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Antecedent Hyperglycemia is Associated with an
Increased Risk of Neutropenic Infections During Bone
Marrow Transplantation
Rachel L. Derr, M.D.,
Ph.D., Victoria C. Hsiao, M.D., Ph.D.
Christopher D. Saudek,
M.D.
(Diabetes Care
Publish Ahead of Print, published online July 23,
2008)
In a BMT population
highly susceptible to infection, there was a
continuous positive association between mean
antecedent glycemia and later infection risk,
particularly in patients who received
glucocorticoids while neutropenic. Tight glycemic
control during BMT and glucocorticoid treatment may
reduce infections.
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Does glycemic status at admission
predict mortality in noncritically ill
hospitalized patients?
Shilpa Harish Jain
and Rajesh Garg
(Nature Clinical
Practice Endocrinology & Metabolism.
Publish Ahead of Print August 2008)
Hyperglycemic patients
hospitalized as a result of acute medical conditions
are prone to increased morbidity and mortality. In
this Practice Point commentary, the authors suggest
that newly detected hyperglycemia is an important
predictor of mortality in this patient group. In
addition, an HbA1c level of >6% identified patients
at the highest risk of death. Efforts to control
glycemia should, therefore, be focused on this
group. Unfortunately, optimal targets and
treatment strategies for glycemic control in
noncritically ill patients have not yet been
determined. Tight glycemic control is associated
with a potential risk of hypoglycemia; however,
glucose levels within the normal range might result
in improved outcomes. Furthermore, several studies
suggest a direct beneficial effect of insulin
therapy. Although the evidence is incomplete, it
seems prudent to initiate insulin treatment whenever
hyperglycemia is recognized in a hospitalized
patient.
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Dynamic Tight Glycemic Control During and After
Cardiac Surgery Is
Effective, Feasible, and Safe
by Patrick
Lecomte, MD, et al
(Anesthesia &
Analgesia 2008;107:51–8)
This
study evaluated the safety and efficacy of a
nurse-driven insulin protocol (the Aalst Glycemia
Insulin Protocol) for achieving a target glucose
level of 80–110 mg/dL during cardiac surgery and in
the intensive care unit (ICU). 483 nondiabetics and
168 diabetics, scheduled for cardiac surgery with
cardiopulmonary bypass, were included in this study.
To anticipate rapid perioperative changes in insulin
requirement and/or sensitivity during surgery,
a dynamic algorithm was developed. The
algorithm adjusts insulin dosage based on blood
glucose level and the projected insulin sensitivity
(e.g., reduced sensitivity during cardiopulmonary
bypass and normalizing sensitivity after surgery).
The Aalst Glycemia Insulin Protocol was effective
for maintaining tight perioperative blood glucose
control during cardiac surgery with minimal risk of
hypoglycemia.
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GlUCOSE
CONTROL REDUCES
POST-OP INFECTIONS
by Christina Frangou
(Anesthesiology News. July
2008)
Summarizes the research
presented at the 128th annual meeting of the
American Surgical Association on how surgical
infection rates could be reduced nationwide if
surgeons and operating room teams monitored and
tightly controlled post-operative glucose levels in
all elective and emergency surgical patients.
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Economic Benefits of Intensive Insulin Therapy in
Critically Ill Patients: The TRIUMPH Project
by Archana R. Sadhu, et al.
(Diabetes Care. 2008 May 20. [Epub ahead
of print])
A clinical team focused
on hyperglycemia management for ICU patients can be
a valuable investment with significant economic
benefits for hospitals.
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A replicable method for blood glucose control in
critically Ill patients
by Alan H. Morris, et al.
(Crit Care Med 2008; 36:1787–1795)
The 91% to 98% clinician
compliance indicates eProtocol-insulin is an
exportable instrument that can establish a
replicable experimental method for clinical trials
of blood glucose management in critically ill
adults. Control of blood glucose was better with
eProtocol-insulin than with a simple clinical
guideline or a paper-based protocol.
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Glucose control in critical illness using a
web-based insulin dose calculator
by Shondipon K. Laha, et al.
(Med Eng Phys. 2008 May;30(4):478-82.
Epub 2007 Jul 23.)
The web-based insulin
calculator facilitates the dosing of insulin in
critical care. The lack of diurnal blood glucose
concentrations suggests that once daily estimation
of blood glucose may be an acceptable method of
monitoring blood glucose concentrations in critical
care.
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this article.
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