1
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Granados A, Carrillo Iregui A. Type 1 Diabetes Management in the Hospital Setting. Pediatr Rev 2024; 45:201-209. [PMID: 38556511 DOI: 10.1542/pir.2022-005645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The incidence of diabetes in children and adolescents has increased during the past decades, with a 1.9% increase per year in type 1 diabetes mellitus (T1DM). Patients with diabetes have a greater risk of hospitalizations compared with those without diabetes. Clear evidence has emerged in the past decade that supports appropriate glycemic control in the hospital setting to improve clinical outcomes and reduce the risk of hospital complications and mortality. Determining the appropriate insulin regimen in patients with T1DM in the hospital depends on the clinical status, type of outpatient insulin regimen (multiple daily injections versus pump therapy), glycemic control before admission, nutritional status, procedures, and enteral versus parenteral nutrition. Due to the complexity of the inpatient management of diabetes, institutions should have an inpatient diabetes management team that includes dietitians, diabetes educators, nurses, pharmacists, social workers, and endocrinologists. The use of inpatient diabetes teams has been demonstrated to be beneficial in the management of patients with T1DM.
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Affiliation(s)
- Andrea Granados
- Division of Pediatric Endocrinology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
| | - Adriana Carrillo Iregui
- Division of Pediatric Endocrinology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
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2
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Combs P, Duffy E, Modic MB. Promoting Type 1 Diabetes Self-care Management in the Hospital: Can It Be Done? CLIN NURSE SPEC 2023; 37:266-271. [PMID: 37870512 DOI: 10.1097/nur.0000000000000777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
PURPOSE The specific aim of the study was to determine whether there was an increased time in target glucose range for individuals with type 1 diabetes mellitus who were permitted to self-manage their insulin plan while hospitalized. DESIGN A retrospective chart review was conducted of 60 inpatients with type 1 diabetes mellitus who met the criteria to self-manage their diabetes care with the use of their continuous subcutaneous insulin infusion pump or a multiple daily injection insulin regimen. A comparison of the 2 groups was examined to assess differences in glucose outcomes and glycemic stability. RESULTS Seven hundred fifty-three glucose results were examined. The total number of hypoglycemic events in both groups was 37. The number of glucose values labeled as stable was 405, and the remaining 311 glucose values were categorized as hyperglycemic. There were no statistically significant differences in glucose levels between the 2 groups. CONCLUSION No patients experienced severe hypoglycemia leading to cognitive impairment or severe hyperglycemia leading to diabetic ketoacidosis. The outcomes of this study suggest that diabetes self-management practices in select individuals hospitalized with type 1 diabetes mellitus can contribute to greater glucose stability and time in targeted glucose range.
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Affiliation(s)
- Pamela Combs
- Author Affiliations: Director of the Howley Aspire Nursing and Pathways Program (Dr Combs), Cleveland Clinic Health Space Building; Professor (Dr Duffy), Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland; and Clinical Nurse Specialist (Dr Modic), Office of Advanced Practice, Cleveland Clinic, Ohio
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3
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Dhatariya KK, Umpierrez G. Gaps in our knowledge of managing inpatient dysglycaemia and diabetes in non-critically ill adults: A call for further research. Diabet Med 2023; 40:e14980. [PMID: 36256494 PMCID: PMC10100017 DOI: 10.1111/dme.14980] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/11/2022] [Accepted: 10/17/2022] [Indexed: 11/28/2022]
Abstract
AIMS To describe the gaps in knowledge for the care of people in the hospital who have dysglycaemia or diabetes. METHODS A review of the current literature and the authors' knowledge of the subject. RESULTS Recent data has suggested that the prevalence of hospitalised people with diabetes is approximately three times the prevalence in the general population and is growing annually. A wealth of observational data over the last 4 decades has shown that people with hyperglycaemia, severe hypoglycaemia or diabetes, all experience more harm whilst in the hospital than those who do not have the condition. This often equates to a longer length of stay and thus higher costs. To date, the proportion of federal funding aimed at addressing the harms that people with dysglycaemia experience in hospitals has been very small compared to outpatient studies. National organisations, such as the Joint British Diabetes Societies for Inpatient Care, the American Diabetes Association and the Endocrine Society have produced guidelines or consensus statements on the management of various aspects of inpatient care. However, whilst a lot of these have been based on evidence, much remains based on expert opinion and thus low-quality evidence. CONCLUSIONS This review highlights that inpatient diabetes is an underfunded and under-researched area.
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Affiliation(s)
- Ketan K Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
- Norwich Medicine School, University of East Anglia, Norfolk, UK
| | - Guillermo Umpierrez
- Department of Medicine, Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia, USA
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4
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Mader JK, Brix JM, Aberer F, Vonbank A, Resl M, Hochfellner DA, Ress C, Pieber TR, Stechemesser L, Sourij H. [Hospital diabetes management (Update 2023)]. Wien Klin Wochenschr 2023; 135:242-255. [PMID: 37101046 PMCID: PMC10133359 DOI: 10.1007/s00508-023-02177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/28/2023]
Abstract
This position statement presents the recommendations of the Austrian Diabetes Association for diabetes management of adult patients during inpatient stay. It is based on the current evidence with respect to blood glucose targets, insulin therapy and treatment with oral/injectable antidiabetic drugs during inpatient hospitalization. Additionally, special circumstances such as intravenous insulin therapy, concomitant therapy with glucocorticoids and use of diabetes technology during hospitalization are discussed.
