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https://www.readbyqxmd.com/read/27761730/influence-of-glycemic-control-on-endogenous-circulating-ketone-concentrations-in-adults-following-traumatic-brain-injury
#1
Stephanie M Wolahan, Mayumi L Prins, David L McArthur, Courtney R Real, David A Hovda, Neil A Martin, Paul M Vespa, Thomas C Glenn
BACKGROUND: The objective was to investigate the impact of targeting tight glycemic control (4.4-6.1 mM) on endogenous ketogenesis in severely head-injured adults. METHODS: The data were prospectively collected during a randomized, within-patient crossover study comparing tight to loose glycemic control, defined as 6.7-8.3 mM. Blood was collected periodically during both tight and loose glycemic control epochs. Post hoc analysis of insulin dose and total nutritional provision was performed...
October 19, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27693206/randomized-evidence-for-reduction-of-perioperative-mortality-an-updated-consensus-process
#2
Giovanni Landoni, Antonio Pisano, Vladimir Lomivorotov, Gabriele Alvaro, Ludhmila Hajjar, Gianluca Paternoster, Caetano Nigro Neto, Nicola Latronico, Evgeny Fominskiy, Laura Pasin, Gabriele Finco, Rosetta Lobreglio, Maria Luisa Azzolini, Giuseppe Buscaglia, Alberto Castella, Marco Comis, Adele Conte, Massimiliano Conte, Francesco Corradi, Erika Dal Checco, Giovanni De Vuono, Marco Ganzaroli, Eugenio Garofalo, Gordana Gazivoda, Rosalba Lembo, Daniele Marianello, Martina Baiardo Redaelli, Fabrizio Monaco, Valentina Tarzia, Marta Mucchetti, Alessandro Belletti, Paolo Mura, Mario Musu, Giovanni Pala, Massimiliano Paltenghi, Vadim Pasyuga, Desiderio Piras, Claudio Riefolo, Agostino Roasio, Laura Ruggeri, Francesco Santini, Andrea Székely, Luigi Verniero, Antonella Vezzani, Alberto Zangrillo, Rinaldo Bellomo
OBJECTIVE: Of the 230 million patients undergoing major surgical procedures every year, more than 1 million will die within 30 days. Thus, any nonsurgical interventions that help reduce perioperative mortality might save thousands of lives. The authors have updated a previous consensus process to identify all the nonsurgical interventions, supported by randomized evidence, that may help reduce perioperative mortality. DESIGN AND SETTING: A web-based international consensus conference...
August 2, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27648831/preventing-unnecessary-costs-of-drug-induced-hypoglycemia-in-older-adults-with-type-2-diabetes-in-the-united-states-and-canada
#3
Mathieu Boulin, Vakaramoko Diaby, Cara Tannenbaum
BACKGROUND: The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes. METHODS: An economic (decision-tree) analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older...
2016: PloS One
https://www.readbyqxmd.com/read/27637719/glycemic-control-mortality-and-hypoglycemia-in-critically-ill-patients-a-systematic-review-and-network-meta-analysis-of-randomized-controlled-trials
#4
Tomohide Yamada, Nobuhiro Shojima, Hisashi Noma, Toshimasa Yamauchi, Takashi Kadowaki
PURPOSE: It is unclear whether tight glycemic control is warranted in all critically ill adults. We employed network meta-analysis to examine the risk of mortality and hypoglycemia associated with different glycemic control targets in critically ill adults. METHODS: Electronic databases were searched up to 2016 for randomized controlled trials comparing various insulin regimens in critically ill adults with hyperglycemia. Two reviewers independently extracted information and evaluated quality with the Cochrane risk-of-bias tool...
