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Intensive glycemic control

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https://www.readbyqxmd.com/read/28344751/management-of-critically-ill-patients-with-diabetes
#1
REVIEW
Livier Josefina Silva-Perez, Mario Alberto Benitez-Lopez, Joseph Varon, Salim Surani
Disorders of glucose homeostasis, such as stress-induced hypoglycemia and hyperglycemia, are common complications in patients in the intensive care unit. Patients with preexisting diabetes mellitus (DM) are more susceptible to hyperglycemia, as well as a higher risk from glucose overcorrection, that may results in severe hypoglycemia. In critically ill patients with DM, it is recommended to maintain a blood glucose range between 140-180 mg/dL. In neurological patients and surgical patients, tighter glycemic control (i...
March 15, 2017: World Journal of Diabetes
https://www.readbyqxmd.com/read/28343792/liberating-a1c-goals-in-older-adults-may-not-protect-against-the-risk-of-hypoglycemia
#2
Medha N Munshi, Christine Slyne, Alissa R Segal, Nora Saul, Courtney Lyons, Katie Weinger
AIMS: Hemoglobin A1C is universally used as a marker for glycemic control and to establish glycemic goals in patients with diabetes. In the older population, experts recommend liberating A1C goals to decrease the risk of hypoglycemia. However, it's not clear which A1C level is optimal for this purpose. This study's aim was to understand the relationship between A1C levels and risk of hypoglycemia. METHODS: In a prospective study, we performed continuous glucose monitoring (CGM) on older adults on insulin...
March 14, 2017: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/28331118/reconsideration-of-secondary-risk-management-strategies-in-patients-with-ischemic-heart-disease
#3
Kuninobu Kashiyama, Shinjo Sonoda, Yutaka Otsuji
The main risk factors in ischemic heart diseases, including myocardial infarction, are hypertension, dyslipidemia, diabetes, obesity and smoking. The incidence of ischemic heart disease in Japan has been lower than that in Western countries because of differences in lifestyle and the anatomy of the coronary arteries, but the situation has been changing recently because of the westernization of lifestyle. Cardiovascular diseases have become the second most common cause of death in Japan, and 40% of those deaths are attributed to ischemic heart disease...
2017: Journal of UOEH
https://www.readbyqxmd.com/read/28314486/insulin-provision-therapy-and-mortality-in-older-adults-with-diabetes-mellitus-and-stable-ischemic-heart-disease-insights-from-bari-2d-trial
#4
Abdulla A Damluji, Erin R Cohen, Mauro Moscucci, Robert J Myerburg, Mauricio G Cohen, Maria M Brooks, Michael W Rich, Daniel E Forman
IMPORTANCE: Optimal strategies for glucose control in very old adults with diabetes and stable ischemic heart disease (SIHD) are unclear. OBJECTIVE: To compare the effects of insulin provision (IP) therapy versus insulin sensitizing (IS) therapy for glycemic control in older (≥75years) and younger (<75years) adults with type II diabetes (DM) and SIHD. DESIGN, SETTING, AND PARTICIPANTS: Adults enrolled in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) were studied...
March 11, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28295962/improving-glycemic-control-in-type-2-diabetes-stimulate-insulin-secretion-or-provide-beta-cell-rest
#5
REVIEW
Daniël H van Raalte, C Bruce Verchere
Type 2 diabetes (T2D) is characterized by a gradual decline of pancreatic beta cell function that determines the progressive course of the disease. While beta-cell failure is an important contributor to hyperglycemia, chronic hyperglycemia itself is also detrimental for beta-cell function, likely by inducing prolonged secretory stress on the beta cell as well as through direct glucotoxic mechanisms that have not been fully defined. For years, research has been carried out in search of therapies targeting hyperglycemia that preserve long-term beta-cell function in T2D, a quest that is still ongoing...
