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hyperglycemia in inpatient

X-F Su, L Sun, B-L Liu, X-J Tao, H-Q Li, F-F Li, L Ye, K-O Lee, J-H Ma, S-L Chen
Aim: Patients with cardiac diseases, especially ischemic heart disease, are known to have a high prevalence of diabetes mellitus (DM). They are at risk of having inadequate glucose control. An intensive diabetes screening and treatment program was developed to identify and treat DM in patients admitted with cardiac diseases. Methods: Adult inpatients of 2 cardiac wards, namely Ward-A and Ward-B, at Nanjing Hospital, Nanjing, China, were studied. Patients were randomly assigned into either ward. In addition to routine examination and treatment, an intensive screening and treatment program to identify and treat patients with DM or impaired glucose regulation (IGR) was only applied in Ward-A patients...
October 17, 2016: Experimental and Clinical Endocrinology & Diabetes
Michael Hang Yang, Melanie Jaeger, Michael Baxter, Elizabeth VanDenKerkhof, Janet van Vlymen
PURPOSE: Elevated glycosylated hemoglobin (HbA1c) is often found in surgical patients with no history of diabetes. The purpose of this prospective observational study was to determine if elevated preoperative HbA1c is associated with postoperative hyperglycemia in non-diabetic surgical patients and to identify predictors of elevated HbA1c. METHODS: This study included 257 non-diabetic adults scheduled for inpatient surgery. Preoperatively, capillary blood glucose (CBG) and HbA1c were measured and patients completed the Canadian Diabetes Risk Questionnaire (CANRISK)...
October 3, 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
S N Narla, M Jones, K L Hermayer, Y Zhu
Maintaining blood glucose concentration within an acceptable range is a goal for patients with diabetes mellitus. Point-of-care glucose meters initially designed for home self-monitoring in patients with diabetes have been widely used in the hospital settings because of ease of use and quick reporting of blood glucose information. They are not only utilized for the general inpatient population but also for critically ill patients. Many factors affect the accuracy of point-of-care glucose testing, particularly in critical care settings...
2016: Advances in Clinical Chemistry
Gregory C Jones, Zhou M Chong, Jennifer Gilmour, Christine Matheson, Gordon MacGregor, Christopher A R Sainsbury
INTRODUCTION: Mortality in patients with cystic fibrosis-related diabetes (CFRD) is higher than that in patients with cystic fibrosis without diabetes. Hypoglycemia, hyperglycemia, and glucose variability confer excess mortality and morbidity in the general inpatient population with diabetes. METHODS: We investigated patterns of hypoglycemia and the association of hypoglycemia, hyperglycemia, and glucose variability with mortality and readmission rate in inpatients with CFRD...
September 2016: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
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
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
Satoshi Ugi, Hiroshi Maegawa, Katsutaro Morino, Yoshihiko Nishio, Toshiyuki Sato, Seiki Okada, Yasuo Kikkawa, Toshihiro Watanabe, Hiromu Nakajima, Atsunori Kashiwagi
BACKGROUND: Management of postprandial hyperglycemia is a key aspect in diabetes treatment. We developed a novel system to measure glucose area under the curve (AUC) using minimally invasive interstitial fluid extraction technology (MIET) for simple monitoring of postprandial glucose excursions. In this study, we evaluated the relationship between our system and continuous glucose monitoring (CGM) by comparing glucose AUC obtained using MIET with that obtained using CGM for a long duration...
August 2016: Diabetes & Metabolism Journal
Anastasia-Stefania Alexopoulos, Maya Fayfman, Liping Zhao, Jeff Weaver, Lauren Buehler, Dawn Smiley, Francisco J Pasquel, Priyathama Vellanki, J Sonya Haw, Guillermo E Umpierrez
OBJECTIVE: Obesity is associated with increased risk of diabetes, hypertension and cardiovascular mortality. Several studies have reported increased length of hospital stay and complications; however, there are also reports of obesity having a protective effect on health, a phenomenon coined the 'obesity paradox'. We aimed to investigate the impact of overweight and obesity on complications and mortality in hospitalized patients with hyperglycemia and diabetes. RESEARCH DESIGN AND METHODS: This retrospective analysis was conducted on 29 623 patients admitted to two academic hospitals in Atlanta, Georgia, between January 2012 and December 2013...
2016: BMJ Open Diabetes Research & Care
Jone Vencloviene, Ruta Marija Babarskiene, Deivydas Kiznys
Hyperglycemia negatively affects cardiovascular variables that are also adversely affected by increased geomagnetic activity. It is likely that geomagnetic storms (GS) could have a stronger negative impact on these patients. We analyzed data on 1548 randomly selected patients with acute coronary syndrome (ACS) who were admitted inpatient treatment in Kaunas city, during 2000-2003. We evaluated the associations of GS, solar proton events (SPE), and high-speed solar wind (HSSW) (solar wind speed ≥600 km/s) with the risk of ACS in patients with diabetes mellitus (DM) and the metabolic syndrome (MS) by using logistic regression with categorical predictors...
June 25, 2016: International Journal of Biometeorology
Richard D Zorowitz
ICU-acquired weakness (ICUAW) occurs with reported incidence rates from 25% to 100%. Risk factors include immobility, sepsis, persistent systemic inflammation, multiorgan system failure, hyperglycemia, glucocorticoids, and neuromuscular blocking agents. The pathophysiology remains unknown. Clinical features may be neuropathic, myopathic, or a combination of both. Although manual muscle testing is more practical in diagnosing ICUAW, the "gold standard" for the diagnosis of ICUAW remains electromyography and nerve conduction studies...
