Journal ArticleDOI
Hypoglycemia in hospitalized patients treated with antihyperglycemic agents.
Precil Varghese,Vanessa Gleason,Rachel Sorokin,Craig Senholzi,Serge Jabbour,Jonathan E. Gottlieb +5 more
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TLDR
Hypoglycemia in hospitalized patients taking antihyperglycemic agents is common; 1 in 25 episodes is associated with an adverse event and opportunities exist to improve care, particularly around discontinuation of feeding.Abstract:
OBJECTIVE
To determine the incidence and manifestations of hypoglycemia in hospitalized patients receiving antihyperglycemic therapy.
RESEARCH DESIGN AND METHODS
The study was a 3-month prospective review of consecutive medical records of all adult, nonpregnant hospitalized patients at a 675-bed university hospital who experienced at least 1 blood glucose (BG) ≤ 60 mg/dL within 48 hours of receiving an antihyperglycemic agent.
MEASUREMENTS AND RESULTS
Of 2174 patients receiving antihyperglycemic agents, 206 (9.5%) experienced 484 hypoglycemic episodes. Of these episodes, 29% occurred in patients with type 1 diabetes, 23% in the ICU, and 72% in patients receiving only insulin for hyperglycemia. More than 1 episode was experienced by 44% of the 206 patients. Furthermore, 4% (20 of 484) of the hypoglycemic episodes were associated with a hypoglycemia-related adverse event, defined as symptoms, signs, or injury. The mean BG of these episodes was 43.0 mg/dL, significantly lower than the mean BG of 50.9 mg/dL for the 464 episodes without adverse events (P = .01). One-third of the adverse events occurred with a BG between 50 and 60 mg/dL; half the adverse events, 10 episodes or 2% of all hypoglycemic episodes, were serious, involving seizures or an unresponsive patient. A decrease in enteral intake accounted for 40% of the episodes; none was attributed to medication error. Less than half the hypoglycemic patients had documented euglycemia within 2 hours. Sulfonylurea agents were associated with higher rates of hypoglycemia than were other oral agents.
CONCLUSIONS
Hypoglycemia in hospitalized patients taking antihyperglycemic agents is common; 1 in 25 episodes is associated with an adverse event. Opportunities exist to improve care, particularly around discontinuation of feeding. Journal of Hospital Medicine 2007;2:234–240. © 2007 Society of Hospital Medicine.read more
Citations
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Journal ArticleDOI
Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline
Guillermo E. Umpierrez,Richard Hellman,Mary T. Korytkowski,Mikhail Kosiborod,Gregory A. Maynard,Victor M. Montori,Jane Jeffrie Seley,Greet Van den Berghe +7 more
TL;DR: This evidence-based guideline provides recommendations for practical, achievable, and safe glycemic targets and describes protocols, procedures, and system improvements required to facilitate the achievement of glycemic goals in patients with hyperglycemia and diabetes admitted in non-critical care settings.
Journal ArticleDOI
Comparison of inpatient insulin regimens with detemir plus aspart versus neutral protamine hagedorn plus regular in medical patients with type 2 diabetes.
Guillermo E. Umpierrez,Tiffany Hor,Dawn Smiley,Angel Temponi,Denise Umpierrez,Miguel Ceron,Christina Munoz,Christopher Newton,Limin Peng,David S. Baldwin +9 more
TL;DR: Treatment with basal/bolus regimen with detemir once daily and aspart before meals results in equivalent glycemic control and no differences in the frequency of hypoglycemia compared to a split-mixed regimen of NPH and regular insulin in patients with type 2 diabetes.
