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hyperglycemia in inpatient

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https://www.readbyqxmd.com/read/29596400/trends-in-diabetic-ketoacidosis-hospitalizations-and-in-hospital-mortality-united-states-2000-2014
#1
Stephen R Benoit, Yan Zhang, Linda S Geiss, Edward W Gregg, Ann Albright
Diabetes is a common chronic condition and as of 2015, approximately 30 million persons in the United States had diabetes (23 million with diagnosed and 7 million with undiagnosed) (1). Diabetic ketoacidosis (DKA) is a life-threatening but preventable complication of diabetes characterized by uncontrolled hyperglycemia (>250 mg/dL), metabolic acidosis, and increased ketone concentration that occurs most frequently in persons with type 1 diabetes (2). CDC's United States Diabetes Surveillance System* (USDSS) indicated an increase in hospitalization rates for DKA during 2009-2014, most notably in persons aged <45 years...
March 30, 2018: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/29575924/what-can-we-learn-from-point-of-care-blood-glucose-values-deleted-and-repeated-by-nurses
#2
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/29555341/knowledge-translation-to-optimize-adult-inpatient-glycemic-management-with-basal-bolus-insulin-therapy-and-improve-patient-outcomes
#3
Karmon E Helmle, Sunita Chacko, Trevor Chan, Alison Drake, Alun L Edwards, Glenda E Moore, Leta C Philp, Naomi Popeski, Rhonda L Roedler, Edwin J R Rogers, Gabrielle L Zimmermann, Julie McKeen
OBJECTIVES: To develop and evaluate a Basal Bolus Insulin Therapy (BBIT) Knowledge Translation toolkit to address barriers to adoption of established best practice with BBIT in the care of adult inpatients. METHODS: This study was conducted in 2 phases and focused on the hospitalist provider group across 4 acute care facilities in Calgary. Phase 1 involved a qualitative evaluation of provider and site specific barriers and facilitators, which were mapped to validated interventions using behaviour change theory...
December 27, 2017: Canadian Journal of Diabetes
https://www.readbyqxmd.com/read/29553071/association-between-diabetic-microangiopathies-and-glycemic-variability-assessed-by-continuous-glucose-monitoring
#4
Satomi Sonoda, Yosuke Okada, Hiroko Mori, Fumi Uemura, Kei Sugai, Maiko Hajime, Kenichi Tanaka, Akira Kurozumi, Manabu Narisawa, Keiichi Torimoto, Yoshiya Tanaka
The aim of this retrospective study was to elucidate the association between glucose profile using the continuous glucose monitoring system (CGMS) and microvascular complications in patients with type 2 diabetes mellitus (T2DM). The subjects were 160 inpatients with T2DM. The mean blood glucose (MBG) level, percentage of time in a 24-hour period spent with blood glucose level higher than 180 mg/dl (time at >180 mg/dl), standard deviation (SD), and mean amplitude of glycemic excursions (MAGE) were measured continuously over 48 hours using the CGMS...
2018: Journal of UOEH
https://www.readbyqxmd.com/read/29550098/evaluating-the-emergency-department-observation-unit-for-the-management-of-hyperglycemia-in-adults
#5
Colin J Crilly, Amy J Allen, Teresa M Amato, Allison Tiberio, Rifka C Schulman, Robert A Silverman
OBJECTIVE: To determine whether hyperglycemic patients can be successfully managed in the Emergency Department Observation Unit (EDOU), as determined by the frequency of inpatient admission following their EDOU stay. METHODS: This was a retrospective chart review of patients≥18years presenting to an academic tertiary care ED between May 1, 2014 and May 31, 2016, found to have a glucose≥300mg/dL, and selected for EDOU admission. Patient demographic information, lab results including an HbA1c, disposition, and hospital revisits within 30days of discharge were recorded...
February 27, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29442175/common-models-used-for-inpatient-diabetes-management
#6
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
#7
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/29407051/hyperglycemia-in-acute-coronary-syndromes-from-mechanisms-to-prognostic-implications
#8
REVIEW
Mikhail Kosiborod
Numerous studies have documented that hyperglycemia is frequent in patients hospitalized with acute coronary syndromes, affects patients with and without established diabetes, and is associated with adverse outcomes, with incremental increase in risk of mortality and complications observed across the spectrum of glucose elevations. This article reviews present knowledge about the association between glucose levels and outcomes of patients hospitalized with acute coronary syndromes; describes available data regarding inpatient glucose management in this patient group, and comparative data across the spectrum of critically ill hospitalized patients; addresses some controversies in this field; and offers practical recommendations for patient management based on existing data...
