Hyperglycemia in Acutely Ill Patients

Incidence, predictors, and outcomes of malignant cerebral edema after acute basilar artery occlusion thrombectomy

“…Moreover, in contrast to previous studies, we did not observe a positive correlation among fasting blood glucose levels and pronounced edema 5 10. The potential explanations for the variable finding are as follows: on the one hand, a lower density of sympathetic innervation in the posterior circulation would lead to attenuated stress reactivity in the neuroendocrine axis and minimize the pathological consequences of stress-mediated hyperglycemia 12 29. On the other hand, chronic hyperglycemia could induce the downregulation of glucose transporters and upregulate the threshold of stress hyperglycemia.…”

“…On the other hand, chronic hyperglycemia could induce the downregulation of glucose transporters and upregulate the threshold of stress hyperglycemia. Non-diabetic individuals exhibit a higher propensity for immunological impairment and microcirculatory dysfunction, thus leading to MCE formation 29. Successful recanalization in patients may potentiate redox-mediated cellular responses, correlated with admission hyperglycemic states 30.…”

Incidence, predictors, and outcomes of malignant cerebral edema after acute basilar artery occlusion thrombectomy

“…Moreover, in contrast to previous studies, we did not observe a positive correlation among fasting blood glucose levels and pronounced edema 5 10. The potential explanations for the variable finding are as follows: on the one hand, a lower density of sympathetic innervation in the posterior circulation would lead to attenuated stress reactivity in the neuroendocrine axis and minimize the pathological consequences of stress-mediated hyperglycemia 12 29. On the other hand, chronic hyperglycemia could induce the downregulation of glucose transporters and upregulate the threshold of stress hyperglycemia.…”

“…On the other hand, chronic hyperglycemia could induce the downregulation of glucose transporters and upregulate the threshold of stress hyperglycemia. Non-diabetic individuals exhibit a higher propensity for immunological impairment and microcirculatory dysfunction, thus leading to MCE formation 29. Successful recanalization in patients may potentiate redox-mediated cellular responses, correlated with admission hyperglycemic states 30.…”

The association between glycaemic control during hospitalization and risk of adverse events: A retrospective cohort study

“…Thus, the practice of using intensive insulin therapy to achieve tight glycaemic control among critically ill patients has not been justified by these studies given such practice may not improve mortality and can increase the risk of hypoglycaemia 34 . Studies performed so far on non‐critically ill patients are fewer, and most studies have shown an increased risk of adverse outcomes among hospitalized patients with hyperglycaemia 1,4–11,26 . In our study, having a glycaemia of >10.0 mmol/L was not found to be associated with an increased risk of adverse outcomes.…”

“…34 Studies performed so far on non-critically ill patients are fewer, and most studies have shown an increased risk of adverse outcomes among hospitalized patients with hyperglycaemia. 1,[4][5][6][7][8][9][10][11]26 In our study, having a glycaemia of >10.0 mmol/L was not found to be associated with an increased risk of adverse outcomes. The meta-analysis by Murad et al 25 demonstrated similar results; intensive glycaemic control, defined largely by fasting blood glucose level between 5.6 to 10 mmol/L, was not associated with reductions of mortality, myocardial infarction or stroke risks.…”

Clinical decision support to improve management of diabetes and dysglycemia in the hospital: a path to optimizing practice and outcomes

“…Similarly, it intended to heighten the interest in improving glycemic control among patients with stress hyperglycemia who were receiving only ISS. In trying to explain the higher number of innapropriate SSI in stress hyperglycemia patients, we speculate that the low response to the messages advocating avoidance of sliding scales as monotherapy among patients with stress hyperglycemia could be related to the tendency of providers to omit stress hyperglycemia and fear of hypoglycemia when scheduling insulin 38 39. It is possible that our message promoting improvement of glucose control could have been less impactful than if it had actually stated outcome benefits from reducing stress hyperglycemia.…”

Incidence, predictors, and outcomes of malignant cerebral edema after acute basilar artery occlusion thrombectomy

“…Moreover, in contrast to previous studies, we did not observe a positive correlation among fasting blood glucose levels and pronounced edema 5 10. The potential explanations for the variable finding are as follows: on the one hand, a lower density of sympathetic innervation in the posterior circulation would lead to attenuated stress reactivity in the neuroendocrine axis and minimize the pathological consequences of stress-mediated hyperglycemia 12 29. On the other hand, chronic hyperglycemia could induce the downregulation of glucose transporters and upregulate the threshold of stress hyperglycemia.…”

“…On the other hand, chronic hyperglycemia could induce the downregulation of glucose transporters and upregulate the threshold of stress hyperglycemia. Non-diabetic individuals exhibit a higher propensity for immunological impairment and microcirculatory dysfunction, thus leading to MCE formation 29. Successful recanalization in patients may potentiate redox-mediated cellular responses, correlated with admission hyperglycemic states 30.…”

