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Inpatient glycemic control

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https://www.readbyqxmd.com/read/27898257/assessment-of-nifedipine-therapy-in-hyperinsulinemic-hypoglycemia-due-to-mutations-in-the-abcc8-gene
#1
M Güemes, P Shah, S Silvera, K Morgan, C Gilbert, L Hinchey, K Hussain
CONTEXT: Previous case reports have documented the effectiveness of L-type calcium channel blockers (such as Nifedipine and Verapamil) for treating different forms of hyperinsulinemic hypoglycemia (HH). OBJECTIVE: To systematically assess the glycemic response to Nifedipine therapy in 11 patients with HH due to mutations in the ABCC8 gene. DESIGN: Dose escalation of Nifedipine therapy Setting: Inpatients at a tertiary hospital Patients or Other Participants: 11 children with diazoxide unresponsive HH due to mutations in the ABCC8 gene...
November 29, 2016: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/27875061/glycemic-control-reduces-infections-in-post-liver-transplant-patients-results-of-a-prospective-randomized-study
#2
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/27864238/outcomes-of-a-pharmacist-managed-glucose-collaborative-practice-agreement
#3
Vidya Pugazhenthi, Travis B Dick, Matthew Call
PURPOSE: The impact of a pharmacist-managed glucose collaborative practice agreement (CPA) on glycemic control at a tertiary medical center was investigated. METHODS: A retrospective data analysis was performed on hospitalized, noncritically ill patients admitted between December 2012 and June 2014 who received at least one dose of subcutaneous insulin and experienced at least one blood glucose concentration of 140 mg/dL or higher. The study population was divided into cohorts based on admittance before versus after implementation of the CPA, as well as glucose management by pharmacist versus nonpharmacist provider...
December 1, 2016: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/27860499/premixed-insulin-analogue-compared-with-basal-plus-regimen-for-inpatient-glycemic-control
#4
Abraham Edgar Gracia-Ramos, María Del Pilar Cruz-Domínguez, Eduardo Osiris Madrigal-Santillán, José Antonio Morales-González, Eduardo Madrigal-Bujaidar, José Leopoldo Aguilar-Faisal
BACKGROUND: No previous studies have investigated the use of a premixed insulin analogue in a hospital setting. OBJECTIVE: To compare the efficacy and safety of treatment with premixed insulin analogue (insulin lispro mix 75/25, LM75/25) with the basal-plus regimen with insulin glargine in hospitalized patients with type 2 diabetes (T2D). MATERIALS AND METHODS: A randomized clinical trial in hospitalized patients with T2D and glucose >140 mg/dL on admission was performed...
November 2016: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/27818228/computerized-insulin-order-sets-and-glycemic-control-in-hospitalized-patients
#5
Bertha Wong, Muhammad M Mamdani, Catherine H Y Yu
OBJECTIVE: To evaluate the impact of computerized provider order entry subcutaneous insulin order sets on inpatient glycemic control and ordering behavior. METHODS: This was an interrupted time series study of non-intensive care patients at an urban teaching hospital. The primary outcome was proportion of capillary blood glucose in optimal range (4.0-10.0 mmol/L [72 -180 mg/dL]) during the six months before and after a change to a computerized provider order entry-integrated insulin order set...
November 3, 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27810722/female-sex-young-age-northern-german-residence-hypoglycemia-and-disabling-diabetes-complications-are-associated-with-depressed-mood-in-the-who-5-questionnaire-a-multicenter-dpv-study-among-17-563-adult-patients-with-type-2-diabetes
#6
Nicole Prinz, Stefan Ebner, Arthur Grünerbel, Uwe Henkelüdecke, Norbert Hermanns, Michael Hummel, Claus Schäfer, Christian Wagner, Jörg Weiland, Reinhard Welp, Reinhard W Holl
BACKGROUND: Like other mental illnesses, depression is a culturally sensitive topic. Hence, findings cannot be transferred between countries. We investigated the frequency of depressed mood and its association with diabetes-related factors in a large type 2 diabetes (T2D) cohort from real-life care in Germany. METHODS: 17,563 adults (median [IQR]: 64.5[55.9-71.1] years) from the multicenter diabetes follow-up registry, DPV (diabetes prospective follow-up), were investigated...
