Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists; American Diabetes Association 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: 8.42). 07/2009; 32(6):1119-31. DOI: 10.2337/dc09-9029
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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 05/2015; 2015. DOI:10.1155/2015/173956 · 2.16 Impact Factor
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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.
    Hospital practice (1995) 03/2015; 43(2):1-5. DOI:10.1080/21548331.2015.1022493
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    • "Established protocols to control inpatient hyperglycemia should be implemented to reduce these risks [5] [7]. We found that most hyperglycemic patients received insulin as suggested by most published guidelines [14]. However, recent studies have shown that the use of other medications, like DPP-4 inhibitors, could provide the same amount of efficacy, with less hypoglycemic risks [13]. "
    Journal of Clinical and Translational Endocrinology 10/2014; 1(2014):176-178. DOI:10.1016/j.jcte.2014.09.004
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