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Affiliation(s)
- Julia K Mader
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich.
| | - Johanna M Brix
- Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
| | - Felix Aberer
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
| | - Alexander Vonbank
- Innere Medizin I mit Kardiologie, Angiologie, Endokrinologie, Diabetologie und Intensivmedizin, Akademisches Lehrkrankenhaus Feldkirch, Feldkirch, Österreich
| | - Michael Resl
- Abteilung für Innere Medizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | - Daniel A Hochfellner
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
| | - Claudia Ress
- Innere Medizin, Department I, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Thomas R Pieber
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
| | - Lars Stechemesser
- Universitätsklinik für Innere Medizin I, Paracelsus Medizinische Privatuniversität - Landeskrankenhaus, Salzburg, Österreich
| | - Harald Sourij
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
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5
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Kietaibl AT, Huber J, Clodi M, Abrahamian H, Ludvik B, Fasching P. [Position statement: surgery and diabetes mellitus (Update 2023)]. Wien Klin Wochenschr 2023; 135:256-271. [PMID: 37101047 PMCID: PMC10133078 DOI: 10.1007/s00508-022-02121-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 04/28/2023]
Abstract
This position statement reflects the perspective of the Austrian Diabetes Association concerning the perioperative management of people with diabetes mellitus based on the available scientific evidence. The paper covers necessary preoperative examinations from an internal/diabetological point of view as well as the perioperative metabolic control by means of oral antihyperglycemic and/or insulin therapy.
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Affiliation(s)
- Antonia-Therese Kietaibl
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Wien, Österreich
| | - Joakim Huber
- Interne Abteilung mit Akutgeriatrie und Palliativmedizin, Franziskus Spital, Standort Landstraße, Wien, Österreich
| | - Martin Clodi
- ICMR - Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz, Linz, Österreich.
- Abteilung für Innere Medizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich.
| | | | - Bernhard Ludvik
- 1. Medizinische Abteilung für Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
| | - Peter Fasching
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Wien, Österreich
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6
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Pattison J, Dungan KM, Faulds ER. Supporting the Use of a Person's Own Diabetes Technology in the Inpatient Setting. Diabetes Spectr 2022; 35:398-404. [PMID: 36561658 PMCID: PMC9668718 DOI: 10.2337/dsi22-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of diabetes technology, including insulin pumps, continuous glucose monitoring devices, and automated insulin delivery systems, has increased significantly in recent years. As more people with diabetes adopt technology in the outpatient setting, we are seeing these devices more frequently in the inpatient setting. This review offers best-practice guidelines for the continuation of personal diabetes technology use in the inpatient setting. It describes policy and guideline stipulations, roles and responsibilities, and device- and brand-specific considerations. Although these devices are not approved for inpatient use by the U.S. Food and Drug Administration, there is general expert consensus that the continuation of personal diabetes devices during hospitalization is appropriate for patients who have sufficient knowledge, are not critically ill, and retain sufficient mental capacity during an acute illness. Health care systems and inpatient providers need to understand the benefits and limitations of personal diabetes technology use during hospitalization.
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Affiliation(s)
| | | | - Eileen R. Faulds
- Ohio State University College of Nursing and The Ohio State University Wexner Medical Center, Columbus, OH
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7
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Smaoui MR, Lafi A. Leeno: Type 1 diabetes management training environment using smart algorithms. PLoS One 2022; 17:e0274534. [PMID: 36107913 PMCID: PMC9477299 DOI: 10.1371/journal.pone.0274534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
Abstract
A growing number of Type-1 Diabetes (T1D) patients globally use insulin pump technologies to monitor and manage their glucose levels. Although recent advances in closed-loop systems promise automated pump control in the near future, most patients worldwide still use open-loop continuous subcutaneous insulin infusion (CSII) devices which require close monitoring and continuous regulation. Apart from specialized diabetes units, hospital physicians and nurses generally lack necessary training to support the growing number of patients on insulin pumps. Most hospital staff and providers worldwide have never seen or operated an insulin pump device. T1D patients at nurseries, schools, in hospital emergency rooms, surgery theatres, and in-patient units all require close monitoring and active management. The lack of knowledge and necessary training to support T1D patients on pumps puts them at life-threatening risks. In this work, we develop a training simulation software for hospitals to educate and train their physicians and nurses on how to effectively operate a T1D pump and reduce hypoglycemia events. The software includes clinically validated T1D virtual patients that users can monitor and adjust their pump settings to improve glycemic outcomes. We develop a Fuzzy-Logic learning algorithm that helps guide users learn how to improve pump parameters for these patients. We recruited and trained 13 nurses on the software and report their improvement in pump administration, basal rates adjustments, and ICR modulation.
