Risk Factors for Inpatient Hypoglycemia during Subcutaneous Insulin Therapy in Non-Critically Ill Patients with Type 2 Diabetes

Abstract Purpose The length of time a critically ill coronavirus disease 2019 (COVID-19) patient remains infectious and should therefore be isolated remains unknown. This prospective study was undertaken in critically ill patients to evaluate the reliability of single negative real-time polymerase chain reaction (RT-PCR) in lower tracheal aspirates (LTA) in predicting a second negative test and to analyze clinical factors potentially influencing the viral shedding. Methods From April 9, 2020 onwards, intubated COVID-19 patients treated in the intensive care unit were systematically evaluated for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by RT-PCR of nasopharyngeal swabs and LTA. The time to negativity was defined as the time between the onset of symptoms and the viral clearance in LTA. In order to identify risk factors for prolonged viral shedding, we used univariate and multivariate Cox proportional hazards models. Results Forty-eight intubated SARS-CoV-2 patients were enrolled. Overall, we observed that the association of the first negative RT-PCR with a second negative result was 96.7%. Median viral shedding was 25 (IQR: 21.5–28) days since symptoms’ onset. In the univariate Cox model analysis, type 2 diabetes mellitus was associated with a prolonged viral RNA shedding (hazard ratio [HR]: 0.41, 95% CI: 0.06–3.11, p = 0.04). In the multivariate Cox model analysis, type 2 diabetes was associated with a prolonged viral RNA shedding (HR: 0.31, 95% CI: 0.11–0.89, p = 0.029). Conclusion Intubated patients with type 2 diabetes mellitus may have prolonged SARS-CoV-2 shedding. In critically ill COVID-19 patients, one negative LTA should be sufficient to assess and exclude infectivity.

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Study protocol and statistical analysis plan for the Liberal Glucose Control in Critically Ill Patients with Pre-existing Type 2 Diabetes (LUCID) trial

Critical Care and Resuscitation ◽

10.51893/2020.2.oa3 ◽

2020 ◽

Vol 22 (2) ◽

pp. 133-141

Author(s):

Alexis P Poole ◽

◽

Mark E Finnis ◽

James Anstey ◽

Rinaldo Bellomo ◽

...

Keyword(s):

Type 2 Diabetes ◽

Clinical Trial ◽

Clinical Trials ◽

Intensive Care ◽

Blood Glucose ◽

Statistical Analysis ◽

Critically Ill ◽

Critically Ill Patients ◽

Statistical Analysis Plan

BACKGROUND: Contemporary glucose management of intensive care unit (ICU) patients with type 2 diabetes is based on trial data derived predominantly from patients without type 2 diabetes. This is despite the recognition that patients with type 2 diabetes may be relatively more tolerant of hyperglycaemia and more susceptible to hypoglycaemia. It is uncertain whether glucose targets should be more liberal in patients with type 2 diabetes. OBJECTIVE: To detail the protocol, analysis and reporting plans for a randomised clinical trial — the Liberal Glucose Control in Critically Ill Patients with Pre-existing Type 2 Diabetes (LUCID) trial — which will evaluate the risks and benefits of targeting a higher blood glucose range in patients with type 2 diabetes. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION: A multicentre, parallel group, open label phase 2B randomised controlled clinical trial of 450 critically ill patients with type 2 diabetes. Patients will be randomised 1:1 to liberal blood glucose (target 10.0–14.0 mmol/L) or usual care (target 6.0–10.0 mmol/L). MAIN OUTCOME MEASURES: The primary endpoint is incident hypoglycaemia (< 4.0 mmol/L) during the study intervention. Secondary endpoints include biochemical and feasibility outcomes. RESULTS AND CONCLUSION: The study protocol and statistical analysis plan described will delineate conduct and analysis of the trial, such that analytical and reporting bias are minimised. TRIAL REGISTRATION: This trial has been registered on the Australian New Zealand Clinical Trials Registry (ACTRN No. 12616001135404) and has been endorsed by the Australian and New Zealand Intensive Care Society Clinical Trials Group.

