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https://www.readbyqxmd.com/read/28792863/addition-of-insulin-to-parenteral-nutrition-for-control-of-hyperglycemia
#1
Adam McCulloch, Vishakha Bansiya, Jeremy M Woodward
Administration of parenteral nutrition (PN) may result in hyperglycemia in patients with preexisting diabetes or disease-related insulin resistance, and it can be associated with increased rates of complications. Treatment requires insulin therapy. Insulin can be administered subcutaneously, intravenously via a variable rate sliding scale, or by adding it directly to the PN. The last method is a potentially attractive technique for a number of reasons-it could deliver the insulin intravenously at a steady rate alongside carbohydrates, and in malnourished patients with little subcutaneous tissue, it may prevent the need for frequent insulin injections...
August 1, 2017: JPEN. Journal of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28660256/a-comparison-of-inpatient-cost-per-day-in-general-surgery-patients-with-type-2-diabetes-treated-with-basal-bolus-versus-sliding-scale-insulin-regimens
#2
Victoria L Phillips, Anwar L Byrd, Saira Adeel, Limin Peng, Dawn D Smiley, Guillermo E Umpierrez
BACKGROUND: The identification of cost-effective glycaemic management strategies is critical to hospitals. Treatment with a basal-bolus insulin (BBI) regimen has been shown to result in better glycaemic control and fewer complications than sliding scale regular insulin (SSI) in general surgery patients with type 2 diabetes mellitus (T2DM), but the effect on costs is unknown. OBJECTIVE: We conducted a post hoc analysis of the RABBIT Surgery trial to examine whether total inpatient costs per day for general surgery patients with T2DM treated with BBI (n = 103) differed from those for patients with T2DM treated with SSI (n = 99) regimens...
2017: PharmacoEconomics open
https://www.readbyqxmd.com/read/28659865/review-of-evidence-for-adult-diabetic-ketoacidosis-management-protocols
#3
REVIEW
Tara T T Tran, Anthony Pease, Anna J Wood, Jeffrey D Zajac, Johan Mårtensson, Rinaldo Bellomo, Elif I I Ekinci
BACKGROUND: Diabetic ketoacidosis (DKA) is an endocrine emergency with associated risk of morbidity and mortality. Despite this, DKA management lacks strong evidence due to the absence of large randomised controlled trials (RCTs). OBJECTIVE: To review existing studies investigating inpatient DKA management in adults, focusing on intravenous (IV) fluids; insulin administration; potassium, bicarbonate, and phosphate replacement; and DKA management protocols and impact of DKA resolution rates on outcomes...
2017: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/28589154/prolonged-ketosis-in-a-patient-with-euglycemic-diabetic-ketoacidosis-secondary-to-dapagliflozin
#4
Shreya Pujara, Adriana Ioachimescu
Since the approval of sodium-glucose cotransporter 2 (SGLT2) inhibitors by the US Food and Drug Administration for type 2 diabetes, there have been several reports of euglycemic diabetic ketoacidosis in patients using this class of medication. We present a case of euglycemic diabetic ketoacidosis where ketonemia and glucosuria persisted well beyond the expected effect of dapagliflozin. Our patient is a 50-year-old woman with type 2 diabetes since age 35 who was taking metformin and dapagliflozin. She presented with fatigue, constipation, and 3 days of reduced oral intake...
April 2017: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/28569662/sliding-scale-insulin-use-in-long-term-care-an-updated-perspective
#5
Joy Woods, Micki Nadelson
Diabetes affects approximately 26% of individuals oldeR THAN 65 years of age in the United States and up to 33% of patients in long-term care facilities. The most commonly prescribed insulin therapy for patients in long-term care is sliding-scale insulin (SSI): the use of finger-stick blood glucose testing to assess the need for insulin administration based on current blood glucose levels. SSI has been on the Beers Criteria of Potentially Inappropriate Medications since 2012. However, its sole use for long-term treatment is specifically not recommended by the American Diabetes Association and other stakeholders in diabetes management...
