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glucose control in icu

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https://www.readbyqxmd.com/read/28806982/software-guided-versus-nurse-directed-blood-glucose-control-in-critically-ill-patients-the-logic-2-multicenter-randomized-controlled-clinical-trial
#1
Dieter Mesotten, Jasperina Dubois, Tom Van Herpe, Roosmarijn T van Hooijdonk, Ruben Wouters, Domien Coart, Pieter Wouters, Aimé Van Assche, Guy Veraghtert, Bart De Moor, Joost Wauters, Alexander Wilmer, Marcus J Schultz, Greet Van den Berghe
BACKGROUND: Blood glucose control in the intensive care unit (ICU) has the potential to save lives. However, maintaining blood glucose concentrations within a chosen target range is difficult in clinical practice and holds risk of potentially harmful hypoglycemia. Clinically validated computer algorithms to guide insulin dosing by nurses have been advocated for better and safer blood glucose control. METHODS: We conducted an international, multicenter, randomized controlled trial involving 1550 adult, medical and surgical critically ill patients, requiring blood glucose control...
August 14, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28797149/-investigation-of-pregestational-diabetes-mellitus-in-15-hospitals-in-guangdong-province
#2
H T Chen, S Q Deng, Z Y Li, Z L Wang, Q Li, J K Gao, Y H Zhong, D M Suo, L N Lu, S L Pan, H X Chen, Y Y Cui, J H Fan, J Y Wen, L R Zhong, F Z Han, Y H Wang, S J Hu, P P Liu
Objective: To investigate the morbidity, diagnostic profile and perinatal outcome of pregestational diabetes mellitus (PGDM) in 15 hospitals in Guangdong province. Methods: A total of 41 338 women delivered in the 15 hospitals during the 6 months, 195 women with PGDM (PGDM group) and 195 women with normal glucose test result (control group) were recruited from these tertiary hospitals in Guangdong province from January 2016 to June 2016. The morbidity and diagnostic profile of PGDM were analyzed. The complications during pregnancy and perinatal outcomes were compared between the two groups...
July 25, 2017: Zhonghua Fu Chan Ke za Zhi
https://www.readbyqxmd.com/read/28765736/factors-influencing-the-quality-of-standardized-treatment-for-patients-with-post-cardiac-arrest-syndrome
#3
Jing Lu, Lijun Liu, Jianliang Zhu, Xinying Guo
BACKGROUND AND OBJECTIVES: For the present study, we investigated the factors that influence the quality of standardized treatment for patients with post-cardiac arrest syndrome (PCAS) to improve the quality of PCAS treatment. SUBJECTS AND METHODS: We collected data on patients with cardiac arrest (CA) who were admitted to the intensive care units (ICUs) of 11 hospitals-Class II Grade A or above-in Suzhou from January to October 2013. Indexes of standardized treatment were observed within 72 hrs of CA...
July 2017: Korean Circulation Journal
https://www.readbyqxmd.com/read/28756769/continuous-glucose-monitoring-in-the-icu-clinical-considerations-and-consensus
#4
REVIEW
James S Krinsley, J Geoffrey Chase, Jan Gunst, Johan Martensson, Marcus J Schultz, Fabio S Taccone, Jan Wernerman, Julien Bohe, Christophe De Block, Thomas Desaive, Pierre Kalfon, Jean-Charles Preiser
Glucose management in intensive care unit (ICU) patients has been a matter of debate for almost two decades. Compared to intermittent monitoring systems, continuous glucose monitoring (CGM) can offer benefit in the prevention of severe hyperglycemia and hypoglycemia by enabling insulin infusions to be adjusted more rapidly and potentially more accurately because trends in glucose concentrations can be more readily identified. Increasingly, it is apparent that a single glucose target/range may not be optimal for all patients at all times and, as with many other aspects of critical care patient management, a personalized approach to glucose control may be more appropriate...
