Over the past few years, glycemic
control has engendered large numbers of investigations,
with conflicting results. The world has largely embraced
intensive insulin as a practice, but applies this
therapy with great variability in the manner of glucose
control and measurement.
To see where glycemic control stands today,
GlycemicControl.net has created a short survey and
request your participation. The survey should take only
a few minutes to complete and results will be available
www.glycemiccontrol.net website in April so we ask
that you complete the survey by March 25.
Go to the Glycemic Control Survey >
Thank you in advance for your cooperation.
Evaluation of a Nurse-Managed
Insulin Infusion Protocol
Passarelli Andrea J., Gibbs Haley, Rowden
Annette M., Efird Leigh, Zink Elizabeth, and
Mathioudakis Nestoras. Diabetes Technology &
Therapeutics. February 2016, 18(2): 93-99.
The purpose of this study was to evaluate the
performance of an insulin infusion protocol targeting a
blood glucose (BG) level of 140–180mg/dL and to
characterize protocol adherence.
This was a retrospective observational cohort study
including patients for whom the protocol was ordered
from January 2012 to May 2013. Performance metrics were
assessed in all patients and in patients with an initial
BG level of ≥200mg/dL. Protocol adherence was assessed
in a random subset of 50 patients without hypoglycemia
and in all hypoglycemic patients.
This protocol provides adequate BG control within the
clinically acceptable range of 80–199mg/dL but not
within the narrower range of 140–180mg/dL, with a low
incidence of hypoglycemia. Risk factors for hypoglycemia
and barriers to protocol adherence in the cardiac
surgery population should be elucidated.
Read more >
Teamwork Boosts Glycemic Control
in Surgical Patients
Pharmacist-led group fosters improved outcomes up to 2
by Jeff Minerd, Contributing Writer,
A team of hospital pharmacists dedicated to optimizing
perioperative glycemic control improved outcomes and
reduced costs for surgical patients with diabetes or
hyperglycemia due to surgical stress, researchers
After the team went to work, rates of glycemic control
doubled, hypoglycemia declined by about 70%, and
hospital readmissions declined by more than 30% among
surgical patients, according to...
read more >
Glycemic management: Protocols
combined With system-wide technology can minimize
penalties and maximize patient care There are two
medical conditions that clearly impact quality, costs
and patient safety but are often not addressed because
their critical role in patient recovery may not be
top-of-mind for many clinicians when dealing with a
myriad of treatment concerns for the hospitalized
Read More >
Pre-morbid Glycemic Control Modifies the Interaction
between Acute Hypoglycemia and Mortality
By Moritoki Egi, James S. Krinsley,
Paula Maurer, Devendra N. Amin, Tomoyuki Kanazawa,
Shruti Ghandi, Kiyoshi Morita, Michael Bailey, Rinaldo
Bellomo. February 2016. Intensive Care Medicine,
Springer International Publishing.
The purpose of this was to study the impact of
pre-morbid glycemic control on the association between
acute hypoglycemia in intensive care unit (ICU) patients
and subsequent hospital mortality in critically ill
The authors performed a
multicenter, multinational, retrospective observational
study of patients with available HbA1c levels within the
3-month period preceding ICU admission. They separated
patients into three cohorts according to pre-admission
HbA1c levels (<6.5, 6.5–7.9, ≥8.0 %, respectively).
Based on published data, and defined a glucose
concentration of 40–69 mg/dL (2.2–3.8 mmol/L) as
moderate hypoglycemia and <40 mg/dL (<2.2 mmol/L) as
severe hypoglycemia. They then applied logistic
regression analysis to study the impact of pre-morbid
glycemic control on the relationship between acute
hypoglycemia and mortality.
The take-home message is that
critically ill patients with higher pre-admission HbA1c
More on this article can be found on the
ICM, Intensive Care Medicine website.
Note access to the
complete article is available for a fee.
Management of Diabetes: The Future is Now
MLO | February 2016 | By: Ross
Molinaro and Carole Dauscher
is a worldwide epidemic. Its prevalence continues to
rise globally at an average rate of 8.7 percent, and it
currently affects 382 million of the world’s population.
Significant increases in populations diagnosed with
diabetes have been reported by many nations as their
lifestyle and dietary norms evolve with globalization.
National healthcare budgets bear the financial burden of
treating diabetes and its complications, exceeding $548
billion dollars globally.1
Through the power of diagnostic testing to help screen,
diagnose, and monitor, a patient’s chronic condition can
be kept in balance and not allowed to escalate to a
critical state that lessens quality of life and may
require hospitalization and more expensive intervention.
The impact of diabetes
Diabetes is defined as a chronic disease that occurs
when the pancreas is no longer able to make insulin or
when the body cannot make good use of the insulin it
produces. Not being able to produce insulin or use it
effectively leads to raised glucose levels in the blood
(known as hyperglycemia). Over the long-term, high
glucose levels are a threat to well-being, and are
associated with damage to the body and failure of
various organs and tissues.
Association of Clinical Endocrinologists and American
College of Endocrinology
ENDOCRINE PRACTICE Vol 22 No. 2
February 2016 231
The measurement of glycemic status is a key element in
the care of all persons with diabetes. Glucose
monitoring (GM) enables clinicians to evaluate the
efficacy of current therapy, make insulin and medication
dose adjustments, ensure patients’ glucose levels are
within therapeutic goal ranges, and monitor treatment
Both capillary blood glucose
monitoring (BGM) and continuous glucose monitoring (CGM)
with interstitial fluid sensors enable patients to
better understand the impact of diet, exercise, illness,
stress, and medications on glucose levels and to
recognize and treat hypoglycemic and hyperglycemic
episodes. Likewise, both BGM and CGM have been shown to
improve the efficacy and safety of diabetes therapy.