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Affiliation(s)
- Mohamed Raef Smaoui
- Department of Computer Science, Faculty of Science, Kuwait University, Kuwait City, Kuwait
- * E-mail:
| | - Ahmad Lafi
- Department of Computer Science, Faculty of Science, Kuwait University, Kuwait City, Kuwait
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8
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Huang J, Yeung AM, Nguyen KT, Xu NY, Preiser JC, Rushakoff RJ, Seley JJ, Umpierrez GE, Wallia A, Drincic AT, Gianchandani R, Lansang MC, Masharani U, Mathioudakis N, Pasquel FJ, Schmidt S, Shah VN, Spanakis EK, Stuhr A, Treiber GM, Klonoff DC. Hospital Diabetes Meeting 2022. J Diabetes Sci Technol 2022; 16:1309-1337. [PMID: 35904143 PMCID: PMC9445340 DOI: 10.1177/19322968221110878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The annual Virtual Hospital Diabetes Meeting was hosted by Diabetes Technology Society on April 1 and April 2, 2022. This meeting brought together experts in diabetes technology to discuss various new developments in the field of managing diabetes in hospitalized patients. Meeting topics included (1) digital health and the hospital, (2) blood glucose targets, (3) software for inpatient diabetes, (4) surgery, (5) transitions, (6) coronavirus disease and diabetes in the hospital, (7) drugs for diabetes, (8) continuous glucose monitoring, (9) quality improvement, (10) diabetes care and educatinon, and (11) uniting people, process, and technology to achieve optimal glycemic management. This meeting covered new technology that will enable better care of people with diabetes if they are hospitalized.
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Affiliation(s)
| | | | | | - Nicole Y. Xu
- Diabetes Technology Society, Burlingame, CA, USA
| | | | | | | | | | - Amisha Wallia
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Umesh Masharani
- University of California San Francisco, San Francisco, CA, USA
| | | | | | | | - Viral N. Shah
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO, USA
| | | | | | | | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
- David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE, Diabetes Research Institute, Mills-Peninsula Medical Center, 100 South San Mateo Drive, Room 5147, San Mateo, CA 94401, USA.
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9
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Galindo RJ, Dhatariya K, Gomez-Peralta F, Umpierrez GE. Safety and Efficacy of Inpatient Diabetes Management with Non-insulin Agents: an Overview of International Practices. Curr Diab Rep 2022; 22:237-246. [PMID: 35507117 PMCID: PMC9065239 DOI: 10.1007/s11892-022-01464-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW The field of inpatient diabetes has advanced significantly over the last 20 years, leading to the development of personalized treatment approaches. However, outdated guidelines still recommend the use of basal-bolus insulin therapy as the preferred treatment approach, and against the use of non-insulin anti-hyperglycemic agents. RECENT FINDINGS Several observational and prospective randomized controlled studies have demonstrated that oral anti-hyperglycemic agents are widely used in the hospital, including studies of DPP-4 agents and GLP-1 agonists. With advances in the field of inpatient diabetes management, a paradigm shift has occurred, from an approach of recommending "basal-bolus regimens" for all patients to a more precision medicine option for hospitalized non-critically ill patients with type 2 diabetes.
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Affiliation(s)
- Rodolfo J Galindo
- Associate Professor of Medicine, Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, USA.
| | - Ketan Dhatariya
- Consultant Diabetes & Endocrinology / Honorary Professor, Norwich Medical School, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals, NHS Foundation Trust, Norwich, UK
| | | | - Guillermo E Umpierrez
- Professor of Medicine, Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, USA
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10
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Halstrom A, Moledina I, Peragallo-Dittko V, Ancona K, Islam S, Klek S, Rothberger G. Continuous Subcutaneous Insulin Infusions vs. Multiple Daily Injections of Insulin in Hospitalized Patients: Glycemic Trends in the First 24 Hours of Admission. J Diabetes Sci Technol 2022; 16:683-688. [PMID: 33563036 PMCID: PMC9294581 DOI: 10.1177/1932296821991136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Continuous subcutaneous insulin infusion (CSII) is a common diabetes treatment modality. Glycemic outcomes of patients using CSII in the first 24 hours of hospitalization have not been well studied. This timeframe is of particular importance because insulin pump settings are programmed to achieve tight outpatient glycemic targets which could result in hypoglycemia when patients are hospitalized. METHODS This retrospective cohort study evaluated 216 hospitalized adult patients using CSII and 216 age-matched controls treated with multiple daily injections (MDI) of insulin. Patients using CSII did not make changes to pump settings in the first 24 hours of admission. Blood glucose (BG) values within the first 24 hours of admission were collected. The primary outcome was frequency of hypoglycemia (BG < 70 mg/dL). Secondary outcomes were frequency of severe hypoglycemia (BG < 40 mg/dL) and hyperglycemia (BG ≥ 180 mg/dL). RESULTS There were significantly fewer events of hypoglycemia [incident rate ratio (IRR) 0.61, 95% confidence interval (CI) 0.42-0.88, p = 0.007] and hyperglycemia (IRR 0.79, 95% CI 0.65-0.96, p = 0.02) in the CSII group compared to the MDI group. There was a trend toward fewer events of severe hypoglycemia in the CSII group (IRR 0.15, 95% CI 0.02-0.93, p = 0.06). CONCLUSIONS Patients using CSII experienced fewer events of both hypoglycemia and hyperglycemia in the first 24 hours of hospital admission than those treated with MDI. Our study demonstrates that CSII use is safe and effective for the treatment of diabetes within the first 24 hours of hospital admission.
