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Intensive glycemic control

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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
#1
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...
June 7, 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28634176/impact-of-glycemic-variability-on-chromatin-remodeling-oxidative-stress-and-endothelial-dysfunction-in-type-2-diabetic-patients-with-target-hba1c-levels
#2
Sarah Costantino, Francesco Paneni, Rodolfo Battista, Lorenzo Castello, Giuliana Capretti, Sergio Chiandotto, Luigi Tanese, Giulio Russo, Dario Pitocco, Gaetano A Lanza, Massimo Volpe, Thomas F Lüscher, Francesco Cosentino
Intensive glycemic control (IGC) targeting HbA1c fails to show an unequivocal reduction of macrovascular complications in type 2 diabetes (T2D), however the underlining mechanisms remain elusive. Epigenetic changes are emerging as important mediators of cardiovascular damage and may play a role in this setting. This study investigates whether epigenetic regulation of the adaptor protein p66(Shc), a key driver of mitochondrial oxidative stress, contributes to persistent vascular dysfunction in T2D patients despite IGC...
June 20, 2017: Diabetes
https://www.readbyqxmd.com/read/28628847/the-importance-of-declining-insulin-requirements-during-pregnancy-in-patients-with-pre-gestational-gestational-diabetes-mellitus
#3
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...
June 3, 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/28620678/effect-of-lifestyle-improvement-program-on-the-biomarkers-of-adiposity-inflammation-and-gut-hormones-in-overweight-obese-asian-indians-with-prediabetes
#4
Kuppan Gokulakrishnan, Harish Ranjani, Mary Beth Weber, Gautam Kumar Pandey, Ranjit Mohan Anjana, Muthuswamy Balasubramanyam, Dorairaj Prabhakaran, Nikhil Tandon, K M Venkat Narayan, Viswanathan Mohan
AIMS: While lifestyle modification is known to offer several metabolic benefits, there is paucity of comprehensive data on changes in biomarkers of adiposity, inflammation as well as gut hormones. We investigated these biomarkers in overweight/obese individuals with prediabetes randomized to either 4 months of a lifestyle improvement program or standard care and followed them up for a year. METHODS: Participants [standard care and intervention arm (n = 75 each)] were randomly selected from the Diabetes Community Lifestyle Improvement Program trial...
June 15, 2017: Acta Diabetologica
https://www.readbyqxmd.com/read/28609547/intensive-insulin-therapy-combined-with-metformin-is-associated-with-reduced-glucose-variability-and-nocturnal-hypoglycemia-in-patients-with-type-2-diabetes
#5
Yifei Zhang, Zhiyun Zhao, Shujie Wang, Wei Zhu, Yiran Jiang, Shouyue Sun, Chen Chen, Kai Wang, Liangshan Mu, Jinyi Cao, Yingxia Zhou, Weiqiong Gu, Jie Hong, Weiqing Wang, Guang Ning
BACKGROUND: The effect on glucose variability in patients with intensive insulin therapy has not been fully understood. This observational study investigated the different glucose variability and hypoglycemia pattern in type 2 diabetes patients treated with continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) with or without metformin administration. METHODS: During hospitalization, totally 501 patients with poor glycemic control and in initial treatment with either CSII alone (n = 187), CSII + Metformin (n = 81), MDI alone (n = 146) or MDI + Metformin (n = 87), were involved in the final analysis...
June 13, 2017: Diabetes/metabolism Research and Reviews
https://www.readbyqxmd.com/read/28606340/cardiovascular-protection-in-the-treatment-of-type-2-diabetes-a%C3%A2-review-of-clinical-trial-results-across-drug-classes
#6
Francesco Paneni, Thomas F Lüscher
Patients with type 2 diabetes (T2DM) have a significantly higher risk of developing cardiovascular disease (CVD)-namely myocardial infarction, heart failure, and stroke. Despite clear advances in the prevention and treatment of CVD, the impact of T2DM on CVD outcome remains high and continues to escalate. Available evidence indicates that the risk of macrovascular complications increases with the severity of hyperglycemia, thus suggesting that the relation between metabolic disturbances and vascular damage is approximately linear...
July 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28601003/finding-the-optimal-volume-and-intensity-of-resistance-training-exercise-for-type-2-diabetes-the-forte-study-a-randomized-trial
#7
Pearl Yang, Walter Swardfager, Daniel Fernandes, Sheila Laredo, George Tomlinson, Paul I Oh, Scott Thomas
AIM: To compare different volumes and intensities of resistance training (RT) combined with aerobic training (AT) for improvements in glycemic control and cardiovascular health for persons with type 2 diabetes (T2DM). METHODS: Participants with T2DM were stratified by HbA1c and randomized: "usual care" (RT1), which consisted of moderate intensity (50% 1-repetition maximum [1-RM]), low volumeRT (initiated half-way through program); higher intensity (75% 1-RM) and higher volume (initiated at program onset) RT (RT2); or moderate intensity but higher volume RT (RT3)...