March 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29357807/hyperglycemia-in-hospitalized-diabetic-non-critically-ill-patients-prevalence-correlates-management-and-nurses-attitudes
#9
Ghada El Khoury, Hanine Mansour, Wissam Kabbara, Nibal Chamoun, Nadim Attalah, Pascale Salameh
BACKGROUND: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to, decrease length of hospital stay and to reduce complications and readmissions. OBJECTIVE: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients...
January 19, 2018: Current Diabetes Reviews
https://www.readbyqxmd.com/read/29346740/role-of-the-diabetes-educator-in-inpatient-diabetes-management
#10
(no author information available yet)
It is the position of American Association of Diabetes Educators (AADE) that all inpatient interdisciplinary teams include a diabetes educator to lead or support improvement efforts that affect patients hospitalized with diabetes or hyperglycemia. This not only encompasses patient and family education but education of interdisciplinary team members and achievement of diabetes-related organizational quality metrics and performance outcomes.
February 2018: Diabetes Educator
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
#11
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/29237289/safely-converting-an-entire-academic-medical-center-from-sliding-scale-to-basal-bolus-insulin-via-implementation-of-the-eglycemic-management-system
#12
Rosalina Newsom, Christopher Patty, Emma Camarena, Regina Sawyer, Raymie McFarland, Thomas Gray, Melanie Mabrey
OBJECTIVE: Hyperglycemia is common in the inpatient setting and providers frequently rely on sliding scale insulin. This case study reviews the experience of one hospital moving from high utilization of sliding scale to basal bolus insulin therapy. METHOD: This Retrospective Quality Improvement Study describes the journey of clinicians at a 580-bed hospital to convert from high usage of SSI to BBI. Hyperglycemic adult patients prescribed insulin, with/without a diagnosis of diabetes, were included...
January 2018: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/29237288/the-effect-of-continuous-glucose-monitoring-in-preventing-inpatient-hypoglycemia-in-general-wards-the-glucose-telemetry-system
#13
Elias K Spanakis, David L Levitt, Tariq Siddiqui, Lakshmi G Singh, Lillian Pinault, John Sorkin, Guillermo E Umpierrez, Jeffrey C Fink
BACKGROUND: Few studies have examined the use of continuous glucose monitoring (CGM) devices in the general wards. The aim of this pilot study was to examine whether CGM readings can be successfully transmitted from the bedside to a central monitoring device in the nursing station, and whether a glucose telemetry system can prevent hypoglycemic events. METHODS: We present pilot data on 5 consecutive insulin treated general medicine patients with type 2 diabetes (T2DM) whose glucose values were observed with CGM (DEXCOM) and the results were transmitted to a central nursing station monitoring system using DEXCOM Follow and Share 2 software...
January 2018: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/29135618/pathway-for-the-management-of-hyperglycemia-in-the-cardiac-care-unit
#14
Seyed Hamed Hosseini Dehkordi, Jeanine Albu, Emad F Aziz, Eyal Herzog
Inpatient hyperglycemia has been associated with increased morbidity and mortality in critically ill patients. Optimal control of blood glucose (BG) levels using insulin infusion protocols has been shown to improve clinical outcomes. Protocols have been developed to prescribe a safe and effective rate of insulin infusion for optimal control of BG levels; however, a major obstacle in their implementation is their complexity. We have revised and updated our previously published pathway for the management of hyperglycemia, which introduces the "wheel" concept for insulin dosing...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29126197/impaired-insulin-action-is-associated-with-increased-glucagon-concentrations-in-nondiabetic-humans
#15
Anu Sharma, Ron T Varghese, Meera Shah, Chiara Dalla Man, Claudio Cobelli, Robert A Rizza, Kent R Bailey, Adrian Vella
Context: Abnormal glucagon concentrations contribute to hyperglycemia, but the mechanisms of α-cell dysfunction in prediabetes are unclear. Objective: We sought to determine the relative contributions of insulin secretion and action to α-cell dysfunction in nondiabetic participants across the spectrum of glucose tolerance. Design: This was a cross-sectional study. A subset of participants (n = 120) was studied in the presence and absence of free fatty acid (FFA) elevation, achieved by infusion of Intralipid (Baxter Healthcare, Deerfield, IL) plus heparin, to cause insulin resistance...
