ISPAD Clinical Practice Consensus Guidelines 2018: Management of children and adolescents with diabetes requiring surgery

Jefferies, Craig; Rhodes, Erinn T.; Rachmiel, Marianna; Agwu, Juliana Chizo; Kapellen, Thomas; Abdulla, Mohamed; Hofer, Sabine E.

doi:10.1111/pedi.12733

Cited by 28 publications

(38 citation statements)

References 51 publications

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“…Therefore, one might criticize that BG target range of 4 to 8 mmol/L, selected in the study presented here, was too tight. The current guideline of ISPAD, in contrast, recommend to keep BG values between 4 and 10 mmol/L and 5 and 10 mmol/L during intercurrent illness or surgery in pediatric patients, respectively …”

Section: Discussionmentioning

confidence: 53%

“…Typical problems are distinct blood glucose (BG) fluctuation, hyperglycemia, and diabetic ketoacidosis because of increased insulin requirements, for example, during infections with fever. In gastroenteritis along with diarrhea and vomiting, as well as loss of appetite and therefore, a decreased food intake, patients could experience more hypoglycemia . Owing to these acute complications, comorbidity and mortality are increased in patients with T1D during intercurrent illness or surgery .…”

Section: Introductionmentioning

confidence: 99%

“…Continuous IV insulin infusion therapy is advantageous as it minimizes BG fluctuations and acute complications resulting in better outcomes of the patients . However, there is still a controversial discussion about safe glycemic targets among critically ill patients to achieve an optimal outcome and prevent complications . Especially, data on glycemic targets, adequate fluid, and insulin dosage during IV insulin infusion therapy in pediatric patients with T1D are rare .…”

Section: Introductionmentioning

confidence: 99%

“…However, there is still a controversial discussion about safe glycemic targets among critically ill patients to achieve an optimal outcome and prevent complications . Especially, data on glycemic targets, adequate fluid, and insulin dosage during IV insulin infusion therapy in pediatric patients with T1D are rare . So far, different regimes for IV insulin infusion therapy exist; none of them was proven as “gold standard.” The aim of this study was to evaluate the effectiveness and safety of the local protocol for IV insulin infusion therapy in children and adolescents with T1D hospitalized because of intercurrent illness or surgery.…”

Section: Introductionmentioning

confidence: 99%

“…diarrhea and vomiting, as well as loss of appetite and therefore, a decreased food intake, patients could experience more hypoglycemia. 5,6 Owing to these acute complications, comorbidity and mortality are increased in patients with T1D during intercurrent illness or surgery. 5,7,8 Adequate sick day management including carefully adapted insulin therapy is indispensable to prevent metabolic crisis in these patients.…”

Section: Introductionmentioning

confidence: 99%

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Review of Leipzig protocol for intravenous insulin infusion in pediatric patients with type 1 diabetes during intercurrent illness and surgery

et al. 2019

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Objective Continuous intravenous (IV) insulin infusion therapy minimizes blood glucose (BG) fluctuations and prevents metabolic deterioration in pediatric patients with type 1 diabetes (T1D) during intercurrent illness and surgery. However, data on the adequate fluid and insulin substitution in this situation is rare. We evaluated the effectiveness and safety of IV insulin therapy according to our local protocol. Methods Retrospective study of 124 cases of hospitalization with IV insulin therapy because of intercurrent illness (n = 78) or minor surgery (n = 46) in 62 patients with T1D (mean age: 9.6 ± 5.4 years). The patients received a glucose‐electrolyte infusion and short‐acting insulin (normal insulin). Infusion rate was adapted according to the BG measured hourly. Glycemic control was analyzed in subgroups subdivided by age, glycated hemoglobin (HbA1c) and reason for hospitalization. Results Mean infusion time was 22 hours (range 1.5‐147 hours). In 65% of the infusion time, patients' BG was within the target range (4‐8 mmol/L). Critical events (BG <3 or > 15 mmol/L) were found in 6% of the infusion time. Comparison of glycemic control in subgroups for HbA1c and the reason for hospitalization revealed no significant differences. However, patients aged <12 years exhibited significant more critical events, primarily hypoglycemia compared to adolescents (hypoglycemia/case 2.4 ± 2.7 vs 0.9 ± 2.0; P < 0.001). Conclusions Our protocol for IV insulin therapy proved to be appropriate for adequate glycemic control in pediatric patients with T1D during intercurrent illness and surgery. However, the regime seems to be more suitable in adolescents. We adapted our protocol in younger patients with reduction of the insulin dose.

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Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%