Glucose Control

2020 ◽  
Author(s):  
Timothy P. Graham ◽  
Erich N. Marks ◽  
Joshua J. Sebranek ◽  
Douglas B. Coursin
Keyword(s):  
Diabetes Mellitus ◽  
Critically Ill ◽  
Glucose Control ◽  
Cost Of Care ◽  
Hospital Length Of Stay ◽  
Glucose Measurement ◽  
Key Words Diabetes Mellitus ◽  
Key Words Diabetes ◽  
Adult Intensive Care Unit ◽  
Patients With Diabetes

Patients with diabetes mellitus routinely require management in the adult intensive care unit (ICU). These patients have increased morbidity, mortality, hospital length of stay, cost of care, and frequency of hospital and ICU admission. Glucose control in these patients presents challenges for the clinician. In the critically ill, hyperglycemia does not occur exclusively in patients with diabetes or prediabetes but may be related to stress-induced hyperglycemia or iatrogenic causes. Hyperglycemia can contribute to decreased wound healing and immune function and a host of cellular and molecular dysfunctions and has been linked to increased hospital mortality. Hypoglycemia in the ICU is associated with patients with preexisting diabetes, those receiving insulin and other medications, and septic individuals, among others. Insulin therapy is the mainstay of glucose management in the critically ill. ICU practitioners should be aware that point-of-care glucose meters are not as accurate as core laboratory results. Finally, both hypoglycemia and wide fluctuations in blood glucose during critical illness are also associated with increased mortality, although clear cause-and-effect relationships have not been established. This review contains 1 figure, 8 tables, and 71 references. Key words: Diabetes mellitus, glucose measurement, glucose targets, hyperglycemia, hypoglycemia, insulin

Preoperative Assessment of the Patient with Diabetes Mellitus

2019 ◽  
Author(s):  
Sean A. Josephs ◽  
Gretchen A. Lemmink
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Diabetic Ketoacidosis ◽  
Preoperative Assessment ◽  
Major Surgery ◽  
Key Words Diabetes Mellitus ◽  
Diabetic Patients ◽  
Key Words Diabetes ◽  
Hyperglycemic Hyperosmolar State ◽  
Patients With Diabetes

Diabetes mellitus is a major cause of morbidity and mortality.  Nearly 30 million Americans have diabetes, more than 25% of which are undiagnosed. Patients with diabetes have multiple problems that should be addressed prior to surgery. They often have uncontrolled glucose levels that should be treated preoperatively. Current studies suggest that outcomes may be improved if perioperative glycemic control is optimized. Patients with diabetes develop end-organ dysfunction that can complicate perioperative management. Preoperative assessment of cardiac, neurologic, vascular, and renal function is necessary for all patients with diabetes that undergo major surgery. Optimization of cardiac disease in particular can reduce major adverse cardiac events for patients with risk factors such as diabetes. Diabetic patients can occasionally present for major surgery with hyperglycemic emergencies such as diabetic ketoacidosis and hyperglycemic hyperosmolar state. These conditions require urgent treatment to prevent mortality regardless of the need for surgery. This article reviews the preoperative assessment and management of these issues. This review contains 1 figure, 4 tables, and 37 references. Key Words: diabetes mellitus (DM), end-organ damage, hyperglycemia, polyuria, polydipsia, polyphagia, perioperative glycemic management, diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), perioperative cardiac risk factors

Heart failure in patients with diabetes in Campania

2019 ◽  
Vol 22 (4) ◽  
pp. 219
Author(s):  
Botta, A.
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Clinical Symptoms ◽  
Healthcare Services ◽  
Key Words Diabetes Mellitus ◽  
Diabetic Patients ◽  
Key Words Diabetes ◽  
Antidiabetic Therapy ◽  
Patients With Diabetes

