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Inpatient glycemic control

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https://www.readbyqxmd.com/read/29907898/inpatient-glycemic-management-of-non-cardiac-cvd-focus-on-stroke-and-pvd
#1
REVIEW
Estelle Everett, Nestoras Mathioudakis
PURPOSE OF REVIEW: Hyperglycemia occurs frequently in hospitalized patients with stroke and peripheral vascular disease (PVD). Guidelines for inpatient glycemic management are not well established for this patient population. We will review the clinical impact of hyperglycemia in this acute setting and review the evidence for glycemic control. RECENT FINDINGS: Hyperglycemia in acute stroke is associated with poor short and long-term outcomes, and perioperative hyperglycemia in those undergoing revascularization for PVD is linked to increased post-surgical complications...
June 16, 2018: Current Diabetes Reports
https://www.readbyqxmd.com/read/29878825/telephone-delivered-lifestyle-support-with-action-planning-and-motivational-interviewing-techniques-to-improve-rehabilitation-outcomes
#2
Andrea Döbler, Bea Herbeck Belnap, Hartmut Pollmann, Erik Farin, Heiner Raspe, Oskar Mittag
OBJECTIVE: In this randomized controlled trial, we evaluated the effectiveness of a telephone-delivered intervention based on the Health Action Process Approach (HAPA) after discharge from inpatient rehabilitation to address behavior change, emotional status, and glycemic control in patients with Type 2 diabetes. DESIGN: In a German rehabilitation center, 249 patients with Type 2 diabetes were separated into randomized groups, either a 12-month telephone follow-up support group or the usual care group...
May 2018: Rehabilitation Psychology
https://www.readbyqxmd.com/read/29807752/targeted-glycemic-control-for-adult-patients-with-type-2-diabetes-mellitus-in-the-acute-care-setting
#3
REVIEW
Ali Pourmand, Maryann Mazer-Amirshahi, Amy Caggiula, Aria Nawab, Christopher Payette, Samuel Johnson
Diabetes mellitus and complications arising from the disease are a leading cause of morbidity and mortality worldwide. With increasing prevalence over the past 50 years and an estimated 20% of health-care spending dedicated to the disease, diabetes is considered by many to be a true public health emergency. Several protocols and management options exist to maximize glycemic control in the ambulatory setting, but the optimal glucose level in critically and noncritically ill inpatients is still debated. This review examines the evidence behind differing degrees of glycemic control across a variety of hospital settings and clinical scenarios...
February 8, 2018: Canadian Journal of Diabetes
https://www.readbyqxmd.com/read/29777522/impact-of-insulin-degludec-in-hospitalized-patients-with-and-without-type-2-diabetes-requiring-parenteral-enteral-nutrition-an-observational-study
#4
Giuseppe Fatati, Agnese Di Donato, Ilenia Grandone, Pina Menicocci, Eva Mirri, Giuseppe Prosperini, Marco Scardapane, Maria Chiara Rossi, Mariangela Palazzi
INTRODUCTION: Hyperglycemia in inpatients is a major problem, especially when nutritional support is required. This study aims to assess the impact of treatment with insulin degludec (IDeg) on mean blood glucose (BG) and glycemic variability in noncritical hospitalized patients with and without type 2 diabetes (T2DM) receiving enteral and/or parenteral nutrition (EN, PN). METHODS: Mean BG and glycemic variability from admission up to 7 days of hospitalization were evaluated in consecutive cases with and without T2DM...
May 17, 2018: Advances in Therapy
https://www.readbyqxmd.com/read/29757058/outcomes-following-hip-and-knee-replacement-in-diabetic-versus-nondiabetic-patients-and-well-versus-poorly-controlled-diabetic-patients-a-prospective-cohort-study
#5
Erik Lenguerrand, Andrew D Beswick, Michael R Whitehouse, Vikki Wylde, Ashley W Blom
Background and purpose - The impact of diabetes and glycemic control before joint replacement on clinical and patient-reported outcomes is unclear. We compared pain, function, complications, and length of hospital stay in diabetic and nondiabetic patients receiving primary total hip (THR) or knee replacement (TKR) and compared these outcomes in patients with poorly controlled versus well-controlled diabetes. Patients and methods - We conducted a prospective cohort study of patients undergoing primary THR (n = 300) or TKR (n = 287) for osteoarthritis...
