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Inpatient glycemic control

John I Shin, Kevin Phan, Parth Kothari, Jun S Kim, Javier Z Guzman, Samuel K Cho
STUDY DESIGN: This is a retrospective analysis of administrative database. OBJECTIVE: To elucidate the effect of glycemic control on surgical outcomes of middle-aged and elderly idiopathic scoliosis patients undergoing spinal fusion surgery. SUMMARY OF BACKGROUND DATA: Diabetes mellitus (DM) is a condition thought to adversely affect outcomes of spine surgery. However, no study has stratified glycemic control levels and their impact on outcome for idiopathic scoliosis patients receiving a spinal fusion surgery...
October 19, 2016: Clinical Spine Surgery
Suqing Li, Sylvia Roschkov, Blair J O'Neill, Constance L Chik, Ross T Tsuyuki, Gabor T Gyenes
OBJECTIVE: To determine the benefits of diabetes nurse practitioner (DNP) intervention on glycemic control, quality of life and diabetes treatment satisfaction in patients with type 2 diabetes (T2DM) admitted to cardiology inpatient services at a tertiary center. PATIENTS AND METHODS: Patients admitted to the cardiology service with T2DM who had sub-optimal control (HbA1c >6.5%) were approached for the study. Diabetes care was optimized by the DNP through medication review, patient education and discharge care-planning...
September 19, 2016: Canadian Journal of Diabetes
Chelsea Smallwood, Danièle Lamarche, Annie Chevrier
Insulin administration in the acute care setting is an integral component of inpatient diabetes management. Although some institutions have moved to insulin pen devices, many acute care settings continue to employ the vial and syringe method of insulin administration. The aim of this study was to evaluate the impact of insulin pen implementation in the acute care setting on patients, healthcare workers and health resource utilization. A review of published literature, including guidelines, was conducted to identify how insulin pen devices in the acute care setting may impact inpatient diabetes management...
September 2, 2016: Canadian Journal of Diabetes
Yunjiao J Wang, Stacey Seggelke, R Matthew Hawkins, Joanna Gibbs, Mark Lindsay, Ingrid Hazlett, Cecilia C Low Wang, Neda Rasouli, Kendra A Young, Boris Draznin
OBJECTIVE: To improve glycemic control of hospitalized patients with diabetes and hyperglycemia, many medical centers have established dedicated glucose management teams (GMT). However, the impact of these specialized teams on clinical outcomes has not been evaluated. METHODS: We conducted a retrospective study of 440 patients with type 2 diabetes admitted to the medical service for cardiac or infection-related diagnosis. The primary endpoint was a composite outcome of several well-recognized markers of morbidity, consisting of: death during hospitalization, transfer to ICU, initiation of enteral or parenteral nutrition, line infection, new in-hospital infection or infection lasting more than 20 days of hospitalization, deep venous thrombosis or pulmonary embolism, rise in plasma creatinine, and hospital readmissions...
August 19, 2016: Endocrine Practice
Sun Y Lee, Gulce Askin, Marie E McDonnell, Lindsay M Arnold, Sara M Alexanian
Objective Hypoglycemia remains one of the main challenges of insulin therapy. To reduce insulin-related hypoglycemia at our institution, we restricted inpatient ordering of high glargine doses (≥0.5u/kg/day) to endocrine staff in 5/2013. This retrospective cohort study assesses its effect on hypoglycemia and glycemic control ≤48 hours of admission. Methods 692 adult patients hospitalized at Boston Medical Center and received glargine upon admission from 11/1/12-4/30/13 were identified as the pre-intervention group, and 651 adult patients from 11/1/13-4/30/14 as the post-intervention group...
August 19, 2016: Endocrine Practice
Brian Petullo, Byron Noble, Kathleen M Dungan
BACKGROUND: Electronic messaging (EM) is increasingly utilized among patients with diabetes, but it is unclear whether it is associated with improved glycemic control, hospital admissions, or emergency visits. METHODS: Patients who were seen over a 1 year period at an academic endocrinology clinic with a diagnosis of diabetes were categorized according to portal activation and whether EMs were actually sent. The association between EM and HbA1c and inpatient or emergency department (ED) visits was further characterized using multivariable (MV) linear or logistic regression models...
September 2016: Diabetes Technology & Therapeutics
Aniza Ismail, Leny Suzana Suddin, Saperi Sulong, Zafar Ahmed, Nor Azmi Kamaruddin, Norlela Sukor
CONTEXT: Diabetes mellitus is a growing health problem in most countries. In Malaysia, there was an increase in prevalence over the years. This makes diabetes also a growing concern in Malaysia, which warrants strengthening of the prevention and control programme. AIMS: This paper aims to describe the profiles of diabetes mellitus type 2 in tertiary setting and to identify the risk factors for high level of HbA1c among the study population. The findings will give a glimpse on current status of diabetes in our country and may reflect the achievement of the country in combating this disease...
