Journal of diabetes science and technology
-
J Diabetes Sci Technol · Sep 2012
Glycemic levels in critically ill patients: are normoglycemia and low variability associated with improved outcomes?
Critically ill patients often experience high levels of insulin resistance and stress-induced hyperglycemia, which may negatively impact outcomes. In 2001, Van den Berghe and coauthors used intensive insulin therapy (IIT) to control blood glucose (BG) to normal levels and reported a reduction in intensive care unit (ICU) mortality from 8% to 4.6%. Many studies tried to replicate these results, with some showing reduced mortality, others failing to match these results, and many seeing no clinically significant difference. The interpretation of results is important when drawing conclusions about the benefits and risks of IIT. There is the potential for negative results to be falsely negative due to unintended patient crossover or cohort overlap. ⋯ Results show that OL are higher for patients with cTIB ≥ 0.3-0.7 than patients with cTIB < 0.3-0.7, irrespective of how cTIB was achieved. A cTIB threshold of 0.5 was found to be a minimum acceptable threshold based on outcome. If cTIB is used in similar BG studies in the future, cTIB ≥ 0.7 may be a good target for glycemic control to ensure outcomes and to separate patients with good BG control from patients with poor control.
-
J Diabetes Sci Technol · Sep 2012
Outcomes of community-dwelling adults without diabetes mellitus who require ambulance services for hypoglycemia.
We evaluate the prevalence, etiology, and outcomes of hypoglycemia requiring emergency medical services (EMS) in patients without diabetes mellitus (non-DM). ⋯ There were multiple etiologies for hypoglycemic episodes in community-dwelling non-DM that required EMS. Critical illness, multifactorial causes, and alcohol/polysubstance abuse were common causes. Hospitalization and mortality were higher with critical illnesses.
-
J Diabetes Sci Technol · Sep 2012
Insulin pump therapy in the perioperative period: a review of care after implementation of institutional guidelines.
An institutional policy was previously established for patients with diabetes on insulin pump therapy undergoing elective surgical procedures. ⋯ Although some processes still require improvement, preliminary data suggest that the policy for perioperative management of insulin pumps has provided useful structure for care of these cases. The data thus far indicate that insulin pump therapy can be continued safely during the perioperative period.
-
J Diabetes Sci Technol · Sep 2012
Comparative StudyComparison of insulin pump therapy (continuous subcutaneous insulin infusion) to alternative methods for perioperative glycemic management in patients with planned postoperative admissions.
Patients with diabetes who use insulin pumps [continuous subcutaneous insulin infusion (CSII)] undergo surgeries that require postoperative hospital admission. There are no defined guidelines for CSII perioperative use. ⋯ In this limited sample, preliminary findings are consistent with similar intraoperative glycemic control between CSII continuation and CSII conversion to intravenous insulin infusions. Continuous subcutaneous insulin infusion suspension had a greater rate of hyperglycemia. Preoperative differences between insulin delivery groups complicate interpretations of findings.
-
J Diabetes Sci Technol · Jul 2012
Randomized Controlled TrialTwo-player partnered exergame for obesity prevention: using discrepancy in players' abilities as a strategy to motivate physical activity.
Physical inactivity is associated with obesity and type 2 diabetes. A key obstacle to physical activity is lack of motivation. Although some interactive exercise games (i.e., exergames--video games that require physical exertion in order to play) motivate players to exercise more, few games take advantage of group dynamics to motivate players' duration of exercise. In a test of the Köhler motivation gain effect, this study varied the ability level of a virtually presented partner in an interactive exergame that focused on abdominal strength to identify effects on a subject's (S') persistence with the task. ⋯ Virtually presented partners who are moderately more capable than participants are the most effective at improving persistence in exergame tasks.