May 14, 2018: Acta Orthopaedica
https://www.readbyqxmd.com/read/29691230/using-indirect-measures-to-identify-geographic-hot-spots-of-poor-glycemic-control-cross-sectional-comparisons-with-an-a1c-registry
#6
David C Lee, Qun Jiang, Bahman P Tabaei, Brian Elbel, Christian A Koziatek, Kevin J Konty, Winfred Y Wu
OBJECTIVE: Focusing health interventions in places with suboptimal glycemic control can help direct resources to neighborhoods with poor diabetes-related outcomes, but finding these areas can be difficult. Our objective was to use indirect measures versus a gold standard, population-based A1C registry to identify areas of poor glycemic control. RESEARCH DESIGN AND METHODS: Census tracts in New York City were characterized by race, ethnicity, income, poverty, education, diabetes-related emergency visits, inpatient hospitalizations, and proportion of adults with diabetes having poor glycemic control, based on A1C >9...
April 24, 2018: Diabetes Care
https://www.readbyqxmd.com/read/29688879/managing-diabetes-in-patients-hospitalized-in-internal-medicine-units
#7
Irit Hochberg
Diabetes and hyperglycemia are present in over one-third of inpatients in internal medicine units and are associated with worse prognosis in multiple morbidities. Treatment of inpatient hyperglycemia is usually with basal bolus insulin in a dose calculated by the patient's weight, with lower doses recommended in patients who are at a higher risk for hypoglycemia. Other antihyperglycemic medications and insulin regimens can be used in selected patients. There are no adequately powered studies on the effect of improving glycemic control on hospitalization outcomes in non-critically ill patients in internal medicine units, and in most patients a modest glucose target of 140-180 mg/dL is recommended...
April 19, 2018: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/29657719/inpatient-diabetes-management-by-specialized-diabetes-team-versus-primary-service-team-in-non-critical-care-units-impact-on-30-day-readmission-rate-and-hospital-cost
#8
Vivek Bansal, Adham Mottalib, Taranveer K Pawar, Noormuhammad Abbasakoor, Eunice Chuang, Abrar Chaudhry, Mahmoud Sakr, Robert A Gabbay, Osama Hamdy
Objective: We compared the cost-effectiveness of two inpatient diabetes care models: one offered by a specialized diabetes team (SDT) versus a primary service team (PST). Research design and methods: We retrospectively evaluated 756 hospital admissions of patients with diabetes to non-critical care units over 6 months. Out of 392 patients who met the eligibility criteria, 262 were matched 1:1 based on the mean of the initial four blood glucose (BG) values after admission...
2018: BMJ Open Diabetes Research & Care
https://www.readbyqxmd.com/read/29575924/what-can-we-learn-from-point-of-care-blood-glucose-values-deleted-and-repeated-by-nurses
#9
Dawn Corl, Tom Yin, May Ulibarri, Heather Lien, Tracy Tylee, Jing Chao, Brent E Wisse
BACKGROUND: Hospitals rely on point-of-care (POC) blood glucose (BG) values to guide important decisions related to insulin administration and glycemic control. Evaluation of POC BG in hospitalized patients is associated with measurement and operator errors. Based on a previous quality improvement (QI) project we introduced an option for operators to delete and repeat POC BG values suspected as erroneous. The current project evaluated our experience with deleted POC BG values over a 2-year period...
March 1, 2018: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/29498747/supporting-transitions-in-care-for-older-adults-with-type-2-diabetes-mellitus-and-obesity
#10
Christina R Whitehouse, Nancy C Sharts-Hopko, Suzanne C Smeltzer, David A Horowitz
The aim of the current study was to compare outcomes for older adults with type 2 diabetes mellitus and obesity following participation in a transitional care intervention that included diabetes self-management education (DSME) and homecare. The three groups analyzed comprised an inpatient DSME plus homecare group (n = 35); an inpatient DSME only group (n = 100); and a group who received usual care (n = 45). Outcomes of interest included rehospitalization rates and hemoglobin A1C (A1C) for up to 1-year post hospital discharge...
