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Chang S, Xu M, Wang Y, Zhang Y. Acute Glycemic Variability and Early Outcomes After Cardiac Surgery: A Meta-Analysis. Horm Metab Res 2023; 55:771-780. [PMID: 37402380 DOI: 10.1055/a-2106-5539] [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: 07/06/2023]
Abstract
The influence of acute glycemic variability (GV) on early outcomes of patients after cardiac surgery remains not fully determined. We performed a systematic review and meta-analysis to evaluate the association between acute GV and in-hospital outcomes of patients after cardiac surgery. Relevant observational studies were obtained by search of electronic databases including Medline, Embase, Cochrane Library, and Web of Science. A randomized-effects model was selected to pool the data by incorporating the influence of potential heterogeneity. Nine cohort studies involving 16 411 patients after cardiac surgery were included in this meta-analysis. Pooled results showed that a high acute GV was associated with an increased risk of major adverse events (MAE) during hospitalization for patients after cardiac surgery [odds ratio [OR]: 1.29, 95% CI: 1.15 to 1.45, p<0.001, I22=38%]. Sensitivity analysis limited to studies of on-pump surgery and GV evaluated by coefficient of variation of blood glucose showed similar results. Subgroup analysis suggested that a high acute GV was related to an increased incidence of MAE in patients after coronary artery bypass graft, but not for those after isolated valvular surgery (p=0.04), and the association was weakened after adjustment of glycosylated hemoglobin (p=0.01). Moreover, a high acute GV was also related to an increased risk of in-hospital mortality (OR: 1.55, 95% CI: 1.15 to 2.09, p=0.004; I22=0%). A high acute GV may be associated with poor in-hospital outcomes in patients after cardiac surgery.
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Affiliation(s)
- Shuo Chang
- Surgery ICU, Cardiac surgery, Fuwai Hospital State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Mian Xu
- Surgery ICU, Cardiac surgery, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Yu Wang
- Surgery ICU, Cardiac surgery, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Yanbo Zhang
- Surgery ICU, Cardiac surgery, Fuwai Hospital State Key Laboratory of Cardiovascular Disease, Beijing, China
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Rupprecht B, Stöckl A, Stöckl S, Dietrich C. [Treatment of diabetes mellitus in perioperative medicine-an update]. Anaesthesist 2021; 70:451-465. [PMID: 33141238 DOI: 10.1007/s00101-020-00875-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 12/15/2022]
Abstract
Patients with diabetes who undergo a surgical intervention have an increased risk of metabolic derailment, anesthesiological complications, postoperative infections and cardiovascular events. The treatment of diabetes mellitus is subject to a continuous further development due to pharmaceutical and technical innovations. This article presents the implications of the current concepts of diabetes treatment for perioperative medicine, particularly the changes due to new oral antidiabetic agents and insulin pump treatment. Some of the currently available guidelines are discussed with respect to the care of diabetes patients in childhood and adulthood in connection with an operation. Finally, possible perspectives in the field of monitoring and treatment of diabetes patients are discussed.
