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Glycemic control in the icu

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https://www.readbyqxmd.com/read/29330638/predictors-of-severe-postoperative-hyperglycemia-after-cardiac-surgery-in-infants-a-single-center-retrospective-observational-study
#1
Natsuhiro Yamamoto, Tomoya Irie, Shunsuke Takaki, Osamu Yamaguchi, Takahisa Goto
PURPOSE: Hyperglycemia is a common issue in infants after cardiac surgery for congenital heart disease. Poor glycemic control is suspected to be associated with adverse postoperative outcomes. This study was performed to investigate clinical factors contributing to hyperglycemia in the perioperative period in infats. METHODS: A total of 69 infants (aged 1-12 months) who were admitted to Yokohama City University Hospital Intensive Care Unit (ICU) after surgical repair of congenital heart diseases with cardiopulmonary bypass (CPB) were retrospectively analysed...
January 12, 2018: Journal of Anesthesia
https://www.readbyqxmd.com/read/29278829/efficacy-of-maternal-and-biological-parameters-at-the-time-of-diagnosis-of-gestational-diabetes-mellitus-in-predicting-neonatal-morbidity
#2
Guillaume Ducarme, François Desroys Du Roure, Aurélie Le Thuaut, Joséphine Grange, Jérôme Dimet, Ingrid Crepin-Delcourt
OBJECTIVE: Gestational diabetes mellitus (GDM) is independently associated with an increased risk of maternal-fetal complications. Improved glycemic control allows reducing perinatal morbidity and mortality and, specifically, the risk of macrosomia and shoulder dystocia which are the most common complications associated with GDM. Nonetheless, a need for early antenatal predictor of neonatal morbidity in women suffering from GDM is required. The objective of the study was to evaluate the efficacy of different maternal, biological, and antenatal parameters at the time of diagnosis of GDM or perinatal variables as predictors of neonatal morbidity...
December 19, 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/29276256/evaluation-of-insulin-use-and-hypoglycemia-in-hospitalized-elderly-patients
#3
Quyen N Bach, Rod A Gilmore, Melody C Sheffield, W Anthony Hawkins
Background: Routine administration of correctional insulin is no longer recommended as a primary strategy to treat hyperglycemia in hospitalized patients. Studies have demonstrated significant improvement in glycemic control in patients treated with basal and correctional insulin (B+C) versus correctional insulin alone (C). However, the effect of C or B+C on hypoglycemic events is not well understood. Objective: The objective of this study was to investigate the effect of B+C versus C on hypoglycemic events in hospitalized elderly patients...
December 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/29251064/risk-of-hypoglycemia-during-insulin-infusion-directed-by-paper-protocol-versus-electronic-glycemic-management-system-in-critically-ill-patients-at-a-large-academic-medical-center
#4
Marina Rabinovich, Jessica Grahl, Emily Durr, Rita Gayed, Katleen Chester, Raymie McFarland, Barbara McLean
BACKGROUND: Insulin infusions are commonly utilized to control hyperglycemia in critically ill patients and decrease hyperglycemia associated complications. Safety concerns have been raised in trials evaluating methods of glycemic control regarding the incidence of hypoglycemia and its relationship to increased mortality. Electronic glycemic management systems (eGMS) may result in less variable blood glucose (BG) control and less hypoglycemia. This study aimed to compare BG control, time in target BG range, and the rate of hypoglycemia when critically ill patients were managed with an insulin infusion guided by paper-based protocol (PBP) versus eGMS...
December 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/29244792/tight-glycemic-control-in-critically-ill-pediatric-patients-a-meta-analysis-and-systematic-review-of-randomized-controlled-trials
#5
Yiyang Zhao, Yang Wu, Bo Xiang
BACKGROUND: There still are controversies in the impact of tight glycemic control (TGC) in critically ill children. The aim of this study was to assess the benefits and risks of TGC compared with conventional glycemic control (CGC) in critically ill pediatric patients admitted to the pediatric intensive care unit (PICU) by using data retrieved from randomized controlled trials (RCTs). METHOD: EMBASE, CNKI, PubMed and the Cochrane Database were searched for RCTs comparing TGC with CGC in critically ill children in PICU...
