Glycemic Control in Neurocritically Ill Patients

2019 ◽  
pp. 241-245
Author(s):  
Carla P. Venegas-Borsellino ◽  
Michael A. Pizzi ◽  
Santiago Naranjo-Sierra
Keyword(s):  
Traumatic Brain Injury ◽  
Ischemic Stroke ◽  
Blood Glucose ◽  
Subarachnoid Hemorrhage ◽  
Brain Injury ◽  
Glycemic Control ◽  
Adverse Outcomes ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Poor Outcomes

Hyperglycemia, hypoglycemia, and variable blood glucose levels are associated with poor outcomes in critically ill patients. Patients with acute brain injury are sensitive to changes in glycemic levels because brain metabolism depends on a continuous, reliable supply of glucose. Numerous studies have shown that even moderate hypoglycemia may cause pronounced neuroglycopenia. Conversely hyperglycemia, which is prevalent in neurocritically ill patients, has been related to adverse outcomes after traumatic brain injury, ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage.

scholarly journals Association between blood glucose levels and Glasgow Outcome Score in patients with traumatic brain injury: secondary analysis of a randomized trial

Trials ◽  
2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Tao Yuan ◽  
Hongyu He ◽  
Yuepeng Liu ◽  
Jianwei Wang ◽  
Xin Kang ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Blood Glucose ◽  
Brain Injury ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Threshold Effect ◽  
Glasgow Outcome Score ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Average Blood Glucose

Abstract Background Blood glucose levels that are too high or too low after traumatic brain injury (TBI) negatively affect patient prognosis. This study aimed to demonstrate the relationship between blood glucose levels and the Glasgow Outcome Score (GOS) in TBI patients. Methods This study was based on a randomized, dual-center, open-label clinical trial. A total of 208 patients who participated in the randomized controlled trial were followed up for 5 years. Information on the disease, laboratory examination, insulin therapy, and surgery for patients with TBI was collected as candidate variables according to clinical importance. Additionally, data on 5-year and 6-month GOS were collected as primary and secondary outcomes, respectively. For multivariate analysis, a generalized additive model (GAM) was used to investigate relationships between blood glucose levels and GOS. The results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). We further applied a two- piecewise linear regression model to examine the threshold effect of blood glucose level and GOS. Results A total of 182 patients were included in the final analysis. Multivariate GAM analysis revealed that a bell-shaped relationship existed between average blood glucose level and 5-year GOS score or 6-month GOS score. The inflection points of the average blood glucose level were 8.81 (95% CI: 7.43–9.48) mmol/L considering 5-year GOS as the outcome and were 8.88 (95% CI 7.43−9.74) mmol/L considering 6-month GOS score as the outcome. The same analysis revealed that there was also a bell relationship between average blood glucose levels and the favorable outcome group (GOS score ≥ 4) at 5 years or 6 months. Conclusion In a population of patients with traumatic brain injury, blood glucose levels were associated with the GOS. There was also a threshold effect between blood glucose levels and the GOS. A blood glucose level that is either too high or too low conveys a poor prognosis. Trial registration ClinicalTrials.gov NCT02161055. Registered on 11 June 2014.

scholarly journals Differential temporal profile of lowered blood glucose levels (3.5 - 6.5 mM versus 5 - 8 mM) in patients with severe traumatic brain injury

Critical Care ◽  
2008 ◽  
Vol 12 (4) ◽  
pp. R98 ◽  
Author(s):  
Regula Meier ◽  
Markus Bechir ◽  
Silke Ludwig ◽  
Jutta Sommerfeld ◽  
Marius Keel ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Blood Glucose ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Temporal Profile ◽  
Glucose Levels ◽  
Blood Glucose Levels

scholarly journals Association between blood glucose levels in insulin therapy and Glasgow Outcome Score in patients with traumatic brain injury: secondary analysis of a randomized trial

2021 ◽  
Author(s):  
Tao Yuan ◽  
Hongyu He ◽  
Yuepeng Liu ◽  
Jianwei Wang ◽  
Xin Kang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Traumatic Brain Injury ◽  
Blood Glucose ◽  
Brain Injury ◽  
Blood Glucose Level ◽  
Insulin Therapy ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Medium Level ◽  
Level Group