Heart Failure (HF) and Type 2 Diabetes Mellitus (T2D) are important clinical conditions that often coexist, mutually influencing intra- and extra-hospital morbidity and mortality. In order to characterize the diagnostic and therapeutic management of patients with HF and T2D, a retrospective observational study was conducted on database of the last 12 months in 8 Campania Diabetology Centers. 164 patients were affected by HF and T2D. Among them, 123 patients had a medical record with reproducible data and were recruited for the study. Diabetic patients were divided into three groups: group A included patients with preserved ejection fraction (EF) (> 50 %), group B patients with midrange EF (40-49%) and the group C patients with reduced EF (< 40%). All patients had performed ECG and echocardiography, repeated every 6 months; 41 patients (33% of the sample) also performed a cardiac Holter. The most frequent causes of HF were ischemic heart disease and hypertension. After a 12 months follow up, the clinical and laboratory parameters and the treatments adopted were re-evaluated. The antidiabetic drugs resulted modified with a reduction in the use of metformin, sulfonylureas, glinids and pioglitazone; at the same time a greater use of gliptins, gliflozines and GLP1 AR and a lower use of insulin therapy was observed. Cardiological therapy was modified with a greater use of diuretics and nitrates and a reduction of ACEI and ARB, probably due to the use of sacubitril/valsartan association in the group of patients with reduced EF. According to the recent guidelines, antidiabetic therapy must be tailored to the characteristics of the patients with diabetes and heart failure, preferring the use of molecules that have shown a cardiovascular protection effect or, secondarily, those with cardiovascular neutrality. Similarly, cardiological therapies have to consider the type of antidiabetic agents used and benefit from molecules that impact clinical symptoms and natural history. Finally, the approach to the patients with both the pathologies must necessarily take place in the healthcare districts and absolutely be multidisciplinary and integrated, involving firstly Diabetologists and Cardiologists, but also other professional roles (nurses, psychologists, physiotherapists, caregivers) operating in the territorial healthcare services. KEY WORDS diabetes mellitus; heart failure; ejection fraction.

scholarly journals The perception of Italian diabetologists on anti-influenza and anti-diphtheria-tetanus-pertussis vaccinations in subjects with diabetes mellitus: the AMD survey

2019 ◽  
Vol 22 (3) ◽  
pp. 99
Author(s):  
Candido, R.
Keyword(s):  
Diabetes Mellitus ◽  
Influenza Vaccine ◽  
Pertussis Vaccine ◽  
Online Survey ◽  
Influenza Infection ◽  
Key Words Diabetes Mellitus ◽  
Diabetic Patients ◽  
Key Words Diabetes ◽  
Patients With Diabetes ◽  
Prevention Plan

Diabetes mellitus is associated with an increased incidence of some infections and a greater severity and/or frequency of complications related to these diseases. Influenza is characterized by an increased severity of clinical course and risk of complications, especially in diabetic patients who are more susceptible to influenza infection. For these reasons, the Italian Vaccine Prevention Plan 2017-19 provides an active and free offer of influenza vaccine for the diabetic subjects. In addition, among the vaccinations recommended by the Italian Prevention Plan in adults, including the diabetes ones, there is the diphtheria-tetanus-pertussis vaccine and the decennial booster. To investigate what is the perception of Italian diabetologists on the role and importance of the influenza and the diphtheria-tetanus-pertussis vaccines, AMD has promoted an online survey. Participants claimed to be aware of the importance of carrying out and recommending influenza vaccination, while awareness of the usefulness of performing and suggesting the decennial booster for diphtheria-tetanus-pertussis was lower. Diabetologists attribute to patients’ resistance and lack of interest in such vaccinations the main motivation for which they are not used to recommend them, even if they acknowledge that they have little knowledge about the decennial booster of diphtheria-tetanus-pertussis vaccine. The survey shows that the percentage of patients with diabetes who seek advice on these vaccinations is inadequate and the diabetologists’ knowledge of the National Vaccination Prevention recommendations and the need to actively promote vaccinations is inappropriate. This survey has allowed to highlight the opinion, of a significant percentage of Italian diabetologists, on some key aspects of the vaccination therapy indicated in diabetic patient, allowing to gather important information to open a debate, to know strengths and weaknesses on this topic and implement training activities. KEY WORDS diabetes mellitus; influenza vaccine; diphtheria-tetanus-pertussis vaccine; survey.

