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Time in blood glucose range 70 to 140 mg/dl >80% is strongly associated with increased survival in non-diabetic critically ill adults
James S Krinsley and Jean-Charles Preiser

Hyperglycemia, hypoglycemia and increased glucose variability are independently associated with
increased risk of death in critically ill adults. The relationship between time in targeted blood glucose range (TIR) and mortality is not well described and may be a factor that has confounded the results of the major interventional trials of intensive insulin therapy.

In this study, the authors conducted a retrospective analysis of prospectively collected data involving 3,297 patients with intensive care unit (ICU) lengths of stay (LOS) of ≥1.0 day who were admitted between 1 January 2009 and 31 December 2013 to a single mixed medical-surgical ICU. We investigated the relationship between TIR 70 to 140 mg/dl with mortality and compared outcomes of non-diabetics (NON) and individuals with diabetes mellitus (DM), including stratifying by TIR above (TIR-hi) and below (TIR-lo) the median value for the NON and DM groups.  More >

Easier Blood-Sugar Monitoring for Diabetics
Advances include smart contact lenses and improved continuous glucose monitors

By Joseph Walker, June 29, 2015, The Wall Street Journal

A new generation of devices promises an easier way to measure blood sugar in people with diabetes—and in doing so reduce the chances that the disease will lead to long-term complications.

Building on advances in wireless telecommunications, nanotechnology and predictive software algorithms, the devices aim to automate a daily chore that most patients still perform manually by drawing blood samples with a prick of the finger, a tedious and sometimes painful measurement technique.

Diabetes, which affects 29 million people in the U.S., occurs when the body is unable to metabolize sugar, or glucose, into energy, leading to high concentrations of sugar in the blood. If left untreated, diabetes can lead to long-term complications including blindness, heart disease and kidney damage.

 

Some diabetic patients prick their fingers as many as 10 times a day to track their blood sugar. But doctors say finger pricking provides only a snapshot of blood sugar and doesn’t show whether it is rising or falling to potentially dangerous levels.  More >

Performance of Cleared Blood Glucose Monitors
David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE1, and Priya Prahalad, MD, PhD, Journal of Diabetes Science and Technology, June 2015

Cleared blood glucose monitor (BGM) systems do not always perform as accurately for users as they did to become cleared. We performed a literature review of recent publications between 2010 and 2014 that present data about the frequency of inaccurate performance using ISO 15197 2003 and ISO 15197 2013 as target standards. We performed an additional literature review of publications that present data about the clinical and economic risks of inaccurate BGMs for making treatment decisions or calibrating continuous glucose monitors (CGMs). More >
Effect of Continuous Glucose Monitoring Accuracy on Clinicians’ Retrospective Decision Making in Diabetes: A Pilot Study
Zeinab Mahmoudi, PhD1, Mette Dencker Johansen, PhD, Hanne Holdflod Nørgaard, RN, Steen Andersen, MD, Ulrik Pedersen-Bjergaard, MD, Lise Tarnow, MD,, Jens Sandahl Christiansen, MD, DMSc, FRCPI, and Ole Hejlesen, PhD, Journal of Diabetes Science and Technology, June 2015

The use of continuous glucose monitoring (CGM) in clinical decision making in diabetes could be limited by
the inaccuracy of CGM data when compared to plasma glucose measurements. The aim of the present study is to investigate the impact of CGM numerical accuracy on the precision of diabetes treatment adjustments. CGM profiles with maximum 5-day duration from 12 patients with type 1 diabetes treated with a basal-bolus insulin regimen were processed by 2 CGM algorithms, with the accuracy of algorithm 2 being higher than the accuracy of algorithm 1, using the median absolute relative difference (MARD) as the measure of accuracy.  More >

Per Capita Health Care Spending on Diabetes:

2009-2013
www.healthcostinstitute.org

Diabetes is a costly chronic condition in the United States, medical costs and productivity loss attributable to diabetes were estimated to be $245 billion in 2012.1 In this issue brief, for individuals covered by employer-sponsored insurance (ESI) and younger than age 65, per capita spending for people with a diagnosis of diabetes was compared to those without a diagnosis for the years 2009 through 2013. During that period, spending for individuals with diabetes increased by roughly $1,000 to about $15,000 per capita. The average per capita spending difference between people with and without diabetes was $10,310 .

 

Additionally, during this period, people with diabetes spent on average 2.5 times more out of pocket than people without diabetes. Among individuals with diabetes, children (ages 0 through 18) and pre-Medicare adults (ages 55 through 64) were the two groups with the highest per capita health care spending in every year of the study period. More >

Effect of Intensive Versus Standard Blood Glucose Control in Patients With Type 2 Diabetes Mellitus in Different Regions of the World
Systematic Review and Meta-analysis of Randomized Controlled Trials


Regional variation in type 2 diabetes mellitus care may affect outcomes in patients treated with intensive versus standard blood glucose control. We sought to evaluate these differences between North America and the rest of the world. More >

In-silico Closed Loop Control Validation Studies for Optimal Insulin Delivery in Type 1 Diabetes
Zavitsanou S, Mantalaris A, Georgiadis M, Pistikopoulos E.

This study presents a general closed loop control strategy for optimal insulin delivery in type 1 Diabetes Mellitus. The proposed control strategy aims towards an individualized optimal insulin delivery that consists of a patient-specific model predictive controller, a state estimator, a personalized scheduling level and an open loop optimization problem subjected to patient-specific process model and constraints. This control strategy can be also modified to address the case of limited patient data availability resulting in an "approximation" control strategy. More >

Glucose Meters in Critically Ill Patients:

What New Guidance Means for Labs
Clinical Laboratory News

What is all the buzz about use of glucose meters in critically ill patients? Glucose meters have been used for more than 30 years to provide rapid measurement of glucose on whole blood fingersticks from patients with diabetes. Originally developed for patient self-testing, glucose meter use has expanded throughout the healthcare industry. Meters currently are being used in physician offices, schools, nursing homes, ambulances, helicopters, airplanes, and cruise ships. Glucose meters have even traveled on the Space Shuttle! They are common throughout hospitals and are used for a variety of reasons, from quick checks of glucose levels to hourly glucose level monitoring as part of intensive insulin protocols. More >

Today's POCT
MAY 2015 • ADVANCE/LABORATORY • WWW.ADVANCEWEB.COM  By Jeffrey A. DuBois, PhD, HCLD/CC (ABB) FACB

Point-of-care test technologies must achieve agreement and concordance with central laboratory analyzer methods Point-of-care (POC) tests are now widely established in hospital settings, providing rapid results at the patient bedside. Increasingly, POC test methods are being used in pre-hospital settings and, as reported in the March 2015 edition1 of this magazine, are crossing the chasm into the primary care setting. More >

© 2015.  MDNLLC

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