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Perioperative hyperglycemia

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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
Elizabeth W Duggan, Matthew A Klopman, Arnold J Berry, Guillermo Umpierrez
Hyperglycemia is a frequent manifestation of critical and surgical illness, resulting from the acute metabolic and hormonal changes associated with the response to injury and stress (Umpierrez and Kitabchi, Curr Opin Endocrinol. 11:75-81, 2004; McCowen et al., Crit Care Clin. 17(1):107-24, 2001). The exact prevalence of hospital hyperglycemia is not known, but observational studies have reported a prevalence of hyperglycemia ranging from 32 to 60 % in community hospitals (Umpierrez et al., J Clin Endocrinol Metab...
March 2016: Current Diabetes Reports
Kazuhiro Hanazaki, Masaya Munekage, Takehiro Okabayashi
No abstract text is available yet for this article.
May 2011: Journal of the American College of Surgeons
David A Fullerton, Thoralf M Sundt
No abstract text is available yet for this article.
December 2014: Journal of Thoracic and Cardiovascular Surgery
Mark T Keegan, Michael E Goldberg, Marc C Torjman, Douglas B Coursin
Patients with dysglycemia related to known or unrecognized diabetes, stress hyperglycemia, or hypoglycemia in the presence or absence of exogenous insulin routinely require care during the perioperative period or critical illness. Recent single and multicenter studies, a large multinational study, and three meta-analyses evaluated the safety of routine tight glycemic control (80-110 mg/dl) in critically ill adults. Results led to a call for more modest treatment goals (initiation of insulin at a blood glucose >180 mg/dl with a goal of approximately 150 mg/dl)...
November 2009: Journal of Diabetes Science and Technology
Heather Ead
Diabetes mellitus (DM) has reached epidemic proportions globally, and its incidence continues to rise. Considering the increasing number of patients diagnosed with diabetes and the associated complications, such as cardiovascular and renal disease, the complexity of care for this population can be very challenging. In addition, specific postoperative complications, such as delayed wound healing, infections, and cardiac dysrhythmias, are more likely to occur in the presence of perioperative hyperglycemia. Recognition of the presence of diabetes and implementation of a diabetic management protocol will optimize patient outcomes by providing guidelines for avoiding such complications...
December 2009: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
T M Merz, S Finfer
Hyperglycaemia is common in acute illness and more severe hyperglycaemia is associated with worse outcomes in critically ill patients in general and after acute myocardial infarction, stroke, and trauma. Normalization of blood glucose by intensive insulin therapy has been shown to reduce morbidity and mortality in one study in surgical intensive care patients; a subsequent study in medical intensive care patients resulted in reduced morbidity but not a reduction in mortality. Multicentre studies and current meta-analyses in the critically ill have not demonstrated improved outcomes when normalization of blood glucose was targeted; furthermore all studies to date have detected an increased risk of hypoglycaemia in patients subjected to intensive insulin therapy...
December 2009: Minerva Anestesiologica
Lesly A Dossett, Bryan Collier, Rafe Donahue, Nathan T Mowery, Marcus J Dortch, Oscar Guillamondegui, Jose J Diaz, Addison K May
BACKGROUND: Intensive insulin therapy (IIT) is the standard of care in the ICU, but precise implementation of insulin protocols has been difficult in clinical practice. The authors' objective was to quantify adherence to an IIT protocol in a practice setting, and to describe how adherence impacts overall blood glucose (BG) control. METHODS: A retrospective analysis of a cohort of critically ill patients treated with IIT was performed. Protocol adherence was evaluated by assessing the timing of BG measurements...
January 2009: JPEN. Journal of Parenteral and Enteral Nutrition
Kenji Minakata, Ryuzo Sakata
It is well recognized that poor perioperative blood glucose (BG) control can increase the risk of infection, cardiovascular accidents, and even death in patients undergoing cardiac surgery. Since it has been reported that tight BG control (80-110 mg/dL) yields better outcomes in critically ill patients, it became a standard of care to control BG using intravenous insulin infusion in ICU. However, it has been debated in terms of the optimal target range whether a strict control with intensive insulin therapy is better than liberal control...
February 2013: General Thoracic and Cardiovascular Surgery
Andrew C Faust, Rebecca L Attridge, Laurajo Ryan
Hyperglycemia, a common finding in critically ill patients, is linked to poor outcomes in multiple conditions. The Leuven I study published in 2001 was the first evaluation of intensive insulin therapy, and the 3.4% absolute reduction in mortality in a single-center surgical intensive care unit led to widespread endorsement of the therapy. In a subsequent study in a medical intensive care unit, reduction in mortality was not significant. Two multicenter studies were stopped early because of significantly higher rates of hypoglycemia in the patients receiving intensive insulin therapy...
August 2011: Critical Care Nurse
L Jane Whitehorn
AIM: This paper critically examines the evidence base for and issues involved in the introduction of an insulin protocol to maintain normoglycaemia in patients within a medical/surgical high dependency ward. BACKGROUND: A growing body of evidence has linked hyperglycaemia to worsened clinical outcomes. This has led to intravenous insulin protocols becoming a new standard of care in intensive care units. However, the use and benefits of insulin protocols within high dependency units have not yet been addressed in the literature...