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Affiliation(s)
- B Rupprecht
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - A Stöckl
- Gemeinschaftspraxis Diedorf, Zertifiziertes Diabeteszentrum DDG Dres. Huß, Baur, Ziesing und Kollegen, Bei den Zäunen 2, 86420, Diedorf, Deutschland
| | - S Stöckl
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - C Dietrich
- Pädiatrische Anästhesiologie, Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum St. Marien Amberg, Mariahilfbergweg 7, 92224, Amberg, Deutschland
- Pädiatrische Anästhesiologie, Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Weiden - Kliniken Nordoberpfalz AG, Söllnerstr. 16, 92637, Weiden, Deutschland
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Witek B, Rochon-Szmejchel D, Stanisławska I, Łyp M, Wróbel K, Zapała A, Kamińska A, Kołątaj A. Activities of Lysosomal Enzymes in Alloxan-Induced Diabetes in the Mouse. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1040:73-81. [PMID: 28905270 DOI: 10.1007/5584_2017_102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The study investigated a panel of lysosomal enzymes in the liver and kidney tissues in alloxan-induced diabetes in the mouse. The mice were divided into six experimental groups receiving 10% alloxan at a dose of 50 and 75 mg/kg over a period of four, eight, and twelve days; each group was compared with controls receiving 0.9% NaCl. The findings were that diabetes induced by both doses of alloxan was accompanied by significant increases in the lysosomal activities of acid phosphatase and the glycosidases investigated: β-glucuronidase, β-galactosidase, β-glucosidase, and N-acetyl-hexosaminidase. The lysosomal enzyme activity in both liver and kidney cells peaked 12 days after onset of diabetes for most enzymes, at the time when hyperglycemia and hyperinsulinemia already started abating after their peak at 8 days into the course of diabetes. The enzyme activity was in most cases higher with the higher dose of alloxan and thus higher level of glycemia. Lysosomal enzymes degrade glycoconjugates, the molecules that are present in the basement membrane of endothelial cells where they contribute to capillary wall stability. Thus, enhanced activity of these enzymes could presage the progression of diabetic microangiopathy, atherosclerosis, and the development of microvascular complications.
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Affiliation(s)
- Bożena Witek
- Department of Animal Physiology, Institute of Biology, The Jan Kochanowski University, Kielce, Poland
| | | | - Iwona Stanisławska
- Department of Dietetics, College of Rehabilitation, 49 Kasprzaka Street, 01-234, Warsaw, Poland.
| | - Marek Łyp
- Department of Dietetics, College of Rehabilitation, 49 Kasprzaka Street, 01-234, Warsaw, Poland
| | | | - Arkadiusz Zapała
- Department of Urology, Regional Specialist Healthcare Center for Tuberculosis and Lung Diseases, Kielce, Poland
| | - Agnieszka Kamińska
- Faculty of Family Studies, The Cardinal Wyszyński University, Warsaw, Poland
| | - Adam Kołątaj
- Department of Dietetics, College of Rehabilitation, 49 Kasprzaka Street, 01-234, Warsaw, Poland
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Setji T, Hopkins TJ, Jimenez M, Manning E, Shaughnessy M, Schroeder R, Mendoza-Lattes S, Spratt S, Westover J, Aronson S. Rationalization, Development, and Implementation of a Preoperative Diabetes Optimization Program Designed to Improve Perioperative Outcomes and Reduce Cost. Diabetes Spectr 2017; 30:217-223. [PMID: 28848317 PMCID: PMC5556583 DOI: 10.2337/ds16-0066] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Tracy Setji
- Department of Medicine (Endocrinology Division), Duke University Medical Center, Durham, NC
| | - Thomas J. Hopkins
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Maria Jimenez
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Erin Manning
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | | | - Rebecca Schroeder
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | | | - Susan Spratt
- Department of Medicine (Endocrinology Division), Duke University Medical Center, Durham, NC
| | - Julie Westover
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Solomon Aronson
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
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Results of a multicenter prospective pivotal trial of the first inline continuous glucose monitor in critically ill patients. J Trauma Acute Care Surg 2017; 82:1049-1054. [DOI: 10.1097/ta.0000000000001444] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nohra E, Buckman S, Bochicchio K, Chamieh J, Reese S, Merrill C, Schuerer D, Bochicchio GV. Results of a near continuous glucose monitoring technology in surgical intensive care and trauma. Contemp Clin Trials 2016; 50:1-4. [PMID: 27394384 DOI: 10.1016/j.cct.2016.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/24/2016] [Accepted: 07/05/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Near-continuous glucose monitoring is expected to increase time in range (TIR) of 80-120mg/dL and to avoid hypoglycemia without increasing workload. We investigated a near-continuous glucose monitor in surgical critically ill and trauma patients. METHODS Patients were enrolled at a surgical intensive care unit associated with a level 1 trauma center. Glucose measurements were compared to the gold standard Yellow Springs Instrument (YSI). The technology withdraws 0.13mL of blood every 15min from a central venous line, centrifuges the sample, and uses mid-infrared spectroscopy to measure glucose. We plotted a Clarke Error Grid, calculated Mean Absolute Relative Deviation (MARD) to analyze trend accuracy, and we present a Bland Altman plot of device versus standard glucose measurements. RESULTS 24 patients were enrolled. One patient was withdrawn due to poor blood return from central venous line. A total of 347 glucose measurements from 23 patients were compared to the gold standard. 94.8% of the data points were in zone A of the Clarke Error Grid and 5.2% in zone B. The MARD was 8.02%. The majority of data points achieved the benchmark for accuracy. The remaining 5.2% are clinically benign. The MARD was below 10%. The Bland Altman plot shows good agreement between the device and reference glucose measurements. There were no device related adverse events. CONCLUSION Our data suggests that near continuous monitoring via infrared spectroscopy is safe and accurate for use in critically ill surgical and trauma patients. A large scale multi-center study is underway to confirm these findings.
