 who received at least one dose of subcutaneous insulin and experienced at least one blood glucose concentration of 140 mg/dL or higher. The study population was divided into cohorts based on admittance before versus after implementation of the CPA, as well as glucose management by pharmacist versus nonpharmacist provider...
December 1, 2016: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/27823609/inpatient-diabetes-management-in-the-twenty-first-century
#3
REVIEW
Natasha B Khazai, Osama Hamdy
In hospitalized patients, both hyperglycemia and hypoglycemia have been associated with poor outcomes. During the inpatient period, hyperglycemia has been associated with increased risk of infection, cardiovascular events, and mortality. It is also associated with longer length of hospital stay. Hypoglycemia has also been associated with an increased risk of mortality. Therefore, current evidence supports avoidance of both conditions among hospitalized patients whether they are admitted to critical care units or noncritical care units...
December 2016: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/27818228/computerized-insulin-order-sets-and-glycemic-control-in-hospitalized-patients
#4
Bertha Wong, Muhammad M Mamdani, Catherine H Y Yu
OBJECTIVE: To evaluate the impact of computerized provider order entry subcutaneous insulin order sets on inpatient glycemic control and ordering behavior. METHODS: This was an interrupted time series study of non-intensive care patients at an urban teaching hospital. The primary outcome was proportion of capillary blood glucose in optimal range (4.0-10.0 mmol/L [72 -180 mg/dL]) during the six months before and after a change to a computerized provider order entry-integrated insulin order set...
November 3, 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27805455/decreased-rates-of-hypoglycemia-following-implementation-of-a-comprehensive-computerized-insulin-order-set-and-titration-algorithm-in-the-inpatient-setting
#5
Naina Sinha Gregory, Jane Jeffrie Seley, Linda M Gerber, Chin Tang, David Brillon
OBJECTIVES: More than one-third of hospitalized patients have hyperglycemia. Despite evidence that improving glycemic control leads to better outcomes, achieving recognized targets remains a challenge. The objective of this study was to evaluate the implementation of a computerized insulin order set and titration algorithm on rates of hypoglycemia and overall inpatient glycemic control. METHODS: A prospective observational study evaluating the impact of a glycemic order set and titration algorithm in an academic medical center in non-critical care medical and surgical inpatients...
November 2, 2016: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/27790855/determinants-of-hemoglobin-a1c-level-in-patients-with-type-2-diabetes-after-in-hospital-diabetes-education-a-study-based-on-continuous-glucose-monitoring
#6
Keiichi Torimoto, Yosuke Okada, Sachiko Sugino, Yoshiya Tanaka
AIMS/INTRODUCTION: We investigated the relationship between blood glucose profile at hospital discharge, evaluated by continuous glucose monitoring (CGM), and hemoglobin A1c (HbA1c) level at 12 weeks after discharge in patients with type 2 diabetes who received inpatient diabetes education. MATERIALS AND METHODS: This was a retrospective study. The subjects were 54 patients with type 2 diabetes who did not change their medication after discharge. The mean blood glucose (MBG), standard deviation (SD), coefficient of variation, mean postprandial glucose excursion, maximum blood glucose, minimum blood glucose, percentage of time with blood glucose at ≥180 mg/dL (Time at ≧180), percentage of time with blood glucose at ≥140 mg/dL, and percentage of time with blood glucose at <70 mg/dL were measured at admission and discharge using CGM...
October 27, 2016: Journal of Diabetes Investigation
https://www.readbyqxmd.com/read/27750353/an-intensive-diabetes-screening-and-treatment-program-improves-diagnosis-treatment-and-outcomes-of-diabetes-in-patients-admitted-with-cardiac-diseases
#7
X-F Su, L Sun, B-L Liu, X-J Tao, H-Q Li, F-F Li, L Ye, K-O Lee, J-H Ma, S-L Chen
Aim: Patients with cardiac diseases, especially ischemic heart disease, are known to have a high prevalence of diabetes mellitus (DM). They are at risk of having inadequate glucose control. An intensive diabetes screening and treatment program was developed to identify and treat DM in patients admitted with cardiac diseases. Methods: Adult inpatients of 2 cardiac wards, namely Ward-A and Ward-B, at Nanjing Hospital, Nanjing, China, were studied. Patients were randomly assigned into either ward. In addition to routine examination and treatment, an intensive screening and treatment program to identify and treat patients with DM or impaired glucose regulation (IGR) was only applied in Ward-A patients...