scholarly journals Pelatihan Teknik Visualsasi Untuk Menurunkan Stres Pada Pasien Diabetes Mellitus di Puskesmas Sukawati I Kabupaten Gianyar Tahun 2019

2020 ◽  
Vol 2 (2) ◽  
pp. 97-102
Author(s):  
I Nengah Sumirta ◽  
I wayan Candra ◽  
IGA Harini
Keyword(s):  
Diabetes Mellitus ◽  
Community Service ◽  
Social Economic ◽  
Key Words Diabetes Mellitus ◽  
P Value ◽  
Key Words Diabetes ◽  
Training Methods ◽  
Before And After ◽  
Patients With Diabetes ◽  
Prevalence Of Diabetes Mellitus

Degenerative diseases especially diabetes mellitus in indonesia has increased in line with the progress work in social economic and the changing lifestyle .International diabetic federation ( idf ) reckon incidence diabetes mellitus in the world 2012 as many as 371 million people , 2013 increased to 382 million people and diperirakan in the 2035 increased to 592 million people . In indonesia, according to the basic health research ( riskesdas ) years 2013 mentioned an increasing prevalence of diabetes mellitus based on the doctor diagnosis in at age ≥15 year in 2013 as much as 1,5 % and in 2018 2,00 %. as much as. This community service aims to reduce the level of stress in patients with Diabetes Mellitus. Using training methods, conduct stress level measurements before and after training, with a total target of 20 people. Data analysis using Paired Sample T-Test. The results show there is the influence of training visualize on the level of stress patients diabetes mellitus with p value much as 0.021 ( lt; 0.05 ) .Suggested in research locations to consider the use of visualize as one of the act of to reduce the level of stress patients diabetes mellitus and to respondents to conduct visualize continuously in any given period of time .Key Words: Diabetes Mellitus, Stress, Visualisasi

Evaluation of complications of the late postoperative period in patients with diabetes mellitus after drainage surgery of neovascular glaucoma

2021 ◽  
pp. 10-12
Author(s):  
V.A. Biletskaya ◽  
◽  
D.V. Lipatov ◽  
M.A. Frolov ◽  
◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Postoperative Period ◽  
Pain Syndrome ◽  
Neovascular Glaucoma ◽  
Research Centre ◽  
Federal State ◽  
Key Words Diabetes Mellitus ◽  
Key Words Diabetes ◽  
Surgical Methods

Today diabetes mellitus (DM) is one of the leading medical and social problems. Its complications lead to terrible concomitant pathologies that qualitatively affect the lives of patients. At the end of 2019, there were more than 463 million people with diabetes in the world and this number is increasing every year. Diabetic retinopathy (DR) is one of the most severe complications of DM on the organ of vision. Secondary neovascular glaucoma (NG) is a manifestation of the end-stage proliferative DR. This is a relatively rare but difficult-to-treat pathology that often leads working-age patients to disability and impaired social adaptation. The main objective of treatment for NG is to compensate for intraocular pressure (IOP), but conservative (drug) therapy is often ineffective. Therefore, doctors are forced to use surgical methods of treatment. At the same time, do not forget about the multiple complications during the operation, as well as in the early and late postoperative periods. A special feature of the course of NG in patients with DM is its combination with the failure of the ligamentous-capsular apparatus of the lens, iris bombage, anterior and posterior synechiae, traction retinal detachment and various hemorrhagic complications. All this allows us to talk about the so-called diabetic glaucoma (DG). Currently, drainage devices have become the standard in the treatment of refractory NG. The effectiveness of such operations according to various sources is about 70-80% of success. Purpose. To assess the condition of patients with DM in the late (10-15 years) postoperative period after performing NG drainage surgery, to analyze the effectiveness of the intervention by studying the dynamics of IOP, the presence or absence of pain syndrome and various intraocular complications. Material and methods. During the period 2006-2020, 150 patients with NG and DM were operated on in the Department of Diabetic Retinopathy of the Federal State Budgetary Institution «Endocrinology Research Centre» of the Ministry of Health of the Russian Federation. Results. In 100% of the postoperative period, the pain syndrome was stopped. And also, in 59.7% of cases, the presence of late complications: vascular thorn, EED, subatrophy and anophthalmos. Conclusion. Despite the presence of complications, drainage surgery in patients with DM continues to be an effective method of choosing surgical treatment for patients with uncompensated NG. Key words: diabetes mellitus; diabetic retinopathy; neovascular glaucoma; drainage surgery.