The association between glycaemic control during hospitalization and risk of adverse events: A retrospective cohort study

“…Thus, the practice of using intensive insulin therapy to achieve tight glycaemic control among critically ill patients has not been justified by these studies given such practice may not improve mortality and can increase the risk of hypoglycaemia 34 . Studies performed so far on non‐critically ill patients are fewer, and most studies have shown an increased risk of adverse outcomes among hospitalized patients with hyperglycaemia 1,4–11,26 . In our study, having a glycaemia of >10.0 mmol/L was not found to be associated with an increased risk of adverse outcomes.…”

“…34 Studies performed so far on non-critically ill patients are fewer, and most studies have shown an increased risk of adverse outcomes among hospitalized patients with hyperglycaemia. 1,[4][5][6][7][8][9][10][11]26 In our study, having a glycaemia of >10.0 mmol/L was not found to be associated with an increased risk of adverse outcomes. The meta-analysis by Murad et al 25 demonstrated similar results; intensive glycaemic control, defined largely by fasting blood glucose level between 5.6 to 10 mmol/L, was not associated with reductions of mortality, myocardial infarction or stroke risks.…”

Clinical decision support to improve management of diabetes and dysglycemia in the hospital: a path to optimizing practice and outcomes

“…Similarly, it intended to heighten the interest in improving glycemic control among patients with stress hyperglycemia who were receiving only ISS. In trying to explain the higher number of innapropriate SSI in stress hyperglycemia patients, we speculate that the low response to the messages advocating avoidance of sliding scales as monotherapy among patients with stress hyperglycemia could be related to the tendency of providers to omit stress hyperglycemia and fear of hypoglycemia when scheduling insulin 38 39. It is possible that our message promoting improvement of glucose control could have been less impactful than if it had actually stated outcome benefits from reducing stress hyperglycemia.…”

Incidence, predictors, and outcomes of malignant cerebral edema after acute basilar artery occlusion thrombectomy

“…Moreover, in contrast to previous studies, we did not observe a positive correlation among fasting blood glucose levels and pronounced edema 5 10. The potential explanations for the variable finding are as follows: on the one hand, a lower density of sympathetic innervation in the posterior circulation would lead to attenuated stress reactivity in the neuroendocrine axis and minimize the pathological consequences of stress-mediated hyperglycemia 12 29. On the other hand, chronic hyperglycemia could induce the downregulation of glucose transporters and upregulate the threshold of stress hyperglycemia.…”

“…On the other hand, chronic hyperglycemia could induce the downregulation of glucose transporters and upregulate the threshold of stress hyperglycemia. Non-diabetic individuals exhibit a higher propensity for immunological impairment and microcirculatory dysfunction, thus leading to MCE formation 29. Successful recanalization in patients may potentiate redox-mediated cellular responses, correlated with admission hyperglycemic states 30.…”

The association between glycaemic control during hospitalization and risk of adverse events: A retrospective cohort study

“…Thus, the practice of using intensive insulin therapy to achieve tight glycaemic control among critically ill patients has not been justified by these studies given such practice may not improve mortality and can increase the risk of hypoglycaemia 34 . Studies performed so far on non‐critically ill patients are fewer, and most studies have shown an increased risk of adverse outcomes among hospitalized patients with hyperglycaemia 1,4–11,26 . In our study, having a glycaemia of >10.0 mmol/L was not found to be associated with an increased risk of adverse outcomes.…”

“…34 Studies performed so far on non-critically ill patients are fewer, and most studies have shown an increased risk of adverse outcomes among hospitalized patients with hyperglycaemia. 1,[4][5][6][7][8][9][10][11]26 In our study, having a glycaemia of >10.0 mmol/L was not found to be associated with an increased risk of adverse outcomes. The meta-analysis by Murad et al 25 demonstrated similar results; intensive glycaemic control, defined largely by fasting blood glucose level between 5.6 to 10 mmol/L, was not associated with reductions of mortality, myocardial infarction or stroke risks.…”

Clinical decision support to improve management of diabetes and dysglycemia in the hospital: a path to optimizing practice and outcomes

“…Similarly, it intended to heighten the interest in improving glycemic control among patients with stress hyperglycemia who were receiving only ISS. In trying to explain the higher number of innapropriate SSI in stress hyperglycemia patients, we speculate that the low response to the messages advocating avoidance of sliding scales as monotherapy among patients with stress hyperglycemia could be related to the tendency of providers to omit stress hyperglycemia and fear of hypoglycemia when scheduling insulin 38 39. It is possible that our message promoting improvement of glucose control could have been less impactful than if it had actually stated outcome benefits from reducing stress hyperglycemia.…”