Perioperative and critical illness dysglycemia--controlling the iceberg

Dysglycaemia in the critically ill and the interaction of chronic and acute glycaemia with mortality

PURPOSE

Hyperglycaemia is common in the critically ill. The objectives of this study were to determine the prevalence of critical illness-associated hyperglycaemia (CIAH) and recognised and unrecognised diabetes in the critically ill as well as to evaluate the impact of premorbid glycaemia on the association between acute hyperglycaemia and mortality.

METHODS

In 1,000 consecutively admitted patients we prospectively measured glycated haemoglobin (HbA1c) on admission, and blood glucose concentrations during the 48 h after admission, to the intensive care unit. Patients with blood glucose ≥7.0 mmol/l when fasting or ≥11.1 mmol/l during feeding were deemed hyperglycaemic. Patients with acute hyperglycaemia and HbA1c <6.5% (48 mmol/mol) were categorised as 'CIAH', those with known diabetes as 'recognised diabetes', and those with HbA1c ≥6.5% but no previous diagnosis of diabetes as 'unrecognised diabetes'. The remainder were classified as 'normoglycaemic'. Hospital mortality, HbA1c and acute peak glycaemia were assessed using a logistic regression model.

RESULTS

Of 1,000 patients, 498 (49.8%) had CIAH, 220 (22%) had recognised diabetes, 55 (5.5%) had unrecognised diabetes and 227 (22.7%) were normoglycaemic. The risk of death increased by approximately 20% for each increase in acute glycaemia of 1 mmol/l in patients with CIAH and those with diabetes and HbA1c levels <7% (53 mmol/mol), but not in patients with diabetes and HbA1c ≥7%. This association was lost when adjusted for severity of illness.

CONCLUSIONS

Critical illness-associated hyperglycaemia is the most frequent cause of hyperglycaemia in the critically ill. Peak glucose concentrations during critical illness are associated with increased mortality in patients with adequate premorbid glycaemic control, but not in patients with premorbid hyperglycaemia. Optimal glucose thresholds in the critically ill may, therefore, be affected by premorbid glycaemia.

How dietary patterns could have a role in prevention, progression, or management of diabetes mellitus? Review on the current evidence

OBJECTIVE

To investigate the role of dietary patterns in prevention and management of type 2 diabetes mellitus.

MATERIALS AND METHODS

A systematic review of databases which were published in ISI, Cochrane Central Register of Controlled Trials databases, PubMed, Iran Medex, and MagIran was performed. "Diabetes" and "dietary pattern" were used as the keywords.

RESULTS

A total of 58 studies which aimed to focus on diabetes mellitus, insulin resistance, metabolic syndrome, dietary pattern, and other related key words were reviewed. More than 47,447 articles were found and 46,709 entries of the extracted studies were excluded on the basis of the title and abstracts. The major dietary patterns were: "Healthy", "Western", "Traditional", "Prudent", "Unhealthy", "Mediterranean", "Modern", and "Dietary Approach to Stop Hypertension" (DASH) diets. Comparison of the effects of different diets revealed that dietary patterns containing fiber-rich foods have a protective role in managing diabetes mellitus. "Healthy", "Mediterranean", "Prudent", and "DASH" dietary patterns were associated with lower risk of hyperglycemia.

CONCLUSIONS

The adherence to the Mediterranean, Prudent, or DASH diets could control hyperglycemia. The higher intake of vegetables, fruits, nuts, whole grains, and lower intake of red meat could reduce the risk of type 2 diabetes mellitus.

The food and drug administration is now preparing to establish tighter performance requirements for blood glucose monitors

On March 16 and 17, 2010, the Food and Drug Administration (FDA) presented a public meeting about blood glucose monitoring at the Gaithersberg Hilton Hotel. The meeting was intended to present expert opinions and solicit input from the public about whether to develop new regulatory policies for blood glucose monitors. The meeting was divided into three sections: (1) Clinical Accuracy Requirements for Blood Glucose Monitors, (2) Interferences and Limitations of Blood Glucose Monitors, and (3) Tight Glycemic Control. Many officials from the Center for Devices and Radiologic Health and the Office of In Vitro Diagnostic Devices, which are the parts of FDA that regulate approval of blood glucose monitors, either spoke on the agenda or attended in the audience. Approximately 300 people attended; they were mostly clinicians (such as adult endocrinologists, pediatric endocrinologists, internists, clinical chemists, intensivists, surgeons, nurses, and diabetes educators) or industry officials from companies involved in glucose monitoring, pharmaceutical products, data analysis, or regulatory consulting.