September 16, 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27596020/real-world-canagliflozin-utilization-glycemic-control-among-patients-with-type-2-diabetes-mellitus-a-multi-database-synthesis
#5
Wing Chow, Gavin Miyasato, Fotios K Kokkotos, Robert A Bailey, Erin K Buysman, Henry J Henk
PURPOSE: Randomized controlled trials have found that treatment of type 2 diabetes mellitus with canagliflozin, a sodium glucose co-transporter 2 inhibitor, is associated with significant reductions in glycosylated hemoglobin (HbA1c) levels. However, very few studies have evaluated the effectiveness of sodium glucose co-transporter 2 inhibitors in a real-world context. This data synthesis aims to examine the demographic characteristics and glycemic control among patients treated with canagliflozin in clinical practice, using results obtained from 2 US-specific retrospective administrative claims databases...
September 2016: Clinical Therapeutics
https://www.readbyqxmd.com/read/27554778/effect-of-hypoglycemia-on-the-incidence-of-revision-in-total-knee-arthroplasty
#6
Martin W Roche, Tsun Yee Law, Jacob J Triplet, Zachary S Hubbard, Jennifer Kurowicki, Sam Rosas
BACKGROUND: It is well established that diabetic patients undergoing total knee arthroplasty (TKA) are more susceptible to infection, problematic wound healing, and overall higher complication rates. However, a paucity in current literature exists. The purpose of this study was to determine the effect of hypoglycemia on TKA revision (rTKA) incidence by analyzing a national private payer database for procedures performed between 2007 and 2015 Q1 Q2. METHODS: A retrospective review of a national private payer database within the PearlDiver Supercomputer application for patients undergoing TKA with blood glucose levels from 20 to 219 mg/mL, in 10-mg/mL increments, was conducted...
July 25, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27553599/glycemic-control-for-patients-with-type-2-diabetes-mellitus-our-evolving-faith-in-the-face-of-evidence
#7
René Rodríguez-Gutiérrez, Victor M Montori
BACKGROUND: We sought to determine the concordance between the accumulating evidence about the impact of tight versus less tight glycemic control in patients with type 2 diabetes mellitus since the publication of UKPDS (UK Prospective Diabetes Study) in 1998 until 2015 with the views about that evidence published in journal articles and practice guidelines. METHODS AND RESULTS: We searched in top general medicine and specialty journals for articles referring to glycemic control appearing between 2006 and 2015 and identified the latest practice guidelines...
September 2016: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/27544297/diabetes-and-sexuality
#8
Fuat Kizilay, Helena Elizabeth Gali, Ege Can Serefoglu
INTRODUCTION: Deterioration in sexual functioning is one of the major and serious complications of diabetes. This common metabolic disorder not only affects sexuality through microvascular and nerve damage but also has psychological aspects. In men, the primary complications are erectile dysfunction, ejaculatory dysfunction, and loss of libido. Women similarly experience sexual problems, including decreased libido and painful intercourse. AIM: To summarize the effects of diabetes on sexuality, evaluate the impact of diabetes on sexual function, and assess the conventional and novel treatment approaches based on recent studies...
August 17, 2016: Sexual Medicine Reviews
https://www.readbyqxmd.com/read/27524280/hypoglycemia-frailty-and-dementia-in-older-people-with-diabetes-reciprocal-relations-and-clinical-implications
#9
Ahmed H Abdelhafiz, Emily McNicholas, Alan J Sinclair
The relationships between hypoglycemia, frailty and dementia appear to be reciprocal and can lead to a vicious circle. Frailty appears to be a crucial factor increasing the risk for both hypoglycemia and dementia, initiating the reciprocal relationships. Weight loss is likely to be the underlying risk factor for frailty. Many frail older people with diabetes seem to have unnecessarily tight glycemic control, being treated with hypoglycemic medications that likely increase the risk of hypoglycemia. As patients get older with significant weight loss their glycemic targets should be reviewed, and reduction or even withdrawal of their hypoglycemic medications should be considered...