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Affiliation(s)
- Amanda Halstrom
- Department of Medicine, NYU Long Island
School of Medicine, Mineola, NY, USA
| | - Iram Moledina
- Department of Medicine, NYU Long Island
School of Medicine, Mineola, NY, USA
| | | | - Karena Ancona
- Division of Endocrinology, NYU Long
Island School of Medicine, Mineola, NY, USA
| | - Shahidul Islam
- Department of Foundations of Medicine,
NYU Long Island School of Medicine, Mineola, NY, USA
| | - Stanislaw Klek
- Department of Medicine, NYU Long Island
School of Medicine, Mineola, NY, USA
- Division of Endocrinology, NYU Long
Island School of Medicine, Mineola, NY, USA
| | - Gary Rothberger
- Department of Medicine, NYU Long Island
School of Medicine, Mineola, NY, USA
- Division of Endocrinology, NYU Long
Island School of Medicine, Mineola, NY, USA
- Gary Rothberger, MD, NYU Long Island School
of Medicine, 101 Mineola Boulevard, 2nd Floor, Mineola, NY 11501, USA.
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11
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Mendes TB, Câmara-de-Souza AB, Halpern B. Hospital management of hyperglycemia in the context of COVID-19: evidence-based clinical considerations. Diabetol Metab Syndr 2022; 14:37. [PMID: 35246230 PMCID: PMC8895065 DOI: 10.1186/s13098-022-00808-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/18/2022] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic led to an unprecedented crisis, and early on, it has been shown that diabetes is an important risk factor for complications and mortality in infected patients, as demonstrated by several studies. Moreover, hyperglycemia, regardless of whether patients have diabetes, is associated with poorer outcomes, which suggests that adequate monitoring and treatment of elevated glycemia in the hospital setting can improve patient outcomes. In patients with COVID-19, glycemic control may be impaired as a consequence of the infection itself (aggravating pre-existing diabetes and potentially precipitating new-onset diabetes), inflammation, or corticosteroid use-a well-established therapy to reduce COVID-19 complications, especially in the intensive care unit. This article reviews the link between diabetes and hyperglycemia, and COVID-19, with a brief review of potential mechanisms, along with emerging evidence on the effect of glycemic control on COVID-19 outcomes, especially in hospital settings.
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Affiliation(s)
- Thiago Bosco Mendes
- Department of Internal Medicine, Hospital das Clínicas, São Paulo State University (UNESP), Botucatu, Brazil
| | | | - Bruno Halpern
- Department of Endocrinology, Hospital 9 de Julho, Rua Alves Guimarães, 462, cj. 72, Pinheiros, São Paulo, SP, 05410-000, Brazil.
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12
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Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL. The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2021; 64:2609-2652. [PMID: 34590174 PMCID: PMC8481000 DOI: 10.1007/s00125-021-05568-3] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycaemia, behavioural considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that healthcare professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors. Graphical abstract.
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Affiliation(s)
- Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - J Hans DeVries
- Amsterdam UMC, Internal Medicine, University of Amsterdam, Amsterdam, the Netherlands
- Profil Institute for Metabolic Research, Neuss, Germany
| | - Amy Hess-Fischl
- Kovler Diabetes Center, University of Chicago, Chicago, IL, USA
| | - Irl B Hirsch
- UW Medicine Diabetes Institute, Seattle, WA, USA
| | - M Sue Kirkman
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Tomasz Klupa
- Department of Metabolic Diseases, Center for Advanced Technologies in Diabetes, Jagiellonian University Medical College, Kraków, Poland
| | - Barbara Ludwig
- University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | | | - Eric Renard
- Montpellier University Hospital, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, Inserm, Montpellier, France
| | - Jay S Skyler
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Frank J Snoek
- Amsterdam UMC, Medical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | | | - Anne L Peters
- Keck School of Medicine of USC, Los Angeles, CA, USA
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13
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Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL. The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2021; 44:2589-2625. [PMID: 34593612 DOI: 10.2337/dci21-0043] [Citation(s) in RCA: 202] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycemia, behavioral considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management, and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that health care professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors.