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Affiliation(s)
- Eden Nohra
- Acute and Critical Care Surgery, Washington University in St. Louis, St. Louis, MO, United States.
| | - Sara Buckman
- Acute and Critical Care Surgery, Washington University in St. Louis, St. Louis, MO, United States
| | - Kelly Bochicchio
- Acute and Critical Care Surgery, Washington University in St. Louis, St. Louis, MO, United States
| | - Jad Chamieh
- Acute and Critical Care Surgery, Washington University in St. Louis, St. Louis, MO, United States
| | - Stacey Reese
- Acute and Critical Care Surgery, Washington University in St. Louis, St. Louis, MO, United States
| | - Corinne Merrill
- Acute and Critical Care Surgery, Washington University in St. Louis, St. Louis, MO, United States
| | - Douglas Schuerer
- Acute and Critical Care Surgery, Washington University in St. Louis, St. Louis, MO, United States
| | - Grant V Bochicchio
- Acute and Critical Care Surgery, Washington University in St. Louis, St. Louis, MO, United States
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Dell'Aquila AM, Lueck S, Ellger B. Surgeon's Tiredness or Patient's Fasting? What Is More Relevant for Outcome in Nonemergent Cardiac Surgery? Ann Thorac Surg 2016; 101:1633-4. [PMID: 27000603 DOI: 10.1016/j.athoracsur.2015.09.092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Angelo M Dell'Aquila
- Department of Cardiothoracic Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Muenster, Germany.
| | - Sabrina Lueck
- Department of Cardiothoracic Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Muenster, Germany
| | - Bjoern Ellger
- Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, University Hospital Muenster, Muenster, Germany
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Gottschalk A, Welp HA, Leser L, Lanckohr C, Wempe C, Ellger B. Continuous Glucose Monitoring in Patients Undergoing Extracorporeal Ventricular Assist Therapy. PLoS One 2016; 11:e0148778. [PMID: 26963806 PMCID: PMC4786282 DOI: 10.1371/journal.pone.0148778] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/22/2016] [Indexed: 12/16/2022] Open
Abstract
Background Dysregulations of blood glucose (BG) are associated with adverse outcome in critical illness; controlling BG to target appears to improve outcome. Since BG-control is challenging in daily intensive care practice BG-control remains poor especially in patients with rapidly fluctuating BG. To improve BG-control and to avoid deleterious hypoglycemia, automated online-measurement tools are advocated. We thus evaluated the point-accuracy of the subcutaneous Sentrino® Continuous Glucose Monitoring System (CGM, Medtronic Diabetes, Northridge, California) in patients undergoing extracorporeal cardiac life support (ECLS) for cardiogenic shock. Methods Management of BG was performed according to institute’s standard aiming at BG-levels between 100–145 mg/dl. CGM-values were recorded without taking measures into therapeutic account. Point-accuracy in comparison to intermittent BG-measurement by the ABL-blood-gas analyzer was determined. Results CGM (n = 25 patients) correlated significantly with ABL-values (r = 0.733, p<0.001). Mean error from standard was 15.0 mg/dl (11.9%). 44.2% of the readings were outside a 15% range around ABL-values. In one of 635 paired data-points, ABL revealed hypoglycemia (BG 32 mg/dl) whereas CGM did not show hypoglycemic values (132mg/dl). Conclusions CGM reveals minimally invasive BG-values in critically ill adults with dynamically impaired tissue perfusion. Because of potential deviations from standard, CGM-readings must be interpreted with caution in specific ICU-populations.
