Inpatient hyperglycemia: Clinical management needs in teaching hospital

Tamez-Pérez, Héctor Eloy; Quintanilla-Flores, Dania Lizet; Proskauer-Peña, S.L.; González-González, José Gerardo; Hernández-Coria, Mayra Ivonne; Garza-Garza, Lucas A.; Tamez-Peña, Alejandra Lorena

doi:10.1016/j.jcte.2014.09.004

Cited by 8 publications

(16 citation statements)

References 15 publications

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“…14 Início de insulinoterapia em doentes sem insulinoterapia prévia 7,14,17,20,25 Terapêutica com glicocorticóide de duração intermédia, uma administração pela manhã. Deve iniciar-se insulina NPH antes do pequeno-almoço, pois o seu perfil de ação acompanha o efeito hiperglicemiante do glicocorticóide.…”

Section: Insulinaunclassified

“…Relativamente à administração intra-articular, deve ter-se o cuidado de suspender a administração de insulina dois a três dias após a última infiltração. 7,14,17,20,25 Nestes casos, deve-se calcular a dose de insulina adicional necessária de acordo com a Tabela 2. O esquema de insulina deverá ser mantido e a este deverão ser acrescentadas as doses de insulina calculadas.…”

Section: Insulinaunclassified

“…A hiperglicemia parece, igualmente, aumentar o risco de infeção 5 e morbimortalidade, e ainda contribuir para o prolongamento do tempo de internamento e do custo associado. 6,7 A prevalência da HIG varia de acordo com diferentes estudos. 8 Estima-se que a sua incidência em doentes hospitalizados com ou sem história conhecida de diabetes varie entre 20% e 50%.…”

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Abordagem e Tratamento da Hiperglicemia Induzida por Glicocorticóides

Paredes

Alves

2016

Acta Med Port

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RESUMOIntrodução: Os glicocorticóides associam-se a vários efeitos adversos, entre os quais se destaca uma importante ação diabetogé-nica. A hiperglicemia induzida pelos glicocorticóides trata-se de uma condição com elevada prevalência e que condiciona importante morbimortalidade. Material e Métodos: Realizou-se uma revisão da literatura relativa à abordagem e tratamento da hiperglicemia induzida pelos glicocorticóides Resultados: Embora não totalmente esclarecidos, sabe-se que vários mecanismos concorrem de forma sinérgica, propiciando o aparecimento da hiperglicemia em doentes não diabéticos e o agravamento do controlo glicémico em diabéticos. A hiperglicemia induzida por glicocorticóides apresenta padrões característicos, mais marcada no momento pós-prandial e muito dependente do horário da toma do glicocorticóide. Apesar da existência de normas de orientação gerais para o tratamento da hiperglicemia em doentes em ambulatório e em doentes hospitalizados não críticos, o mesmo não acontece no que diz respeito ao tratamento da hiperglicemia induzida por glicocorticóides. E, de facto, frequentemente é difícil e exigente a abordagem deste tipo de hiperglicemia, sendo necessária uma atuação específica. Esta abordagem depende não só do glicocorticóide em causa, como também da sua dose, frequência e horário de administração. De igual forma, a escolha do esquema de tratamento também depende do tipo de terapêutica previamente usado. Discussão e Conclusão: Os autores fizeram uma revisão do tema, congregando e definindo linhas orientadoras para o tratamento da hiperglicemia induzida por glicocorticóides, em doentes diabéticos e não diabéticos, em regime de ambulatório ou internamento, que serão úteis em diferentes contextos e transversalmente às diversas especialidades. Palavras-chave: Glucocorticóides/efeitos adversos; Hiperglicemia/diagnóstico; Hiperglicemia/induzida quimicamente; Hiperglicemia/ tratamento. ABSTRACT Introduction:Glucocorticoids have been associated to several side effects, specially a diabetogenic action, the most common and representative effect. Glucocorticoid-induced hyperglycemia is a common medical condition, with general associated morbidity and mortality. Material and Methods: It was performed a literature review about the management and treatment of glucocorticoid-induced hyperglycemia.Results: Through numerous not quite fully understood mechanics, glucocorticoids promote hyperglycemia in non-diabetic patients and worsen diabetes control in diabetic individuals. Glucocorticoid-induced hyperglycemia presents key patterns, enhanced in the postprandial period and scheduled-dependent. Despite the existence of guidelines for hyperglycemia treatment in non-critic hospitalized and non-hospitalized patients, there are no guidelines respecting glucocorticoid-induced hyperglycemia. Nevertheless, it is known that glucocorticoid-induced hyperglycemia is complex and demanding, requiring a specific approach. Indeed, glucocorticoid-induced hyperglycemia treatment depends on the glucocorticoid used, its dose, ...

