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Intensive glycemic control

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https://www.readbyqxmd.com/read/28069712/an-evidence-based-medicine-approach-to-antihyperglycemic-therapy-in-diabetes-mellitus-to-overcome-overtreatment
#1
Anil N Makam, Oanh K Nguyen
Overtreatment is pervasive in medicine and leads to potential patient harms and excessive costs in health care. Although evidence-based medicine is often derided as practice by rote algorithmic medicine, the appropriate application of key evidence-based medicine principles in clinical decision making is fundamental to preventing overtreatment and promoting high-value, individualized patient-centered care. Specifically, this article discusses the importance of (1) using absolute rather than relative estimates of benefits to inform treatment decisions; (2) considering the time horizon to benefit of treatments; (3) balancing potential harms and benefits; and (4) using shared decision making by physicians to incorporate the patient's values and preferences into treatment decisions...
January 10, 2017: Circulation
https://www.readbyqxmd.com/read/28067740/update-on-management-of-type-1-diabetes-and-type-2-diabetes-in-athletes
#2
Jane E Yardley, Sheri R Colberg
Optimal blood glucose management still remains the biggest challenge in active individuals with diabetes, particularly in insulin users, but some newer strategies have been introduced to maintain blood glucose control. Recent studies emphasize the importance of exercise intensity on glycemic balance. In individuals with type 1 and type 2 diabetes, both resistance and high-intensity intermittent exercise have been shown to confer beneficial physiological adaptations in training studies, while also showing acute glycemic benefits from single sessions...
January 2017: Current Sports Medicine Reports
https://www.readbyqxmd.com/read/28063297/higher-glucose-variability-in-type-1-than-in-type-2-diabetes-patients-admitted-to-the-intensive-care-unit-a-retrospective-cohort-study
#3
Marjolein K Sechterberger, Sigrid C J van Steen, Esther M N Boerboom, Peter H J van der Voort, Rob J Bosman, Joost B L Hoekstra, J Hans DeVries
PURPOSE: Although the course of disease of type 1 and type 2 diabetes differs, the distinction is rarely made when patients are admitted to the intensive care unit (ICU). Here, we report patient- and admission-related characteristics in relation to glycemic measures of patients with type 1 and type 2 diabetes admitted to the ICU. MATERIALS AND METHODS: A retrospective chart review was performed of 1574 patients with diabetes admitted between 2004 and 2011 to our ICU...
December 29, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/28061430/exploring-the-characteristics-of-suboptimally-controlled-patients-after-24weeks-of-basal-insulin-treatment-an-individualized-approach-to-intensification
#4
Kamlesh Khunti, Taner Damci, Lise Lotte Husemoen, Vinay Babu, Andreas Liebl
AIM: To identify characteristics of suboptimally controlled patients with type 2 diabetes (T2DM) on basal insulin treatment who may benefit from intensive titration or further intensification of treatment. METHODS: A post hoc analysis of SOLVE: a 24-week, international, observational study conducted in 17,374 patients with T2DM inadequately controlled on oral antidiabetic drugs (OADs) started on once-daily insulin detemir. Patients were divided into two groups based on whether they achieved HbA1c<7...
December 9, 2016: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/28050932/physical-activity-levels-of-adolescents-with-type-1-diabetes
#5
Valderi Abreu de Lima, Luis Paulo Gomes Mascarenhas, Juliana Pereira Decimo, William Cordeiro de Souza, Anna Louise Stellfeld Monteiro, Ian Lahard, Suzana Nesi França, Neiva Leite
: The aim of this study was to evaluate the level of physical activity and cardiorespiratory fitness in teenagers with type 1 diabetes mellitus (T1D) in comparison with healthy scholar participants. Total of 154 teenagers (T1D=45 and CON=109). Height, weight, cardiorespiratory fitness (VO2max), and the level of physical activity by the Bouchard's Physical Activity Record were measured, and glycated hemoglobin (HbA1c) in T1D. The VO2 max was lower in the T1D (38.38 ± 7.54) in comparison with the CON (42...
