Inpatient Management of Hyperglycemia and Diabetes

Magaji, Vasudev; Johnston, Jann M.

doi:10.2337/diaclin.29.1.3

Cited by 45 publications

(49 citation statements)

References 31 publications

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“…Uncontrolled hyperglycemia in hospitalized patients, with or without a previous diagnosis of diabetes, has been associated with adverse outcomes and longer lengths of stay [21]. Hyperglycemia is a common phenomenon in critically ill patients, and can be attributed to a variety of different reasons [22][23].…”

Section: Discussionmentioning

confidence: 99%

Feasibility and safety of continuous glucose monitoring systems in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions

Zhang¹,

Ling²,

Cao³

et al. 2015

CIM

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Feasibility and safety of continuous glucose monitoring systems in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions AbstractPurpose: The purpose of this study was to evaluate the feasibility and safety of continuous glucose monitoring systems (CGMS) in ST segment elevation myocardial infarction (S-TEMI) patients undergoing primary percutaneous coronary interventions (p-PCI) in coronary care units (CCU).Methods: CGMS was performed for 3 days during CCU hospitalization for each of the subjects. The correlation between glucose values, recorded with CGMS, and finger-stick capillary glucose values was examined. The parameters and safety of CGMS were also investigated.Results: Data from 219 subjects were included in the statistical analysis. Correlation analysis showed a strong positive correlation between interstitial glucose values recorded by CGMS and the corresponding capillary glucose values (P<0.001). The daytime mean blood glucose MBG), the nighttime MBG and PT7.8 were the highest in the first day of CGMS compared with the second and third day. Furthermore, there were no indications of major hemorrhage or hematoma at the site of sensor insertion. Any adverse events were mild.Conclusions: CGMS glucose values are relatively accurate and reliable. CGMS were safe and can be used as a tool to detect trends in glucose levels and to predict upcoming glucose excursions in STEMI patients undergoing p-PCI. It is commonly accepted that continuous glucose monitoring systems (CGMS) can provide detailed and accurate glucose information. Relaying this detailed glucose information to patients has been shown to have a positive influence on glycemic control, including reductions in glucose variability, time spent in nocturnal hypoglycemia, time spent in hyperglycemia and levels of glycosylated hemoglobin [1][2][3][4]. Hyperglycemia commonly occurs during acute myocardial infarction (AMI), and in-hospital hyperglycemia is a strong predictor of mortality in AMI patients both with and without a history of diabetes mellitus [5][6]. The adverse outcomes associated with in-hospital hyperglycemia have prompted professional societies to recommend glucose control in AMI patients [5][6][7]; however, implementation of glucose control has been hindered by fear of hypoglycemia, as low glucose levels have been associated with adverse outcomes in AMI patients [8][9]. Patients with STsegment elevation myocardial infarction (STEMI) who are undergoing primary percutaneous coronary interventions (p-PCI) should receive aggressive management and treatment in coronary care units (CCU). As glucose management is a significant component of CCU activity, CGMS are particularly attractive for managing blood glucose (BG) because of their potential to detect hypo-and hyperglycemia as they occur. Many studies have concluded that CGMS face challenges in terms of sensitivity, stability, calibration and the physiological delay between BG and interstitial glucose (IG) concentration [10][11][12]. Moreover, CGMS are more e...

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Section: Discussionmentioning

confidence: 99%

Feasibility and safety of continuous glucose monitoring systems in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions

Zhang¹,

Ling²,

Cao³

et al. 2015

CIM

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“…Even in patients without a previous diagnosis of DM, uncontrolled hyperglycemia, regardless of cause during hospitalization, is associated with adverse outcomes and longer lengths of stay [8,9].…”

Section: A Call To Actionmentioning

confidence: 99%

Hospital-Based Management of Diabetes Mellitus

Ford

Brogan

Volturo

et al. 2014

Curr Emerg Hosp Med Rep

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Patients with insulin-dependent diabetes mellitus or noninsulin-dependent diabetes mellitus are frequently admitted to a hospital, usually for primary conditions other than diabetes. In addition to endorsing tight glycemic control in critical care units, current standards of care recommend treatment targets similar to those of outpatients for noncritically ill patients in hospital. Given the current prevalence of diabetes (DM), how best to address hyperglycemia in the Emergency Department (ED) is an increasingly relevant issue in which the principal goals are to minimize disruption of the metabolic state and achieve a stable glycemic balance as promptly as possible. Transition of care from the ED to an inpatient service can result in gaps in comprehensive care, particularly in patients with DM who may have other serious comorbidities. In critically ill patients, insulin therapy should be initiated for treatment of persistent hyperglycemia, starting at [180 mg/dL (10 mmol/ L). After insulin therapy has been started, the standard of care recommends a random glucose range of 140-180 mg/dL (7.8-10 mmol/L) for the majority of hospitalized patients. The traditional model of care among hospital-based physicians has been to treat the diabetic patient with a regular insulin on a sliding scale. Current evidence suggests that while this approach is straightforward, it may not be the best for patient care. Patients who present to the ED or are hospitalized often require an insulin regimen that can change rapidly as their condition changes. A basal/bolus insulin regimen fulfills those criteria and mimics a normal insulin profile.Keywords Diabetes related heart disease Á Insulindependent diabetes mellitus Á Emergency and hospital medicine Á Cardiovascular health Á Noninsulin-dependent diabetes mellitus Á Hospital-based management of DM

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“…18 O uso de glicocorticóides de ação intermédia pela manhã tende a provocar hiperglicemia durante os períodos pós-prandiais do almoço e do jantar. 19 De facto, doentes tratados com prednisolona (glicocorticóide de ação intermédia mais utilizado na práti-ca clínica) pela manhã apresentam elevação das glicemias capilares nos períodos entre as 12h e as 24h.…”

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“…25 As sulfonilureias comportam ainda o risco de hipoglicemia em doentes que de forma não previsível deixam de comer. 18 Os inibidores da DPP-4 aumentam a secreção de insulina e diminuem a secreção de glucagon, condicionando um importante efeito anti-hiperglicemiante na glicemia pós--prandial. Apresentam ainda um rápido início de ação e um baixo risco de hipoglicemia uma vez que atuam de forma glicose-dependente.…”

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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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Inpatient Management of Hyperglycemia and Diabetes

Abstract: IN BRIEF Control of hyperglycemia in hospitalized patients is important for optimal clinical outcomes, but can be very challenging. This article provides practical recommendations for insulin therapy for common situations that arise during hospitalization.

Cited by 45 publications

References 31 publications

Feasibility and safety of continuous glucose monitoring systems in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions

Feasibility and safety of continuous glucose monitoring systems in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions

Hospital-Based Management of Diabetes Mellitus

Abordagem e Tratamento da Hiperglicemia Induzida por Glicocorticóides

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