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A Systematic Approach for the Prevention and Reduction of Hypoglycemia in Hospitalized Patients

Published on Nov 1, 2017in Current Diabetes Reports3.996
路 DOI :10.1007/s11892-017-0934-8
Paulina Cruz1
Estimated H-index: 1
(WashU: Washington University in St. Louis),
Mary Clare Blackburn2
Estimated H-index: 2
(WashU: Washington University in St. Louis),
Garry S. Tobin9
Estimated H-index: 9
(WashU: Washington University in St. Louis)
Abstract
Purpose of Review Hypoglycemia and severe hypoglycemia (SH) in the inpatient setting are associated with poor outcomes. This review is designed to highlight approaches to predict and prevent inpatient hypoglycemia that has been successfully implemented focusing on developing overlapping policies and procedures that allow safe glycemic management to occur at all levels of the institution.
  • References (42)
  • Citations (1)
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References42
Newest
#1Robert J. Rushakoff (UCSF: University of California, San Francisco)H-Index: 15
#2Mary M. Sullivan (UCSF: University of California, San Francisco)H-Index: 5
Last. Michael A. Kohn (UCSF: University of California, San Francisco)H-Index: 24
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14 CitationsSource
Background Practice variations in insulin management and glycemic adverse events led nine Dignity Health hospitals to initiate a collaborative effort to improve hypoglycemia, uncontrolled hyperglycemia, and glycemic control. Methods Non鈥揷ritical care adult inpatients with 鈮4 point-of-care blood glucose (BG) readings in a 鈮2-day period were included. Balanced glucometric goals for each hospital were individualized to improve performance by 10%鈥20% from baseline or achieve top performance derived ...
5 CitationsSource
#1Armando CocaH-Index: 2
#2Ana Lucia ValenciaH-Index: 1
Last. J眉rgen Floege (RWTH Aachen University)H-Index: 75
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Background Hypoglycemia is a serious complication following the administration of insulin for hyperkalemia. We determined the incidence of hypoglycemia and severe hypoglycemia (blood glucose <70 or 鈮40 mg/dl, respectively) in a cohort of AKI and non-dialysis dependent CKD patients who received an intravenous infusion of insulin plus glucose to treat hyperkalemia. Methods We retrospectively reviewed charts of all AKI and non-dialysis dependent CKD patients who received 10 U of insulin plus 50 g g...
9 CitationsSource
#1Amit Akirov (TAU: Tel Aviv University)H-Index: 7
#2Alon Grossman (TAU: Tel Aviv University)H-Index: 13
Last. Ilan Shimon (TAU: Tel Aviv University)H-Index: 33
view all 4 authors...
Context:Hypoglycemia is common among hospitalized patients with and without diabetes mellitus (DM) but the prognostic implications may differ with spontaneous versus insulin-related hypoglycemia.Objective:Investigate the association between spontaneous or insulin-related hypoglycemia and mortality in hospitalized patients.Design:Hypoglycemia was defined as blood glucose <70mg/dl (3.9 mmol/l), including moderate hypoglycemia (40-70mg/dl, 2.2-3.9 mmol/l) and severe hypoglycemia (<40mg/dl, 2.2 mmol...
21 CitationsSource
#1Francisco J. Pasquel (Emory University)H-Index: 14
#2Roma Y. Gianchandani (UM: University of Michigan)H-Index: 7
Last. Guillermo E. Umpierrez (Emory University)H-Index: 61
view all 13 authors...
Summary Background The role of incretin-based drugs in the treatment of patients with type 2 diabetes admitted to hospital has not been extensively assessed. In this study, we compared the safety and efficacy of a dipeptidyl peptidase-4 inhibitor (sitagliptin) plus basal insulin with a basal鈥揵olus insulin regimen for the management of patients with type 2 diabetes in general medicine and surgery in hospitals. Methods We did a multicentre, prospective, open-label, non-inferiority randomised clini...
39 CitationsSource
#1Joseph A. Aloi (Wake Forest University)H-Index: 6
#2Bruce W. BodeH-Index: 49
Last. Amisha Wallia (NU: Northwestern University)H-Index: 11
view all 10 authors...
Background:American Diabetes Association (ADA) guidelines recommend a basal bolus correction insulin regimen as the preferred method of treatment for non鈥揷ritically ill hospitalized patients. However, achieving ADA glucose targets safely, without hypoglycemia, is challenging. In this study we evaluated the safety and efficacy of basal bolus subcutaneous (SubQ) insulin therapy managed by providers compared to a nurse-directed Electronic Glycemic Management System (eGMS).Method:This retrospective ...
11 CitationsSource
#1Elizabeth Lowden (NU: Northwestern University)H-Index: 1
#2Kathleen Schmidt (NU: Northwestern University)H-Index: 7
Last. Mark E. MolitchH-Index: 70
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Objective: The objective of the study was to elucidate 30-day and long-term outcomes in patients experiencing postoperative hypoglycemia. Methods: We conducted a retrospective review of patients who underwent cardiac surgery between September 4, 2007, and April 30, 2011, at Northwestern Memorial Hospital who had intensive treatment of hyperglycemia postoperatively. Of 1,325 patients, 215 experienced a hypoglycemic episode (blood glucose <70 mg/dL) within the first 3 postoperative days. A total o...
3 CitationsSource
#1Sun Y. LeeH-Index: 6
#2Gulce AskinH-Index: 1
Last. Sara M. AlexanianH-Index: 6
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Objective: Hypoglycemia remains one of the main challenges of insulin therapy. To reduce insulin-related hypoglycemia at our institution, we restricted inpatient ordering of high glargine doses (鈮0.5 U/kg/day) to endocrine staff in May 2013. This retrospective cohort study assesses its effect on hypoglycemia and glycemic control within 48 hours of admission (ADM). Methods: We identified 692 adult patients hospitalized at Boston Medical Center who received glargine upon ADM from November 1, 2012 ...
6 CitationsSource
#1Naina Sinha Gregory (Cornell University)H-Index: 1
#2Jane Jeffrie Seley (Cornell University)H-Index: 4
Last. David J. Brillon (Cornell University)H-Index: 15
view all 5 authors...
ABSTRACTObjectives: More than one-third of hospitalized patients have hyperglycemia. Despite evidence that improving glycemic control leads to better outcomes, achieving recognized targets remains a challenge. The objective of this study was to evaluate the implementation of a computerized insulin order set and titration algorithm on rates of hypoglycemia and overall inpatient glycemic control.Methods: A prospective observational study evaluating the impact of a glycemic order set and titration ...
7 CitationsSource
#1Amit Akirov (TAU: Tel Aviv University)H-Index: 7
#2Dror Dicker (TAU: Tel Aviv University)H-Index: 8
Last. Ilan Shimon (TAU: Tel Aviv University)H-Index: 33
view all 4 authors...
Abstract Aims Investigate the importance of treating diabetes by evaluating mortality risk of untreated and medically-treated diabetic patients. Methods Historical prospectively collected observational data of hospitalized patient 鈮18years, admitted for any-cause to medical wards, between January 2011 and December 2013. Main outcome was all-cause mortality at end of follow-up. Results Cohort included 35,340 patients (51% male, median age 70years); 24,159 without diabetes and 11,181 with diabetes...
3 CitationsSource
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Newest
#1Allison Zuern (SUNY: State University of New York System)
#2Luke A. Probst (SUNY: State University of New York System)H-Index: 1
Last. Robert W. Seabury (SUNY: State University of New York System)H-Index: 2
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