July 31, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28724042/hyperglycemia-in-critical-patients-determinants-of-insulin-dose-choice
#5
Aline Klitzke Paliosa, Cassiano Teixeira, Regis Goulart Rosa, Carine Raquel Blatt
Objective: To identify factors that can determine the choice of intermittent subcutaneous regular insulin dose in critically ill patients with hyperglycemia. Method: Cross-sectional study in a general adult ICU with 26 beds, data collected between September and October 2014. The variables analyzed were: sex, age, previous diagnosis of diabetes mellitus, use of corticosteroids, use of lactulose, sepsis, fasting, enteral nutrition, use of dextrose 5% in water, NPH insulin prescription and blood glucose level...
May 2017: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/28707484/autoregressive-modeling-of-drift-and-random-error-to-characterize-a-continuous-intravascular-glucose-monitoring-sensor
#6
Tony Zhou, Jennifer L Dickson, J Geoffrey Chase
BACKGROUND: Continuous glucose monitoring (CGM) devices have been effective in managing diabetes and offer potential benefits for use in the intensive care unit (ICU). Use of CGM devices in the ICU has been limited, primarily due to the higher point accuracy errors over currently used traditional intermittent blood glucose (BG) measures. General models of CGM errors, including drift and random errors, are lacking, but would enable better design of protocols to utilize these devices. This article presents an autoregressive (AR) based modeling method that separately characterizes the drift and random noise of the GlySure CGM sensor (GlySure Limited, Oxfordshire, UK)...
July 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28683239/comparison-of-efficacy-and-safety-of-glargine-and-detemir-insulin-in-the-management-of-inpatient-hyperglycemia-and-diabetes
#7
Rodolfo J Galindo, Georgia M Davis, Maya Fayfman, David Reyes-Umpierrez, David Alfa, Limin Peng, Ronald Tamler, Francisco J Pasquel, Guillermo E Umpierrez
OBJECTIVE: Glargine and detemir insulin are the two most commonly prescribed basal insulin analogs for the ambulatory and inpatient management of diabetes. The efficacy and safety of basal insulin analogs in the hospital setting has not been established. METHODS: This observational study compared differences in glycemic control and outcomes in non-ICU patients with blood glucose (BG) >140 mg/dl who were treated with glargine or detemir, between 01/01/2012 and 09/30/2015 in two academic centers...
July 6, 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28651513/the-performance-of-flash-glucose-monitoring-in-critically-ill-patients-with-diabetes
#8
Paolo Ancona, Glenn M Eastwood, Luca Lucchetta, Elif I Ekinci, Rinaldo Bellomo, Johan Mårtensson
OBJECTIVE: Frequent glucose monitoring may improve glycaemic control in critically ill patients with diabetes. We aimed to assess the accuracy of a novel subcutaneous flash glucose monitor (FreeStyle Libre [Abbott Diabetes Care]) in these patients. METHODS: We applied the FreeStyle Libre sensor to the upper arm of eight patients with diabetes in the intensive care unit and obtained hourly flash glucose measurements. Duplicate recordings were obtained to assess test-retest reliability...
June 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/28645517/glucose-control-diabetes-status-and-mortality-in-critically-ill-patients-the-continuum-from-intensive-care-unit-admission-to-hospital-discharge
#9
James S Krinsley, Paula Maurer, Sharon Holewinski, Roy Hayes, Douglas McComsey, Guillermo E Umpierrez, Stanley A Nasraway
OBJECTIVE: To describe the relationships among glycemic control, diabetes mellitus (DM) status, and mortality in critically ill patients from intensive care unit (ICU) admission to hospital discharge. PATIENTS AND METHODS: This is a retrospective investigation of 6387 ICU patients with 5 or more blood glucose (BG) tests and 4462 ICU survivors admitted to 2 academic medical centers from July 1, 2010, through December 31, 2014. We studied the relationships among mean BG level, hypoglycemia (BG level <70 mg/dL [to convert to mmol/L, multiply by 0...