January 4, 2017: Pediatric Exercise Science
https://www.readbyqxmd.com/read/28004200/hyperinsulinemic-normoglycemia-decreases-glucose-variability-during-cardiac-surgery
#6
Alaa Abd-Elsayed, Edward J Mascha, Dongsheng Yang, Daniel I Sessler, Andra Duncan
PURPOSE: Increased glucose variability may be associated with worse outcomes in critically ill patients. Hyperinsulinemic normoglycemia provides intensive glucose control during surgery and may reduce glucose variability. Our objective was to compare glycemic variability between two methods of glucose control in cardiac surgical patients: hyperinsulinemic normoglycemia vs standard insulin infusion. We also assessed whether the effect differed between patients with and without diabetes mellitus...
December 21, 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/28000140/flash-glucose-sensing-technology-as-a-replacement-for-blood-glucose-monitoring-for-the-management-of-insulin-treated-type-2-diabetes-a-multicenter-open-label-randomized-controlled-trial
#7
Thomas Haak, Hélène Hanaire, Ramzi Ajjan, Norbert Hermanns, Jean-Pierre Riveline, Gerry Rayman
INTRODUCTION: Glycemic control in participants with insulin-treated diabetes remains challenging. We assessed safety and efficacy of new flash glucose-sensing technology to replace self-monitoring of blood glucose (SMBG). METHODS: This open-label randomized controlled study (ClinicalTrials.gov, NCT02082184) enrolled adults with type 2 diabetes on intensive insulin therapy from 26 European diabetes centers. Following 2 weeks of blinded sensor wear, 2:1 (intervention/control) randomization (centrally, using biased-coin minimization dependant on study center and insulin administration) was to control (SMBG) or intervention (glucose-sensing technology)...
December 20, 2016: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/27994380/validity-of-bedside-blood-glucose-measurement-in-critically-ill-patients-with-intensive-insulin-therapy
#8
Ata Mahmoodpoor, Hadi Hamishehkar, Kamran Shadvar, Sarvin Sanaie, Afshin Iranpour, Vahid Fattahi
BACKGROUND AND AIMS: There have been variable results on the practice of tight glycemic control, and studies have demonstrated that point-of-care (POC) glucometers have variable accuracy. Glucometers must be accurate, and many variables can affect blood glucose levels. The purpose of this study was to determine the difference between blood glucose concentrations obtained from POC glucometers and laboratory results in critically ill patients with intensive insulin therapy. MATERIALS AND METHODS: This was a descriptive study which enrolled 300 critically ill patients...
November 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27987236/evaluation-of-the-counter-regulatory-responses-to-hypoglycemia-in-patients-with-type-1-diabetes-during-opiate-receptor-blockade-with-naltrexone
#9
Sarita Naik, Renata Belfort-DeAguiar, Anne-Sophie Sejling, Barbara Szepietowska, Robert S Sherwin
AIMS: Hypoglycemia is the major limiting factor in achieving optimal glycemic control in people with type 1 diabetes (T1DM), especially intensively treated patients with impaired glucose counterregulation during hypoglycemia. Naloxone, an opiate receptor blocker, has been reported to enhance the acute counterregulatory response to hypoglycemia when administered intravenously in humans. The current study was undertaken to investigate if the oral formulation of the long acting opiate antagonist, naltrexone, could have a similar effect, and thus might be useful therapeutically in T1DM patients with a high risk for hypoglycemia...
December 17, 2016: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/27967228/safety-and-efficacy-of-personalized-glycemic-control-in-critically-ill-patients-a-2-year-before-and-after-interventional-trial
#10
James S Krinsley, Jean-Charles Preiser, Irl B Hirsch
Objective To determine the safety and efficacy of a change in blood glucose (BG) control protocol from a single target to 2 targets based on diabetes status and glycated hemoglobin (A1C) in a cohort of critically ill patients. Methods This investigation includes 1,979 patients admitted to a single intensive care unit between September 16, 2013 and September 15, 2015. The BG target was 90-120 mg/dL in the PRE era and 80-140 mg/dL for patients without diabetes (NON) and diabetes patients (DM) with A1C < 7% and 110-160 mg/dL for DM with A1C > 7% (TIGHT and LOOSE protocols) in the POST era...