February 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28527646/high-dose-amino-acid-administration-achieves-an-anabolic-response-in-type-2-diabetic-patients-that-is-independent-of-glycaemic-control-a-randomized-clinical-trial
#6
Chelsia Gillis, Patricia S Roque, Jürgen Bläss, Albert Urwyler, Harald Schepperle, Guido Kunz, Thomas Peters, Thomas Schricker, Linda Wykes, Andrea Kopp Lugli
BACKGROUND & AIMS: Surgical stress provokes protein catabolism and hyperglycaemia that is enhanced in patients with type 2 diabetes (T2DM), and increases perioperative morbidity. This study hypothesized that perioperative administration of high dose intravenous (IV) amino acids (AA) will augment protein balance in T2DM patients receiving tight plasma glucose control via continuous IV insulin compared to standard plasma glucose control via subcutaneous (SC) insulin sliding scale. METHODS: Eighteen patients with well-controlled T2DM (HbA1C% < 7...
May 3, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28495320/comparison-of-2-intravenous-insulin-protocols-glycemia-variability-in-critically-ill-patients
#7
Marta Gómez-Garrido, Ana M Rodilla-Fiz, María Girón-Lacasa, Laura Rodríguez-Rubio, Anselmo Martínez-Blázquez, Fernando Martínez-López, María Dolores Pardo-Ibáñez, Juan M Núñez-Marín
OBJECTIVE: Glycemic variability is an independent predictor of mortality in critically ill patients. The objective of this study was to compare two intravenous insulin protocols in critically ill patients regarding the glycemic variability. MATERIAL AND METHODS: This was a retrospective observational study performed by reviewing clinical records of patients from a Critical Care Unit for 4 consecutive months. First, a simpler Scale-Based Intravenous Insulin Protocol (SBIIP) was reviewed and later it was compared for the same months of the following year with a Sliding Scale-Based Intravenous Insulin Protocol (SSBIIP)...
May 2017: Endocrinología, diabetes y nutrición
https://www.readbyqxmd.com/read/28156156/hyperglycemia-and-hypoglycemia-in-patients-with-diabetes-in-skilled-nursing-facilities
#8
Rushad Patell, Denis Nigmatoulline, James Bena, Do Gyun Kim, Barbara Messinger-Rapport, M Cecilia Lansang
OBJECTIVE: Endocrinologists are faced with a growing elderly patient population with diabetes mellitus (DM), some of whom are in skilled nursing facilities (SNFs). Efforts at managing their DM is hampered by concerns for hypoglycemia. This study aimed to determine the frequency of hypo- and hyperglycemia in SNFs, and associated factors. METHODS: We reviewed medical records of 200 consecutive residents admitted to two SNFs in the Cleveland area in 2014 with documented DM, aged ≥65 years...
April 2, 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28118045/impact-of-a-paper-based-dynamic-insulin-infusion-protocol-on-glycemic-variability-time-in-target-and-hypoglycemic-risk-a-stepped-wedge-trial-in-medical-intensive-care-unit-patients
#9
Antoine Clergeau, Jean-Jacques Parienti, Yves Reznik, Deborah Clergeau, Amelie Seguin, Xavier Valette, Damien du Cheyron, Michael Joubert
BACKGROUND: Stress-induced hyperglycemia is a common feature of intensive care unit (ICU) patients. Besides mean blood glucose (BG) level, glucose variability and hypoglycemia have been highlighted as independent predictors of ICU and hospital mortality. Recent ICU recommendations suggest using insulin infusion protocols that can minimize glucose variability and hypoglycemic risk. Our aim was to assess the efficacy, safety, and acceptance by nurses of a paper-based simple dynamic insulin protocol compared with those by nurses of a paper-based static protocol...
February 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28067472/efficacy-of-basal-bolus-insulin-regimens-in-the-inpatient-management-of-non-critically-ill-patients-with-type-2-diabetes-a-systematic-review-and-meta-analysis
#10
REVIEW
Merete B Christensen, Anders Gotfredsen, Kirsten Nørgaard
Hyperglycemia during hospitalization is associated with increased rates of complications and longer hospital stays. Various insulin regimens are used in the inpatient diabetes management of non-critically ill patients. In this systematic review and meta-analysis, we aimed to assess the efficacy and safety of basal-bolus insulin therapy (BBI) by summarizing evidence from studies of BBI versus sliding scale insulin therapy (SSI) in the management of hospitalized non-critically ill type 2 diabetes patients. We searched MEDLINE, EMBASE, Scopus, and the Cochrane Library for studies comparing BBI therapy with SSI therapy in hospitalized non-critically ill patients with type 2 diabetes...