March 1, 2018: Research in Gerontological Nursing
https://www.readbyqxmd.com/read/29442175/common-models-used-for-inpatient-diabetes-management
#11
REVIEW
Andjela T Drincic, Padmaja Akkireddy, Jon T Knezevich
PURPOSE OF REVIEW: Diabetes affects about a third of all hospitalized patients and up to 50% of inpatients go on to experience hyperglycemia. Despite strong evidence supporting the importance of adequate glycemic control, as well detailed guidelines from major national organizations, many patients continue to have hypo- and hyperglycemia during their hospital stay. While this may be partially related to provider and patient-specific factors, system-based barriers continue to pose a major obstacle...
February 14, 2018: Current Diabetes Reports
https://www.readbyqxmd.com/read/29431513/safety-and-feasibility-of-the-omnipod-hybrid-closed-loop-system-in-adult-adolescent-and-pediatric-patients-with-type-1-diabetes-using-a-personalized-model-predictive-control-algorithm
#12
Bruce A Buckingham, Gregory P Forlenza, Jordan E Pinsker, Mark P Christiansen, R Paul Wadwa, Jennifer Schneider, Thomas A Peyser, Eyal Dassau, Joon Bok Lee, Jason O'Connor, Jennifer E Layne, Trang T Ly
BACKGROUND: The safety and feasibility of the OmniPod personalized model predictive control (MPC) algorithm in adult, adolescent, and pediatric patients with type 1 diabetes were investigated. METHODS: This multicenter, observational trial included a 1-week outpatient sensor-augmented pump open-loop phase and a 36-h inpatient hybrid closed-loop (HCL) phase with announced meals ranging from 30 to 90 g of carbohydrates and limited physical activity. Patients aged 6-65 years with HbA1c between 6...
April 2018: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/29283470/effect-of-a-glucagon-receptor-antibody-remd-477-in-type-1-diabetes-a-randomized-controlled-trial
#13
Jeremy Pettus, Dominic Reeds, Tricia S Cavaiola, Schafer Boeder, Michelle Levin, Garry Tobin, Edda Cava, Dung Thai, Jim Shi, Hai Yan, Edgar Bautista, John McMillan, Roger Unger, Robert R Henry, Samuel Klein
The aim of the current study (Clinical trial reg. no. NCT02715193, clinicaltrials.gov) was to study the efficacy and safety of REMD-477, a glucagon receptor antagonist, in type 1 diabetes. This was a randomized controlled trial in which 21 patients with type 1 diabetes were enrolled. Glycaemic control and insulin use were evaluated in outpatient and inpatient settings, before and after a single 70-mg dose of REMD-477 (half-life 7-10 days) or placebo. Inpatient insulin use was 26% (95% CI, 47%, 4%) lower 1 day after dosing with REMD-477 than with placebo (P = ...
May 2018: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/29251063/decreased-rates-of-inpatient-hypoglycemia-following-implementation-of-an-automated-tool-in-the-electronic-medical-record-for-identifying-root-causes
#14
Naina Sinha Gregory, Jane Jeffrie Seley, Jenny Ukena, Sona Shah, Matthew R Fred, Savira Kochhar Dargar, Elizabeth Mauer, Robert J Kim
OBJECTIVE: The objective was to identify root causes of hypoglycemia on medicine inpatient units using an automated tool. Data collected will guide educational interventions aimed at improving patient care and safety by decreasing rates of hypoglycemia. METHODS: A survey was conducted among RNs to identify risk factors for hypoglycemia. Survey data were used to create a hypoglycemia root cause survey tool in the EMR. RNs were prompted to utilize the tool when blood glucose (BG) < 70 mg/dL...
January 2018: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/29241843/quantifying-the-effect-of-diabetes-on-surgical-hand-and-forearm-infections
#15
Ketan Sharma, Deng Pan, James Friedman, Jenny L Yu, Aaron Mull, Amy M Moore
PURPOSE: Diabetes has long been established as a risk factor for hand and forearm infections. The purpose of this study was to review the effect of glycemic factors on outcomes among diabetic patients with surgical upper-extremity infections. We hypothesized that diabetic inpatients may benefit from stronger peri-infection glycemic control. METHODS: A prospective cohort study enrolled diabetic and nondiabetic surgical hand and forearm infections over 3 years. Glycemic factors included baseline glycosylated hemoglobin, blood glucose (BG) at presentation, and inpatient BG...