Abstract Background: Too high or low blood glucose levels after traumatic brain injury (TBI) negatively affect the prognosis of patients with TBI. This study aimed to examine the relationship between different levels of blood glucose in insulin therapy and Glasgow Outcome Score (GOS) in patients with TBI.Methods: This study was based on a randomized, dual-center, open-label clinical trial. A total of 208 patients who participated in the randomized controlled trial were followed up for 5 years. The information on disease, lab examination, insulin therapy, and operation of patients with TBI was collected. Also, the data on 5-year and 6-month GOS were collected as primary and secondary outcomes. The univariate analysis was used to detect variables that might contribute to outcomes, while the multivariate regression analysis was used to reveal the independent relationship between insulin therapy and outcomes. A generalized additive model (GAM) was used to investigate dose–response relationships between blood glucose levels and GOS. The results were presented as odds ratios (ORs) with their 95% confidence intervals (95% CIs). We further applied a two-piecewise linear regression model to examine the threshold effect of blood glucose level and GOS.Results: A total of 182 patients were involved in the final analysis. Compared with the non-intensive insulin therapy group, the 5-year GOS in the moderate-control intensive insulin therapy (IIT) group and the slight-control IIT group was 1.45 and 1.39 higher, respectively (both P < 0.05); the 5-year GOS in the strict-control IIT group was 0.23 higher (P > 0.05). GAM revealed that a bell-shaped relationship existed between blood glucose levels in insulin therapy and 5-year or 6-month GOS. The inflection points of the mean blood glucose level were 6.73 and 8.97 mmol/L considering 5-year GOS as the outcome and were 6.95 and 8.88 mmol/L considering 6-month GOS as the outcome. The multivariate analysis showed that the 5-year GOS in the medium-level group (≥6.73 and <8.97 mmol/L) increased by 0.83 [95% confidence interval (CI): 0.22–1.47] compared with that in the low-level group (<6.73 mmol/L). Also, the 5-year GOS in the medium-level group increased by 0.57 (95% CI: 0.02–1.08) compared with that in the high-level group (≥8.97 mmol/L).Conclusion: A proper blood glucose range in insulin therapy could improve the outcomes of patients with TBI; the range was 6.73–8.97 mmol/L according to our limited analysis.Clinical Trial Registration: ClinicalTrials.gov, NCT02161055. Registered 11 Jun 2014.

Association between Blood Glucose Levels the Day after Targeted Temperature Initiation and Outcome in Traumatic Brain Injury: APost-HocAnalysis of the B-HYPO Study

2017 ◽  
Vol 34 (5) ◽  
pp. 987-995 ◽  
Author(s):  
Hitoshi Kobata ◽  
Akira Sugie ◽  
Eiichi Suehiro ◽  
Kenji Dohi ◽  
Tadashi Kaneko ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Blood Glucose ◽  
Brain Injury ◽  
Glucose Levels ◽  
Blood Glucose Levels

scholarly journals Glucose levels during gestational diabetes pregnancy and the risk of developing postpartum diabetes or prediabetes

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Chadakarn Phaloprakarn ◽  
Siriwan Tangjitgamol
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Gestational Diabetes ◽  
Confidence Interval ◽  
Control Group ◽  
Oral Glucose ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
The Impact

Abstract Background Blood glucose levels during pregnancy may reflect the severity of insulin secretory defects and/or insulin resistance during gestational diabetes mellitus (GDM) pregnancy. We hypothesized that suboptimal glycemic control in women with GDM could increase the risk of postpartum type 2 diabetes mellitus (T2DM) or prediabetes. Our objective was to evaluate the impact of plasma glucose levels throughout GDM pregnancy on the risk of postpartum T2DM or prediabetes. Methods The medical records of 706 women with GDM who underwent a postpartum 75-g, 2-hour oral glucose tolerance test at our institution between January 2011 and December 2018 were reviewed. These women were classified into 2 groups according to glycemic control during pregnancy: ≤ 1 occasion of either fasting glucose ≥ 95 mg/dL or 2-hour postprandial glucose ≥ 120 mg/dL was defined as optimal glycemic control or else was classified as suboptimal glycemic control. Rates of postpartum T2DM and prediabetes were compared between women with optimal (n = 505) and suboptimal (n = 201) glycemic control. Results The rates of postpartum T2DM and prediabetes were significantly higher in the suboptimal glycemic control group than in the optimal glycemic control group: 22.4% vs. 3.0%, P < 0.001 for T2DM and 45.3% vs. 23.5%, P < 0.001 for prediabetes. In a multivariate analysis, suboptimal glucose control during pregnancy was an independent risk factor for developing either postpartum T2DM or prediabetes. The adjusted odds ratios were 8.4 (95% confidence interval, 3.5–20.3) for T2DM and 3.9 (95% confidence interval, 2.5–6.1) for prediabetes. Conclusion Our findings suggest that blood glucose levels during GDM pregnancy have an impact on the risk of postpartum T2DM and prediabetes.

