Background: Continuous subcutaneous insulin infusion (CSII) is a common diabetes treatment modality. Glycemic outcomes of patients using CSII in the first 24 hours of hospitalization have not been well studied. This timeframe is of particular importance because insulin pump settings are programmed to achieve tight outpatient glycemic targets which could result in hypoglycemia when patients are hospitalized. Methods: This retrospective cohort study evaluated 216 hospitalized adult patients using CSII and 216 age-matched controls treated with multiple daily injections (MDI) of insulin. Patients using CSII did not make changes to pump settings in the first 24 hours of admission. Blood glucose (BG) values within the first 24 hours of admission were collected. The primary outcome was frequency of hypoglycemia (BG < 70 mg/dL). Secondary outcomes were frequency of severe hypoglycemia (BG < 40 mg/dL) and hyperglycemia (BG ≥ 180 mg/dL). Results: There were significantly fewer events of hypoglycemia [incident rate ratio (IRR) 0.61, 95% confidence interval (CI) 0.42–0.88, p = 0.007] and hyperglycemia (IRR 0.79, 95% CI 0.65–0.96, p = 0.02) in the CSII group compared to the MDI group. There was a trend toward fewer events of severe hypoglycemia in the CSII group (IRR 0.15, 95% CI 0.02–0.93, p = 0.06). Conclusions: Patients using CSII experienced fewer events of both hypoglycemia and hyperglycemia in the first 24 hours of hospital admission than those treated with MDI. Our study demonstrates that CSII use is safe and effective for the treatment of diabetes within the first 24 hours of hospital admission.
Background: Insulin pumps have become an increasingly popular alternative to traditional forms of insulin therapy for patients with type 1 and type 2 diabetes. Despite the increasing prevalence of insulin pumps, the safety of their use in hospitalized patients has not been well studied. In this study, we aim to determine the incidence of hypoglycemia in hospitalized patients using insulin pumps within 24 hours of admission prior to any adjustments of their insulin pump settings. Methods: This is a retrospective analysis of adult patients with diabetes (type 1 and 2) who used insulin pumps during the first 24 hours of admission to NYU Winthrop Hospital and did not make any adjustments to the pump settings during that time. Patients <18 years of age, pregnant patients and those who were electively admitted for surgery were excluded from this study. Demographic data and clinical data were collected, which included the presence of steroid use, total daily dose of basal insulin, creatinine level, HbA1c level, and serum and capillary blood glucose values. Hypoglycemia was defined as blood glucose <70mg/dL and severe hypoglycemia was defined as blood glucose <40mg/dL. Results: Two hundred and fifty-seven patients were included in the study. The mean age was 56 years, 152 (59%) patients were male, and 130 (55%) had type 1 diabetes. The mean hemoglobin A1c was 7.9%. A total of 2097 finger stick blood glucose values were obtained, and 1290 (62%) were <180 mg/dL. There were 88 episodes of hypoglycemia (4.1% of all finger stick blood glucose values) and 2 episodes of severe hypoglycemia (0.1% of all finger stick blood glucose values). Conclusion: Insulin pumps are safe and effective for the treatment of both type 1 and type 2 diabetes in the first 24 hours of hospital admission. Disclosure A. Halstrom: None. I. Moledina: None. V. Peragallo-Dittko: None. K. Ancona: None. S. Islam: None. G. Rothberger: None. S.P. Klek: None.
PURPOSE: Healthcare Associated-Venous Thrombo-Embolism (HA-VTE) occurs commonly in patients with recent hospitalization or surgery. HA-VTE accounts for more almost half of the case burden of total patients with any form of VTE and may be preventable if appropriate guidelines are followed. The impact of various VTE guidelines on HA-VTE is unknown. METHODS: Using the National Inpatient Sample database for adult patients, we evaluated the inpatient trends in HA-VTE, and its association on in-hospital mortality, length of stay and healthcare expenditure from the years 1997-2013. We included patients with principle discharge diagnoses of Iatrogenic Pulmonary Embolism (ICD 9-CM CODE: 415.11). We used Spearman's correlation technique and Goodness of Fit Chi-Square to demonstrate the statistical correlation between the parameters. RESULTS: For the year 1996, the total number of patients discharged with principle discharge diagnosis of Iatrogenic Pulmonary Embolism was 6300 (19.8 per 100,000 discharges) and decreased to 5850 (16.4 per 100,000 discharges) in the year 2013 (p<0.001). The average length of stay for these patients decreased from 7.02 days in the year 1997 to 4.37 days in the year 2013 (rho ¼-0.977, p<0.001). The percent of in-hospital mortality also decreased from 5.16% in the year 1997 to 8.4% in the year 2013 (rho ¼-0.96, p<0.
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