Prediction of Hypoglycemia During Admission of Non-Critically Ill Patients: Results from the MENU Study

2020 ◽  
Vol 52 (09) ◽  
pp. 660-668
Author(s):  
Israel Khanimov ◽  
Meital Ditch ◽  
Henriett Adler ◽  
Sami Giryes ◽  
Noa Felner Burg ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Glucose Monitoring ◽  
Cross Sectional Study ◽  
Nutritional Risk ◽  
Blood Glucose Monitoring ◽  
Cross Sectional ◽  
Hospitalization Period ◽  
Diabetes Mellitus Status

AbstractThe objective of the work was to study admission parameters associated with an increased incidence of hypoglycemia during hospitalization of non-critically ill patients. Included in this cross-sectional study were patients admitted to internal medicine units. The Nutritional Risk Screening 2002 (NRS2002) was used for nutritional screening. Data recorded included admission serum albumin (ASA) and all glucose measurements obtained by the institutional blood glucose monitoring system. Neither of these are included in the NRS2002 metrics. Hypoalbuminemia was defined as ASA<3.5 g/dl. Patients were categorized as hypoglycemic if they had at least one documented glucose≤70 mg/dl during the hospitalization period. Included were 1342 patients [median age 75 years (IQR 61–84), 51.3% male, 52.5% with diabetes mellitus, (DM)], who were screened during three distinct periods of time from 2011–2018. The incidence of hypoglycemia was 10.8% with higher rates among DM patients (14.6 vs. 6.6%, p<0.001). Hypoglycemia incidence was negatively associated with ASA regardless of DM status. Multivariable regression showed that ASA (OR 0.550 per g/dl, 95% CI 0.387–0.781, p=0.001) and positive NRS2002 (OR 1.625, 95% CI 1.072–2.465, p=0.022) were significantly associated with hypoglycemia. The addition of hypoalbuminemia status to the NRS2002 tool improved the overall sensitivity from 0.55 to 0.71, but reduced specificity from 0.63 to 0.46. The negative predictive value was 0.93. Our data suggest that the combination of positive malnutrition screen and hypoalbuminemia upon admission are independently associated with the incidence of hypoglycemia among non-critically ill patients, regardless of diabetes mellitus status.

scholarly journals RESILIENCE AND SELF-CARE IN PEOPLE WITH DIABETES MELLITUS

2020 ◽  
Vol 29 ◽  
Author(s):  
Julia Estela Willrich Boell ◽  
Denise Maria Guerreiro Vieira da Silva ◽  
Maria Elena Echevarria Guanilo ◽  
Kathleen Hegadoren ◽  
Betina Hörner Schlindwein Meirelles ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Statistical Significance ◽  
Glucose Monitoring ◽  
Self Care ◽  
Cross Sectional Study ◽  
Blood Glucose Monitoring ◽  
Foot Care ◽  
Cross Sectional ◽  
Resilience Scale ◽  
One Year

ABSTRACT Objective: to investigate the association between resilience and self-care in people with diabetes mellitus treated in Primary Health Care. Method: Cross-sectional study, sample consisting of 362 people, aged 18 years or older, diagnosed with diabetes for at least one year. Descriptive analyzes and comparison of means were performed, assuming statistical significance with a value of p <0.05. The Resilience Scale and Questionnaire on Diabetes Self-Care Activities were applied, containing six dimensions: general food, specific food, physical activity, blood glucose monitoring, foot care, medication use, plus three items on smoking. Data collection took place between December and May 2016, in ten Health Centers in a city in the south of the country. Results: among the 15 self-care activities, four showed a statistically significant association when compared to the average resilience, highlighting: healthy eating and professional guidance, desirable sweet consumption, blood sugar assessment as recommended. Conclusion: the results obtained highlight the relationship between high averages of resilience and adequate performance in the care of diabetes mellitus.

scholarly journals Hyperglycemia in critical patients: Determinants of insulin dose choice

2017 ◽  
Vol 63 (5) ◽  
pp. 441-446
Author(s):  
Aline Klitzke Paliosa ◽  
Cassiano Teixeira ◽  
Regis Goulart Rosa ◽  
Carine Raquel Blatt
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Insulin Dose ◽  
Regular Insulin ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Diagnosis Of Diabetes Mellitus

Summary Objective: To identify factors that can determine the choice of intermittent subcutaneous regular insulin dose in critically ill patients with hyperglycemia. Method: Cross-sectional study in a general adult ICU with 26 beds, data collected between September and October 2014. The variables analyzed were: sex, age, previous diagnosis of diabetes mellitus, use of corticosteroids, use of lactulose, sepsis, fasting, enteral nutrition, use of dextrose 5% in water, NPH insulin prescription and blood glucose level. Patients with one or more episodes of hyperglycemia (blood glucose greater than 180 mg/dL) were included as a convenience sample, not consecutively. Those with continuous insulin prescription were excluded from analysis. Results: We included 64 records of hyperglycemia observed in 22 patients who had at least one episode of hyperglycemia. The median administered subcutaneous regular human insulin was 6 IU and among the factors evaluated only blood glucose levels were associated with the choice of insulin dose administered. Conclusion: Clinical characteristics such as diet, medications and diagnosis of diabetes mellitus are clearly ignored in the decision-making regarding insulin dose to be administered for glucose control in critically ill patients with hyperglycemia.