March 14, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28291838/level-and-correlates-of-physical-activity-and-sedentary-behavior-in-patients-with-type-2-diabetes-a-cross-sectional-analysis-of-the-italian-diabetes-and-exercise-study_2
#6
Stefano Balducci, Valeria D'Errico, Jonida Haxhi, Massimo Sacchetti, Giorgio Orlando, Patrizia Cardelli, Nicolina Di Biase, Lucilla Bollanti, Francesco Conti, Silvano Zanuso, Antonio Nicolucci, Giuseppe Pugliese
OBJECTIVE: Patients with type 2 diabetes usually show reduced physical activity (PA) and increased sedentary (SED)-time, though to a varying extent, especially for low-intensity PA (LPA), a major determinant of daily energy expenditure that is not accurately captured by questionnaires. This study assessed the level and correlates of PA and SED-time in patients from the Italian Diabetes and Exercise Study_2 (IDES_2). METHODS: Three-hundred physically inactive and sedentary patients with type 2 diabetes were enrolled in the IDES_2 to be randomized to an intervention group, receiving theoretical and practical exercise counseling, and a control group, receiving standard care...
2017: PloS One
https://www.readbyqxmd.com/read/28289653/efficacy-of-low-and-moderate-intensity-statins-for-achieving-low-density-lipoprotein-cholesterol-targets-in-thai-type-2-diabetic-patients
#7
Nuntakorn Thongtang, Chaiyut Sitthananun, Sutin Sriussadaporn, Wannee Nitiyanant
BACKGROUND: Low dose statins are commonly used among Asians, because plasma low-density lipoprotein cholesterol (LDL-C) reductions similar to those observed in Westerners are achieved at lower doses. We aimed to assess the efficacy of low- and moderate-intensity statins for achieving plasma lipid targets in Thai type2 diabetes (T2D) and to evaluate factors associated with greater LDL-C reduction by statins. METHODS: T2D patients who were treated with low- and moderate-intensity statins at the Siriraj Diabetes Clinic during the January 2013 to December 2014 study period were eligible for inclusion(n = 978), 400 patients were randomly recruited...
2017: Journal of Diabetes and Metabolic Disorders
https://www.readbyqxmd.com/read/28286340/intensive-gestational-glycemic-management-and-childhood-obesity-a-systematic-review-and-meta-analysis
#8
REVIEW
L Guillemette, A Durksen, R Rabbani, R Zarychanski, A M Abou-Setta, T A Duhamel, J M McGavock, B Wicklow
BACKGROUND AND OBJECTIVES: Hyperglycemia in pregnancy is associated with increased risk of offspring childhood obesity. Treatment reduces macrosomia, however it is unclear if this effect translates into a reduced risk of childhood obesity. We performed a systematic review and meta-analysis of randomized controlled trials to evaluate the efficacy and safety of intensive glycemic management in pregnancy in preventing childhood obesity. METHODS: We searched MEDLINE, EMBASE, CENTRAL, and ClinicalTrials...
March 13, 2017: International Journal of Obesity: Journal of the International Association for the Study of Obesity
https://www.readbyqxmd.com/read/28273644/practices-perceptions-and-expectations-for-carbohydrate-counting-in-patients-with-type-1-diabetes-results-from-an-online-survey
#9
Andréanne Fortin, Rémi Rabasa-Lhoret, Amélie Roy-Fleming, Katherine Desjardins, Anne-Sophie Brazeau, Martin Ladouceur, Véronique Gingras
AIMS: Characterize adult patients with diabetes on intensive insulin therapy in terms of: (a) practices and perceived difficulties relative to carbohydrate counting (CC) and diabetes treatment, and (b) their perceptions and expectations relative to CC. METHODS: Participants completed a 30-question web-based questionnaire. RESULTS: Participants with type 1 diabetes (T1D) and using CC as part of their treatment plan (n=180) were included in this analysis...
February 22, 2017: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/28260455/triplet-pregnancy-in-a-diabetic-mother-with-kidney-transplant-case-report-and-review-of-the-literature
#10
Tarek Mahmoud, Khalida Mujaibel, Hosam Attia, Zakaria Zakaria, Jude Yagan, Osama Gheith, Medhat Abdel Halim, Prasad Nair, Torki Al-Otaibi
Triplet and higher-order multiple pregnancies can carry increased fetal and maternal complications. Reports of triplet pregnancies after kidney transplant are scarce and have been associated with perinatal complications. Presence of diabetes in such cases worsens both fetal and maternal outcomes. Here, we present a triplet pregnancy in a kidney transplant recipient with diabetes. We also reviewed the literature for causes, prevalence, and outcomes in association with chronic kidney disease, kidney transplant, and diabetes mellitus...
