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Continuous glucose monitoring in T1DM patients
A
Szypowska, A Ramotowska, K DŜygało, D Golicki
November 2011 European Society of Endocrinology.
Real-time continuous glucose monitoring (RT-CGM)
provides detailed information on glucose patterns
and trends, thus allowing the patients to manage
their diabetes more effectively. The aim of this
study was to explore potential beneficial effects of
the use of RTCGM on diabetes management as compared
to self blood glucose measurement (SBGM) in patients
with type 1 diabetes (T1DM), by means of a
systematic review and meta-analysis of randomized
controlled trials (RCTs).
MEDLINE, EMBASE
and The Cochrane Library were searched through by
two independent investigators for RCTs concerning
the use of RT-CGM in patients with T1DM. Only
studies with a similar insulin regimen in the
experimental and in the control group were included
in the analysis.
more >
The glucogram: A new quantitative tool for
glycemic analysis in the surgical intensive care
unit
SPA
Stawicki, D Schuster, JF Liu, J Kamal, S Erdal, AT
Gerlach, ML Whitmill, DE Lindsey, C Murphy, SM
Steinberg, and CH Cook
Department of Surgery, Division of Critical Care,
Trauma, and Burn, The Ohio State University Medical
Center, Columbus, OH 43210, USA
Glycemic control is an important aspect of patient
care in the surgical intensive care unit (SICU).
This is a pilot study of a novel glycemic analysis
tool – the glucogram. We hypothesize that the
glucogram may be helpful in quantifying the clinical
significance of acute hyperglycemic states (AHS) and
in describing glycemic variability (GV) in
critically ill patients. Serial glucose measurements
were analyzed in SICU patients with lengths of stay
(LOS) >30 days.
Glucose data were
formatted into 12-hour epochs and graphically
analyzed using stochastic and momentum indicators.
Recorded clinical events were classified as major or
minor (control). Examples of major events include
cardiogenic shock, acute respiratory failure, major
hemorrhage, infection/sepsis, etc. Examples of minor
(control) events include non-emergent bedside
procedures, blood transfusion given to a
hemodynamically stable patient, etc.
Positive/negative
indicator status was then correlated with AHS and
associated clinical events. The conjunction of
positive indicator/major clinical event or negative
indicator/minor clinical event was defined as
clinical “match”.
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Mild hypoglycemia is strongly associated with
increased intensive care unit length of stay
Annals
of Intensive Care 2011, 1:49, James Krinsley, Marcus
J. Schultz, Peter E. Spronk, Floris van Braam
Houckgeest, Johannes P. van der Sluijs, Christian
Mélot, and Jean-Charles Preiser
Hypoglycemia is associated with increased mortality
in critically ill patients. The impact of
hypoglycemia on resource utilization has not been
investigated. The objective of this investigation
was to evaluate the association of hypoglycemia,
defined as a blood glucose concentration (BG) <70
mg/dL, and intensive care unit (ICU) length of stay
(LOS) in three different cohorts of critically ill
patients. This is a retrospective investigation of
prospectively collected data, including patients
from two large observational cohorts: 3,263 patients
admitted to Stamford Hospital (ST) and 2,063
patients admitted to three institutions in The
Netherlands (NL) as well as 914 patients from the
GLUCONTROL trial (GL), a multicenter prospective
randomized controlled trial of intensive insulin
therapy.
more >
Both resistance- and
endurance-type exercise reduce the prevalence of
hyperglycaemia in individuals with impaired glucose
tolerance and in insulin-treated and
non-insulin-treated type 2 diabetic patients
J.-W.
van Dijk & R. J. F. Manders & K. Tummers & A. G.
Bonomi & C. D. A. Stehouwer & F. Hartgens & L. J. C.
van Loon, October 2011
The present study compares the impact of endurance-
vs resistance-type exercise on subsequent 24 h blood
glucose homeostasis in individuals with impaired
glucose tolerance (IGT) and type 2 diabetes.
Fifteen
individuals with IGT, 15 type 2 diabetic patients
treated with exogenous insulin (INS), and 15 type 2
diabetic patients treated with oral glucose-lowering
medication (OGLM) participated in a randomised
crossover experiment. Participants were studied on
three occasions for 3 days under strict dietary
standardisation, but otherwise free-living
conditions.
Blood glucose
homeostasis was assessed by ambulatory continuous
glucose monitoring over the 24 h period following a
45 min session of resistance-type exercise (75% one
repetition maximum), endurance-type exercise (50%
maximum workload capacity) or no exercise at all.
