scholarly journals Glargine insulin: an alternative to regular insulin for glycemic control in critically ill patients

Critical Care ◽  
2007 ◽  
Vol 11 (Suppl 2) ◽  
pp. P131
Author(s):  
M Bhattacharyya ◽  
SK Todi ◽  
A Majumdar
Keyword(s):  
Glycemic Control ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Regular Insulin ◽  
Glargine Insulin

scholarly journals Second pilot trials of the STAR-Liege protocol for tight glycemic control in critically ill patients

2012 ◽  
Vol 11 (1) ◽  
pp. 58 ◽  
Author(s):  
Sophie Penning ◽  
Aaron J Le Compte ◽  
Paul Massion ◽  
Katherine T Moorhead ◽  
Christopher G Pretty ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tight Glycemic Control ◽  
Pilot Trials

Association Effects Of Comorbid Versus Uncomorbid Diabetes And Blood Glucose Concentrations On Short-term Outcomes In Patients With Critical Illness: A Real-World Study Based On Propensity Score Analyses

2020 ◽  
Author(s):  
Shan Lin ◽  
Shanhui Ge ◽  
Wanmei He ◽  
Mian Zeng
Keyword(s):  
Critical Illness ◽  
Glycemic Control ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Model ◽  
Inverse Probability Weighting ◽  
Probability Weighting ◽  
Optimal Range ◽  
Short Term ◽  
Inverse Probability

Abstract Background: The effects of combined diabetes and glycemic control strategies on the short-term prognosis in patients with a critical illness are currently ambiguous. The objectives of our study were to determine whether comorbid diabetes affects short-term prognosis and the optimal range of glycemic control in critically ill patients.Methods: We performed this study with the critical care database. The primary outcomes were 28-day mortality in critically ill patients with comorbid diabetes and the optimal range of glycemic control. Association of comorbid diabetes with 28-day mortality was assessed by multivariable Cox regression model with inverse probability weighting. Smooth curves were applied to fit the association for glucose and 28-day mortality.Results: Of the 33,680 patients enrolled in the study, 8,701 (25.83%) had diabetic comorbidity. Cox model with inverse probability weighting showed that the 28-day mortality rate was reduced by 29% (HR=0.71, 95% CI 0.67-0.76) in the group with diabetes in comparison to the group without diabetes. The E value of 2.17 indicated robustness to unmeasured confounders. The effect of the association between comorbid diabetes and 28-day mortality was generally in line for all subgroup variables, significant interactions were observed for glucose on first day, admission type, and use of insulin or not (Interaction P <0.05). A V-shaped relationship was observed between glucose concentrations and 28-day mortality in patients without diabetes, with the lowest 28-day mortality corresponding to the glucose level was 101.75 mg/dl (95% CI 94.64-105.80 mg/dl); whereas in patients with comorbid diabetes, the effect of glucose concentration on 28-day mortality was structurally softer than in those with uncomorbid diabetes. Lastly, of all patients, hyperglycemia had the greatest deleterious effect on patients admitted to CSRU.Conclusions: Our study further confirmed the protective effect of comorbid diabetes on the short-term prognosis of critically ill patients, resulting in an approximately 29% reduction in 28-day mortality. Besides, we also demonstrated the personalized glycemic control strategy for critically ill patients. Lastly, clinicians should be aware of the occurrence and the prompt management of hyperglycemia in critically ill patients admitted to the CSRU.

The Long and Winding Road to Personalized Glycemic Control in the Intensive Care Unit

2019 ◽  
Vol 40 (05) ◽  
pp. 571-579
Author(s):  
Mayanka Tickoo
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Glycemic Control ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Physiological Stress ◽  
Close Monitoring ◽  
Physiological Stress Response ◽  
Downstream Effects ◽  
Personalized Approach

AbstractIn the critically ill adult, dysglycemia is a marker of disease severity and is associated with worse clinical outcomes. Close monitoring of glucose and use of insulin in critically ill patients have been done for more than 2 decades, but the appropriate target glycemic range in critically ill patients remains controversial. Physiological stress response, levels of inflammatory cytokines, nutritional intake, and level of mobility affect glycemic control, and a more personalized approach to patients with dysglycemia is warranted in critically ill intensive care unit (ICU) patients. We discuss the pathophysiology and downstream effects of altered glycemic response in critical illness, management of glycemic control in the ICU, and future strategies toward personalization of critical care glycemic management.

Hyperglycemia Management in Non-critically Ill Hospitalized Patients

2009 ◽  
Vol 22 (5) ◽  
pp. 467-477
Author(s):  
Lindsay M. Arnold ◽  
Darcie L. Keller ◽  
Toyin S. Tofade
Keyword(s):  
Health Care ◽  
Glycemic Control ◽  
Critically Ill ◽  
Health Care Providers ◽  
Critically Ill Patients ◽  
Hospitalized Patients ◽  
Negative Consequences ◽  
Care Providers ◽  
Specific Patient ◽  
Oral Agents

There is increasing evidence demonstrating negative consequences and poor clinical outcomes associated with untreated hyperglycemia in hospitalized patients. Data in specific patient populations, primarily critically ill patients, demonstrate improved patient outcomes with tight glycemic control. To date, no clear evidence exists to determine optimal glycemic targets in non-critically ill patients; however, experts agree that better glycemic control in hospitalized patients is warranted. Glycemic control is complicated by numerous factors in hospitalized patients including increased circulating stress hormones, changing nutritional status, and administration of medication therapies that contribute to hyperglycemia. In addition, fear of hypoglycemia among health care providers, a commonly cited barrier, contributes to the failure to adopt more intensive insulin regimens. Current practice trends have proven ineffective and major changes are needed. Some of those trends include the use of sliding scale insulin, continuation of oral agents or combination insulins upon admission, and provider reluctance to initiate insulin in patients not receiving insulin prior to admission. With proper education, safe and effective use of insulin can be used during hospitalization to improve glycemic control. The following article reviews the benefits of glycemic control, identifies barriers to achieving glycemic control, and describes strategies for health care providers and institutions to realize glycemic control in medically ill hospitalized patients.

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