February 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28260302/-insulin-regimes-and-impact-on-glycemic-control-in-patients-with-type-1-diabetes
#11
J H Yan, Y Zhang, X Y Zheng, S H Luo, H Y Ai, J Lü, L L Qiu, X W Zhang, D Z Yang, B Yao, J P Weng
Objective: To describe the insulin regimens and their associations with glycemic control and to explore factors associated with intensive insulin therapy. Methods: Patients with type 1 diabetes (T1DM) were recruited from Guangdong Type 1 Diabetes Mellitus Translational Medicine Study which was conducted in 16 centers in Guangdong province. The demographic and clinical data were collected. Patients were grouped according to different insulin regimens: insulin pump (R1), basal insulin plus regular insulin or short-acting insulin (R2), insulin injection 1-3 times per day (R3)...
February 28, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28230459/estimated-cost-effectiveness-cost-benefit-and-risk-reduction-associated-with-an-endocrinologist-pharmacist-diabetes-intense-medical-management-tune-up-clinic
#12
Jan D Hirsch, Mark Bounthavong, Anisa Arjmand, David R Ha, Christine L Cadiz, Andrew Zimmerman, Heather Ourth, Anthony P Morreale, Steven V Edelman, Candis M Morello
BACKGROUND: In 2012 U.S. diabetes costs were estimated to be $245 billion, with $176 billion related to direct diabetes treatment and associated complications. Although a few studies have reported positive glycemic and economic benefits for diabetes patients treated under primary care physician (PCP)-pharmacist collaborative practice models, no studies have evaluated the cost-effectiveness of an endocrinologist-pharmacist collaborative practice model treating complex diabetes patients versus usual PCP care for similar patients...
March 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28223299/hemoglobin-a1c-and-mortality-in-older-adults-with-and-without-diabetes-results-from-the-national-health-and-nutrition-examination-surveys-1988-2011
#13
Priya Palta, Elbert S Huang, Rita R Kalyani, Sherita H Golden, Hsin-Chieh Yeh
OBJECTIVE: Hemoglobin A1c (HbA1c) level has been associated with increased mortality in middle-aged populations. The optimal intensity of glucose control in older adults with diabetes remains uncertain. We sought to estimate the risk of mortality by HbA1c levels among older adults with and without diabetes. RESEARCH DESIGN AND METHODS: We analyzed data from adults aged ≥65 years (n = 7,333) from the Third National Health and Nutrition Examination Survey (NHANES III) (1998-1994) and Continuous NHANES (1999-2004) and their linked mortality data (through December 2011)...
February 21, 2017: Diabetes Care
https://www.readbyqxmd.com/read/28197046/outcome-of-noncardiac-surgical-patients-admitted-to-a-multidisciplinary-intensive-care-unit
#14
Pradeep Kumar, M K Renuka, M S Kalaiselvan, A S Arunkumar
CONTEXT: Surgical procedures carry significant morbidity and mortality depending on the type of surgery and patients. There is a dearth of evidence from India on the outcome of surgical patients admitted to an Intensive Care Unit (ICU). AIMS: We aimed to describe the incidence and risk factors of postoperative complications and mortality in noncardiac surgical patients admitted to the ICU. SETTINGS AND DESIGN: This was a prospective observational study on all perioperative patients admitted to a multidisciplinary ICU for 18 months...
January 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28191471/lipids-a-suitable-therapeutic-target-in-diabetic-neuropathy
#15
REVIEW
M C Perez-Matos, M C Morales-Alvarez, C O Mendivil
Diabetic polyneuropathy (DPN) encompasses multiple syndromes with a common pathogenesis. Glycemic control shows a limited correlation with DPN, arguing in favor of major involvement of other factors, one of which is alterations of lipid and lipoprotein metabolism. Consistent associations have been found between plasma triglycerides/remnant lipoproteins and the risk of DPN. Studies in cultured nerve tissue or in murine models of diabetes have unveiled mechanisms linking lipid metabolism to DPN. Deficient insulin action increases fatty acids flux to nerve cells, inducing mitochondrial dysfunction, anomalous protein kinase C signaling, and perturbations in the physicochemical properties of the plasma membrane...
