Addressing transition of care is not a choice but an important quality of care marker. The transition of care determines where patients with diabetes will follow up and how payers will remunerate hospitals for management of diabetes during hospitalization, discharge planning process and readmission rates. Different transition of care models have been identified, utilized and evaluated. However, more research needs to be done to establish standardized transitional care guidelines specific to this population.

Continuous glucose monitors (CGMs) have become an important tool to aid self-management of blood glucose for many patients with diabetes in the U.S., and the benefits of CGM use are well-documented. However, disparities in CGM use exist, with lower use in certain marginalized racial and ethnic groups. CGM may be an important and underutilized tool to help reduce inequities. Evidence supporting the use of CGMs as a part of virtual care is discussed, with an emphasis on designing virtual diabetes care programs to promote health equity. Recommendations for clinical practice and research are presented. In clinical practice, CGM should be an option for all people with diabetes who qualify based on clinical practice guidelines, regardless of race, ethnicity, or other individual characteristics. Future research should characterize the use of, benefit from, and preferences for CGM among individuals from racial and ethnic groups to guide interventions at the health system, clinic, provider, and patient levels to promote equitable, evidence-based, and guideline-directed CGM use in marginalized racial and ethnic groups with diabetes.

After the survey, all patients desired to continue with iPCSK9. Conclusion After 6-12 weeks of iPCSK9 treatment, all patients reduced LDL level except 1 who was non-adherent. The LDL reduction ranged between 54%-71% and all patients on evolocumab achieved a LDL <70 mg/dL.The tolerability was excellent and only mild adverse events in about 8% of patients were experienced.A high acceptance of both alirocumab and evolocumab was reported by all patients who would continue with iPCSK9 treatment.

Background: Hyperglycemia is a recognized complication of supraphysiological steroid dosing. There are no consensus guidelines on optimal treatment of steroid-induced hyperglycemia. We assessed the safety of a weight-based insulin protocol for persons treated with supraphysiological doses of steroids to examine the efficacy of using this protocol in patients with diabetes treated with prednisone or methylprednisolone. Areas of Uncertainty: There is uncertainty about the optimal dosing of insulin to manage steroid-induced hyperglycemia; thus, a weight-based protocol was created with the goal of reaching euglycemia faster than current practice in persons with diabetes. Variables such as steroid dosing, baseline glycemic control, and duration of steroid use further complicated the ability to manage these patients. Innovations: The interdisciplinary team of diabetes providers and pharmacists worked together to devise a protocol to manage steroid-induced hyperglycemia with the goal of reducing hyperglycemia while avoiding hypoglycemia, as well as to allow for less reliance on endocrine consultation. The protocol used weight, insulin naivety, renal function, blood glucose measurements, and steroid dosing to determine the insulin dose. There was some evidence to suggest the proportion of blood glucose levels more than 200 mg/dL was lower after protocol initiation compared with before protocol initiation (P = 0.053). Several factors decreased the rate of successful outcomes, including minimal primary team participation, accurate completion of calculations based on the protocol, and initiation of the protocol after several days of hyperglycemia.

come across with altered blood-glucose concentration in patients on TPN feeding who require closer monitoring with complex and dynamic treatment such as insulin. Despite such potential benefits, insulin added to TPN is still controversial due mainly to the potential risk of hypoglycaemia related to its biodisponibility. Purpose Analyse and evaluate the efficacy and safety of fastacting insulin added to TPN admixtures, in patients with altered glycaemia, followed up by nutrition support pharmacists (NSP). Material and methods Observational and retrospective study carried out in a General Hospital for 19 months (January 2017 to July 2018). Data was collected from electronic clinical records and the electronic prescribing system. Data collected: total patients on TPN with altered blood-sugar levels followed up by the pharmacy team, patients treated with fastacting insulin (TPN bag additive), daily (three times) bloodsugar levels (BMs), patient's demographics, hypoglycaemias (blood-sugar levels less than 70 mg/dL) and hyperglycaemias (BMs>180 mg/dL). Patients admitted to the critical care unit (CCU) or not followed up by the pharmacy team were excluded. We considered target BMs between 140-180 mg/dL. All insulin adjustments were done by NSP. Results The total number of patients on NPT with altered BMs was 148, and 36 (24.3%) patients required fast-acting insulin therapy. Thirty patients were included in this study due to six being admitted to the CCU. Patients included: 20 were males (66.6%), average age 67 years (range 45-91). Twenty-five (83.3%) patients had hyperglycaemia (!1BMs>180 mg/dL) of whom 17 (56.6%) required fast-acting insulin therapy on the TPN bag. Average NPT duration on fast-acting insulin-treated patients was 10 days (range 3-36). Average days BMs>180 mg/dL:4.5 (range 1-11). Average BMs>180 mg/dL: 242 mg/dL (range 181-427 mg/dL; mode: 220 mg/dL). One patient had hypoglycaemia non-insulinrelated. None treated with fast-acting insulin had hypoglycaemia. Conclusion Despite more than half of the patients treated with fast-acting insulin therapy having hyperglycaemia, none of them had hypoglycaemia. On the other hand, a cautious use of the fast-acting insulin TPN bag added could boost hyperglycaemias in our patients. Administering insulin along with TPN continuously appeared to be a safe method, providing a smoother glycaemic profile.