scholarly journals Transient bilateral diabetic cataracts in a Brazilian Terrier puppy

2005 ◽  
Vol 35 (3) ◽  
pp. 709-712
Author(s):  
Carla de Freitas Campos ◽  
Lilian Stefanoni Ferreira ◽  
Marlos Gonçalves Sousa ◽  
Fernanda Gomes Velasque Gama ◽  
José Luiz Laus ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Lens Opacity ◽  
Human Beings ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
And Control

A case of a Brazilian Terrier puppy presenting diabetic lens opacity that restored transparency after insulin therapy and control of blood glucose levels is reported. This entity has been rarely reported in human beings and has not been reported in dogs before. The rapid glycemic control may have been responsible for the transparency recovery.

scholarly journals Evaluation of prescription pattern and efficacy of anti-diabetic drugs in Coimbatore, India

2017 ◽  
Vol 6 (5) ◽  
pp. 27-33
Author(s):  
Nagarajaperumal Govindasamy ◽  
Mohan Sellappan
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Tamil Nadu ◽  
Pharmaceutical Journal ◽  
Scientific Data ◽  
Brand Names ◽  
Prescribing Pattern ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Improving Health Care

In this present study, 1500 Diabetes Mellitus (DM) patients were included from Coimbatore zone, Tamil Nadu, India. The blood glucose levels were monitored to correlate the glycemic control with the antidiabetic drug treatment. This study addressed many variabilities in such treatments including the prescribing pattern of various novel entities along with existing drugs for glycemic control, diabetic vascular complexities on Coimbatore zone, lack of relevant scientific data, occurrences of prescription errors, less awareness of the DM patients, the insufficient number of local hospitals and high cost of the medicine. Data analysis was carried out by segregating the DM patients under study according to their blood glucose level. Results demonstrated that brand names of anti-diabetic drugs were taken more frequently by outpatients when contrasted with inpatients. Also, the number of drugs prescribed under generic names were significantly less than prescribe brand names. Prescribed formulations results indicated that tablets were preferred over other formulations. Frequently prescribed twenty-one brands and their combination results demonstrated the popularity of the insulin human Mixtard® injection 30-40 IU. Moreover, frequently prescribed 21 branded drugs' cost were analyzed. It can be concluded from the current work that appropriate steps should be taken to raise awareness of the DM patients in Coimbatore zone so that they can follow the specialists' instruction for better hyperglycemia control. Finally, it can be suggested that the Tamil Nadu Government should put more effort on improving health care support in Coimbatore zone.Govindasamy and Sellappan, International Current Pharmaceutical Journal, April 2017, 6(5): 27-33http://www.icpjonline.com/documents/Vol6Issue5/01.pdf

scholarly journals Correlation of blood glucose levels, HbA1c, hemoglobin and leukocytes with outcome on acute stroke

2019 ◽  
Vol 7 (5) ◽  
pp. 1430
Author(s):  
Meiriani . ◽  
Yuneldi Anwar ◽  
Puji Pinta Omas Sinurat
Keyword(s):  
Ischemic Stroke ◽  
Blood Glucose ◽  
Acute Stroke ◽  
Hemorrhagic Stroke ◽  
Cross Sectional Study ◽  
P Value ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Glucose Levels ◽  
Blood Glucose Levels