January 2007: Journal of Clinical Nursing
Malgorzata E Wilinska, Jan Blaha, Ludovic J Chassin, Jeremy J Cordingley, Natalie C Dormand, Martin Ellmerer, Martin Haluzik, Johannes Plank, Dirk Vlasselaers, Pieter J Wouters, Roman Hovorka
BACKGROUND: Numerous guidelines and algorithms exist to achieve glycemic control. Their strengths and weaknesses are difficult to assess without head-to-head comparison in time-consuming clinical trials. We hypothesized that computer simulations may be useful. METHODS: Two open-label randomized clinical trials were replicated using computer simulations. One study compared performance of the enhanced model predictive control (eMPC) algorithm at two intensive care units in the United Kingdom and Belgium...
July 2011: Diabetes Technology & Therapeutics
J P van Kuijk, O Schouten, W J Flu, C A den Uil, J J Bax, D Poldermans
Diabetes mellitus (DM) is an independent predictor for morbidity and mortality in the general population, which is even more apparent in patients with concomitant cardiovascular risk factors. As the prevalence of DM is increasing, with an ageing general population, it is expected that the number of diabetic patients requiring surgical interventions will increase. Perioperative hyperglycaemia, without known DM, has been identified as a predictor for morbidity and mortality in patients undergoing surgery. Moreover, early studies showed that intensive blood-glucose-lowering therapy reduced both morbidity and mortality among patients admitted to the postoperative intensive care unit (ICU)...
November 2009: European Journal of Vascular and Endovascular Surgery
Carlos E Mendez, Guillermo Umpierrez
Patients with type 1 diabetes mellitus (T1DM) have minimal to absent pancreatic β-cell function and rely on the exogenous delivery of insulin to obtain adequate and life-sustaining glucose homeostasis. Maintaining glycemic control is challenging in hospitalized patients with T1DM, as insulin requirements are influenced by the presence of acute medical or surgical conditions, as well as altered nutritional intake. The risks of hyperglycemia, ketoacidosis, hypoglycemia, and glycemic variability are increased in hospitalized patients with T1DM...
August 2013: Hospital Practice (Minneapolis)
Ana Maria Gomez, Guillermo E Umpierrez
Inpatient hyperglycemia, in patients with and without a history of diabetes, is associated with increased risk of complications, mortality, and longer hospital stay in medicine and surgical patients. Bedside capillary point of care testing is widely recommended as the preferred method for glucose monitoring and for guiding glycemic management of individual patients; however, the accuracy of most handheld glucose meters is far from optimal. Recent studies in the hospital setting have reported that the use of continuous glucose monitoring (CGM) can provide real-time information about glucose concentration, direction, and rate of change over a period of several days...
September 2014: Journal of Diabetes Science and Technology
M McCavert, F Mone, M Dooher, R Brown, M E O'Donnell
BACKGROUND: Hyperglycaemia impairs many of the physiological processes involved in recovery from surgery but there is limited research on the effect of optimal peri-operative glucose control in diabetic general surgery patients. The objectives of this study were to assess blood glucose management in diabetic general surgical patients and to determine if protocol deviations were associated with adverse outcomes. METHODS: All diabetic patients undergoing elective and emergency general surgical procedures between August 2007 and July 2008 were included in the study...
2010: International Journal of Surgery
Abbas E Kitabchi, Amado X Freire, Guillermo E Umpierrez
Inpatient hyperglycemia in patients with and without a history of diabetes is common and is associated with increased hospital morbidity and mortality. The objectives of this communication are to examine results of randomized clinical trials of strict inpatient glucose control in medical and surgical intensive care units and to provide guidelines for achieving and maintaining glycemic control in patients admitted to critical and noncritical settings. We propose a more conservative approach of glycemic control than current American Association of Clinical Endocrinology recommendations until results of prospective, multicenter, randomized studies become available...
January 2008: Metabolism: Clinical and Experimental
John G T Augoustides, Prakash Patel
There have been major advances in perioperative cardiothoracic and vascular medicine. Because of promising data, steroids, statins, and endothelin antagonists are being clinically tested in randomized trials with adult cardiac surgical patients. In vascular surgical patients, recent meta-analysis has revealed that interventions such as beta-blockade or endovascular stenting for peripheral vascular lesions may not improve outcome overall. Furthermore, a landmark trial has shown that anesthetic technique does not affect outcome after carotid endarterectomy...
June 2009: Journal of Cardiothoracic and Vascular Anesthesia
Samer Ellahham
Hyperglycemia frequently occurs with acute medical illness, especially among patients with cardiovascular disease, and has been linked to increased morbidity and mortality in critically ill patients. Even patients who are normoglycemic can develop hyperglycemia in response to acute metabolic stress. An expanding body of literature describes the benefits of normalizing hyperglycemia with insulin therapy in hospitalized patients. As a result, both the American Diabetes Association and the American College of Endocrinology have developed guidelines for optimal control of hyperglycemia, specifically targeting critically ill, hospitalized patients...
2010: Vascular Health and Risk Management
Megan Harbin, Anar Dossa, Jane de Lemos, Isla Drummond, Breay Paty, Bobby Taylor
BACKGROUND: Practice guidelines have recommended scheduled basal, nutritional and correction insulin to manage hyperglycemia in the hospital setting. For many decades, however, the primary practice has been sliding scale insulin. OBJECTIVE: To evaluate the efficacy and safety of an institution-specific basal-nutritional-correction insulin preprinted order (BNC-PPO). METHODS: A retrospective, single-centre chart review was conducted on patients admitted to a vascular surgery service to compare inpatient glycemia control before and after implementation of the BNC-PPO...
June 2015: Canadian Journal of Diabetes
2016-07-17 22:17:26
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