December 14, 2016: Endocrine Practice
https://www.readbyqxmd.com/read/27967226/use-of-a-computer-guided-glucose-management-system-to-improve-glycemic-control-and-address-national-quality-measures-a-7-year-retrospective-observational-study-at-a-tertiary-care-teaching-hospital
#11
Robert J Tanenberg, Sandra Hardee, Caitlin Rothermel, Almond J Drake
Objectives Inpatient hyperglycemia, hypoglycemia, and glucose variability are associated with increased mortality. The use of electronic Glucose Management Systems (eGMS) to guide intravenous (IV) insulin infusion have been found to significantly improve blood glucose (BG) control. This retrospective observational study evaluated the 7-year (1/2009-12/2015) impact of the EndoTool(®) eGMS in intensive and intermediate units at Vidant Medical Center, a 900-bed tertiary teaching hospital. Methods Patients assigned to eGMS had indications for IV insulin infusion, including uncontrolled diabetes, stress hyperglycemia, and/or post-operative BG levels >140 mg/dL...
December 14, 2016: Endocrine Practice
https://www.readbyqxmd.com/read/27908250/hypoglycemia-and-cardiac-arrhythmia-mechanisms-evidence-base-and-current-recommendations
#12
Sitara Gulrukh Khan, Mohammed Shahriar Huda
BACKGROUND: With the use of intensive insulin therapy and insulin secretagogues to optimize glycemic control in diabetes, hypoglycemia continues to present a clinical challenge. Hypoglycemia has been implicated in nocturnal sudden death in type 1 diabetes, and the mechanism underlying this is postulated to be cardiac arrhythmia. OBJECTIVE: This article reviews the evidence surrounding hypoglycemia and cardiac arrhythmia. METHODS: A structured search of the Pubmed bibliographic database was undertaken, and relevant peer-reviewed articles on the topic were included in the review...
December 1, 2016: Current Diabetes Reviews
https://www.readbyqxmd.com/read/27894316/dietary-patterns-in-obese-pregnant-women-influence-of-a-behavioral-intervention-of-diet-and-physical-activity-in-the-upbeat-randomized-controlled-trial
#13
Angela C Flynn, Paul T Seed, Nashita Patel, Suzanne Barr, Ruth Bell, Annette L Briley, Keith M Godfrey, Scott M Nelson, Eugene Oteng-Ntim, Sian M Robinson, Thomas A Sanders, Naveed Sattar, Jane Wardle, Lucilla Poston, Louise M Goff
BACKGROUND: Understanding dietary patterns in obese pregnant women will inform future intervention strategies to improve pregnancy outcomes and the health of the child. The aim of this study was to investigate the effect of a behavioral intervention of diet and physical activity advice on dietary patterns in obese pregnant woman participating in the UPBEAT study, and to explore associations of dietary patterns with pregnancy outcomes. METHODS: In the UPBEAT randomized controlled trial, pregnant obese women from eight UK multi-ethnic, inner-city populations were randomly assigned to receive a diet/physical activity intervention or standard antenatal care...
November 29, 2016: International Journal of Behavioral Nutrition and Physical Activity
https://www.readbyqxmd.com/read/27884157/manual-versus-automated-monitoring-accuracy-of-glucose-ii-manage-ii
#14
Cláudia Righy Shinotsuka, Alexandre Brasseur, David Fagnoul, Timothy So, Jean-Louis Vincent, Jean-Charles Preiser
BACKGROUND: Intravascular continuous glucose monitoring (CGM) may facilitate glycemic control in the intensive care unit (ICU). We compared the accuracy of a CGM device (OptiScanner®) with a standard reference method. METHODS: Adult patients who had blood glucose (BG) levels >150 mg/dl and required insertion of an arterial and central venous catheter were included. The OptiScanner® was inserted into a multiple-lumen central venous catheter. Patients were treated using a dynamic-scale insulin algorithm to achieve BG values between 80 and 150 mg/dl...