October 17, 2016: Experimental and Clinical Endocrinology & Diabetes
https://www.readbyqxmd.com/read/27699579/postoperative-dysglycemia-in-elective-non-diabetic-surgical-patients-a-prospective-observational-study
#8
Michael Hang Yang, Melanie Jaeger, Michael Baxter, Elizabeth VanDenKerkhof, Janet van Vlymen
PURPOSE: Elevated glycosylated hemoglobin (HbA1c) is often found in surgical patients with no history of diabetes. The purpose of this prospective observational study was to determine if elevated preoperative HbA1c is associated with postoperative hyperglycemia in non-diabetic surgical patients and to identify predictors of elevated HbA1c. METHODS: This study included 257 non-diabetic adults scheduled for inpatient surgery. Preoperatively, capillary blood glucose (CBG) and HbA1c were measured and patients completed the Canadian Diabetes Risk Questionnaire (CANRISK)...
October 3, 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/27645817/critical-care-glucose-point-of-care-testing
#9
S N Narla, M Jones, K L Hermayer, Y Zhu
Maintaining blood glucose concentration within an acceptable range is a goal for patients with diabetes mellitus. Point-of-care glucose meters initially designed for home self-monitoring in patients with diabetes have been widely used in the hospital settings because of ease of use and quick reporting of blood glucose information. They are not only utilized for the general inpatient population but also for critically ill patients. Many factors affect the accuracy of point-of-care glucose testing, particularly in critical care settings...
2016: Advances in Clinical Chemistry
https://www.readbyqxmd.com/read/27550550/patterns-and-impact-of-hypoglycemia-hyperglycemia-and-glucose-variability-on-inpatients-with-insulin-treated-cystic-fibrosis-related-diabetes
#10
Gregory C Jones, Zhou M Chong, Jennifer Gilmour, Christine Matheson, Gordon MacGregor, Christopher A R Sainsbury
INTRODUCTION: Mortality in patients with cystic fibrosis-related diabetes (CFRD) is higher than that in patients with cystic fibrosis without diabetes. Hypoglycemia, hyperglycemia, and glucose variability confer excess mortality and morbidity in the general inpatient population with diabetes. METHODS: We investigated patterns of hypoglycemia and the association of hypoglycemia, hyperglycemia, and glucose variability with mortality and readmission rate in inpatients with CFRD...
September 2016: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/27540884/impact-of-glucose-management-team-on-outcomes-of-hospitalization-in-patients-with-type-2-diabetes-admitted-to-the-medical-service
#11
Yunjiao J Wang, Stacey Seggelke, R Matthew Hawkins, Joanna Gibbs, Mark Lindsay, Ingrid Hazlett, Cecilia C Low Wang, Neda Rasouli, Kendra A Young, Boris Draznin
OBJECTIVE: To improve glycemic control of hospitalized patients with diabetes and hyperglycemia, many medical centers have established dedicated glucose management teams (GMT). However, the impact of these specialized teams on clinical outcomes has not been evaluated. METHODS: We conducted a retrospective study of 440 patients with type 2 diabetes admitted to the medical service for cardiac or infection-related diagnosis. The primary endpoint was a composite outcome of several well-recognized markers of morbidity, consisting of: death during hospitalization, transfer to ICU, initiation of enteral or parenteral nutrition, line infection, new in-hospital infection or infection lasting more than 20 days of hospitalization, deep venous thrombosis or pulmonary embolism, rise in plasma creatinine, and hospital readmissions...