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Affiliation(s)
- Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, U.K. .,Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, U.K
| | - J Hans DeVries
- Amsterdam UMC, Internal Medicine, University of Amsterdam, Amsterdam, the Netherlands.,Profil Institute for Metabolic Research, Neuss, Germany
| | | | | | - M Sue Kirkman
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Tomasz Klupa
- Department of Metabolic Diseases, Center for Advanced Technologies in Diabetes, Jagiellonian University Medical College, Kraków, Poland
| | - Barbara Ludwig
- University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | | | - Eric Renard
- Montpellier University Hospital, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, Inserm, Montpellier, France
| | - Jay S Skyler
- University of Miami Miller School of Medicine, Miami, FL
| | - Frank J Snoek
- Amsterdam UMC, Medical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
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Akkermansia, a Possible Microbial Marker for Poor Glycemic Control in Qataris Children Consuming Arabic Diet-A Pilot Study on Pediatric T1DM in Qatar. Nutrients 2021; 13:nu13030836. [PMID: 33806427 PMCID: PMC7999932 DOI: 10.3390/nu13030836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 12/12/2022] Open
Abstract
In Qatar, Type 1 Diabetes mellitus (T1DM) is one of the most prevalent disorders. This study aimed to explore the gut microbiome's relation to the continuous subcutaneous insulin infusion (CSII) therapy, dietary habits, and the HbA1c level in the pediatric T1DM subjects in Qatar. We recruited 28 T1DM subjects with an average age of 10.5 ± 3.53 years. The stool sample was used to measure microbial composition by 16s rDNA sequencing method. The results have revealed that the subjects who had undergone CSII therapy had increased microbial diversity and genus Akkermansia was significantly enriched in the subjects without CSII therapy. Moreover, genus Akkermansia was higher in the subjects with poor glycemic control (HbA1c > 7.5%). When we classified the subjects based on dietary patterns and nationality, Akkermansia was significantly enriched in Qataris subjects without the CSII therapy consuming Arabic diet than expatriates living in Qatar and eating a Western/mixed diet. Thus, this pilot study showed that abundance of Akkermansia is dependent on the Arabic diet only in poorly controlled Qataris T1DM patients, opening new routes to personalized treatment for T1DM in Qataris pediatric subjects. Further comprehensive studies on the relation between the Arabic diet, ethnicity, and Akkermansia are warranted to confirm this preliminary finding.
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15
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Boeder S, Kulasa K. Hospital care: improving outcomes in type 1 diabetes. Curr Opin Endocrinol Diabetes Obes 2021; 28:14-20. [PMID: 33315629 DOI: 10.1097/med.0000000000000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Caring for patients with type 1 diabetes (T1D) in the hospital presents unique challenges. This review provides an update on significant issues relevant to the inpatient management of T1D. Topics include trends in diabetic ketoacidosis (DKA), hypoglycemia, and adapting ambulatory technologies for inpatient use. RECENT FINDINGS Rates of DKA in the United States are rising. Although socioeconomic status, health insurance coverage, and hemoglobin A1c are persistently associated with DKA in individuals with T1D, newer risk factors have also emerged. These include the off-label use of sodium-glucose cotransporter inhibitor medications, immune checkpoint inhibitor-induced diabetes, and infection with severe acute respiratory syndrome coronavirus 2. Hypoglycemia is common among hospitalized patients with T1D. Use of validated hypoglycemia risk prediction models and multidisciplinary care initiatives can reduce the risk of inpatient hypoglycemia. Finally, continuous glucose monitoring is being adapted for use in the hospital setting and has shown promise during the coronavirus disease 2019 (COVID-19) pandemic. SUMMARY Evidence-based treatment algorithms, risk prediction calculators, multidisciplinary interventions, and wearable technology hold promise for improved outcomes in hospitalized patients with T1D.
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Affiliation(s)
- Schafer Boeder
- Department of Medicine, Division of Endocrinology and Metabolism, University of California, San Diego, La Jolla, California, USA
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16
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Abstract
PURPOSE OF REVIEW Type 2 diabetes (T2DM) is a major comorbidity of coronavirus disease 2019 (COVID-19) but less is known about COVID-19 and type 1 diabetes (T1DM). Thus, our goal was to review the literature on COVID and T1DM. RECENT FINDINGS We identified 21 reports focusing on COVID-19 infections among patients with preexisting T1DM (n = 7), incident T1DM presentations during the COVID-19 quarantine (n = 6), and outpatient management of T1DM during the COVID-19 quarantine (n = 8). These studies showed that patients with preexisting T1DM and COVID-19 infection often present with hyperglycemia and/or diabetic ketoacidosis (DKA). Although the risk of in-hospital mortality may be increased, hospitalization rates among patients with T1DM mirror that of the general population. The numbers of patients presenting with incident T1DM during COVID-19 quarantine have remained stable, but cases with severe DKA may have increased. COVID-19 quarantine has also impacted outpatient T1DM management and studies examining changes in glycemic control have shown mixed results. SUMMARY COVID-19 has important implications for patients with type 1 diabetes, but additional studies with larger numbers of patients and longer term follow-up are needed to confirm the early findings highlighted in this review.