scholarly journals Self-care activities and their relationship to metabolic and clinical control of people with diabetes Mellitus

2015 ◽  
Vol 24 (3) ◽  
pp. 697-705 ◽  
Author(s):  
Anna Claudia Martins Coelho ◽  
Lilian Cristiane Gomes Villas Boas ◽  
Daniele dos Santos Gomides ◽  
Maria Cristina Foss-Freitas ◽  
Ana Emilia Pace
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Glucose Monitoring ◽  
Self Care ◽  
Disease Diagnosis ◽  
Cross Sectional Study ◽  
Blood Glucose Monitoring ◽  
Foot Care ◽  
Cross Sectional ◽  
Clinical Control

Cross-sectional study with the aim to evaluate self-care in people with type 2 diabetes mellitus and verify its relationship with sociodemographic and clinical characteristics. The sample included 218 patients under outpatient follow-up. Self-care activities were evaluated by means of a questionnaire that was previously translated and validated for Brazil. The questionnaire items that reached the highest means were related to drug therapy, whereas those with the lowest means were related to the practice of physical activity. Age correlated inversely with physical activity and foot care, and elapsed time since the disease diagnosis showed a direct correlation with blood glucose monitoring. Data showed that self-care activities related to behavioral changes are the ones that require greater investments to achieve its goals, and age and time since diagnosis should be considered in the planning of nursing care for people with diabetes mellitus.

scholarly journals Adherence to diabetes mellitus care at three levels of health care

2017 ◽  
Vol 21 (4) ◽  
Author(s):  
Jackline Duran Souza ◽  
Marcelo Henrique Barbosa Baptista ◽  
Danielle dos Santos Gomides ◽  
Ana Emilia Pace
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Tertiary Care ◽  
Glucose Monitoring ◽  
Self Care ◽  
Cross Sectional Study ◽  
Blood Glucose Monitoring ◽  
Nursing Interventions ◽  
Cross Sectional ◽  
Quantitative Descriptive

ABSTRACT Objective: To evaluate adherence to self-care among people with diabetes mellitus cared for at the three levels of health care. Method: Quantitative, descriptive, cross-sectional study addressing a sample of 143 people from a city in the interior of São Paulo, Brazil from primary (45), secondary (48) and tertiary (50) units. Adherence to self-care was assessed using the "The Summary of Diabetes Self-Care Activities Measure" and "Measurement of Treatment Adherence". Results: Adherence to exercises, blood glucose monitoring, shoe inspection, and the use of insulin differed between units; better results were obtained for those in tertiary care. Conclusion: The results indicate a need for greater investment in the initial phase of treatment to improve self-care adherence. Implications for practice: The study enabled identifying the profile of individuals in terms of self-care adherence and supporting the planning of nursing interventions in diabetes mellitus.

scholarly journals Continuous Glucose Monitoring in Critically Ill Patients With COVID-19: Results of an Emergent Pilot Study

2020 ◽  
Vol 14 (6) ◽  
pp. 1065-1073
Author(s):  
Archana R. Sadhu ◽  
Ivan Alexander Serrano ◽  
Jiaqiong Xu ◽  
Tariq Nisar ◽  
Jessica Lucier ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Pilot Study ◽  
Insulin Therapy ◽  
Critically Ill ◽  
Continuous Glucose Monitoring ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Target Range

Background: Amidst the coronavirus disease 2019 (COVID-19) pandemic, continuous glucose monitoring (CGM) has emerged as an alternative for inpatient point-of-care blood glucose (POC-BG) monitoring. We performed a feasibility pilot study using CGM in critically ill patients with COVID-19 in the intensive care unit (ICU). Methods: Single-center, retrospective study of glucose monitoring in critically ill patients with COVID-19 on insulin therapy using Medtronic Guardian Connect and Dexcom G6 CGM systems. Primary outcomes were feasibility and accuracy for trending POC-BG. Secondary outcomes included reliability and nurse acceptance. Sensor glucose (SG) was used for trends between POC-BG with nursing guidance to reduce POC-BG frequency from one to two hours to four hours when the SG was in the target range. Mean absolute relative difference (MARD), Clarke error grids analysis (EGA), and Bland-Altman (B&A) plots were calculated for accuracy of paired SG and POC-BG measurements. Results: CGM devices were placed on 11 patients: Medtronic ( n = 6) and Dexcom G6 ( n = 5). Both systems were feasible and reliable with good nurse acceptance. To determine accuracy, 437 paired SG and POC-BG readings were analyzed. For Medtronic, the MARD was 13.1% with 100% of readings in zones A and B on Clarke EGA. For Dexcom, MARD was 11.1% with 98% of readings in zones A and B. B&A plots had a mean bias of −17.76 mg/dL (Medtronic) and −1.94 mg/dL (Dexcom), with wide 95% limits of agreement. Conclusions: During the COVID-19 pandemic, CGM is feasible in critically ill patients and has acceptable accuracy to identify trends and guide intermittent blood glucose monitoring with insulin therapy.

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