November 2016: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/27510392/impact-of-glycemic-control-and-metformin-use-on-the-recurrence-and-progression-of-non-muscle-invasive-bladder-cancer-in-patients-with-diabetes-mellitus
#10
Ji Hoon Ahn, Seung Il Jung, Sang Un Yim, Sun Woo Kim, Eu Chang Hwang, Dong Deuk Kwon
The purpose of the present study was to determine the potential relationships of glycemic control and use of metformin with non-muscle invasive bladder cancer characteristics. We reviewed data from 645 patients with non-muscle invasive bladder cancer between January 2004 and May 2015. We analyzed the association of pre and post-operative glycemic control and use of metformin with clinical characteristics of bladder tumors. We also analyzed the association of glycemic control and use of metformin with recurrence-free and progression-free survivals...
September 2016: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/27479624/vision-loss-in-older-adults
#11
Allen L Pelletier, Ledy Rojas-Roldan, Janis Coffin
Vision loss affects 37 million Americans older than 50 years and one in four who are older than 80 years. The U.S. Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in adults older than 65 years. However, family physicians play a critical role in identifying persons who are at risk of vision loss, counseling patients, and referring patients for disease-specific treatment. The conditions that cause most cases of vision loss in older patients are age-related macular degeneration, glaucoma, ocular complications of diabetes mellitus, and age-related cataracts...
August 1, 2016: American Family Physician
https://www.readbyqxmd.com/read/27472253/ketosis-after-cardiopulmonary-bypass-in-children-is-associated-with-an-inadequate-balance-between-oxygen-transport-and-consumption
#12
Philippe Klee, Delphine Arni, Sonja Saudan, Valérie M Schwitzgebel, Ruchika Sharma, Oliver Karam, Peter C Rimensberger
OBJECTIVES: Hyperglycemia after cardiac surgery and cardiopulmonary bypass in children has been associated with worse outcome; however, causality has never been proven. Furthermore, the benefit of tight glycemic control is inconsistent. The purpose of this study was to describe the metabolic constellation of children before, during, and after cardiopulmonary bypass, in order to identify a subset of patients that might benefit from insulin treatment. DESIGN: Prospective observational study, in which insulin treatment was initiated when postoperative blood glucose levels were more than 12 mmol/L (216 mg/dL)...
September 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27472251/clinical-impact-of-accurate-point-of-care-glucose-monitoring-for-tight-glycemic-control-in-severely-burned-children
#13
Nam K Tran, Zachary R Godwin, Amanda N Steele, Steven E Wolf, Tina L Palmieri
OBJECTIVES: The goal of this study was to retrospectively evaluate the clinical impact of an accurate autocorrecting blood glucose monitoring system in children with severe burns. Blood glucose monitoring system accuracy is essential for providing appropriate intensive insulin therapy and achieving tight glycemic control in critically ill patients. Unfortunately, few comparison studies have been performed to evaluate the clinical impact of accurate blood glucose monitoring system monitoring in the high-risk pediatric burn population...
September 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27425889/role-of-hypoxia-inducible-factor-1-in-hyperglycemia-exacerbated-blood-brain-barrier-disruption-in-ischemic-stroke
#14
Ziyan Zhang, Jingqi Yan, Honglian Shi
Diabetes is a major stroke risk factor and is associated with poor functional recovery after stroke. Accumulating evidence indicates that the worsened outcomes may be due to hyperglycemia-induced cerebral vascular complications, especially disruption of the blood-brain barrier (BBB). The present study tested a hypothesis that the activation of hypoxia inducible factor-1 (HIF-1) was involved in hyperglycemia-aggravated BBB disruption in an ischemic stroke model. Non-diabetic control and Streptozotocin-induced type I diabetic mice were subjected to 90min transient middle cerebral artery occlusion (MCAO) followed by reperfusion...
November 2016: Neurobiology of Disease
https://www.readbyqxmd.com/read/27352408/improving-care-in-older-patients-with-diabetes-a-focus-on-glycemic-control
#15
Eric A Lee, Nancy E Gibbs, John Martin, Fred Ziel, Jennifer K Polzin, Darryl Palmer-Toy
Diabetes affects more than 25% of Americans older than age 65 years. The medical care of older patients must differ from the care of their younger counterparts. Older patients are at high risk of drug toxicity. A hemoglobin A1c (HbA1c) level less than 7.0% has historically been the goal of all patients with diabetes, regardless of age. Recent research has demonstrated that using medications to achieve such tight glycemic control is not necessary and is often not safe.This article discusses the seminal research findings that strongly suggest that HbA1c goals should be relaxed in older patients...