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Affiliation(s)
- Diana J Chang
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, UCLA David Geffen School of Medicine
| | - Tannaz Moin
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, UCLA David Geffen School of Medicine
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Health System, Los Angeles, California, USA
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17
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Yuan C, Sun X, Liu Y, Wu J. The thyroid hormone levels and glucose and lipid metabolism in children with type 1 diabetes: a correlation analysis. Transl Pediatr 2021; 10:276-282. [PMID: 33708513 PMCID: PMC7944189 DOI: 10.21037/tp-20-204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) is common in clinical setting, the relationship between thyroid hormone levels and glucose and lipid metabolism in patients with T1DM remains unclear. We attempted to analyze the correlation of thyroid hormone levels and blood glucose and lipid metabolism in children with normal thyroid function. METHODS Children with T1DM were selected, and 85 healthy children who underwent physical examinations in our hospital as control group. The characteristics and laboratory testing results were compared, the correlation of thyroid hormone levels with blood glucose and blood lipids was analyzed by Pearson correlation analysis. RESULTS A total of 167 participants were included. the low-density lipoprotein-cholesterol (LDL-C), triglyceride (TG), fasting blood glucose (FBG), and glycated hemoglobin (HbAlc) in T1DM patients were higher than those in healthy controls, while the high-density lipoprotein-cholesterol (HDL-C), thyroid stimulating hormone (TSH) and free triiodothyronine (FT3) in T1DM patients were lower than that of healthy children (all P<0.05). TSH was positively correlated with LDL-C (r=0.169, P=0.032), TC (r=0.182, P=0.017) and TG (r=0.197, P=0.008), negatively correlated with FBG (r=-0.196, P=0.023) and HbAlc (r=-0.328, P=0.002). FT3 was negatively correlated with TG (r=-0.182, P=0.011), FBG (r=-0.184, P=0.009) and HbAlc (r=-0.223, P=0.005). TG in the high TSH group and the middle TSH group is higher than that of low TSH group. However, FBG and HbAlc were lower than those in the low TSH group (all P<0.05). Compared with the low FT3 group, the TG, FBG and HbAlc decreased in the high and middle FT3 group (all P<0.05). CONCLUSIONS The serum TSH are closely associated with FT3 and glycolipid metabolism in children with T1DM, which may be the useful indicators to assess the severity of T1DM in clinical settings to provide insights into the management of T1DM.
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Affiliation(s)
- Chuanjie Yuan
- Department of Pediatric Endocrinology and Metabolism, West China Second Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xiaomei Sun
- Department of Pediatric Endocrinology and Metabolism, West China Second Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yin Liu
- Department of Pediatric Endocrinology and Metabolism, West China Second Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Jin Wu
- Department of Pediatric Endocrinology and Metabolism, West China Second Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
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18
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Zhao M, Xu S, Cavagnaro MJ, Zhang W, Shi J. Quantitative Analysis and Visualization of the Interaction Between Intestinal Microbiota and Type 1 Diabetes in Children Based on Multi-Databases. Front Pediatr 2021; 9:752250. [PMID: 34976889 PMCID: PMC8715853 DOI: 10.3389/fped.2021.752250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background: As an important autoimmune disease, type 1 diabetes (T1D) is often diagnosed in children, but due to the complexity of the etiology of diabetes and many other factors, the disease pathogenesis of diabetes is still unclear. The intestinal microbiota has been proved to have close relationships with T1D in recent years, which is one of the most important molecular bases of pathogenesis and prognosis factors for T1D. Using the multi-omics and multicenter sample analysis method, a number of intestinal microbiota in T1D have been discovered and explained, which has provided comprehensive and rich information. However, how to find more useful information and get an intuitive understanding that people need conveniently in the huge data sea has become the focus of attention. Therefore, quantitative analysis and visualization of the interaction between intestinal microbiota and T1D in children are urgently needed. Methods: We retrieved the detailed original data from the National Center for Biotechnology Information, GMREPO, and gutMEGA databases and other authoritative multiple projects with related research; the ranking of intestinal microbiota abundance from healthy people, overall T1D patients, and T1D in children (0-18 years old) were detailed analyzed, classified, and visualized. Results: A total of 515 bacterial species and 161 related genera were fully analyzed. Also, Prevotella copri was led by 21.25% average abundance, followed by Clostridium tertium of 10.39% in all-cross T1D patients. For children with T1D, Bacteroides vulgatus has high abundance in all age periods, whereas the abundance of each intestinal microbiota was more uniform in female samples, with the ranking from high to low as Bacteroides dorei 9.56%, P. copri 9.53%, Streptococcus pasteurianus 8.15%, and C. tertium 7.53%, whereas in male samples, P. copri was accounted for the largest by 22.72%. The interaction between intestinal microbiota and comparison between healthy people and children with T1D was also detailed analyzed. Conclusions: This study provides a new method and comprehensive perspectives for the evaluation of the interaction between intestinal microbiota and T1D in children. A set of useful information of intestinal microbiota with its internal interaction and connections has been presented, which could be a compact, immediate, and practical scientific reference for further molecular biological and clinical translational research of T1D in children.