November 25, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27878572/a-comparison-of-two-insulin-infusion-protocols-in-the-medical-intensive-care-unit-by-continuous-glucose-monitoring
#15
Christophe E M De Block, Peter Rogiers, Philippe G Jorens, Tom Schepens, Cosimo Scuffi, Luc F Van Gaal
BACKGROUND: Achieving good glycemic control in intensive care units (ICU) requires a safe and efficient insulin infusion protocol (IIP). We aimed to compare the clinical performance of two IIPs (Leuven versus modified Yale protocol) in patients admitted to medical ICU, by using continuous glucose monitoring (CGM). This is a pooled data analysis of two published prospective randomized controlled trials. CGM monitoring was performed in 57 MICU patients (age 64 ± 12 years, APACHE-II score 28 ± 7, non-diabetic/diabetic: 36/21)...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27875539/secular-trends-in-admissions-and-mortality-rates-from-diabetes-mellitus-in-the-central-belt-of-ghana-a-31-year-review
#16
Osei Sarfo-Kantanka, Fred Stephen Sarfo, Eunice Oparebea Ansah, Benjamin Eghan, Nana Kwame Ayisi-Boateng, Emmanuel Acheamfour-Akowuah
INTRODUCTION: Diabetes Mellitus is currently a leading cause of morbidity and mortality throughout the world, particularly in sub-Saharan Africa where a significant proportion of diabetes cases are now found. Longitudinal profiling of in-patient admissions and mortality trends from diabetes provide useful insights into the magnitude of the burden of diabetes, serve as a sentinel on the state of out-patient diabetes care and provide effective tools for planning, delivering and evaluating the health care needs relating to the disease in sub-Saharan Africa...
2016: PloS One
https://www.readbyqxmd.com/read/27875061/glycemic-control-reduces-infections-in-post-liver-transplant-patients-results-of-a-prospective-randomized-study
#17
Amisha Wallia, Kathleen Schmidt, Diana Johnson Oakes, Teresa Pollack, Nicholas Welsh, Susan Kling-Colson, Suruchi Gupta, Candice Fulkerson, Grazia Aleppo, Neehar Parikh, Josh Levitsky, J P Norvell, Alfred Rademaker, Mark E Molitch
CONTEXT: Prior studies have shown a relationship between glycemic control and post-transplant morbidity. OBJECTIVE: We conducted a prospective randomized controlled trial in post liver transplant patients, evaluating intensive inpatient glycemic control and effects on outcomes to 1 year. Research Design and Intervention: 164 patients (blood glucose (BG) > 180 mg/dL) were randomized to two target groups: BG 140 mg/dL (N= 82) and 180 mg/dL (N= 82). Patients were initiated on insulin drips and then converted to subcutaneous basal bolus insulin therapy by our Glucose Management Service...
November 22, 2016: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/27872156/association-between-blood-pressure-and-adverse-renal-events-in-type-1-diabetes
#18
Elaine Ku, Charles E McCulloch, Michael Mauer, Stephen E Gitelman, Barbara A Grimes, Chi-Yuan Hsu
OBJECTIVE: To compare different blood pressure (BP) levels in their association with the risk of renal outcomes in type 1 diabetes and to determine whether an intensive glycemic control strategy modifies this association. RESEARCH DESIGN AND METHODS: We included 1,441 participants with type 1 diabetes between the ages of 13 and 39 years who had previously been randomized to receive intensive versus conventional glycemic control in the Diabetes Control and Complications Trial (DCCT)...
December 2016: Diabetes Care
https://www.readbyqxmd.com/read/27850123/483-postoperative-glycemic-control-in-a-cardiovascular-intensive-care-unit-beyond-the-insulin-infusion
#19
Maria Zhorne
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27848229/ambulatory-screening-of-diabetic-neuropathy-and-predictors-of-its-severity-in-outpatient-settings
#20
M S Qureshi, M Iqbal, S Zahoor, J Ali, M U Javed
INTRODUCTION: Diabetic neuropathy is one of the most common causes of chronic neuropathic symptomatology and the most disabling and difficult-to-treat diabetic microangiopathic complication. The neuropathies associated with diabetes are typically classified into generalized, focal and multifocal varieties. There exists a scarcity of literature studying the correlation of different patient- and disease-related variables with severity of neuropathy. OBJECTIVES: This study aims to delineate the prevalence of diabetic neuropathy in type 2 diabetes, describe its characteristics and find out predictors of its severity...
November 15, 2016: Journal of Endocrinological Investigation
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