July 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28645302/untangling-glycaemia-and-mortality-in-critical-care
#10
Vincent Uyttendaele, Jennifer L Dickson, Geoffrey M Shaw, Thomas Desaive, J Geoffrey Chase
BACKGROUND: Hyperglycaemia is associated with adverse outcomes in the intensive care unit, and initial studies suggested outcome benefits of glycaemic control (GC). However, subsequent studies often failed to replicate these results, and they were often unable to achieve consistent, safe control, raising questions about the benefit or harm of GC as well as the nature of the association of glycaemia with mortality and clinical outcomes. In this study, we evaluated if non-survivors are harder to control than survivors and determined if glycaemic outcome is a function of patient condition and eventual outcome or of the glycaemic control provided...
June 24, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28637358/comparative-simulation-study-of-glucose-control-methods-designed-for-use-in-the-intensive-care-unit-setting-via-a-novel-controller-scoring-metric
#11
Jeremy DeJournett, Leon DeJournett
BACKGROUND: Effective glucose control in the intensive care unit (ICU) setting has the potential to decrease morbidity and mortality rates and thereby decrease health care expenditures. To evaluate what constitutes effective glucose control, typically several metrics are reported, including time in range, time in mild and severe hypoglycemia, coefficient of variation, and others. To date, there is no one metric that combines all of these individual metrics to give a number indicative of overall performance...
June 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28628847/the-importance-of-declining-insulin-requirements-during-pregnancy-in-patients-with-pre-gestational-gestational-diabetes-mellitus
#12
Maya Ram, Larissa Feinmesser, Shiri Shinar, Sharon Maslovitz
OBJECTIVE: In patients with pre-gestational and gestational diabetes mellitus (GDM), insulin requirements often increase during the third trimester of pregnancy in order to maintain proper glycemic control. However, a fraction of patients demonstrate a significant decrease in insulin requirements in late gestation. We aimed to evaluate the clinical significance of decreasing insulin requirements in patients with pre-gestational diabetes and GDM with respect to fetal wellbeing and pregnancy outcome...
August 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/28608489/continuous-glucose-monitoring-following-pancreatectomy-with-islet-autotransplantation-in-children
#13
Deborah A Elder, Jose M Jiminez-Vega, Lindsey N Hornung, Ranjit S Chima, Maisam Abu-El-Haija, Tom K Lin, Joseph J Palermo, Jaimie D Nathan
Aim was to determine whether CGM could accurately monitor blood glucose concentration in the immediate postoperative period following pancreatectomy with IAT in children. CGM was used in nine patients undergoing IAT at our institution between April 2015 and September 2016 (eight total pancreatectomy and one subtotal pancreatectomy). MAD and MARD of CGM values compared to time-matched serum blood glucose were calculated during the first 5 days of ICU admission. Goal range was defined as 70-140 mg/dL and out-of-range was >140 mg/dL or <70 mg/dL...
June 12, 2017: Pediatric Transplantation
https://www.readbyqxmd.com/read/28588245/retinol-binding-protein-4-expression-marks-the-short-term-mortality-of-critically-ill-patients-with-underlying-liver-disease-lipid-but-not-glucose-matters
#14
Wei-Ting Chen, Mu-Shien Lee, Chia-Lin Chang, Cheng-Tang Chiu, Ming-Ling Chang
The implications of retinol-binding protein-4 (RBP4) expression in critically ill patients with underlying liver diseases remain unclear. A prospective cohort study involving 200 liver intensive care unit (ICU) patients was conducted, with 274 blood donors as controls. Patient outcomes were assessed using Cox and Kaplan-Meier analyses. Of the 200 ICU patients (mean age: 56.0 yrs), 79.5% were male, 72.5% were cirrhotic, 62% were septic, 29.5% were diabetic, and 29% expired in the ICU (median admission: 7.5 days)...
June 6, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28572099/nurse-directed-blood-glucose-management-in-a-medical-intensive-care-unit
#15
Friederike Compton, Robert Ahlborn, Torsten Weidehoff
BACKGROUND: Insulin-delivery algorithms for achieving glycemic control in the intensive care unit require frequent checks of blood glucose level and thus increase nursing workload. Hypoglycemia is a serious complication associated with intensive insulin therapy. OBJECTIVES: To evaluate a nurse-directed protocol for blood glucose management that allows individualized insulin delivery within a predefined blood glucose corridor, intended to avoid hypoglycemia while maintaining adequate control of blood glucose level without increasing nursing workload...