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Affiliation(s)
- Mingyi Zhao
- Department of Pediatric, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Shaokang Xu
- Department of Pediatric, The Third Xiangya Hospital, Central South University, Changsha, China.,Xiangya School of Medicine, Central South University, Changsha, China
| | | | - Wei Zhang
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Jian Shi
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China.,Department of Hematology and Critical Care Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
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19
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Rodrigues AK, Melo AE, Domingueti CP. Association between reduced serum levels of magnesium and the presence of poor glycemic control and complications in type 1 diabetes mellitus: A systematic review and meta-analysis. Diabetes Metab Syndr 2020; 14:127-134. [PMID: 32088645 DOI: 10.1016/j.dsx.2020.01.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the association between reduced serum magnesium levels and poor glycemic control and/or complications in patients with type 1 diabetes mellitus through a systematic review and meta-analysis. METHODS The articles were selected using the Medline/PubMed, Web of Science, Scopus and Scielo databases. Eligibility criteria were cross-sectional, cohort or case-control observational studies that assessed the association between reduced magnesium levels and poor glycemic control and/or complications in patients with type 1 diabetes mellitus. RESULTS Nine articles were included in the systematic review and two in the meta-analysis, all articles being cross-sectional. Among the seven studies that were designed to evaluate glycemic control, five showed an association between reduced levels of magnesium and poor glycemic control, and these findings were corroborated by the meta-analysis. Among the two studies in which dyslipidemia was evaluated, both showed higher levels of triglycerides, total cholesterol and LDL cholesterol, and lower levels of HDL cholesterol in patients with lower levels of magnesium as compared to those with higher magnesium levels. The three studies that evaluated diabetes kidney disease and the two studies that evaluated diabetic retinopathy found divergent results. CONCLUSION There is an association between reduced levels of magnesium and poor glycemic control in patients with type 1 diabetes mellitus, however, this needs further studies.
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Affiliation(s)
- Ana Kelen Rodrigues
- Universidade Federal de São João del Rei, Campus Centro Oeste Dona Lindu, Divinópolis, MG, Brazil
| | - Ana Elisa Melo
- Universidade Federal de São João del Rei, Campus Centro Oeste Dona Lindu, Divinópolis, MG, Brazil
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20
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Duggan E, Chen Y. Glycemic Management in the Operating Room: Screening, Monitoring, Oral Hypoglycemics, and Insulin Therapy. Curr Diab Rep 2019; 19:134. [PMID: 31749027 DOI: 10.1007/s11892-019-1277-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW This review provides a literature update and practical outline for the management of diabetes and stress hyperglycemia for adult surgical patients in the pre- and intraoperative settings. RECENT FINDINGS Hyperglycemia in surgical patients has been associated with increased risk of complication in both diabetic and non-diabetic patients in the perioperative setting. While current recommended perioperative blood glucose target is < 180 mg/dL (10 mmol/L), optimal outcomes may require different treatment targets for diabetic versus non-diabetic patients. Hemoglobin A1C level is associated with elevated risk of hyperglycemia and adverse outcomes, but there is insufficient evidence to recommend routine preoperative testing or optimal values in elective surgical patients. Day of surgery blood glucose testing and treatment are recommended in the perioperative period, and anesthetic management includes appropriate patient selection for use of subcutaneous insulin, intravenous insulin infusions, and insulin pumps. Additionally, administration of both intravenous and perineural dexamethasone is associated with increased blood glucose levels and clinicians should consider the risk benefit ratio in surgical patients. For enhanced recovery after surgery protocols, further evidence is needed to support routine use of carbohydrate loading in diabetic patients. Optimal perioperative care includes screening at-risk patients, use of preoperative oral hypoglycemics and home insulin, anesthetic type and medication selection, blood glucose testing, and treatment for hyperglycemia in the operating room. Partnerships with surgery and endocrinology teams aid optimal postoperative management and discharge planning.
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Affiliation(s)
- Elizabeth Duggan
- Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA, 30322, USA.
| | - York Chen
- Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA, 30322, USA
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21
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Mader JK, Brix J, Aberer F, Vonbank A, Resl M, Pieber TR, Stechemesser L, Sourij H. [Hospital diabetes management (Update 2019)]. Wien Klin Wochenschr 2019; 131:200-211. [PMID: 30980162 DOI: 10.1007/s00508-019-1447-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This position statement presents the recommendations of the Austrian Diabetes Association for diabetes management of adult patients during inpatient stay. It is based on the current evidence with respect to blood glucose targets, insulin therapy and treatment with oral antidiabetic drugs during inpatient hospitalization. Additionally, special circumstances such as intravenous insulin therapy, concomitant therapy with glucocorticoids and use of diabetes technology during hospitalization are discussed.