Background: Diabetes and higher HbA1c level have increased the incidence of stroke. Hemoglobin levels both high and low are associated with poor outcomes. Leukocytes play an important role in the initiation of the atherosclerosis process.Methods: This was a cross-sectional study with a sample size of 62 people selected by non-random sampling method on a consecutive basis, patients with acute stroke were taken blood to measure blood glucose levels, HbA1c, Hb and Leucocytes when entering the hospital room. Outcomes were assessed using NIHSS and MRS. The calculation of NIHSS and MRS scores was performed on the first day of admission and the fourteenth day. To analyze the correlation of blood sugar levels during HbA1c, Hb and leukocytes in acute stroke, this study used Spearman's correlation test. The p value <0.05 was considered statistically significant.Results: The study subjects of 62 acute stroke patients (acute ischemic stroke 31 people and 31 people hemorrhagic stroke). Acute stroke patients were consisted of 38 men (61.3%) and 24 women (38.7%). Of 31 people with hemorrhagic stroke, there were 16 men (51.6%) and 15 women (48.4%), ischemic stroke patients were consisted of 22 people (71, 0%) and women were 9 people. Spearrman repair test showed no symptoms between blood glucose levels, HbA1c, Hemoglobin and leukocytes with outcomes in acute stroke.Conclusions: There was no significant association between blood glucose levels, HbA1c, hemoglobin and leukocytes with outcomes in acute stroke.

scholarly journals Correlation between short- and mid-term hemoglobin A1c and glycemic control determined by continuous glucose monitoring

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Jen-Hung Huang ◽  
Yung-Kuo Lin ◽  
Ting-Wei Lee ◽  
Han-Wen Liu ◽  
Yu-Mei Chien ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Continuous Glucose Monitoring ◽  
Hemoglobin A1c ◽  
Glucose Monitoring ◽  
Mean Amplitude ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Before And After ◽  
Patients With Diabetes

Abstract Background Glucose monitoring is vital for glycemic control in patients with diabetes mellitus (DM). Continuous glucose monitoring (CGM) measures whole-day glucose levels. Hemoglobin A1c (HbA1c) is a vital outcome predictor in patients with DM. Methods This study investigated the relationship between HbA1c and CGM, which remained unclear hitherto. Data of patients with DM (n = 91) who received CGM and HbA1c testing (1–3 months before and after CGM) were retrospectively analyzed. Diurnal and nocturnal glucose, highest CGM data (10%, 25%, and 50%), mean amplitude of glycemic excursions (MAGE), percent coefficient of variation (%CV), and continuous overlapping net glycemic action were compared with HbA1c values before and after CGM. Results The CGM results were significantly correlated with HbA1c values measured 1 (r = 0.69) and 2 (r = 0.39) months after CGM and 1 month (r = 0.35) before CGM. However, glucose levels recorded in CGM did not correlate with the HbA1c values 3 months after and 2–3 months before CGM. MAGE and %CV were strongly correlated with HbA1c values 1 and 2 months after CGM, respectively. Diurnal blood glucose levels were significantly correlated with HbA1c values 1–2 months before and 1 month after CGM. The nocturnal blood glucose levels were significantly correlated with HbA1c values 1–3 months before and 1–2 months after CGM. Conclusions CGM can predict HbA1c values within 1 month after CGM in patients with DM.

Gingival Crevicular Blood Glucose Detection: Screening for Diabetes in the Dental OPD

2020 ◽  
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Chronic Periodontitis ◽  
Early Screening ◽  
Pathological Effect ◽  
Glucose Levels ◽  
Periodontal Inflammation ◽  
Blood Glucose Levels ◽  
Screening And Diagnosis ◽  
Control Diabetes

The key to successful management of any disease is its timely screening and diagnosis. Undetected and uncontrolled diabetes increases the chances of oral diseases, especially periodontitis. Chronic periodontitis and diabetes are two mutually related pathologies and are known to aggravate each other’s pathological effect. Since diabetes acts as an important risk factor for periodontal inflammation, it is essential to screen blood glucose levels to detect diabetes in patients presenting with chronic periodontitis. Periodontal inflammation produces ample gingival bleeding (gingival crevicular blood: GCB) during examination by the periodontal probe, which could be utilized to evaluate blood glucose levels and glycemic control at the dental office. Early screening and diagnosis of diabetes intervenes in the long-term complications of both the diseases and helps in better disease management. The objective of this review was to highlight the reliability and acceptability of different techniques using gingival crevicular blood for evaluation of blood glucose levels along with their advantages and limitations. By this literature review, we analysed over 60 studies published regarding the use of gingival crevicular blood for screening diabetes in periodontitis patients. The data was gathered via Google scholar and Medline using the keywords “Periodontitis, Inflammation, Glycemic control, Diabetes, Gingival crevicular blood” from the years 1993-2019. Keywords: Periodontitis; Inflammation; Glycemic Control; Diabetes; Gingival Crevicular Blood

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