October 2016: Chest
Latha Dulipsingh, Betsy Gaudian, Wendy Spurrier, Linda Taylor, Dorothy Wakefield, Susie Rychlewicz, Kim Giwa
OBJECTIVE: To continuously improve safe coordination of diabetes care throughout the hospital by ongoing implementation of standardized, hospital-wide staff education, and glucose management policies/protocols. METHODS: In December 2013, a hospital-wide multidisciplinary task force was formed to standardize the care for all patients being admitted to Saint Francis Hospital and Medical Center with the diagnosis of diabetes. The purpose of this team was to help develop policies and procedures on glucose management and educate staff on the current clinical practice guidelines...
April 2016: Connecticut Medicine
Ayumi Tenjin, Yoshio Nagai, Sayaka Yuji, Satoshi Ishii, Hiroyuki Kato, Akio Ohta, Yasushi Tanaka
BACKGROUND: The carotid artery intima-media thickness (CIMT) has been used as a predictor of cardiovascular events, but it remains unclear whether CIMT can change over the short term. We evaluated changes of CIMT in patients with diabetes during admission to hospital for 2 weeks. METHODS: A total of 279 inpatients with diabetes aged 61 ± 14 years were recruited. They were on treatment with insulin and/or oral agents, excluding drugs that influence the fluid balance and hemodynamics...
2016: BMC Research Notes
Dustin Jones, Brian Scharfenberg, Jessica Perkins, Keri Childers, Godwin Y Dogbey, Jay H Shubrook
BACKGROUND: Hyperglycemia is commonly seen in hospitalized patients. Glycated hemoglobin (HbA1c) correlates with the average blood glucose level over the previous 8 to 12 weeks. Thus, an HbA1c test offers a longitudinal view that reduces etiologic ambiguity of disease. Screening of HbA1c levels plays an important role in the diagnosis and management of diabetes mellitus in the outpatient setting but remains underused in the evaluation of hyperglycemia with undiagnosed diabetes in the inpatient setting...
June 1, 2016: Journal of the American Osteopathic Association
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
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
Pamela Arnold, Danielle Scheurer, Andrew W Dake, Angela Hedgpeth, Amy Hutto, Caroline Colquitt, Kathie L Hermayer
BACKGROUND: The Joint Commission Advanced Inpatient Diabetes Certification Program is founded on the American Diabetes Association's Clinical Practice Recommendations and is linked to the Joint Commission Standards. Diabetes currently affects 29.1 million people in the USA and another 86 million Americans are estimated to have pre-diabetes. On a daily basis at the Medical University of South Carolina (MUSC) Medical Center, there are approximately 130-150 inpatients with a diagnosis of diabetes...
April 2016: American Journal of the Medical Sciences
Ling Hinshaw, Michele Schiavon, Vikash Dadlani, Ashwini Mallad, Chiara Dalla Man, Adil Bharucha, Rita Basu, Jennifer R Geske, Rickey E Carter, Claudio Cobelli, Ananda Basu, Yogish C Kudva
CONTEXT: Early postprandial hyperglycemia and delayed hypoglycemia remain major problems in current management of type 1 diabetes (T1D). OBJECTIVE: Our objective was to investigate the effects of pramlintide, known to suppress glucagon and delay gastric emptying, on postprandial glucose fluxes in T1D. DESIGN: This was a single-center, inpatient, randomized, crossover study. PATIENTS: Twelve patients with T1D who completed the study were analyzed...
May 2016: Journal of Clinical Endocrinology and Metabolism
Amal K Suleiman
BACKGROUND: Diabetes mellitus has considerable public health implications for communities, individuals, and health services. Increasing prevalence of diabetes all over the world intensifies the demand for health care services, and particularly for inpatient care. AIM: The present study aims to assess the current prevalence of diabetes and its etiology among hospitalized Jordanian adults. METHODS: This was a cross sectional study conducted at Specialist Hospital (SH) in the Jordanian capital of Amman, with data collection taking place between June and August 2015, and data was extracted manually from medical records...
April 2016: Diabetes & Metabolic Syndrome
Martha Engle, Allison Ferguson, Willa Fields
PURPOSE: The purpose of this quality improvement project was to redesign a hospital meal delivery process in order to shorten the time between blood glucose monitoring and corresponding insulin administration and improve glycemic control. DESCRIPTION: This process change redesigned the workflow of the dietary and nursing departments. Modifications included nursing, rather than dietary, delivering meal trays to patients receiving insulin. Dietary marked the appropriate meal trays and phoned each unit prior to arrival on the unit...
March 2016: Clinical Nurse Specialist CNS
Maya Fayfman, Priyathama Vellanki, Anastasia-Stefania Alexopoulos, Lauren Buehler, Liping Zhao, Dawn Smiley, Sonya Haw, Jeff Weaver, Francisco J Pasquel, Guillermo E Umpierrez
CONTEXT: A higher prevalence of diabetes-related complications is reported in minority populations; however, it is not known if there are racial disparities in diabetes care and outcomes in hospitalized patients. OBJECTIVE: Our objective was to determine the association between hyperglycemia, in patients with and without diabetes mellitus (non-DM), and complications among different racial groups. DESIGN: This observational study compared the frequency of hyperglycemia (blood glucose ≥ 180 mg/dL; 10 mmol/L) and DM and hospital complications between Black and White patients hospitalized patients between January 2012 and December 2013...
March 2016: Journal of Clinical Endocrinology and Metabolism
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