July 2016: Indian Journal of Community Medicine
Andrew O Paulus, Jeffrey A Colburn, Mark W True, Darrick J Beckman, Richard P Davis, Jana L Wardian, Sky D Graybill, Irene Folaron, Jack E Lewi
OBJECTIVE: Patients using U-500 regular insulin are severely insulin resistant requiring high doses of insulin. It has been observed that a patient's insulin requirements may dramatically decrease during hospitalization. This study sought to systemically investigate this phenomenon. METHODS: We performed a retrospective chart review of patients with U-500 insulin outpatient regimens who were admitted to the San Antonio Military Medical Center over a five-year period...
June 30, 2016: Endocrine Practice
M Cecilia Lansang, Guillermo E Umpierrez
Inpatient hyperglycemia is common and is associated with an increased risk of hospital complications, higher healthcare resource utilization, and higher in-hospital mortality rates. Appropriate glycemic control strategies can reduce these risks, although hypoglycemia is a concern. In critically ill patients, intravenous (IV) insulin is most appropriate, with a starting threshold no higher than 180 mg/dL. Once IV insulin is started, the glucose level should be maintained between 140 and 180 mg/dL. In noncritically ill patients, basal-bolus regimens with basal, prandial, and correction components are preferred for those with good nutritional intake...
May 2016: Cleveland Clinic Journal of Medicine
Nicholas Welsh, Teresa Derby, Suruchi Gupta, Candice Fulkerson, Diana Johnson Oakes, Kathleen Schmidt, Neehar D Parikh, J P Norvell, Josh Levitsky, Alfred Rademaker, Mark E Molitch, Amisha Wallia
OBJECTIVE: Inpatient hypoglycemia (glucose ≤70 mg/dL) is a limitation of intensive control with insulin. Causes of hypoglycemia were evaluated in a randomized controlled trial examining intensive glycemic control (IG, target 140 mg/dL) versus moderate glycemic control (MG, target 180 mg/dL) on post-liver transplant outcomes. METHODS: Hypoglycemic episodes were reviewed by a multidisciplinary team to calculate and identify contributing pathophysiologic and operational factors...
September 2016: Endocrine Practice
Gregory P Forlenza, Brandon M Nathan, Antoinette Moran, Ty B Dunn, Gregory J Beilman, Timothy L Pruett, Boris P Kovatchev, Melena D Bellin
BACKGROUND: Among postsurgical and critically ill patients, malglycemia is associated with increased complications. Continuous glucose monitoring (CGM) in the inpatient population may enhance glycemic control. CGM reliability may be compromised by postsurgical complications such as edema or vascular changes. We utilized Clarke Error Grid (CEG) and Surveillance Error Grid (SEG) analysis to evaluate CGM performance after total pancreatectomy with islet autotransplantation. MATERIALS AND METHODS: This subanalysis evaluated Medtronic Enlite 2 CGM values against YSI serum glucose in seven post-transplant patients (86% female; 38...
August 2016: Diabetes Technology & Therapeutics
Catherine E Palladino, Mary E Eberly, John T Emmons, Lisa R Tannock
AIMS: The purpose of this study was to compare inpatient insulin needs with usual home insulin needs for severely insulin resistant individuals using U-500 insulin. METHODS: This was a retrospective review of patients using U-500 insulin at one institution. Subjects were divided into 3 groups according to their pre-admission HbA1c [<8%, 8-8.99%, ≥9%] as glycemic control could impact inpatient insulin requirements. The primary outcome was the average total daily insulin dose during hospitalization...
April 2016: Diabetes Research and Clinical Practice
Susan Brumm, Kathleen Theisen, Mercedes Falciglia
PURPOSE: The purpose of the study was to evaluate a diabetes transition care program in a population of veterans with diabetes by calculating 30-day readmission rates and assessing glycemic control. METHODS: Hospitalized patients with poorly controlled diabetes were identified to participate in the diabetes transition care program. The program included follow-up through a postdischarge telephone call by the diabetes educator, with an opportunity for a face-to-face clinic visit...