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Surmounting Obstacles and
Saving Lives in the ICU
Improving
Survival, Reducing Costs
Stanley
A. Nasraway, MD, FCCM, Professor Surgery, Medicine
and Anesthesiology Tufts University School of
Medicine Director, Surgical Intensive Care Unit
Tufts Medical Center Boston, MA
The background of this presentation included study
of 3,672 ICU admissions (Apache III), and
identification of qualities of ICUs that perform
better. Critical to the study was ICU team,
collaboration, strong MD & RN leadership and
communication, as well as superior organization &
coordination and collaboration in conflict
resolution.
A major need was
determined to be a powerful database, as measuring
performance is vital to continuing improvement. For
this study, Project Impact was used from 1997-2009,
and ICUTracker from 2010- present (why the change?).
More > |
Creation of a Protocol and
Data-driven Culture of Quality Improvement in the
ICU
You can’t
improve what you can’t measure!
James
Krinsley MD, FCCM, Director of Critical Care,
Stamford Hospital, Clinical Professor of Medicine,
Columbia University College of Physicians and
Surgeons
This presentation discusses requirements needed to
standardize care in the ICU and includes guidelines
on how to find a champion, and getting
administration's support.
Other
requirements include, moving beyond
“pseudo-autonomy”, establishing a multidisciplinary
focus, creating strong nursing leadership, with
openness to new ideas, creating a culture of
collaboration, and perhaps most importantly,
determining a way to measure outcomes.
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What is the Optimal Blood Glucose Target in
Critically Ill Patients?
A nested
cohort study. Published, October 2011 in Annals
of Thoracic Medicine
There is an uncertainty about what constitutes an
optimal level of blood glucose (BG) in critically
ill patients. The objective of this study is to
identify the optimal BG target for glycemic control
in critically ill patients that is associated with
survival benefit with the least hypoglycemia risk.
The study was carried out in a single center to
assess the effect of intensive insulin therapy [IIT;
target BG 4.4-6.1 mmol/L (80-110 mg/dL)] versus
conventional insulin therapy [CIT; target BG 10-11.1
mmol/L (180-200 mg/dL)] in a medical/surgical ICU.
All patients were divided into six groups based on
the mean daily BG levels. A logistic regression
model was used to determine the association of BG
and ICU mortality. We compared different outcomes
below and above different BG thresholds of 0.1 mmol/L
(2 mg/dL) increments using multivariate analyses.
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ER, ICU Testing:
Limits, Logistics, and Laurels
Demand
for critical care has never been higher,
says Charles Cairns, MD, professor and chair
of the Department of Emergency Medicine at
the University of North Carolina, Chapel
Hill. Throughout the country, “there’s a
wide variation in who gets intensive care,
and part of that is due to the availability
of resources because critical care is
expensive to build, maintain, and staff.
Even though we’ve gotten better at standard
hospital care—so not as many patients run
into conditions where they have to go to
intensive care—overall utilization of the
ICU continues to increase,” says Dr. Cairns.
While the
laboratory responds to the resulting
increased testing demand, critical care in
turn, like a crucible, tests the mettle of
the laboratory. With its continual,
high-stakes urgency, critical care presents
unique challenges to labs’ ability to solve
diagnostic mysteries, alert clinicians to
unexpected risks, flexibly manage heavy
workloads, and get accurate results back
fast enough to count.
more>
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UVa Gets $25 Million NIH Grant to Study
Diabetic Strokes
The University of
Virginia has received a $25 million grant that
could lead to breakthroughs for diabetic stroke
patients. The grant, from the National
Institutes of Health, provides money for UVa to lead a 56-center nationwide
clinical trial of a new treatment for acute
stroke victims with hyperglycemia, or high blood
sugar. According to Karen Johnston, chair of the
UVa Department of Neurology and principal
investigator of the study, the new treatment
applies to diabetic stroke victims. “The people
who will be eligible for this research will be
hyperglycemic acute stroke patients,” Johnston
said. “All or nearly all will have diabetes.”
The new treatment involves giving patients an
insulin IV starting within 12 hours of a stroke
for up to three days. The amount of insulin will
be determined using MAS Informatics
GlucoStabilizer insulin dosing software, which
calculates the IV dose based on the patient’s
current glucose reading and instructs the
caregiver to adjust the IV drip accordingly.
GlucoStabilizer was selected for use in the
study based on its performance and widely used
acceptance in critical care settings throughout
the country, as well as its unique computer
networking capability.
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