December 0: Permanente Journal
https://www.readbyqxmd.com/read/27337958/management-of-type-1-diabetes-in-pregnancy
#16
REVIEW
Anna Z Feldman, Florence M Brown
Women with type 1 diabetes (T1DM) have unique needs during the preconception, pregnancy, and postpartum periods. Preconception counseling is essential for women with T1DM to minimize pregnancy risks. The goals of preconception care should be tight glycemic control with a hemoglobin A1c (A1C) < 7 % and as close to 6 % as possible, without significant hypoglycemia. This will lower risks of congenital malformations, preeclampsia, and perinatal mortality. The safety of medications should be assessed prior to conception...
August 2016: Current Diabetes Reports
https://www.readbyqxmd.com/read/27310986/treated-glycosylated-hemoglobin-levels-in-individuals-with-diabetes-mellitus-vary-little-by-health-status-a-retrospective-cohort-study
#17
Finlay A McAlister, Erik Youngson, Dean T Eurich
As choosing wisely has raised the issue of whether some individuals with type 2 diabetes may be overtreated, we examined the intensity of glycemic control across health status strata defined by comorbidities or frailty.This is a retrospective cohort study of commercially insured patients from 50 US states (Clinformatics Data Mart). We evaluated treated HbA1c levels in adults with new diabetes diagnosed between January 2004 and December 2009 who had HbA1C measured after at least 1 year of follow-up.Of 191,590 individuals with diabetes, 78...
June 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27246619/clinical-characteristics-and-outcomes-of-the-oldest-old-people-with-type-2-diabetes-perspective-from-a-tertiary-diabetes-center-in-thailand
#18
Thewjitcharoen Yotsapon, Krittiyawong Sirinate, Wanothayaroj Ekgaluck, Vongterapak Somboon, Anuntakulnatee Tawee, Kittipoom Worawit, Nakasatien Soontaree, Himathongkam Thep
BACKGROUND: Advance in medicine has led to an increase in life expectancy of elderly diabetic patients especially on the growing population called the "oldest old", those in their mid-80s upwards. The aim of this study is to describe clinical characteristics and outcomes of "oldest old" patients in a specialized diabetes center. METHODS: A retrospective review was conducted on medical records of type 2 diabetes who were older than 85 years at Theptarin hospital from September 2014 to August 2015...
2016: BMC Endocrine Disorders
https://www.readbyqxmd.com/read/27242122/glycemic-control-and-fracture-risk-in-elderly-patients-with-diabetes
#19
Baqiyyah N Conway, Dustin M Long, M Kathleen Figaro, Michael E May
AIMS: Elderly patients with diabetes are at increased fracture risk. Although long exposure to hyperglycemia may increase fracture risk via adverse effects on bone metabolism, tight glycemic control may increase risk via trauma subsequent to hypoglycemia. We tested the prospective relationship between glycemic control and fracture risk in 10,572 elderly patients (age ≥65) with diabetes. METHODS: Geriatric patients with diabetes were drawn from Vanderbilt University Medical Center's Electronic Health Record...
December 0: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/27175953/top-20-research-studies-of-2015-for-primary-care-physicians
#20
Mark H Ebell, Roland Grad
In 2015, a group of primary care clinicians with expertise in evidence-based practice performed monthly surveillance of more than 110 English-language clinical research journals. They identified 251 studies that addressed a primary care question and had the potential to change practice if valid (patient-oriented evidence that matters, or POEMs). Each study was critically appraised and disseminated to subscribers via e-mail, including members of the Canadian Medical Association who had the option to use a validated tool to assess the clinical relevance of each POEM and the benefits they expect for their practice...
May 1, 2016: American Family Physician
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