July 2017: Diabetes/metabolism Research and Reviews
https://www.readbyqxmd.com/read/27928867/reduction-of-medication-errors-related-to-sliding-scale-insulin-by-the-introduction-of-a-standardized-order-sheet
#11
Saki Harada, Akio Suzuki, Shohei Nishida, Ryo Kobayashi, Sayuri Tamai, Keisuke Kumada, Nobuo Murakami, Yoshinori Itoh
Insulin is frequently used for glycemic control. Medication errors related to insulin are a common problem for medical institutions. Here, we prepared a standardized sliding scale insulin (SSI) order sheet and assessed the effect of its introduction. Observations before and after the introduction of the standardized SSI template were conducted at Gifu University Hospital. The incidence of medication errors, hyperglycemia, and hypoglycemia related to SSI were obtained from the electronic medical records. The introduction of the standardized SSI order sheet significantly reduced the incidence of medication errors related to SSI compared with that prior to its introduction (12/165 [7...
June 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/27821581/association-between-the-use-of-long-acting-insulin-and-hypoglycemia-in-nondiabetic-patients-in-the-surgical-intensive-care-unit
#12
Jordan Masse, Christopher Alan Giuliano, Sara Brown, Renee Alexander Paxton
PURPOSE: The purpose of this study was to examine the association between long-acting insulin and hypoglycemia in nondiabetic surgical intensive care patients. METHODS: This single-center, retrospective cohort study evaluated glycemic control in nondiabetic critically ill surgical patients receiving long-acting insulin plus sliding scale versus those receiving sliding scale alone. Patients were matched based on sliding scale order and type of surgery. The primary outcome was the proportion of patients who experienced hypoglycemia (glucose values <70 mg/dL)...
November 7, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27749721/pediatric-type-1-diabetes-reducing-admission-rates-for-diabetes-ketoacidosis
#13
Jeniece Trast Ilkowitz, Steven Choi, Michael L Rinke, Kathy Vandervoot, Rubina A Heptulla
BACKGROUND: Diabetes ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM). Reducing DKA admissions in children with T1DM requires a coordinated, comprehensive management plan. We aimed to decrease DKA admissions, 30-day readmissions, and length of stay (LOS) for DKA admissions. METHODS: A multipronged intervention was designed in 2011 to reach all patients: (1) increase insulin pump use and basal-bolus regimen versus sliding scales, (2) transform educational program, (3) increased access to medical providers, and (4) support for patients and families...
October 2016: Quality Management in Health Care
https://www.readbyqxmd.com/read/27725022/inappropriate-medicine-prescribing-in-older-south-africans-a-cross-sectional-analysis-of-medicine-claims-data
#14
J A Van Heerden, J R Burger, J J Gerber
BACKGROUND: Prescribing for older patients is a well-recognised problem, and inappropriate items are prescribed frequently. Several tools and criteria are available to promote rational prescribing in older patients. OBJECTIVE: To determine the prevalence of potentially inappropriate prescriptions (PIPs) in older South African patients. METHODS: A retrospective drug utilisation review was conducted using medicine claims data over a 1-year period...
September 9, 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/27557726/strict-blood-glucose-control-by-an-artificial-endocrine-pancreas-during-hepatectomy-may-prevent-postoperative-acute-kidney-injury
#15
Naoji Mita, Shinji Kawahito, Tomohiro Soga, Kazumi Takaishi, Hiroshi Kitahata, Munehide Matsuhisa, Mitsuo Shimada, Hiroyuki Kinoshita, Yasuo M Tsutsumi, Katsuya Tanaka
The aim of the present study was to evaluate the usefulness of a closed-loop system (STG-55; Nikkiso, Tokyo, Japan), a type of artificial endocrine pancreas for the continuous monitoring and control of intraoperative blood glucose, for preventing postoperative acute kidney injury (AKI) in patients undergoing hepatectomy. Thirty-eight patients were enrolled in this study. Glucose concentrations were controlled with either a manual injection of insulin based on a commonly used sliding scale (manual insulin group, n = 19) or the programmed infusion of insulin determined by the control algorithm of the artificial endocrine pancreas (programmed insulin group, n = 19)...
