R Matthew Hawkins

Publications (2)6.5 Total impact

• Article: Subcutaneous administration of glargine to diabetic patients receiving insulin infusion prevents rebound hyperglycemia.

  Elisa Hsia, Stacey Seggelke, Joanna Gibbs, R Matthew Hawkins, Elizabeth Cohlmia, Neda Rasouli, Cecilia Wang, Igal Kam, Boris Draznin
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  ABSTRACT: Context: Transition of diabetic patients from iv insulin infusion to sc insulin frequently results in rebound hyperglycemia. Objectives: We hypothesized that initiation of a long-acting insulin therapy concurrently with iv insulin infusion would decrease the rate of rebound hyperglycemia after discontinuation of the insulin infusion. Design and Intervention: Sixty-one diabetic patients receiving iv insulin therapy participated in this prospective randomized study. Subjects in the intervention group received daily injections of glargine sc (0.25 U/kg body weight) starting within 12 h of initiation of iv insulin infusion. Capillary blood glucose measurements were obtained up to 12 h after discontinuation of insulin infusion. Rebound hyperglycemia was defined as a blood glucose level greater than 180 mg/dl. Setting: The study was conducted at the University of Colorado Hospital. Patients: Sixty-one hospitalized patients with known type 1 or type 2 diabetes receiving iv insulin infusion participated in the study. Main Outcome: The primary outcome of this study was to compare the rates of rebound hyperglycemia between the control and the intervention groups after iv insulin infusion is discontinued. Results: Overall, 29 subjects in the control group (93.5%) had at least one glucose value above 180 mg/dl during the 12-h follow-up period. This was significantly greater than the rate of rebound hyperglycemia in the intervention group (10 subjects or 33.3%, P < 0.001). The effect of the intervention was apparent in subjects who presented with diabetic ketoacidosis, after solid organ transplantation, and in patients with other surgical and medical diagnoses. There were three hypoglycemic measurements in two control subjects (68, 62, and 58 mg/dl) and none in the intervention group. Conclusions: Once-daily sc insulin glargine administered during iv insulin infusion is a safe method for preventing future rebound hyperglycemia, without increased risk of hypoglycemia.
  The Journal of clinical endocrinology and metabolism 06/2012; 97(9):3132-7. · 6.50 Impact Factor
• Article: Cystic Fibrosis-Related Diabetes in Adults: Inpatient Management of 121 Patients during 410 Admissions.

  Neda Rasouli, Stacey Seggelke, Joanna Gibbs, R Matthew Hawkins, Matthew L Casciano, Elizabeth Cohlmia, Jennifer Taylor-Cousar, Cecilia Wang, Rocio Pereira, Elisa Hsia, Boris Draznin
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  ABSTRACT: Background: With improved longevity, cystic fibrosis (CF)-related diabetes (CFRD) has emerged as the most common nonpulmonary complication of CF. Patients with CFRD are frequently admitted to the hospital with infections and deterioration of pulmonary function, during which time glycemic control might have an impact on pulmonary function, recovery from infection, and survival. Methods and Results: In an attempt to share our insight into inpatient management of CFRD, this article summarizes the experience of our inpatient glucose management team with hospital management of 121 adult CFRD patients who were hospitalized on 410 occasions at the University of Colorado Hospital between January 2009 and September 2011. This is a retrospective chart review descriptive study of inpatient management of CFRD in our center. Our cohort includes CFRD patients treated with basal and mealtime insulin through multiple daily injections or continuous subcutaneous insulin infusion (CSII), as well as patients receiving steroids or enteral nutrition, which adds complexity to the management of CFRD during hospitalization. Conclusions: Multiple hospitalizations and intensive inpatient management of CF are integral elements of treatment. Inpatient therapy for CFRD requires a customized approach that is uniquely different from that of type 1 or type 2 diabetes. Our experience highlights clinical circumstances such as irregular food intake, high dose steroid therapy, and supplemental tube feeding. For many patients, it is possible to continue CSII therapy during hospitalization through a combination of mutual trust between the patient and hospital staff and oversight provided by the glucose management team.
  Journal of diabetes science and technology 01/2012; 6(5):1038-44.