December 15, 2017: Pediatric Research
https://www.readbyqxmd.com/read/29218549/accuracy-and-reliability-of-a-subcutaneous-continuous-glucose-monitoring-device-in-critically-ill-patients
#6
S Rijkenberg, S C van Steen, J H DeVries, P H J van der Voort
Subcutaneous continuous glucose monitoring (CGM) may have benefits in achieving glycemic control in critically ill patients. The aim of this study was to assess the accuracy and reliability of the FreeStyle Navigator I in critically ill patients and to assess patient related factors influencing the accuracy and reliability. This study is a retrospective analysis of data from a randomized controlled trial conducted in a 20-bed mixed intensive care unit. Analytical accuracy, clinical accuracy and reliability were assessed against arterial blood glucose samples as reference...
December 7, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29157245/low-1-5-anhydroglucitol-levels-are-associated-with-long-term-cardiac-mortality-in-acute-coronary-syndrome-patients-with-hemoglobin-a1c-levels-less-than-7-0
#7
Shohei Ouchi, Kazunori Shimada, Tetsuro Miyazaki, Shuhei Takahashi, Yurina Sugita, Megumi Shimizu, Azusa Murata, Tomoyasu Kadoguchi, Takao Kato, Tatsuro Aikawa, Shoko Suda, Eiryu Sai, Masaru Hiki, Hiroshi Iwata, Takatoshi Kasai, Katsumi Miyauchi, Hiroyuki Daida
BACKGROUND: Diabetes mellitus is considered an important risk factor for cardiovascular diseases. High hemoglobin A1c (HbA1c) levels, which indicate poor glycemic control, have been associated with occurrence of cardiovascular diseases. There are few parameters which can predict cardiovascular risk in patients with well-controlled diabetes. Low 1,5-anhydroglucitol (1,5-AG) levels are considered a clinical marker of postprandial hyperglycemia. We hypothesized that low 1,5-AG levels could predict long-term mortality in acute coronary syndrome (ACS) patients with relatively low HbA1c levels...
November 21, 2017: Cardiovascular Diabetology
https://www.readbyqxmd.com/read/29154111/pten-expression-and-its-association-with-glucose-control-and-calorie-supplementation-in-critically-ill-patients
#8
Alessio Molfino, Francesco Alessandri, Paola Mosillo, Donatella Dell'Utri, Alessio Farcomeni, Maria Ida Amabile, Alessandro Laviano
BACKGROUND & AIM: Phosphatase and tensin homologue (PTEN) reduces insulin sensitivity. Since critically ill patients present insulin resistance, we aimed at assessing the role of PTEN expression on glucose homeostasis and clinical outcome in patients admitted to an intensive care unit (ICU) and receiving artificial nutrition. METHODS: Observational, single-center study conducted in one ICU in Rome, Italy on adult patients hospitalized for trauma. Plasma glucose levels and its variability were recorded in patients receiving artificial nutrition...
November 4, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/29103302/continuous-glucose-monitoring-measures-can-be-used-for-glycemic-control-in-the-icu-an-in-silico-study
#9
Tony Zhou, Jennifer L Dickson, Geoffrey M Shaw, J Geoffrey Chase
BACKGROUND: Continuous glucose monitoring (CGM) technology has become more prevalent in the intensive care unit (ICU), offering potential benefits of increased safety and reduced workload in glycemic control (GC). The drift and higher point accuracy errors of CGM devices over traditional intermittent blood glucose (BG) measures have so far limited their application in the ICU. This study delineates the trade-offs of performance, safety and workload that CGM sensors provide in GC protocols...
November 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/29044305/dysglycemia-in-the-critically-ill-patient-current-evidence-and-future-perspectives
#10
Ignacio Aramendi, Gastón Burghi, William Manzanares
Dysglycemia in critically ill patients (hyperglycemia, hypoglycemia, glycemic variability and time in range) is a biomarker of disease severity and is associated with higher mortality. However, this impact appears to be weakened in patients with previous diabetes mellitus, particularly in those with poor premorbid glycemic control; this phenomenon has been called "diabetes paradox". This phenomenon determines that glycated hemoglobin (HbA1c) values should be considered in choosing glycemic control protocols on admission to an intensive care unit and that patients' target blood glucose ranges should be adjusted according to their HbA1c values...
July 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/29040204/perioperative-glycemic-control-and-postoperative-complications-in-patients-undergoing-emergency-general-surgery-what-is-the-role-of-plasma-hemoglobin-a1c
#11
Faisal Jehan, Muhammad Khan, Joseph V Sakran, Mohammad Khreiss, Terence O'Keeffe, Albert Chi, Narong Kulvatunyou, Arpana Jain, El Rasheid Zakaria, Bellal Joseph
BACKGROUND: Plasma hemoglobin A1c (HbA1c) reflects quality of glucose control in diabetic patients. Literature reports that patients undergoing surgery with an elevated HbA1c level are associated with increased postoperative morbidity and mortality. The aim of our study was to evaluate the impact of HbA1c level on outcomes after emergency general surgery (EGS). METHODS: We performed a 3-year analysis of our prospectively maintained EGS database. Patients who had HbA1c levels measured within 3 months before surgery were included...