Journal ArticleDOI
Enhancing insulin-use safety in hospitals: Practical recommendations from an ASHP Foundation expert consensus panel
Daniel J. Cobaugh,Gregory A. Maynard,Lebron Cooper,Patricia C. Kienle,Robert A. Vigersky,Diana Childers,Robert J. Weber,Stacy L. Carson,Melanie E. Mabrey,Nicki Roderman,Frederick C. Blum,Rebecca Burkholder,Marcus J. Dortch,George Grunberger,Daniel P. Hays,Rashida Henderson,Jeffrey M. Ketz,Todd D. Lemke,S. K. Varma,Michael R. Cohen +19 more
TL;DR: The panel's consensus recommendations include the development of protocol-driven insulin order sets, elimination of the routine use of correction/sliding-scale insulin doses, restrictions on the types of insulin products stored in patient care areas, and policies to restrict the preparation of insulin bolus doses.
Journal ArticleDOI
A Randomized Trial of Two Weight-Based Doses of Insulin Glargine and Glulisine in Hospitalized Subjects With Type 2 Diabetes and Renal Insufficiency
David S. Baldwin,Jennifer Zander,Christina Munoz,Preeya Raghu,Susan DeLange-Hudec,Hong Lee,Mary Ann Emanuele,Valerie Glossop,Kimberly Smallwood,Mark E. Molitch +9 more
TL;DR: Reduction of initial glargine/glulisine insulin weight-based dosing in hospitalized patients with diabetes and renal insufficiency reduced the frequency of hypoglycemia by 50% without compromising the control of hyperglycemia.
Journal ArticleDOI
Risk factors for inpatient hypoglycemia during subcutaneous insulin therapy in non-critically ill patients with type 2 diabetes.
Farnoosh Farrokhi,Olena Klindukhova,Prakash Chandra,Limin Peng,Dawn Smiley,Christopher Newton,Francisco J. Pasquel,Maria Eugenia Fereira,Guillermo E. Umpierrez +8 more
TL;DR: Age, impaired kidney function, impaired renal function, daily insulin dose, and insulin regimen (basal/bolus versus SSI) are important predictors of hypoglycemia during insulin therapy in patients with type 2 diabetes mellitus.
References
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Journal ArticleDOI
Intensive Insulin Therapy in Critically Ill Patients
Greet Van den Berghe,Pieter Wouters,Frank Weekers,Charles Verwaest,Frans Bruyninckx,Miet Schetz,Dirk Vlasselaers,Patrick Ferdinande,Peter Lauwers,Roger Bouillon +9 more
TL;DR: Intensive insulin therapy to maintain blood glucose at or below 110 mg per deciliter reduces morbidity and mortality among critically ill patients in the surgical intensive care unit.
Journal ArticleDOI
Intensive insulin therapy in the medical ICU.
Greet Van den Berghe,Alexander Wilmer,Greet Hermans,Wouter Meersseman,Pieter Wouters,Ilse Milants,Eric Van Wijngaerden,Herman Bobbaers,Roger Bouillon +8 more
TL;DR: Intensive insulin therapy significantly reduced morbidity but not mortality among all patients in the medical ICU, and the risk of subsequent death and disease was reduced in patients treated for three or more days.
Journal ArticleDOI
Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures.
TL;DR: Use of perioperative continuous intravenous insulin infusion in diabetic patients undergoing open heart surgical procedures significantly reduces major infectious morbidity and its associated socioeconomic costs.
Journal ArticleDOI
Management of diabetes and hyperglycemia in hospitals.
Stephen Clement,Susan S. Braithwaite,Michelle F. Magee,Andrew J. Ahmann,Elizabeth P. Smith,Rebecca G. Schafer,Irl B. Hirsch +6 more
TL;DR: The purpose of this technical review is to evaluate the evidence relating to the management of hyperglycemia in hospitals, with particular focus on the issue of glycemic control and its possible impact on hospital outcomes.
Book
Hypoglycemia in Diabetes
TL;DR: Pending the prevention and cure of diabetes or the development of methods that provide glucose-regulated insulin replacement or secretion, the authors need to learn to replace insulin in a much more physiological fashion, to prevent, correct, or compensate for compromised glucose counterregulation, or both if they are to achieve near-euglycemia safely in most people with diabetes.
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