Benefits of Intense Glucose Control in Critically Ill Patients

Pierre, Ketsia B.; Jones, Christopher M.; Stain, Steven C.

doi:10.1016/j.cursur.2004.09.014

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…Monitoring glucose levels can be challenging, and patients often spend significant periods with high blood sugar levels (outside the target range). Intensive insulin administration, in these cases, have been associated with an increased risk of death, while more frequent assessments of blood sugar levels have been shown to reduce mortality and morbidity in critically ill individuals, leading to improved outcomes [158,164,165].…”

Section: Monitoring Glucose Levelsmentioning

confidence: 99%

A Narrative Review on Strategies for the Reversion of Prediabetes to Normoglycemia: Food Pyramid, Physical Activity, and Self-Monitoring Innovative Glucose Devices

Rondanelli,

Barrile,

Cavioni

et al. 2023

Nutrients

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In 2019, “Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report” was published. This consensus report, however, did not provide an easy way to illustrate to subjects with prediabetes (SwPs) how to follow a correct dietary approach. The purpose of this review is to evaluate current evidence on optimum dietary treatment of SwPs and to provide a food pyramid for this population. The pyramid built shows that everyday consumption should consist of: whole-grain bread or potatoes eaten with their skins (for fiber and magnesium) and low glycemic index carbohydrates (GI < 55%) (three portions); fruit and vegetables (5 portions), in particular, green leafy vegetables (for fiber, magnesium, and polyphenols); EVO oil (almost 8 g); nuts (30 g, in particular, pistachios and almonds); three portions of dairy products (milk/yogurt: 300–400 g/day); mineral water (almost 1, 5 L/day for calcium intake); one glass of wine (125 mL); and three cups of coffee. Weekly portions should include fish (four portions), white meat (two portions), protein plant-based food (four portions), eggs (egg portions), and red/processed meats (once/week). At the top of the pyramid, there are two pennants: a green one means that SwPs need some personalized supplementation (if daily requirements cannot be satisfied through diet, vitamin D, omega-3, and vitamin B supplements), and a red one means there are some foods and factors that are banned (simple sugar, refined carbohydrates, and a sedentary lifestyle). Three to four times a week of aerobic and resistance exercises must be performed for 30–40 min. Finally, self-monitoring innovative salivary glucose devices could contribute to the reversion of prediabetes to normoglycemia.

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Section: Monitoring Glucose Levelsmentioning

confidence: 99%

A Narrative Review on Strategies for the Reversion of Prediabetes to Normoglycemia: Food Pyramid, Physical Activity, and Self-Monitoring Innovative Glucose Devices

Rondanelli,

Barrile,

Cavioni

et al. 2023

Nutrients

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“…3 To avoid adverse outcomes associated with hyperglycemia in the ICU, it is ideal to carefully control BG levels in critical care patients. 2,4 This can be challenging because BG levels in this population tend to be labile because of the severity of illness. In addition, variability in nutritional intake and timing of insulin administration in the ICU may also contribute to lability.…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Cohort Analysis of Two Computerized Insulin Infusion Protocols

Lalani

Gosselin

Penno

et al. 2023

J Diabetes Sci Technol

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Objective: The primary objective of this analysis was to compare the safety and efficacy of a novel computerized insulin infusion protocol (CIIP), the Lalani Insulin Infusion Protocol (LIIP), with an established CIIP, Glucommander. Methods: We conducted a 10-month retrospective analysis of 778 patients in whom LIIP was used (August 18, 2020 to June 25, 2021) at six HonorHealth Hospitals in the Phoenix metropolitan area. These data were compared with Glucommander that was used at those same hospitals from January 1, 2018 to August 17, 2020, n = 4700. Primary end points of the project included average time to euglycemia and average time in hyperglycemia (>180 mg/dL) and hypoglycemia (<70 mg/dL). Additional subgroup analysis was done to evaluate CIIP performance in patients in whom maintenance of euglycemia was more challenging. Results: The LIIP had a faster time to euglycemia (191 vs 222 minutes, P < .001) and similar time in hypoglycemia (2.79 vs 2.76 minutes, P = .50) for all patients, when compared with Glucommander. Similar observations were made for the following subgroups: diabetic ketoacidosis/hyperosmolar hyperglycemic state (DKA/HHS) patients, COVID-19 patients, patients on steroids, patients with ≥60 glomerular filtration rate (GFR), patients with renal insufficiency, and patients with sepsis. Conclusions: The LIIP is a safe and effective CIIP in managing intravenous insulin infusion rates. Utilization of LIIP resulted in reduced time to euglycemia, P < .001, when compared with Glucommander and did not cause increased hypoglycemia during the project period. Contributing factors to the success of LIIP may include improved clinical workflow, learnability and ease of use, compatibility with the Epic electronic health record (EHR), and its unique, dynamic and adaptive algorithm.

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“…4 References to hypoglycemia in the literature include values between 40 and 80 mg/dL, [8][9][10][11][12] while the range of hyperglycemia is that of 180 to 200 mg/dL. [8][9][10][11][12] The Brazilian Society of Diabetes (SBD) and the guidelines of the American Diabetes Association/American Association of Clinical Endocrinologists (ADA/AACE) recommend, for patients hospitalized in ICU, target blood glucose ranges between 140-180 mg/dL and initiation of insulin therapy when blood glucose values are persistently greater than 180 mg/dL. 8,13 A US study analyzed blood glucose tests performed at the bedside in ICU and non-ICU wards of 126 hospitals in different regions of the country and showed a prevalence of hyperglycemia (> 180 mg/dL) of 46% in ICU and 31.7% outside the ICU.…”

mentioning

confidence: 99%

Hyperglycemia in critical patients: Determinants of insulin dose choice

Paliosa

Teixeira

Rosa

et al. 2017

Rev. Assoc. Med. Bras.

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Objective: To identify factors that can determine the choice of intermittent subcutaneous regular insulin dose in critically ill patients with hyperglycemia. Method: Cross-sectional study in a general adult ICU with 26 beds, data collected between September and October 2014. The variables analyzed were: sex, age, previous diagnosis of diabetes mellitus, use of corticosteroids, use of lactulose, sepsis, fasting, enteral nutrition, use of dextrose 5% in water, NPH insulin prescription and blood glucose level. Patients with one or more episodes of hyperglycemia (blood glucose greater than 180 mg/dL) were included as a convenience sample, not consecutively. Those with continuous insulin prescription were excluded from analysis. Results: We included 64 records of hyperglycemia observed in 22 patients who had at least one episode of hyperglycemia. The median administered subcutaneous regular human insulin was 6 IU and among the factors evaluated only blood glucose levels were associated with the choice of insulin dose administered. Conclusion: Clinical characteristics such as diet, medications and diagnosis of diabetes mellitus are clearly ignored in the decision-making regarding insulin dose to be administered for glucose control in critically ill patients with hyperglycemia.

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Benefits of Intense Glucose Control in Critically Ill Patients

Cited by 4 publications

References 8 publications

A Narrative Review on Strategies for the Reversion of Prediabetes to Normoglycemia: Food Pyramid, Physical Activity, and Self-Monitoring Innovative Glucose Devices

A Narrative Review on Strategies for the Reversion of Prediabetes to Normoglycemia: Food Pyramid, Physical Activity, and Self-Monitoring Innovative Glucose Devices

A Retrospective Cohort Analysis of Two Computerized Insulin Infusion Protocols

Hyperglycemia in critical patients: Determinants of insulin dose choice

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