June 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28562794/cost-of-nursing-most-frequent-procedures-performed-on-severely-burned-patients
#16
Talita de Oliveira Melo, Antônio Fernandes Costa Lima
Objective: to identify the mean direct cost (MDC) of the most frequent procedures performed by nursing professionals on severely burned patients in an Intensive Care Unit. Method: exploratory-descriptive quantitative single-case study. The MDC was calculated by multiplying time (timed) spent by nursing professionals in the performance of the procedures by the unit cost of direct labor, and adding the costs of material and medicine/solutions. Results: a MDC of US$ 0...
May 2017: Revista Brasileira de Enfermagem
https://www.readbyqxmd.com/read/28551140/continuous-and-simultaneous-determination-of-venous-blood-metabolites
#17
Anneli Andersson, Qun Chen, Leif Groop, Leif Bülow, Bin Xie
Metabolic syndrome is associated with cardiovascular disease, type 2 diabetes mellitus (T2DM) and prediabetes. Metabolic syndrome is a cluster of interrelated clinical disorders. Difficulties in regulating glucose levels in blood are implicated in many of these disorders. Lactate, another energy metabolite, is produced under anaerobic conditions and can be used to monitor the balance between aerobic and anaerobic metabolism. Tested together, these metabolite levels can provide pro-diagnostic information that improves patient outcomes...
August 15, 2017: Talanta
https://www.readbyqxmd.com/read/28548198/-diabetic-ketoacidosis-with-mild-hyperglycemia-associated-with-the-use-of-canagliflozin-report-of-one-case-with-type-1-diabetes
#18
Victoria Novik A, Claudia García B, Daniela Oliva I
Diabetic ketoacidosis with mild hyperglycemia is a major complication of sodium-glucose cotransporter 2 inhibitors. Although its use is not approved for patients with type 1 diabetes mellitus, the drug is often prescribed with the hope of optimizing metabolic control. We report a 20 years old female with hypothyroidism and type 1 diabetes consulting for vomiting and abdominal pain. The patient had used canagliflozin during the two previous months. Laboratory showed a blood glucose of 200 mg/dl, a severe metabolic acidosis (pH 7...
March 2017: Revista Médica de Chile
https://www.readbyqxmd.com/read/28545129/direct-and-indirect-costs-of-diabetes-mellitus-in-mali-a-case-control-study
#19
Clara Bermudez-Tamayo, Stéphane Besançon, Mira Johri, Sidibe Assa, Jonathan Betz Brown, Kaushik Ramaiya
BACKGROUND: Diabetes mellitus (DM) is one of the most burdensome chronic diseases and is associated with shorter lifetime, diminished quality of life and economic burdens on the patient and society as a result of healthcare, medication, and reduced labor market participation. We aimed to estimate the direct (medical and non-medical) and indirect costs of DM and compare them with those of people without DM (ND), as well as the cost predictors. METHODS AND FINDINGS: Observational retrospective case-control study performed in Mali...
2017: PloS One
https://www.readbyqxmd.com/read/28532199/determination-of-the-fetal-myocardial-performance-index-in-women-with-gestational-impaired-glucose-tolerance-and-to-assess-whether-this-parameter-is-a-possible-prognostic-indicator-of-adverse-fetal-outcome
#20
Ismail Bhorat, Morgan Pillay, Tarylee Reddy
AIM: The aim of this study was to investigate if the myocardial performance index (MPI) is altered in fetuses in women with gestational impaired glucose tolerance (GIGT), controlled on diet and whether this parameter is also predictive of adverse outcome in this group, as in poorly controlled gestational diabetes. METHODS: In a prospective cross-sectional study, 32 women with GIGT on diet in the 3rd trimester were recruited and matched with 32 women with normal pregnancies (control group)...
June 6, 2017: Journal of Maternal-fetal & Neonatal Medicine
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