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Section: Insulinaunclassified

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Abordagem e Tratamento da Hiperglicemia Induzida por Glicocorticóides

Paredes

Alves

2016

Acta Med Port

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“…Hyperglycemia is frequently viewed as a secondary concern, a non-consequential manifestation of acute illness, or a state that will subside upon the resolution of illness. These views potentially allow type 2 diabetes to remain undiagnosed and the conduct of a proper risk assessment, either in the hospital or subsequent to inpatient care to be delayed 34 , 36 , 37 .…”

Section: Introductionmentioning

confidence: 99%

Lack of recognition and documentation of stress hyperglycemia is a disruptor of optimal continuity of care

Moyer

Lehman

Bolton

et al. 2021

Sci Rep

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Stress hyperglycemia (SH) is a manifestation of altered glucose metabolism in acutely ill patients which worsens outcomes and may represent a risk factor for diabetes. Continuity of care can assess this risk, which depends on quality of hospital clinical documentation. We aimed to determine the incidence of SH and documentation tendencies in hospital discharge summaries and continuity notes. We retrospectively examined diagnoses during a 12-months period. A 3-months representative sample of discharge summaries and continuity clinic notes underwent manual abstraction. Over 12-months, 495 admissions had ≥ 2 blood glucose measurements ≥ 10 mmol/L (180 mg/dL), which provided a SH incidence of 3.3%. Considering other glucose states suggestive of SH, records showing ≥ 4 blood glucose measurements ≥ 7.8 mmol/L (140 mg/dL) totaled 521 admissions. The entire 3-months subset of 124 records lacked the diagnosis SH documentation in discharge summaries. Only two (1.6%) records documented SH in the narrative of hospital summaries. Documentation or assessment of SH was absent in all ambulatory continuity notes. Lack of documentation of SH contributes to lack of follow-up after discharge, representing a disruptor of optimal care. Activities focused on improving quality of hospital documentation need to be integral to the education and competency of providers within accountable health systems.

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“…The fear of causing hypoglycemia[ 3 ] and the clinical inertia of no treatment remain the main barriers for initiating insulin. Physicians commonly use a sliding-scale regimen until stabilization of glucose levels[ 7 ]; however, a study by Umpierrez et al[ 8 ] found that a basal-bolus insulin algorithm was more effective than a sliding-scale regimen for glucose control.…”

Section: Introductionmentioning

confidence: 99%

Neutral protamine hagedorn/regular insulin in the treatment of inpatient hyperglycemia: Comparison of 3 basal-bolus regimens

Quintanilla-Flores

González-González

Cruz

et al. 2017

WJD

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AIMTo compare the safety and efficacy or 3 basal-bolus regimens of neutral protamine hagedorn (NPH)/regular insulin in the management of inpatient hyperglycemia.METHODSWe randomized 105 patients with blood glucose levels between 140 and 400 mg/dL to a basal-bolus regimen of NPH insulin given once (n = 30), twice (n = 40) or three times (n = 35) daily, in addition to pre-meal regular insulin. Major outcomes included were differences in glycemic control, frequency of hypoglycemia and total insulin dose.RESULTSNPH insulin given in a once-daily regimen was associated with better glycemic control (58.3%) compared to twice daily (42.4%) and three times daily (48.9) regimens (P = 0.031). The frequency of hypoglycemia was similar between the three groups (2.0%, 0.7% and 1.2%, P = 0.21). The mean insulin dose at discharge was 0.48 ± 0.14 U/kg in the once-daily group compared to 0.69 ± 0.28 in the twice-daily, and 0.65 ± 0.20 in the three times daily regimens (P < 0.001).CONCLUSIONNPH insulin administered in a once-daily regimen resulted in improvement in glycemic control with similar rates of hypoglycemia compared to a twice-daily and a three times-daily regimen. Further studies are needed to evaluate whether this regimen could be implemented in all hospitalized patients with hyperglycemia.

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Inpatient hyperglycemia: Clinical management needs in teaching hospital

Cited by 8 publications

References 15 publications

Abordagem e Tratamento da Hiperglicemia Induzida por Glicocorticóides

Abordagem e Tratamento da Hiperglicemia Induzida por Glicocorticóides

Lack of recognition and documentation of stress hyperglycemia is a disruptor of optimal continuity of care

Neutral protamine hagedorn/regular insulin in the treatment of inpatient hyperglycemia: Comparison of 3 basal-bolus regimens

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