May 19, 2017: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/28597588/prevention-of-cardiovascular-disease-by-the-reduction-of-glycemic-exposure-in-type-2-diabetes-a-perspective-on-glucose-lowering-interventions
#8
REVIEW
Ronan Roussel, Philippe Gabriel Steg, Kamel Mohammedi, Michel Marre, Louis Potier
Type 2 diabetes is a leading cause of cardiovascular disease (CVD). Observational studies showed consistently an association between glycemic level and risk of major cardiovascular events (MACE). However, the intervention studies provided limited evidence supporting the reduction of cardiovascular burden of diabetes by intensive glucose control. Here, we propose to apply the concept of cumulative glycemic exposure to protection against CVD in diabetes. We address how we can move from a binary approach in trials, to a more quantitative approach based on differences in cumulative glycemic exposure...
June 9, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28592062/-glucose-excursion-in-senior-patients-with-type-2-diabetes-mellitus-and-coronary-artery-disease
#9
J Liu, F H Liu, Y N Zhao, D E Yan, X Y Gao, L N Wen, J J Wei, S H Su, Y S Zhou
Objectives: To explore glucose excursion and incidence of hypoglycemia in senior patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) with different hemoglobin A1c (HbA1c) values. Methods: Eighty-nine outpatients [58 male, 31 female, aged 69.0 (66.0, 73.0) years] diagnosed with T2DM and CAD in Beijing Anzhen Hospital between June 2013 and March 2016 were divided into group A (HbA1c<6.5%, n=25) and group B (HbA1c≥6.5%, n=64). Every patient wore continuous glucose monitoring system (CGMS) for 72 h...
May 30, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28572099/nurse-directed-blood-glucose-management-in-a-medical-intensive-care-unit
#10
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/28571934/intensive-glycemic-control-in-younger-and-older-u-s-adults-with-type-2-diabetes
#11
Sarah Casagrande, Catherine C Cowie, Judith E Fradkin
AIMS: To determine the extent to which older vs. younger adults with diabetes intensively control glycemia. METHODS: Participants were age≥40years who self-reported a physician diagnosis of diabetes in the 2009-2014 National Health and Nutrition Examination Surveys (N=1554). Intensive glycemic control was defined as A1c<7.0% and taking insulin, sulfonylureas, or ≥2 glycemic medications. Logistic regression was used to determine the adjusted odds of intensive control in older (≥65years) vs...
May 18, 2017: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/28559400/risk-of-cardiovascular-events-in-patients-with-diabetes-mellitus-on-%C3%AE-blockers
#12
Tetsuro Tsujimoto, Takehiro Sugiyama, Martin F Shapiro, Mitsuhiko Noda, Hiroshi Kajio
Although the use of β-blockers may help in achieving maximum effects of intensive glycemic control because of a decrease in the adverse effects after severe hypoglycemia, they pose a potential risk for the occurrence of severe hypoglycemia. This study aimed to evaluate whether the use of β-blockers is effective in patients with diabetes mellitus and whether its use is associated with the occurrence of severe hypoglycemia. Using the ACCORD trial (Action to Control Cardiovascular Risk in Diabetes) data, we performed Cox proportional hazards analyses with a propensity score adjustment...
July 2017: Hypertension
https://www.readbyqxmd.com/read/28558975/critical-review-of-the-current-literature-on-the-safety-of-sucralose
#13
REVIEW
Bernadene A Magnuson, Ashley Roberts, Earle R Nestmann
Sucralose is a non-caloric high intensity sweetener that is approved globally for use in foods and beverages. This review provides an updated summary of the literature addressing the safety of use of sucralose. Studies reviewed include chemical characterization and stability, toxicokinetics in animals and humans, assessment of genotoxicity, and animal and human feeding studies. Endpoints evaluated include effects on growth, development, reproduction, neurotoxicity, immunotoxicity, carcinogenicity and overall health status...
May 27, 2017: Food and Chemical Toxicology
https://www.readbyqxmd.com/read/28557817/accuracy-of-capillary-and-arterial-whole-blood-glucose-measurements-using-a-glucose-meter-in-patients-under-general-anesthesia-in-the-operating-room
#14
Brad S Karon, Leslie J Donato, Chelsie M Larsen, Lindsay K Siebenaler, Amy E Wells, Christina M Wood-Wentz, Mary E Shirk-Marienau, Timothy B Curry
BACKGROUND: The aim of this study was to evaluate the use of a glucose meter with surgical patients under general anesthesia in the operating room. METHODS: Glucose measurements were performed intraoperatively on 368 paired capillary and arterial whole blood samples using a Nova StatStrip (Nova Biomedical, USA) glucose meter and compared with 368 reference arterial whole blood glucose measurements by blood gas analyzer in 196 patients. Primary outcomes were median bias (meter minus reference), percentage of glucose meter samples meeting accuracy criteria for subcutaneous insulin dosing as defined by Parkes error grid analysis for type 1 diabetes mellitus, and accuracy criteria for intravenous insulin infusion as defined by Clinical and Laboratory Standards Institute guidelines...