2017: Journal of Diabetes Research
https://www.readbyqxmd.com/read/28187798/critical-care-in-acute-ischemic-stroke
#16
REVIEW
M McDermott, T Jacobs, L Morgenstern
Most ischemic strokes are managed on the ward or on designated stroke units. A significant proportion of patients with ischemic stroke require more specialized care. Several studies have shown improved outcomes for patients with acute ischemic stroke when neurocritical care services are available. Features of acute ischemic stroke patients requiring intensive care unit-level care include airway or respiratory compromise; large cerebral or cerebellar hemisphere infarction with swelling; infarction with symptomatic hemorrhagic transformation; infarction complicated by seizures; and a large proportion of patients require close management of blood pressure after thrombolytics...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28183874/novel-insights-into-dna-methylation-and-its-critical-implications-in-diabetic-vascular-complications
#17
Jia Zheng, Jing Cheng, Qian Zhang, Xinhua Xiao
Recent epidemiological and clinical studies have shown that type 2 diabetic patients can develop diabetic vascular complications even after intensive glycemic control. It has been suggested that this phenomenon could be explained by the hypothesis of "metabolic memory". The underlying mechanisms between these enduring effects and the prior hyperglycemic state are still not well understood. Preliminary studies demonstrate that hyperglycemia can regulate gene expression by epigenetic modifications, such as DNA methylation, which can persistently exist even after glucose normalization...
February 9, 2017: Bioscience Reports
https://www.readbyqxmd.com/read/28182863/randomized-controlled-trial-of-a-community-health-worker-self-management-support-intervention-among-low-income-adults-with-diabetes-seattle-washington-2010-2014
#18
Karin Nelson, Leslie Taylor, Julie Silverman, Meghan Kiefer, Paul Hebert, Dan Lessler, James Krieger
INTRODUCTION: Community health workers (CHWs) can improve diabetes outcomes; however, questions remain about translating research findings into practical low-intensity models for safety-net providers. We tested the effectiveness of a home-based low-intensity CHW intervention for improving health outcomes among low-income adults with diabetes. METHODS: Low-income patients with glycated hemoglobin A1c (HbA1c) of 8.0% or higher in the 12 months before enrollment from 3 safety-net providers were randomized to a 12-month CHW-delivered diabetes self-management intervention or usual care...
February 9, 2017: Preventing Chronic Disease
https://www.readbyqxmd.com/read/28168204/rationale-design-and-baseline-characteristics-of-beijing-prediabetes-reversion-program-a-randomized-controlled-clinical-trial-to-evaluate-the-efficacy-of-lifestyle-intervention-and-or-pioglitazone-in-reversion-to-normal-glucose-tolerance-in-prediabetes
#19
Yingying Luo, Sanjoy K Paul, Xianghai Zhou, Cuiqing Chang, Wei Chen, Xiaohui Guo, Jinkui Yang, Linong Ji, Hongyuan Wang
Background. Patients with prediabetes are at high risk for diabetes and cardiovascular disease (CVD). No study has explored whether intervention could revert prediabetes to normal glycemic status as the primary outcome. Beijing Prediabetes Reversion Program (BPRP) would evaluate whether intensive lifestyle modification and/or pioglitazone could revert prediabetic state to normoglycemia and improve the risk factors of CVD as well. Methods. BPRP is a randomized, multicenter, 2 × 2 factorial design study. Participants diagnosed as prediabetes were randomized into four groups (conventional/intensive lifestyle intervention and 30 mg pioglitazone/placebo) with a three-year follow-up...
2017: Journal of Diabetes Research
https://www.readbyqxmd.com/read/28161384/hospitalization-costs-and-clinical-outcomes-in-cabg-patients-treated-with-intensive-insulin-therapy
#20
Saumeth Cardona, Francisco J Pasquel, Maya Fayfman, Limin Peng, Sol Jacobs, Priyathama Vellanki, Jeff Weaver, Michael Halkos, Robert A Guyton, Vinod H Thourani, Guillermo E Umpierrez
BACKGROUND: The financial impact of intensive (blood glucose [BG] 100-140mg/dl [5.5-7.8mM] vs. conservative (141-180mg/dl (7.9-10.0mM) glucose control in the ICU in patients, with and without diabetes, undergoing coronary artery bypass graft (CABG) surgery is not known. METHODS: This post-hoc cost analysis determined differences in hospitalization costs, resource utilization and perioperative complications in 288 CABG patients with diabetes (n=143) and without diabetes (n=145), randomized to intensive (n=143) and conservative (n=145) glucose control...
April 2017: Journal of Diabetes and its Complications
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