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Affiliation(s)
- Antje Gottschalk
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Henryk A. Welp
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany
- * E-mail:
| | - Laura Leser
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Christian Lanckohr
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Carola Wempe
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Björn Ellger
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
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Fong R, Sweitzer BJ. Preoperative Optimization of Patients Undergoing Ambulatory Surgery. CURRENT ANESTHESIOLOGY REPORTS 2014. [DOI: 10.1007/s40140-014-0082-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Amrein K, Kachel N, Fries H, Hovorka R, Pieber TR, Plank J, Wenger U, Lienhardt B, Maggiorini M. Glucose control in intensive care: usability, efficacy and safety of Space GlucoseControl in two medical European intensive care units. BMC Endocr Disord 2014; 14:62. [PMID: 25074071 PMCID: PMC4118658 DOI: 10.1186/1472-6823-14-62] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 07/15/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The Space GlucoseControl system (SGC) is a nurse-driven, computer-assisted device for glycemic control combining infusion pumps with the enhanced Model Predictive Control algorithm (B. Braun, Melsungen, Germany). We aimed to investigate the performance of the SGC in medical critically ill patients. METHODS Two open clinical investigations in tertiary centers in Graz, Austria and Zurich, Switzerland were performed. Efficacy was assessed by percentage of time within the target range (4.4-8.3 mmol/L; primary end point), mean blood glucose, and sampling interval. Safety was assessed by the number of hypoglycemic episodes (≤2.2 mmol/L) and the percentage of time spent below this cutoff level. Usability was analyzed with a standardized questionnaire given to involved nursing staff after the trial. RESULTS Forty medical critically ill patients (age, 62 ± 15 years; body mass index, 30.0 ± 8.9 kg/m2; APACHE II score, 24.8 ± 5.4; 27 males; 8 with diabetes) were included for a period of 6.5 ± 3.7 days (n = 20 in each center). The primary endpoint (time in target range 4.4 to 8.3 mmol/l) was reached in 88.3% ± 9.3 of the time and mean arterial blood glucose was 6.7 ± 0.4 mmol/l. The sampling interval was 2.2 ± 0.4 hours. The mean daily insulin dose was 87.2 ± 64.6 IU. The adherence to the given insulin dose advice was high (98.2%). While the percentage of time spent in a moderately hypoglycemic range (2.2 to 3.3 mmol/L) was low (0.07 ± 0.26% of the time), one severe hypoglycemic episode (<2.2 mmol/L) occurred (2.5% of patients or 0.03% of glucose readings). CONCLUSIONS SGC is a safe and efficient method to control blood glucose in critically ill patients as assessed in two European medical intensive care units.
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Affiliation(s)
- Karin Amrein
- Medical University of Graz, Austria, Department of Internal Medicine, Division of Endocrinology and Metabolism, Auenbruggerplatz 15, 8036 Graz, Austria
| | | | | | - Roman Hovorka
- Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Thomas R Pieber
- Medical University of Graz, Austria, Department of Internal Medicine, Division of Endocrinology and Metabolism, Auenbruggerplatz 15, 8036 Graz, Austria
- Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - Johannes Plank
- Medical University of Graz, Austria, Department of Internal Medicine, Division of Endocrinology and Metabolism, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Urs Wenger
- Medical University of Zurich, Department of Internal Medicine, Medical Intensive Care Unit, Zurich, Switzerland
| | - Barbara Lienhardt
- Medical University of Zurich, Department of Internal Medicine, Medical Intensive Care Unit, Zurich, Switzerland
| | - Marco Maggiorini
- Medical University of Zurich, Department of Internal Medicine, Medical Intensive Care Unit, Zurich, Switzerland
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