Comparison of Inpatient Insulin Regimens with Detemir plus Aspart Versus Neutral Protamine Hagedorn plus Regular in Medical Patients with Type 2 Diabetes

Umpiérrez, Guillermo E.; Hor, Tiffany; Smiley, Dawn; Temponi, Ángel; Umpierrez, Denise; Cerón, Miguel; Munoz, Christina; Newton, Christopher A.; Baldwin, David

doi:10.1210/jc.2008-1441

Cited by 148 publications

(137 citation statements)

References 38 publications

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“…A study of inpatients with diabetes in the UK found that 22% had one or more hypoglycaemic episodes over the previous 7 days of their stay (blood glucose measurement of 70 mg/ dl (3.9 mmol/l) or less) [52]. In the USA, the reported prevalence of hypoglycaemia in inpatients is from 3 to 29% [53][54][55][56]. The risk factors for developing inpatient hypoglycemia include older age, presence of comorbidities, diabetes, increasing number of antidiabetic agents, tight glycaemic control, septic shock, renal insufficiency, mechanical ventilation, and severity of illness [57,58].…”

Section: Hypoglycaemia and Outcomesmentioning

confidence: 99%

The impact of glycaemic variability on the surgical patient

Dhatariya

Levy

Hall

2016

Current Opinion in Anaesthesiology

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Section: Hypoglycaemia and Outcomesmentioning

confidence: 99%

The impact of glycaemic variability on the surgical patient

Dhatariya

Levy

Hall

2016

Current Opinion in Anaesthesiology

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“…The prevalence of hypoglycemia in critically ill patients ranged between 5% and 28%, [18] and in noncritical care settings between 1% and 33%. [19] The most common risk factors are older age, change in nutritional intake (reduced oral intake, emesis, unexpected interruption of enteral or parenteral feedings), inappropriate administration of short-acting insulin's relation to meals and failure to adjust treatment when we reduce the infusion rate of intravenous dextrose or steroid therapy. [20,21] Hypoglycemia in hospitalized T2DM patients has been associated with poor outcomes and 2.8 days longer hospital stay.…”

Section: Treatment Of Hypoglycemiamentioning

confidence: 99%

Management of hospitalized type 2 diabetes mellitus patients

Marín-Peñalver

Martín-Timón

Cañizo-Gómez

2016

Journal of Translational Internal Medicine

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Both hyperglycemia and hypoglycemia in hospitalized patients are associated with adverse outcomes including increased rates of infection, longer hospital length of stay, and even death. Clinical trials in patients with type 2 diabetes mellitus proved that by improving glycemic control, we can reduce all of them. Insulin is the preferred treatment for glycemic control in most cases, but alternative treatment options that can normalize blood glucose levels without hypoglycemia are being sought. Moreover, hospitalized patients are particularly vulnerable to severe, prolonged hypoglycemia since they may be unable to sense or respond to the early warning signs and symptoms of low blood glucose. Finally, nutritional support, corticosteroid therapy, and surgery increase the risk of hyperglycemia that leads to an increased risk of morbidity and mortality. We review the management of type 2 diabetes mellitus patients who are admitted to the general medical wards of the hospital for a procedure of intercurrent illness.

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“…Correction or supplemental insulin aims to control existing excessive hyperglycemia. The use of insulin regimens that consider these components is an effective strategy to control hyperglycemia and to maintain euglycemia in hospitalized noncritically ill patients [11, 25,26]. Correction or supplemental insulin should be distinguished from sliding scale insulin, which refers to insulin administered as monotherapy on an 'as needed' basis in an attempt to treat hyperglycemia after it occurs.…”

Section: Management Of Hyperglycemia In the Medical And Surgical Wardsmentioning

confidence: 99%

Management of Hyperglycemia in Hospitalized Patients: Noncritical Care Setting

Pichardo-Lowden¹

2014

Frontiers in Diabetes

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Hyperglycemia is a common in-hospital problem and is associated with poor clinical outcomes. A critical review of pertinent studies and peer-reviewed publications related to inpatient glycemia was conducted. Diabetes mellitus is a problem of worldwide proportion that leads to frequent hospitalization. Hyperglycemia is often found in inpatient settings and is associated with increased risk of morbidity and mortality, surgical interventions, in-hospital infections and surgical site infections, higher admission rates to intensive care units (ICUs), increased hospital length of stay, and increased postdischarge care needs. In some studies, improved inpatient glycemia showed a positive impact in clinical outcomes. Attainment of adequate glycemic control requires addressing various clinical scenarios. The approach to hyperglycemia should abide by the principles of provision of adequate insulin regimens that consider the individual clinical situation of patients and aim for safe glucose targets. The control of hyperglycemia in the nonintensive care setting is a relevant clinical problem that requires effective and prudent strategies. This chapter provides an overview of scenarios encountered in general medical and surgical units, offers a practical approach to management of dysglycemia, lists factors contributing to hyperglycemia and hypoglycemia, reviews the recommended targets for treatment, and presents a strategy for transition to outpatient care. The research evidence available suggests that hyperglycemia is associated with poor clinical outcomes in critically and noncritically ill patients. Additionally, tight glycemic control increases the risk for hypoglycemia and mortality, and less stringent glucose targets may result in lower rates of hypoglycemia. Therefore, judicious glucose control, as opposed to stringent near-normal control proposed in previous clinical guidelines and statements, is probably sufficient to prevent poor clinical outcomes related to hyperglycemia in the ICU. The data available in non-ICU settings is less robust; however, good glucose management remains important in hospitalized patients across clinical units and an attentive attitude toward care of inpatient hyperglycemia should prevail among providers.

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Comparison of Inpatient Insulin Regimens with Detemir plus Aspart Versus Neutral Protamine Hagedorn plus Regular in Medical Patients with Type 2 Diabetes

Abstract: Treatment with basal/bolus regimen with detemir once daily and aspart before meals results in equivalent glycemic control and no differences in the frequency of hypoglycemia compared to a split-mixed regimen of NPH and regular insulin in patients with type 2 diabetes.

Cited by 148 publications

References 38 publications

The impact of glycaemic variability on the surgical patient

The impact of glycaemic variability on the surgical patient

Management of hospitalized type 2 diabetes mellitus patients

Management of Hyperglycemia in Hospitalized Patients: Noncritical Care Setting

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