Hospital practice (1995)
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Hospital practice (1995) · Apr 2014
ReviewShould guidelines for glycemic control of the critically ill be individualized?: Weighing the evidence from randomized and observational investigations.
The monitoring of blood glucose and treatment of hyperglycemia has been a standard of care in intensive care units since the publication of a single-center randomized controlled trial (RCT) of intensive insulin therapy in 2001 that demonstrated marked improvements in mortality. Professional societies created guidelines based on the results of this investigation, and revised them based on the results of a very small group of RCTs that followed. This commentary reviews the weight of evidence provided by the RCTs in comparison to the large body of evidence from observational studies regarding glycemic control of the critically ill, and suggests that the totality of evidence should be considered in the formulation of clinical practice paradigms.
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Hospital practice (1995) · Apr 2014
ReviewEffect of continuous positive airway pressure on type 2 diabetes mellitus and glucose metabolism.
Obstructive sleep apnea (OSA) is a prevalent condition that is associated with significant comorbidities, including obesity, hypertension, cardiovascular disease, and insulin resistance. Continuous positive airway pressure (CPAP) is an effective treatment for OSA. The effect of CPAP on glucose metabolism in patients with OSA has been controversial. This study evaluates the impact of CPAP on patients with OSA and type 2 diabetes mellitus (T2DM) or prediabetes. ⋯ This literature review shows that CPAP improves not only hypoxia while restoring normal breathing during sleep, but also glucose metabolism in patients with OSA and T2DM or prediabetes. A few studies have shown that patients can experience even better results with long-term CPAP treatment (≥ 3 months of daily use) for > 4 hours a night. Therefore, this improvement in glucose metabolism with the use of CPAP may contribute to T2DM prevention and decrease further progression of the disease. However, additional studies are needed to confirm these findings.