Article

American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control

Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
Diabetes care (Impact Factor: 8.57). 07/2009; 32(6):1119-31. DOI: 10.2337/dc09-9029
Source: PubMed
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Available from: Monica Dinardo, Jul 20, 2015
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    • "Over the past two decades, the management of hyperglycemia and diabetes in the inpatient setting has been the focus of many studies and recommendations [1] [2] [3] [4] [5] [6] [7] [8] [9] [10]. The extensive data from observational and randomized controlled trials (RCTs) indicating increased risk of complications and mortality , a longer hospital stay, a higher admission rate to the intensive care unit (ICU), and a higher need for transitional or nursing home care after hospital discharge of patients admitted with hyperglycemia and diabetes has led to increased attention on blood glucose control in hospitalized patients [1] [11] [12] [13] [14] [15]. "
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    ABSTRACT: Abstract Evidence of poor outcomes in hospitalized patients with hyperglycemia has led to new and revised guidelines for inpatient management of diabetes. As providers become more aware of the need for better blood glucose control, they are finding limited guidance in the management of patients receiving enteral nutrition. To address the lack of guidelines in this population, Duke University Health System has developed a consistent practice for managing such patients. Here, we present our practice strategies for insulin use in patients receiving enteral nutrition. Essential factors include assessing the patients' history of diabetes, hyperglycemia, or hypoglycemia and timing and type of feedings. Insulin practices are then designed to address these issues keeping in mind patient safety in the event of abrupt cessation of nutrition. The outcome of the process is a consistent and safe method for glucose control with enteral nutrition.
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    • "There are no guidelines suggesting specific strategies to prevent hypoglycemia in hospital caused by insufficient carbohydrate intake with the diet or prolonged fasting [1] [2] [3] [4] [5]. This is one of the few studies assessing the efficacy of feasible, practical nurse-managed strategies to reduce hypoglycemic events [31] "
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    ABSTRACT: Background. Hypoglycemia due to inadequate carbohydrate intake is a frequent complication of insulin treatment of diabetic in-patients. Objective. To assess the effectiveness of a nurse-managed protocol to prevent hypoglycemia during subcutaneous insulin treatment. Design. Prospective pre-post-intervention study. Methods. In 350 consecutive diabetic in-patients the incidence of hypoglycemia (blood glucose < 70 mg/dL) during subcutaneous insulin treatment was assessed before (phase A) and after (phase B) the protocol was adopted to permit (1) the patient to opt for substitutive food to integrate incomplete carbohydrate intake in the meal; (2) in case of lack of appetite or repeatedly partial intake of the planned food, prandial insulin administered at the end of the meal to be related to the actual amount of carbohydrates eaten; (3) intravenous infusion of glucose during prolonged fasting. Results. Eighty-four patients in phase A and 266 in phase B received subcutaneous insulin for median periods of, respectively, 7 (Q1–Q3 6–12) and 6 days (Q1–Q3 4–9). Hypoglycemic events declined significantly from 0.34 ± 0.33 per day in phase A to 0.19 ± 0.30 in phase B . Conclusions. A nurse-managed protocol focusing on carbohydrate intake reduced the incidence of hypoglycemia in patients with diabetes receiving subcutaneous insulin in hospital.
    Journal of Diabetes Research 01/2015; 2015. DOI:10.1155/2015/173956 · 3.54 Impact Factor
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    • "Ces données suggèrent qu'une intervention précoce pour prévenir et corriger l'hyperglycémie pourrait améliorer l'évolution clinique des patients bénéficiant d'une nutrition artificielle [12]. En situation chronique, plusieurs sociétés scientifiques recommandent de maintenir la glycémie entre 140–180 mg/dL (7,8–10 mmol/L), même si aucune étude clinique contrôlée randomisée n'a été jusqu'à présent conduite en dehors des soins intensifs [11] [13] [23]. On estime qu'environ 5 à 8 % des patients hospitalisés bénéficient d'un support nutritionnel artificiel entéral pour traiter ou prévenir la dénutrition, sous forme de suppléments ou pour couvrir la totalité des apports nutritionnels [11]. "
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    ABSTRACT: Hyperglycaemia in patients receiving enteral or parenteral nutrition is a major problem due to its high prevalence and possible consequences in terms of morbidity and mortality. However, the management of diabetes/stress hyperglycaemia during artificial nutrition remains largely unknown, especially in non-critically ill patients. The indications and access routes for artificial nutrition are not different in patients with diabetes/stress diabetes than in non-diabetics. We do not recommend using enteral formulas designed for patients with diabetes. The glycaemic objective must be individualized. We recommend a preprandial blood glucose levels between 100 and 140 mg/dL (5.5 and 7.8 mmol/L) and postprandial levels between 140 and 180 mg/dL (7.8 and 10 mmol/L). A frequent monitoring of capillary glycaemias is mandatory. The best drug treatment for treating hyperglycaemia/diabetes is insulin and we recommend to adapt the theoretical insulin action to the nutrition infusion regimen. The management of these patients needs the help of a multidisciplinary experimented staff.
    Nutrition Clinique et Métabolisme 09/2014; DOI:10.1016/j.nupar.2014.05.003 · 0.62 Impact Factor
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