August 19, 2016: Endocrine Practice
https://www.readbyqxmd.com/read/27540877/hypoglycemia-rates-after-restriction-of-high-dose-glargine-in-hospitalized-patients
#12
Sun Y Lee, Gulce Askin, Marie E McDonnell, Lindsay M Arnold, Sara M Alexanian
Objective Hypoglycemia remains one of the main challenges of insulin therapy. To reduce insulin-related hypoglycemia at our institution, we restricted inpatient ordering of high glargine doses (≥0.5u/kg/day) to endocrine staff in 5/2013. This retrospective cohort study assesses its effect on hypoglycemia and glycemic control ≤48 hours of admission. Methods 692 adult patients hospitalized at Boston Medical Center and received glargine upon admission from 11/1/12-4/30/13 were identified as the pre-intervention group, and 651 adult patients from 11/1/13-4/30/14 as the post-intervention group...
August 19, 2016: Endocrine Practice
https://www.readbyqxmd.com/read/27535643/evaluation-of-a-novel-glucose-area-under-the-curve-auc-monitoring-system-comparison-with-the-auc-by-continuous-glucose-monitoring
#13
Satoshi Ugi, Hiroshi Maegawa, Katsutaro Morino, Yoshihiko Nishio, Toshiyuki Sato, Seiki Okada, Yasuo Kikkawa, Toshihiro Watanabe, Hiromu Nakajima, Atsunori Kashiwagi
BACKGROUND: Management of postprandial hyperglycemia is a key aspect in diabetes treatment. We developed a novel system to measure glucose area under the curve (AUC) using minimally invasive interstitial fluid extraction technology (MIET) for simple monitoring of postprandial glucose excursions. In this study, we evaluated the relationship between our system and continuous glucose monitoring (CGM) by comparing glucose AUC obtained using MIET with that obtained using CGM for a long duration...
August 2016: Diabetes & Metabolism Journal
https://www.readbyqxmd.com/read/27486518/impact-of-obesity-on-hospital-complications-and-mortality-in-hospitalized-patients-with-hyperglycemia-and-diabetes
#14
Anastasia-Stefania Alexopoulos, Maya Fayfman, Liping Zhao, Jeff Weaver, Lauren Buehler, Dawn Smiley, Francisco J Pasquel, Priyathama Vellanki, J Sonya Haw, Guillermo E Umpierrez
OBJECTIVE: Obesity is associated with increased risk of diabetes, hypertension and cardiovascular mortality. Several studies have reported increased length of hospital stay and complications; however, there are also reports of obesity having a protective effect on health, a phenomenon coined the 'obesity paradox'. We aimed to investigate the impact of overweight and obesity on complications and mortality in hospitalized patients with hyperglycemia and diabetes. RESEARCH DESIGN AND METHODS: This retrospective analysis was conducted on 29 623 patients admitted to two academic hospitals in Atlanta, Georgia, between January 2012 and December 2013...
2016: BMJ Open Diabetes Research & Care
https://www.readbyqxmd.com/read/27344660/a-possible-association-between-space-weather-conditions-and-the-risk-of-acute-coronary-syndrome-in-patients-with-diabetes-and-the-metabolic-syndrome
#15
Jone Vencloviene, Ruta Marija Babarskiene, Deivydas Kiznys
Hyperglycemia negatively affects cardiovascular variables that are also adversely affected by increased geomagnetic activity. It is likely that geomagnetic storms (GS) could have a stronger negative impact on these patients. We analyzed data on 1548 randomly selected patients with acute coronary syndrome (ACS) who were admitted inpatient treatment in Kaunas city, during 2000-2003. We evaluated the associations of GS, solar proton events (SPE), and high-speed solar wind (HSSW) (solar wind speed ≥600 km/s) with the risk of ACS in patients with diabetes mellitus (DM) and the metabolic syndrome (MS) by using logistic regression with categorical predictors...
