Newer methods in the diagnosis and treatment for pituitary adenomas greatly expand our ability to care for affected patients.

No abstract

Newly updated national guidelines call for a blood glucose target for critically ill patients of 140-180 mg/dl, using a continuous insulin infusion if needed. In the noncritically ill, a value less than 140 mg/dl before meals and less than 180 on random checks is recommended. A regimen of basal insulin in conjunction with premeal and supplemental insulin is preferred, as opposed to simple sliding scale insulin. Importantly, these guidelines are merely recommendations and management of the hyperglycemic inpatient must be tailored to suit the individual, considering their other comorbidities, risk factors for hypoglycemia, availability and training of hospital staff, and overall prognosis.

No abstract

Prior to 2009, intensive glycemic control was the standard in main intensive care units (ICUs). Glucose targets have been recalibrated after publication of the NICE-SUGAR study in that year, followed by updated guidelines that endorsed more moderated control. We sought to determine if the prevalence of hyperglycemia in US ICUs had increased after the NICE-SUGAR study's results were reported. We used data from hospitals submitted to the Yale Glucometrics™ website to assess mean blood glucose values, percentage of blood glucose within various ranges, and the prevalence of hypo-and hyperglycemic excursions, based on the patient-day method, comparing the pre-to post-NICE-SUGAR time period. Among more than a total of 2 million blood glucose determinations, comprising 408 790 patient-days, median patient-day blood glucose decreased from 144 mg/dL to 141 mg/dL (P < .001) in the pre-versus post-NICE-SUGAR time period. The percentage of patient days with a mean blood glucose of 110-179 mg/dl increased from 58.3 to 63.6%. The percentage of patient-days with either hypoglycemia (<70 mg/dl) or severe hyperglycemia (≥300 mg/dl) decreased during this time. Our results suggest that glycemic control in US ICUs has improved when comparing time periods before versus after publication of the NICE-SUGAR study. We found no evidence that fewer hypoglycemic events were achieved at the expense of more hyperglycemia.