June 2016: Diabetes Educator
John J Ko, Jackie Lu, Karen Rascati, Eileen M Stock, Joyce Juan, Kangho Suh, Yoona Kim, Patricia A Tabor, Paul J Godley
BACKGROUND: An integrated health care system with its own regional health plan located in Texas implemented a pharmacist-led diabetes medication management program (MMP) to treat type 2 diabetic patients (baseline A1c > 7.5%). The MMP formed collaborative practice agreements with the system's physicians to allow ambulatory care pharmacists to modify and adjust diabetic drug regimens when appropriate. Enrolled MMP patients received personalized visits with ambulatory care pharmacists and a copay waiver on diabetes medications...
January 2016: Journal of Managed Care & Specialty Pharmacy
Shengnan Yang, Weimin Kong, Cunyi Hsue, Anne F Fish, Yufeng Chen, Xiaohui Guo, Qingqing Lou, Robert Anderson
This study was to identify current A1c understanding status among Chinese patients with type 2 diabetes, assess if knowledge of A1c affects their diabetes self-management and their glycemic control and recognize the factors influencing knowledge of A1c among patients with type 2 diabetes. A multi-center, cross-sectional survey was conducted between April and July 2010 in 50 medical centers in the Mainland China. Participants were recruited from inpatients and outpatients who were admitted to or visited those medical centers...
2016: PloS One
David Rometo, Mary Korytkowski
Bariatric surgery in patients with type 2 diabetes has been shown to improve glycemic control and reduce need for glucose-lowering medications. Some of these improvements occur in the early postoperative period prior to any weight loss. These early reductions in circulating glucose can be attributed to primarily perioperative caloric restriction and prolonged fasting. Inpatient glycemic targets for patients undergoing bariatric surgery are similar to those recommended for other surgical procedures as a way of minimizing risk for complications...
April 2016: Current Diabetes Reports
Martha Engle, Allison Ferguson, Willa Fields
PURPOSE: The purpose of this quality improvement project was to redesign a hospital meal delivery process in order to shorten the time between blood glucose monitoring and corresponding insulin administration and improve glycemic control. DESCRIPTION: This process change redesigned the workflow of the dietary and nursing departments. Modifications included nursing, rather than dietary, delivering meal trays to patients receiving insulin. Dietary marked the appropriate meal trays and phoned each unit prior to arrival on the unit...
March 2016: Clinical Nurse Specialist CNS
Maya Fayfman, Priyathama Vellanki, Anastasia-Stefania Alexopoulos, Lauren Buehler, Liping Zhao, Dawn Smiley, Sonya Haw, Jeff Weaver, Francisco J Pasquel, Guillermo E Umpierrez
CONTEXT: A higher prevalence of diabetes-related complications is reported in minority populations; however, it is not known if there are racial disparities in diabetes care and outcomes in hospitalized patients. OBJECTIVE: Our objective was to determine the association between hyperglycemia, in patients with and without diabetes mellitus (non-DM), and complications among different racial groups. DESIGN: This observational study compared the frequency of hyperglycemia (blood glucose ≥ 180 mg/dL; 10 mmol/L) and DM and hospital complications between Black and White patients hospitalized patients between January 2012 and December 2013...
March 2016: Journal of Clinical Endocrinology and Metabolism
Ram D Pathak, Emily B Schroeder, Elizabeth R Seaquist, Chan Zeng, Jennifer Elston Lafata, Abraham Thomas, Jay Desai, Beth Waitzfelder, Gregory A Nichols, Jean M Lawrence, Andrew J Karter, John F Steiner, Jodi Segal, Patrick J O'Connor
OBJECTIVE: Appropriate glycemic control is fundamental to diabetes care, but aggressive glucose targets and intensive therapy may unintentionally increase episodes of hypoglycemia. We quantified the burden of severe hypoglycemia requiring medical intervention in a well-defined population of insured individuals with diabetes receiving care in integrated health care delivery systems across the U.S. RESEARCH DESIGN AND METHODS: This observational cohort study included 917,440 adults with diabetes receiving care during 2005 to 2011 at participating SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) network sites...
March 2016: Diabetes Care
R Mateo, S Gupta, A Wallia, C Cameron, K Schmidt, D J Oakes, G Aleppo, A-C Andrei, J E Wilcox, K Grady, R Gordon, M E Molitch
PURPOSE: Hyperglycemia increases risks of kidney and liver transplant rejection. To determine whether perioperative and subsequent glycemic control was associated with increased risk of heart transplant rejection over the year after transplantation, we performed a retrospective analysis of glycemic control and rejection rates in heart transplantation patients. METHODS: Perioperative glucose levels were analyzed in 157 patients undergoing transplantation at Northwestern Memorial Hospital from June 2005 to December 2012 and compared in patients with and without rejection found on routine follow-up biopsy specimens...
November 2015: Transplantation Proceedings
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