January 1, 2018: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/29106815/high-dose-glucocorticoid-treatment-does-not-induce-severe-hyperglycemia-in-young-patients-with-autoimmune-diseases-by-cgms
#16
Ying Zhou, Yan Zhao, Tao Yuan, Nan Jiang, Yingyue Dong, Yunjiao Yang, Li Wang, Jiuliang Zhao, Le Min, Weigang Zhao
OBJECTIVE: High-dose glucocorticoids (HDG) are used in the treatment of autoimmune diseases. Glucocorticoids-induced hyperglycemia (GIH) is often described in elderly patients. In young patients with autoimmune diseases, however, the risk for GIH has not been well characterized. METHODS: We recruited 24 inpatients (median age, 32 years; interquartile range, 25-42) with exacerbations of autoimmune diseases, receiving 1 to 2 mg/kg/day prednisone or equivalent methylprednisone...
January 2018: Endocrine Practice
https://www.readbyqxmd.com/read/29067261/active-cocaine-use-does-not-increase-the-likelihood-of-hyperglycemic-crisis
#17
Katherine L Modzelewski, Denis V Rybin, Janice M Weinberg, Sara M Alexanian, Marie E McDonnell, Devin W Steenkamp
OBJECTIVE: Hyperglycemic crisis encompasses a group of diabetes emergencies characterized by insulin deficiency with high morbidity and mortality. Cocaine use is increasingly prevalent in the United States and may be associated with increased risk of diabetic ketoacidosis. The objective was to determine if active cocaine use at hospital admission could be considered a risk factor for development of hyperglycemic crisis. METHODS: A retrospective case-control analysis was performed on 950 inpatients with hyperglycemia at an urban academic hospital...
September 2017: Journal of Clinical & Translational Endocrinology
https://www.readbyqxmd.com/read/29019269/the-burden-of-severe-hypoglycemia-in-type-1-diabetes
#18
Jieruo Liu, Rosa Wang, Michael L Ganz, Yurek Paprocki, Doron Schneider, James Weatherall
AIMS: Approximately 1.25 million people in the US have type 1 diabetes mellitus (T1DM), a chronic metabolic disease that develops from the body's inability to produce insulin, and requires life-long insulin therapy. Poor insulin adherence may cause severe hypoglycemia (SHO), leading to hospitalization and long-term complications; these, in turn, drive up costs of SHO and T1DM overall. This study's objective was to estimate the prevalence and costs of SHO-related hospitalizations and their additional longer-term impacts on patients with T1DM using basal-bolus insulin...
January 2018: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/29017368/the-burden-of-severe-hypoglycemia-in-type-2-diabetes
#19
Jieruo Liu, Rosa Wang, Michael L Ganz, Yurek Paprocki, Doron Schneider, James Weatherall
AIMS: More than 29 million people in the US have type 2 diabetes mellitus (T2DM), a chronic metabolic disorder characterized by a progressive deterioration of glucose control, which eventually requires insulin. Abnormally low levels of blood glucose, a feared side-effect of insulin treatment, may cause severe hypoglycemia (SHO), leading to emergency department (ED) admission, hospitalization, and long-term complications; these, in turn, drive up the costs of T2DM. This study's objective was to estimate the prevalence and costs of SHO-related hospitalizations and their additional longer-term impacts on patients with T2DM using insulin...
January 2018: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28913745/management-of-type-1-diabetes-in-the-hospital-setting
#20
REVIEW
Carlos E Mendez, Guillermo E Umpierrez
PURPOSE OF REVIEW: The purpose of this article was to review recent guideline recommendations on glycemic target, glucose monitoring, and therapeutic strategies, while providing practical recommendations for the management of medical and surgical patients with type 1 diabetes (T1D) admitted to critical and non-critical care settings. RECENT FINDINGS: Studies evaluating safety and efficacy of insulin pump therapy, continuous glucose monitoring, electronic glucose management systems, and closed loop systems for the inpatient management of hyperglycemia are described...
September 14, 2017: Current Diabetes Reports
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