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Affiliation(s)
- Julia K Mader
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich.
| | - Johanna Brix
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Krankenanstalt Rudolfstiftung, Wien, Österreich
| | - Felix Aberer
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
| | - Alexander Vonbank
- Innere Medizin I mit Kardiologie, Angiologie, Endokrinologie, Diabetologie und Intensivmedizin, Akademisches Lehrkrankenhaus Feldkirch, Feldkirch, Österreich
| | - Michael Resl
- Abteilung für Innere Medizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | - Thomas R Pieber
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
| | - Lars Stechemesser
- Universitätsklinik für Innere Medizin I, Paracelsus Medizinische Privatuniversität - Landeskrankenhaus, Salzburg, Österreich
| | - Harald Sourij
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
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22
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Röhling M, Redaélli M, Simic D, Lorrek K, Samel C, Schneider P, Kempf K, Stock S, Martin S. TeDia - A Telemedicine-Based Treatment Model for Inpatient and Interprofessional Diabetes Care. Diabetes Metab Syndr Obes 2019; 12:2479-2487. [PMID: 31819573 PMCID: PMC6890178 DOI: 10.2147/dmso.s229933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/25/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The proportion of hospitalized patients with diabetes as a secondary diagnosis increases continuously. Therefore, we have developed a team-based interprofessional and telemedicine-based diabetes management system named TeDia ("Telemedical Diabetology") and implemented it in an inpatient setting. The aim of the retrospective real-world study was to show the clinical impact of TeDia following its implementation. MATERIAL AND METHODS TeDia is characterized by an interpersonal and telemedicine-based exchange of hospital routine data between specially trained nurses ("diabetes managers") and external diabetologists. It was implemented in three acute hospitals of the Düsseldorf Catholic Hospital Group in Düsseldorf, Germany. Clinical awareness of diabetes, diabetes-related complications and diagnosis-related group (DRG)-based revenues were analyzed using ICD routine coding. Furthermore, the frequency of HbA1c determinations as well as hospitalization days were investigated. RESULTS Before (2010), during (2012) and after the implementation of TeDia (2014), the number of patients with ICD coding for diabetes, decompensated diabetes, diabetic neuropathy, diabetic nephropathy as well as complicated diabetes increased by +18%, +93%, +101%, +113% and +89%, respectively. Using the same DRG grouper, revenues increased by +53% (from 27 (2013) to 42 (2014) DRG points). Frequency of HbA1c determinations rose by +85%, whereas the time for an average length of stay decreased by -12% (-0, 91 days) in comparison to patients without diabetes. CONCLUSION TeDia improved clinical awareness for diabetes and its complications. This new treatment model increased revenues and reduced hospital days indicating enhanced treatment quality. Our findings emphasize the necessity of novel technologies in inpatient settings for the improvement of efficacy, safety and efficiency of diabetes care.
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Affiliation(s)
- Martin Röhling
- West-German Center of Diabetes and Health, Düsseldorf Catholic Hospital Group, Düsseldorf, Germany
- Correspondence: Martin Röhling West-German Centre of Diabetes and Health, Düsseldorf Catholic Hospital Group, Hohensandweg 37, Düsseldorf40591, GermanyTel +49 211-56 60 360 76Fax +49 211-56 60 360 72 Email
| | - Marcus Redaélli
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - Dusan Simic
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - Kristina Lorrek
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - Christina Samel
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | - Kerstin Kempf
- West-German Center of Diabetes and Health, Düsseldorf Catholic Hospital Group, Düsseldorf, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - Stephan Martin
- West-German Center of Diabetes and Health, Düsseldorf Catholic Hospital Group, Düsseldorf, Germany
- Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Umpierrez GE, Klonoff DC. Diabetes Technology Update: Use of Insulin Pumps and Continuous Glucose Monitoring in the Hospital. Diabetes Care 2018; 41:1579-1589. [PMID: 29936424 PMCID: PMC6054505 DOI: 10.2337/dci18-0002] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/20/2018] [Indexed: 02/03/2023]
Abstract
The use of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) systems has gained wide acceptance in diabetes care. These devices have been demonstrated to be clinically valuable, improving glycemic control and reducing risks of hypoglycemia in ambulatory patients with type 1 diabetes and type 2 diabetes. Approximately 30-40% of patients with type 1 diabetes and an increasing number of insulin-requiring patients with type 2 diabetes are using pump and sensor technology. As the popularity of these devices increases, it becomes very likely that hospital health care providers will face the need to manage the inpatient care of patients under insulin pump therapy and CGM. The American Diabetes Association advocates allowing patients who are physically and mentally able to continue to use their pumps when hospitalized. Health care institutions must have clear policies and procedures to allow the patient to continue to receive CSII treatment to maximize safety and to comply with existing regulations related to self-management of medication. Randomized controlled trials are needed to determine whether CSII therapy and CGM systems in the hospital are associated with improved clinical outcomes compared with intermittent monitoring and conventional insulin treatment or with a favorable cost-benefit ratio.
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Affiliation(s)
- Guillermo E Umpierrez
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - David C Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA
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