January 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28970655/liraglutide-as-an-alternative-to-insulin-for-glycemic-control-in-intensive-care-unit-a-randomized-open-label-clinical-study
#12
Vishesh Verma, Narendra Kotwal, Vimal Upreti, Monish Nakra, Yashpal Singh, K Anand Shankar, Amit Nachankar, K V S Hari Kumar
BACKGROUND: Intravenous insulin is the cornerstone in the management of hyperglycemia in the Intensive Care Unit (ICU). We studied the efficacy of liraglutide compared with insulin in the ICU. MATERIALS AND METHODS: In this prospective, open-labeled, randomized study, we included 120 patients (15-65 years, either sex) admitted to ICU with capillary blood glucose (CBG) between 181 and 300 mg/dl. We excluded patients with secondary diabetes and APACHE score >24...
September 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28904479/effect-of-fat-based-versus-carbohydrate-based-enteral-feeding-on-glycemic-control-in-critically-ill-patients-a-randomized-clinical-trial
#13
Mahdieh Nourmohammadi, Omid Moradi Moghadam, Mohammad Niakan Lahiji, Sevak Hatamian, Zahra Vahdat Shariatpanahi
BACKGROUND AND AIMS: The aim of this study was to evaluate the preventive effects of high-fat enteral feeding on glycemic control and clinical outcomes in critically ill patients: a randomized clinical trial. MATERIALS AND METHODS: This study was done on 42 normoglycemic patients admitted to Intensive Care Unit (ICU). Patients were randomly classified into three groups of 14 each. Control group (A) received carbohydrate-based diet (protein: 20%, fat: 30%, and carbohydrate: 50%), study groups received two types of high-fat diet; Group B (protein: 20%, fat: 45% including half of olive oil and half sunflower oil, and carbohydrate: 35%); and Group C (protein: 20%, fat: 45% including sunflower oil, and carbohydrate: 35%) in the first 48 h of admission...
August 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28875724/the-long-and-winding-road-toward-personalized-glycemic-control-in-the-critically-ill
#14
James Stephen Krinsley
Hyperglycemia is very common in critically ill patients and interventional studies of intensive insulin therapy with the goal of returning ICU glycemia to normal levels have demonstrated mixed results. A large body of literature has demonstrated that diabetes, per se, is not independently associated with increased risk of mortality in this population and that the relationship of glucose metrics to mortality is different for patients with and without diabetes. Moreover, these relationships are confounded by preadmission glycemia; in this regard, patients with diabetes and good preadmission glucose control, as reflected by HbA1c levels obtained at the time of ICU admission, are similar to patients without diabetes...
September 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28836877/management-of-hyperglycemia-in-the-neurosurgery-patient
#15
REVIEW
Rene Daniel, Satya Villuri, Kevin Furlong
Hyperglycemia is associated with adverse outcomes in patients who are candidates for or underwent neurosurgical procedures. Specific concerns and settings that relate to these patients are preoperative glycemic control, intraoperative control, management in the neurological intensive care unit (NICU), and postoperative control. In each of these settings, physicians have to ensure appropriate glycemic control to prevent or minimize adverse events. The glycemic control is usually managed by a neurohospitalist in co-management with the neurosurgery team pre- and post-operatively, and by the neurocritical care team in the setting of NICU...
October 2017: Hospital Practice (Minneapolis)
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
#16
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, Dieter Mesotten
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/28707484/autoregressive-modeling-of-drift-and-random-error-to-characterize-a-continuous-intravascular-glucose-monitoring-sensor
#17
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
#18
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 analogues for the ambulatory and inpatient management of diabetes. The efficacy and safety of basal insulin analogues in the hospital setting has not been established. METHODS: This observational study compared differences in glycemic control and outcomes in non-intensive care unit patients with blood glucose (BG) >140 mg/dL who were treated with glargine or detemir, between January 1, 2012, and September 30, 2015, in two academic centers...
September 2017: Endocrine Practice
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
#19
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/28628847/the-importance-of-declining-insulin-requirements-during-pregnancy-in-patients-with-pre-gestational-gestational-diabetes-mellitus
#20
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
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