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Inpatient glycemic control

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https://www.readbyqxmd.com/read/29575924/what-can-we-learn-from-point-of-care-blood-glucose-values-deleted-and-repeated-by-nurses
#1
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
#2
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
#3
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
#4
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...
February 12, 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
#5
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 = ...
December 28, 2017: 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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
https://www.readbyqxmd.com/read/28745091/continuous-glucose-monitoring-use-in-type-1-diabetes-longitudinal-analysis-demonstrates-meaningful-improvements-in-hba1c-and-reductions-in-health-care-utilization
#13
Christopher G Parkin, Claudia Graham, John Smolskis
BACKGROUND: Real-time continuous glucose monitoring (rtCGM) improves glycemic control in type 1 diabetes (T1D) patients treated with continuous subcutaneous insulin infusion (CSII). However, the benefits of rtCGM in T1D patients treated with multiple daily insulin injection (MDI) therapy has not been well studied. We explored the effects of rtCGM versus self-monitoring of blood glucose (SMBG) on clinical outcomes within a large T1D population treated with either CSII or MDI therapy. METHODS: This retrospective, longitudinal analysis utilized datasets from T1D patients enrolled in a commercial health plan to assess changes in HbA1c in 187 naïve to rtCGM users and 6260 SMBG users...
May 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28699089/cardiovascular-safety-of-antidiabetic-drugs-in-the-hospital-setting
#14
REVIEW
Stacey A Seggelke, Mark C Lindsay, Ingrid Hazlett, Rebecca Sanagorski, Robert H Eckel, Cecilia C Low Wang
PURPOSE OF REVIEW: Patients with diabetes and/or stress hyperglycemia requires good glycemic control in the hospital setting, often requiring the use of glucose-lowering therapy. Standard-of-care dictates that non-insulin therapy be discontinued, with insulin therapy initiated using a basal-bolus approach. However, insulin is associated with a high risk for hypoglycemia and medical errors. Alternatives to insulin are needed in the inpatient setting, but the cardiovascular (CV) safety of non-insulin therapy is a concern...
August 2017: Current Diabetes Reports
https://www.readbyqxmd.com/read/28683239/comparison-of-efficacy-and-safety-of-glargine-and-detemir-insulin-in-the-management-of-inpatient-hyperglycemia-and-diabetes
#15
COMPARATIVE STUDY
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/28664252/nutrition-and-hyperglycemia-management-in-the-inpatient-setting-meals-on-demand-parenteral-or-enteral-nutrition
#16
REVIEW
Andjela T Drincic, Jon T Knezevich, Padmaja Akkireddy
PURPOSE OF REVIEW: The goal of this paper is to provide the latest evidence and expert recommendations for management of hospitalized patients with diabetes or hyperglycemia receiving enteral (EN), parenteral (PN) nutrition support or, those with unrestricted oral diet, consuming meals on demand. RECENT FINDINGS: Patients with and without diabetes mellitus commonly develop hyperglycemia while receiving EN or PN support, placing them at increased risk of adverse outcomes, including in-hospital mortality...
August 2017: Current Diabetes Reports
https://www.readbyqxmd.com/read/28567711/the-case-for-diabetes-population-health-improvement-evidence-based-programming-for-population-outcomes-in-diabetes
#17
REVIEW
Sherita Hill Golden, Nisa Maruthur, Nestoras Mathioudakis, Elias Spanakis, Daniel Rubin, Mihail Zilbermint, Felicia Hill-Briggs
PURPOSE OF REVIEW: The goal of this review is to describe diabetes within a population health improvement framework and to review the evidence for a diabetes population health continuum of intervention approaches, including diabetes prevention and chronic and acute diabetes management, to improve clinical and economic outcomes. RECENT FINDINGS: Recent studies have shown that compared to usual care, lifestyle interventions in prediabetes lower diabetes risk at the population-level and that group-based programs have low incremental medial cost effectiveness ratio for health systems...
July 2017: Current Diabetes Reports
https://www.readbyqxmd.com/read/28549013/effect-of-preoperative-diabetes-management-on-glycemic-control-and-clinical-outcomes-after-elective-surgery
#18
Rajesh Garg, Brooke Schuman, Angela Bader, Shelley Hurwitz, Alexander Turchin, Patricia Underwood, Cheyenne Metzger, Raquel Rein, Meghan Lortie
OBJECTIVE: The aim of this study was to evaluate whether preoperative diabetes management can improve glycemic control and clinical outcomes after elective surgery. BACKGROUND: There is lack of data on the importance of diabetes treatment before elective surgery. Diabetes is often ignored before surgery and aggressively treated afterwards. METHODS: Patients with diabetes were identified and treated proactively before their scheduled surgeries...
May 25, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28504012/inpatient-glycemic-management-in-internal-medicine-an-observational-multicenter-study-in-nanjing-china
#19
MULTICENTER STUDY
Shujie Hao, Ning Zhang, Anne Folta Fish, Xiaodan Yuan, Lin Liu, Fan Li, Zhaohui Fang, Qingqing Lou
AIMS: To evaluate the prevalence of hyperglycemia among inpatients in internal medicine, and specifically, to assess the glycemic management of inpatients in non-endocrinology departments in three large urban hospitals in China. METHODS: A multicenter observational study was conducted using electronic health records, and a survey of 1939 patients who were admitted to internal medicine units and followed until discharge. Those with previously diagnosed diabetes, newly diagnosed diabetes, or impaired fasting glucose were included...
August 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28502888/prospective-study-of-postoperative-glycemic-control-with-a-standardized-insulin-infusion-protocol-after-infrainguinal-bypass-and-open-abdominal-aortic-aneurysm-repair
#20
Andrea M Steely, Lisa Smith, Peter W Callas, Muriel H Nathan, Julie E Lahiri, Andrew C Stanley, Georg Steinthorsson, Daniel J Bertges
BACKGROUND: The aim of this study is to examine the effect of moderate postoperative glycemic control in diabetic and nondiabetic patients undergoing infrainguinal bypass (INFRA) or open abdominal aortic aneurysm (OAAA) repair. METHODS: In a single center prospective study, we investigated postoperative glycemic control using a standardized insulin infusion protocol after elective INFRA bypass (n = 53, 62%) and OAAA repair (n = 33, 38%) between January 2013 and March 2015...
October 2017: Annals of Vascular Surgery
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