March 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/27242119/risk-factors-for-hypoglycemia-in-patients-with-type-2-diabetes-hospitalized-in-internal-medicine-wards-findings-from-the-fadoi-diamond-study
#16
V Borzì, S Frasson, G Gussoni, M Di Lillo, R Gerloni, G Augello, G Gulli, A Ceriello, B Solerte, E Bonizzoni, A Fontanella
AIMS: Hypoglycemia is a potential risk in the management of patients suffering from type 2 diabetes (T2DM) and hospitalized in internal medicine units (IMUs). The aim of this analysis was to evaluate incidence of hypoglycemia and related risk factors in a group of patients admitted to IMUs. METHODS: We used the FADOI-DIAMOND study carried out in 53 Italian IMUs. The DIAMOND design included two cross-sectional surveys interspersed with an educational program. In both phases each center reviewed the charts of the last 30 hospitalized patients with known T2DM (n=3167), including information about hypoglycemia during hospital stay...
May 2016: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/27145387/hypoglycemic-treatment-of-diabetic-patients-in-the-emergency-department
#17
Carmen Caballero Requejo, Elena Urbieta Sanz, Abel Trujillano Ruiz, Celia García-Molina Sáez, María Onteniente Candela, Pascual Piñera Salmerón
OBJECTIVES: To analyze if the hypoglycemic therapy prescribed in the Emergency Department adapts to the consensus recommendations available, as well as to assess its clinical impact. METHODS: A descriptive observational study, which included patients awaiting hospital admission, who were in the Observation Ward of the Emergency Department and had been previously diagnosed with diabetes mellitus, and were receiving treatment with hypoglycemic drugs at home. The management of antidiabetic treatment and its clinical impact were assessed...
May 1, 2016: Farmacia Hospitalaria
https://www.readbyqxmd.com/read/26850631/technical-and-clinical-accuracy-of-three-blood-glucose-meters-clinical-impact-assessment-using-error-grid-analysis-and-insulin-sliding-scales
#18
Hannah Lise Sutheran, Timothy Reynolds
AIMS: Manufacturers of point-of-care testing (POCT) glucose systems must adhere to International Organisation for Standardisation (ISO) 15197 performance standards, a tightened version of which becomes mandatory in May 2016. Using methods deviating from the evaluation requirements of ISO 15197, we investigated the accuracy and clinical utility of three glucose testing systems. METHODS: Whole blood glucose was measured on 62 EDTA-preserved samples with each system followed by plasma glucose determination with a laboratory hexokinase method...
October 2016: Journal of Clinical Pathology
https://www.readbyqxmd.com/read/26839477/in-silico-trials-for-glucose-control-in-hospitalized-patients-with-type-2-diabetes
#19
Karam Choi, Tae Jung Oh, Jung Chan Lee, Myungjoon Kim, Hee Chan Kim, Young Min Cho, Sungwan Kim
Although various basal-bolus insulin therapy (BBIT) protocols have been used in the clinical environment, safer and more effective BBIT protocols are required for glucose control in hospitalized patients with type 2 diabetes (T2D). Modeling approaches could provide an evaluation environment for developing the optimal BBIT protocol prior to clinical trials at low cost and without risk of danger. In this study, an in-silico model was proposed to evaluate subcutaneous BBIT protocols in hospitalized patients with T2D...
February 2016: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/26826772/effective-adverse-event-reduction-with-bolus-basal-versus-sliding-scale-insulin-therapy-in-patients-with-diabetes-during-conventional-hospitalization-systematic-review-and-meta-analysis
#20
Covadonga Gómez Cuervo, Ana Sánchez Morla, María Asunción Pérez-Jacoiste Asín, Otilia Bisbal Pardo, Luis Pérez Ordoño, Juan Vila Santos
INTRODUCTION: The aim of this review was to assess the effectiveness to reduce clinical adverse events and safety of insulin administered in basal-bolus-corrector or basal-corrector regimens (BB) versus a sliding scale scheme (SS) in patients with diabetes or newly diagnosed hyperglycemia admitted to a conventional (not critical) medical or surgical hospital ward. METHOD: A Medline search was conducted. The Odds ratio was the main summary measure. A random effects model with the Mantel-Haenszel procedure was used...
April 2016: Endocrinología y Nutrición: órgano de la Sociedad Española de Endocrinología y Nutrición
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