June 25, 2016: International Journal of Biometeorology
https://www.readbyqxmd.com/read/27312737/icu-acquired-weakness-a-rehabilitation-perspective-of-diagnosis-treatment-and-functional-management
#16
Richard D Zorowitz
ICU-acquired weakness (ICUAW) occurs with reported incidence rates from 25% to 100%. Risk factors include immobility, sepsis, persistent systemic inflammation, multiorgan system failure, hyperglycemia, glucocorticoids, and neuromuscular blocking agents. The pathophysiology remains unknown. Clinical features may be neuropathic, myopathic, or a combination of both. Although manual muscle testing is more practical in diagnosing ICUAW, the "gold standard" for the diagnosis of ICUAW remains electromyography and nerve conduction studies...
October 2016: Chest
https://www.readbyqxmd.com/read/27215550/short-term-change-of-carotid-intima-media-thickness-after-treatment-of-hyperglycemia-in-patients-with-diabetes-a-cross-sectional-study
#17
Ayumi Tenjin, Yoshio Nagai, Sayaka Yuji, Satoshi Ishii, Hiroyuki Kato, Akio Ohta, Yasushi Tanaka
BACKGROUND: The carotid artery intima-media thickness (CIMT) has been used as a predictor of cardiovascular events, but it remains unclear whether CIMT can change over the short term. We evaluated changes of CIMT in patients with diabetes during admission to hospital for 2 weeks. METHODS: A total of 279 inpatients with diabetes aged 61 ± 14 years were recruited. They were on treatment with insulin and/or oral agents, excluding drugs that influence the fluid balance and hemodynamics...
2016: BMC Research Notes
https://www.readbyqxmd.com/read/27214771/glycated-hemoglobin-testing-to-identify-undiagnosed-diabetes-mellitus-in-the-inpatient-setting
#18
Dustin Jones, Brian Scharfenberg, Jessica Perkins, Keri Childers, Godwin Y Dogbey, Jay H Shubrook
BACKGROUND: Hyperglycemia is commonly seen in hospitalized patients. Glycated hemoglobin (HbA1c) correlates with the average blood glucose level over the previous 8 to 12 weeks. Thus, an HbA1c test offers a longitudinal view that reduces etiologic ambiguity of disease. Screening of HbA1c levels plays an important role in the diagnosis and management of diabetes mellitus in the outpatient setting but remains underused in the evaluation of hyperglycemia with undiagnosed diabetes in the inpatient setting...
June 1, 2016: Journal of the American Osteopathic Association
https://www.readbyqxmd.com/read/27176681/inpatient-hyperglycemia-management-a-practical-review-for-primary-medical-and-surgical-teams
#19
REVIEW
M Cecilia Lansang, Guillermo E Umpierrez
Inpatient hyperglycemia is common and is associated with an increased risk of hospital complications, higher healthcare resource utilization, and higher in-hospital mortality rates. Appropriate glycemic control strategies can reduce these risks, although hypoglycemia is a concern. In critically ill patients, intravenous (IV) insulin is most appropriate, with a starting threshold no higher than 180 mg/dL. Once IV insulin is started, the glucose level should be maintained between 140 and 180 mg/dL. In noncritically ill patients, basal-bolus regimens with basal, prandial, and correction components are preferred for those with good nutritional intake...
May 2016: Cleveland Clinic Journal of Medicine
https://www.readbyqxmd.com/read/27105121/accuracy-of-continuous-glucose-monitoring-in-patients-after-total-pancreatectomy-with-islet-autotransplantation
#20
Gregory P Forlenza, Brandon M Nathan, Antoinette Moran, Ty B Dunn, Gregory J Beilman, Timothy L Pruett, Boris P Kovatchev, Melena D Bellin
BACKGROUND: Among postsurgical and critically ill patients, malglycemia is associated with increased complications. Continuous glucose monitoring (CGM) in the inpatient population may enhance glycemic control. CGM reliability may be compromised by postsurgical complications such as edema or vascular changes. We utilized Clarke Error Grid (CEG) and Surveillance Error Grid (SEG) analysis to evaluate CGM performance after total pancreatectomy with islet autotransplantation. MATERIALS AND METHODS: This subanalysis evaluated Medtronic Enlite 2 CGM values against YSI serum glucose in seven post-transplant patients (86% female; 38...
August 2016: Diabetes Technology & Therapeutics
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