May 30, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28551774/continuous-glucose-monitoring-for-patients-with-type-1-diabetes-on-multiple-daily-injections-of-insulin-pros-and-cons
#15
Maria Ida Maiorino, Michela Petrizzo, Giuseppe Bellastella, Katherine Esposito
Continuous glucose monitoring associated with intensive insulin regimens represents a useful tool to lower HbA1c in selected adults with type 1 diabetes. Recent randomized controlled trials demonstrated greater glycemic benefits in type 1 diabetic patients treated with multiple daily injections of insulin and continuous glucose monitoring over usual care. These positive outcomes, however, are counter-balanced by several limitations that restrict the use of continuous glucose monitoring in the real life, including the apparent lack of benefits in children and pregnant diabetic women, the high cost, the stringent patients' selection, and the presence of a multi-disciplinary team with specific expertise...
May 27, 2017: Endocrine
https://www.readbyqxmd.com/read/28550608/shifting-paradigms-in-the-medical-management-of-type-2-diabetes-reflections-on-recent-cardiovascular-outcome-trials
#16
Faramarz Ismail-Beigi, Etie Moghissi, Mikhail Kosiborod, Silvio E Inzucchi
An important challenge in the management of patients with type 2 diabetes is cardiovascular disease (CVD) prevention. While it is well established that intensive glycemic control prevents the onset and slows the progression of certain microvascular complications, such a strategy utilized in multiple clinical trials over the past few decades has failed to show a similar benefit with regard to cardiovascular events, including mortality. Despite this, a major hope has been the discovery of glucose-lowering medications that simultaneously improve cardiovascular outcomes...
May 26, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28545493/three-approaches-to-glucose-monitoring-in-non-insulin-treated-diabetes-a-pragmatic-randomized-clinical-trial-protocol
#17
Laura A Young, John B Buse, Mark A Weaver, Maihan B Vu, April Reese, C Madeline Mitchell, Tamara Blakeney, Kimberlea Grimm, Jennifer Rees, Katrina E Donahue
BACKGROUND: For the nearly 75% of patients living with type 2 diabetes (T2DM) that do not use insulin, decisions regarding self-monitoring of blood glucose (SMBG) can be especially problematic. While in theory SMBG holds great promise for sparking favorable behavior change, it is a resource intensive activity without firmly established patient benefits. This study describes our study protocol to assess the impact of three different SMBG testing approaches on patient-centered outcomes in patients with non-insulin treated T2DM within a community-based, clinic setting...
May 25, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28541131/clinical-use-of-continuous-glucose-monitoring-in-adults-with-type-1-diabetes
#18
David Slattery, Pratik Choudhary
With the emphasis on intensive management of type 1 diabetes, data from studies support frequent monitoring of glucose levels to improve glycemic control and reduce glucose variability, which can be related to an increase in macro and microvascular complications. However, few perform capillary blood glucose that frequently. There are currently two available alternatives that this review will discuss, continuous glucose monitoring (CGM) and flash glucose monitoring. CGM has become an important diagnostic and therapeutic option in optimizing diabetes management...
May 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28539618/effect-of-exenatide-after-short-time-intensive-insulin-therapy-on-glycaemic-remission-maintenance-in-type-2-diabetes-patients-a-randomized-controlled-trial
#19
Xiulin Shi, Yalin Shi, Ning Chen, Mingzhu Lin, Weijuan Su, Huijie Zhang, Changqin Liu, Haiqu Song, Fangsen Xiao, Peiying Huang, Liying Wang, Wei Liu, Jinyang Zeng, Bing Yan, Qi Liu, Suhuan Liu, Shuyu Yang, Xiaoying Li, Zhibin Li, Xuejun Li
Early short-term intensive insulin (STII) therapy can induce drug-free glycemic remission for up to 1 year in half of newly diagnosed type 2 diabetic mellitus (T2DM) patients. Whether exenatide following STII therapy will induce higher long-term glycaemic remission is currently unknown. To assess the effect of STII+ exenatide therapy, compared with STII only, on maintenance of glycaemic remission in newly diagnosed T2DM patients. In this randomized, parallel-group, open-label, controlled trial, 129 patients (66 in STII+ exenatide group and 63 in STII only group) firstly completed 3-week STII therapy, then STII+ exenatide group was treated with exenatide for 12 weeks further...
May 24, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28528456/pharmacologic-treatment-of-dyslipidemia-in-diabetes-a-case-for-therapies-in-addition-to-statins
#20
REVIEW
Abeer Anabtawi, Patrick M Moriarty, John M Miles
PURPOSE OF REVIEW: The purpose of the study is to review the use of statins and the role of both non-statin lipid-lowering agents and diabetes-specific medications in the treatment of diabetic dyslipidemia. RECENT FINDINGS: Statins have a primary role in the treatment of dyslipidemia in people with type 2 diabetes, defined as triglyceride levels >200 mg/dl and HDL cholesterol levels <40 mg/dL. A number of clinical trials suggest that treatment with a fibrate may reduce cardiovascular events...
July 2017: Current Cardiology Reports
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