1075-P: Acute and Chronic Glucose Control in Critically Ill Patients with Diabetes: Impact of Prior Insulin Treatment

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 1075-P
Author(s):  
JAMES S. KRINSLEY ◽  
PETER R. RULE ◽  
JEAN-CHARLES PREISER ◽  
GREG ROBERTS ◽  
SHEHROSE CHAUDRY ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Glucose Control ◽  
Insulin Treatment ◽  
Patients With Diabetes

scholarly journals Effect of Fenugreek (Methi) on Cortical Thickness of the Thymus in Streptozotocin-Induced Diabetic Rats

1970 ◽  
Vol 7 (1) ◽  
pp. 37-41
Author(s):  
DK Mondal ◽  
MMA Moinuddin ◽  
MM Saha ◽  
AM Khanom ◽  
BMA Yousuf ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cortical Thickness ◽  
Diabetic Control ◽  
Diabetic Rats ◽  
Control Group ◽  
Key Words Diabetes Mellitus ◽  
Key Words Diabetes ◽  
Nondiabetic Control ◽  
The Mean ◽  
Long Evans

Objective: To find out microscopically whether Trigonella foenumgraecum (fenugreek seeds/methi seeds) has got any preventive role against the lowering of cortical thickness of the thymic lobules in diabetes mellitus. Design: An experimental study on Long Evans rats which were divided into three equal groups depending on their different shorts of dietary feeding and drug treatment. Setting: Anatomy department of IPGMR (Institute of Post Graduate Medicine and Research) at present BSMMU (Bangabandhu Sheikh Mujib Medical University) and BIRDEM (Bangladesh Institute of Research and Rehabilitation in diabetes, Endocrine & Metabolic Disorders). Subjects: Fifty eight healthy young Long Evans rats of either sex weighing 72 to 174gm aged between 50 to 60 days were used in this study. Main outcome measures: Variation of cortical thickness of the thymic lobules in different groups of rat. Result: Cortical thickness in the nondiabetic control group, which ranges from 30.17 to 36.99. and the mean was 34.83 ± 0.60. In diabetic control group the cortical thickness ranges from 17.78 to 26.46 and the mean was 21.85 ± 1 On the other hand, in the fenugreek- treated diabetic rats the cortical thickness ranges from 25.71 to 32.95 and mean cortical thickness was 30.49 ± 0.75. Conclusion: Fenugreek showed a tendency of acting against lowering of the cortical thickness of the thymic lobule of Streptozotocin-induced diabetes mellitus. However, further investigations are recommended for establishing fenugreek as a safe, useful effective agent to preserve the cortical thickness improving the diabetic condition by acting as antidiabetogenic agent. Key words: Diabetes mellitus, Differential lymphocyte count, Fenugreek, Thymus   doi: 10.3329/bja.v7i1.3017 Bangladesh Journal of Anatomy January 2009, Vol. 7 No. 1 pp. 37-41

scholarly journals Thyroid Disorders and Diabetes Mellitus

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Mirella Hage ◽  
Mira S. Zantout ◽  
Sami T. Azar
Keyword(s):  
Diabetes Mellitus ◽  
Glucose Control ◽  
Systematic Approach ◽  
Endocrine System ◽  
Thyroid Disorders ◽  
Patients With Diabetes

Studies have found that diabetes and thyroid disorders tend to coexist in patients. Both conditions involve a dysfunction of the endocrine system. Thyroid disorders can have a major impact on glucose control, and untreated thyroid disorders affect the management of diabetes in patients. Consequently, a systematic approach to thyroid testing in patients with diabetes is recommended.

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