February 2018: Journal of Hand Surgery
https://www.readbyqxmd.com/read/29162073/patient-navigation-to-improve-diabetes-outpatient-care-at-a-safety-net-hospital-a-retrospective-cohort-study
#16
Michal Horný, Wiljeana Glover, Gouri Gupte, Aruna Saraswat, Varsha Vimalananda, James Rosenzweig
BACKGROUND: Recent emphasis on value based care and population management, such as Accountable Care Organizations in the United States, promote patient navigation to improve the quality of care and reduce costs. Evidence supporting the efficacy of patient navigation for chronic disease care is limited. The objective of this study was to evaluate the effect of a patient navigation program on medical and administrative outcomes among patients with diabetes in an urban, safety-net hospital clinic setting...
November 21, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/29134125/how-is-the-weather-forecasting-inpatient-glycemic-control
#17
George E Saulnier, Janna C Castro, Curtiss B Cook, Bithika M Thompson
Aim: Apply methods of damped trend analysis to forecast inpatient glycemic control. Method: Observed and calculated point-of-care blood glucose data trends were determined over 62 weeks. Mean absolute percent error was used to calculate differences between observed and forecasted values. Comparisons were drawn between model results and linear regression forecasting. Results: The forecasted mean glucose trends observed during the first 24 and 48 weeks of projections compared favorably to the results provided by linear regression forecasting...
November 2017: Future Science OA
https://www.readbyqxmd.com/read/29072567/never-events-and-hospital-acquired-conditions-after-kidney-transplant
#18
Zhobin Moghadamyeghaneh, Linda J Chen, Mahmoud Alameddine, Anupam K Gupta, George W Burke, Gaetano Ciancio
INTRODUCTION: Never events (NE) and hospital-acquired conditions (HAC) after surgery have been designated as quality metrics in health-care by the Centres for Medicare and Medicaid Services (CMS). METHODS: The Nationwide Inpatient Sample (NIS) database 2002-2012 was used to identify patientswho underwent kidney transplant. Multivariate analysis using logistic regression was used to identify outcomes and risk factors of HAC and NE after transplantation; however, we were limited by using a retrospective database missing some important variables specified for the kidney transplant, such as some operative factors, donor factors, and cold and warm ischemia times...
November 2017: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
https://www.readbyqxmd.com/read/29063208/glucometrics-and-insulinometrics
#19
REVIEW
Bithika M Thompson, Curtiss B Cook
PURPOSE OF REVIEW: Glucometrics is the systematic analysis of inpatient glucose data and is of key interest as hospitals strive to improve inpatient glycemic control. Insulinometrics is the systematic analysis and reporting of inpatient insulin therapy. This paper reviews some of the questions to be resolved before a national benchmarking process can be developed that will allow institutions to track and compare inpatient glucose control performance against established guidelines. RECENT FINDINGS: There remains a lack of standardization on how glucometircs should be measured and reported...
October 23, 2017: Current Diabetes Reports
https://www.readbyqxmd.com/read/28790874/lack-of-change-in-glucose-metabolism-in-eszopiclone-treated-primary-insomnia-patients
#20
Orfeu M Buxton, Milena K Pavlova, Shawn P O'Connor, Wei Wang, John W Winkelman
STUDY OBJECTIVES: Primary insomnia (PI) may increase diabetes risk. We tested the hypothesis that the effects of PI on glucose metabolism could be improved by 2 months of pharmacological treatment. METHODS: Adult men and women meeting clinical criteria for PI were studied (n=20, body mass index 25.1±2.7 kg/m(2), age 39.7±7.9) in a randomized, double-blind, placebo-controlled clinical trial. The study consisted of two 1-day inpatient admissions to a General Clinical Research Center separated by 2 months of at-home treatment with 3 mg eszopiclone or placebo...
2017: Nature and Science of Sleep
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