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Improvement of cardiovascular risk factors in patients with type 2 diabetes after long‐term continuous subcutaneous insulin infusion

Diabetes/Metabolism Research and Reviews ◽

10.1002/dmrr.849 ◽

2008 ◽

Vol 24 (5) ◽

pp. 384-391 ◽

Cited By ~ 20

Author(s):

Yun‐Hee Noh ◽

Se‐Myung Lee ◽

Eun‐Ju Kim ◽

Do‐Young Kim ◽

Hyunil Lee ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Continuous Subcutaneous Insulin Infusion ◽

Insulin Infusion ◽

Subcutaneous Insulin

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Influence of the dynamics of body weight on the risk factors of cardiovascular disease in patients with type 2 diabetes during the first year of insulin treatment

Obesity and metabolism ◽

10.14341/2071-8713-5067 ◽

2013 ◽

Vol 10 (1) ◽

pp. 22-25

Author(s):

T S Dzhavakhishvili ◽

T I Romantsova ◽

O V Roik

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Insulin Therapy ◽

Insulin Treatment ◽

Insulin Analogues ◽

First Year ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Type 2 Diabetic

The aim of the present study was to investigate whether insulin treatment-induced weight gain had an adverse impact on cardiovascular risk factors in insulin-treated type 2 diabetic patients during the first year after initiating insulin therapy when insulin analogues or human insulins are used. A total of 157 patients with newly insulinized type 2 diabetes were included in the study. The patients were divided in two groups. First group consisted of subjects (mean age 57 [45; 73], duration of diabetes of 10 years [4; 16]) who had received long-acting basal (glargine, detemir), premixed (biphasic insulin aspart 30, Humalog Mix 25) or short-acting (aspart, lispro) insulin analogues. Patients from second group (mean age 59 [46; 75], duration of diabetes of 10 years [5; 15]) were treated with intermediate-acting basal (Protophane, Humulin NPH insulin), premixed (biphasic human insulin 30, Humulin M3) and regular (Actrapid, Humulin R) human insulins. Our study has shown that insulin-induced weight gain may not adversely affect cardiovascular risk factors, particularly, lipid profile, in insulin-treated type 2 diabetic patients during the first year after initiating insulin therapy. Use of insulin analogues for treatment of type 2 diabetes patients results in better glycaemic control, significant declines in blood lipid concentrations, less increase in waist circumference compared with human insulins during the first year after initiating insulin therapy.

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Insulin Treatment Is Associated With Increased Mortality in Critically Ill Patients With Type 2 Diabetes in the Intensive Care Unit

10.21203/rs.3.rs-674359/v1 ◽

2021 ◽

Author(s):

Rongping Fan ◽

Xuemin Peng ◽

Bo Yu ◽

Jiaojiao Huang ◽

Xuefeng Yu ◽

...

Keyword(s):

Type 2 Diabetes ◽

Critically Ill ◽

Critically Ill Patients ◽

Insulin Treatment ◽

Icu Mortality ◽

Icu Admission ◽

Icu Stay ◽

Before And After ◽

Length Of Icu Stay

Abstract Aims: Although insulin treatment is widely used in critically ill patients with type 2 diabetes mellitus in the intensive care unit (ICU), the clinical outcomes of insulin treatment remain unclear. This retrospective study aimed to explore the impact of insulin treatment on mortality and ICU stay among patients with type 2 diabetes. Methods: We consecutively recruited 578 ICU patients with type 2 diabetes, from 2011 to 2021. According to their medication history regarding insulin use before and after ICU admission, these patients were categorized into three groups: N-N (treated without insulin before and after ICU admission), N-I (treated without insulin before and with insulin after ICU admission) and I-I (treated with insulin before and after ICU admission). Clinical characteristics were analyzed, and clinical outcomes including mortality and the length of ICU stay were compared between the groups. Propensity score matching was performed to obtain comparable subpopulation and the Kaplan-Meier survival curves were graphed to describe the survival trend of different groups. Results: Compared with the N-N group, the N-I and I-I groups had significantly higher ICU mortality rates [20.0% (N-I) and 24.6% (I-I) vs. 0.0% (N-N); p < 0.001; respectively] and longer lengths of ICU stay [ 8.5 (N-I), 9 (I-I) vs. 6 (N-N), p < 0.05, respectively]. After propensity score matching, the N-I group had a significantly higher ICU mortality (15.4% vs. 0.0%, p = 0.025) and poorer survival rates (log-rank p = 0.040) than the N-N group. The length of ICU stay was significantly longer in the I-I group than in the N-N group (10 vs. 7, p = 0.026). Conclusions: Insulin treatment was associated with increased ICU mortality rate and longer length of ICU stay among critically ill patients with type 2 diabetes. Caution is warranted for the regular application of insulin in critical patients with type 2 diabetes.

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