October 11, 2016: Journal of Affective Disorders
https://www.readbyqxmd.com/read/27805455/decreased-rates-of-hypoglycemia-following-implementation-of-a-comprehensive-computerized-insulin-order-set-and-titration-algorithm-in-the-inpatient-setting
#7
Naina Sinha Gregory, Jane Jeffrie Seley, Linda M Gerber, Chin Tang, David Brillon
OBJECTIVES: More than one-third of hospitalized patients have hyperglycemia. Despite evidence that improving glycemic control leads to better outcomes, achieving recognized targets remains a challenge. The objective of this study was to evaluate the implementation of a computerized insulin order set and titration algorithm on rates of hypoglycemia and overall inpatient glycemic control. METHODS: A prospective observational study evaluating the impact of a glycemic order set and titration algorithm in an academic medical center in non-critical care medical and surgical inpatients...
November 2, 2016: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/27790855/determinants-of-hemoglobin-a1c-level-in-patients-with-type-2-diabetes-after-in-hospital-diabetes-education-a-study-based-on-continuous-glucose-monitoring
#8
Keiichi Torimoto, Yosuke Okada, Sachiko Sugino, Yoshiya Tanaka
AIMS/INTRODUCTION: We investigated the relationship between blood glucose profile at hospital discharge, evaluated by continuous glucose monitoring (CGM), and hemoglobin A1c (HbA1c) level at 12 weeks after discharge in patients with type 2 diabetes who received inpatient diabetes education. MATERIALS AND METHODS: This was a retrospective study. The subjects were 54 patients with type 2 diabetes who did not change their medication after discharge. The mean blood glucose (MBG), standard deviation (SD), coefficient of variation, mean postprandial glucose excursion, maximum blood glucose, minimum blood glucose, percentage of time with blood glucose at ≥180 mg/dL (Time at ≧180), percentage of time with blood glucose at ≥140 mg/dL, and percentage of time with blood glucose at <70 mg/dL were measured at admission and discharge using CGM...
October 27, 2016: Journal of Diabetes Investigation
https://www.readbyqxmd.com/read/27764054/impact-of-glycemic-control-on-morbidity-and-mortality-in-adult-idiopathic-scoliosis-patients-undergoing-spinal-fusion
#9
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
https://www.readbyqxmd.com/read/27658765/the-effect-of-nurse-practitioner-led-intervention-in-diabetes-care-for-patients-admitted-to-cardiology-services
#10
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
https://www.readbyqxmd.com/read/27600025/examining-factors-that-impact-inpatient-management-of-diabetes-and-the-role-of-insulin-pen-devices
#11
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
https://www.readbyqxmd.com/read/27540884/impact-of-glucose-management-team-on-outcomes-of-hospitalization-in-patients-with-type-2-diabetes-admitted-to-the-medical-service
#12
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
https://www.readbyqxmd.com/read/27540877/hypoglycemia-rates-after-restriction-of-high-dose-glargine-in-hospitalized-patients
#13
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
https://www.readbyqxmd.com/read/27398824/effect-of-electronic-messaging-on-glucose-control-and-hospital-admissions-among-patients-with-diabetes
#14
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
https://www.readbyqxmd.com/read/27385874/profiles-and-factors-associated-with-poor-glycemic-control-among-inpatients-with-diabetes-mellitus-type-2-as-a-primary-diagnosis-in-a-teaching-hospital
#15
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
https://www.readbyqxmd.com/read/27359287/evaluation-of-total-daily-dose-and-glycemic-control-for-patients-taking-u-500-regular-insulin-admitted-to-the-hospital
#16
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 systematically 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 5-year period...
October 2016: Endocrine Practice
https://www.readbyqxmd.com/read/27176681/inpatient-hyperglycemia-management-a-practical-review-for-primary-medical-and-surgical-teams
#17
REVIEW
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
https://www.readbyqxmd.com/read/27124695/inpatient-hypoglycemic-events-in-a-comparative-effectiveness-trial-for-glycemic-control-in-a-high-risk-population
#18
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
https://www.readbyqxmd.com/read/27105121/accuracy-of-continuous-glucose-monitoring-in-patients-after-total-pancreatectomy-with-islet-autotransplantation
#19
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
https://www.readbyqxmd.com/read/27103366/management-of-u-500-insulin-users-during-inpatient-admissions-within-a-veterans-affairs-medical-center
#20
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
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