Comparison of an Electronic Glycemic Management System Versus Provider-Managed Subcutaneous Basal Bolus Insulin Therapy in the Hospital Setting

Aloi, Joseph; Bode, Bruce W.; Ullal, Jagdeesh; Chidester, Paul; McFarland, R.; Bedingfield, Amy E.; Mabrey, Melanie; Booth, Robby; Mumpower, April; Wallia, Amisha

doi:10.1177/1932296816664746

Cited by 33 publications

(24 citation statements)

References 18 publications

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“…El manejo de la hiperglucemia en los Servicios de Urgencias Hospitalaria (SUH) es un tema complejo y ampliamente estudiado ( 10,11,(14)(15)(16)(17)(18)(19)(20). Se han establecido una gran cantidad de pautas, algoritmos, modelos, sin poder llegar a obtener una solución que sea altamente eficaz en su manejo, pudiendo incluso influir de forma importante la experiencia del médico a cargo del paciente.…”

Section: Discussionunclassified

“…Según nuestra búsqueda, aunque hay varios estudios de manejo de la glucemia en paciente diabéticos con aplicaciones informáticas [9][10][11][21][22][23] , este es el primer ensayo clínico realizado en urgencias, que valida una aplicación informática en la ayuda al tratamiento de la hiperglucemia. Los resultados obtenidos en este estudio indican, que la utilización de GLIKAL como apoyo a los MU en la decisión de tratamiento de paciente con hiperglucemia, es segura y eficiente, y que su uso debería estandarizarse para asegurar el cumplimiento de las guías clínicas, lo que redundaría en un mejor control de las cifras de glucemia en los pacientes ingresados, con los beneficios que el control de las cifras de glucemias por herramientas informáticas de ayuda al clínico, han demostrado en numerosas publicaciones previas 14,21 .…”

Section: Discussionunclassified

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Ensayo clínico multicéntrico para la validación de la aplicación Glikal en la ayuda al manejo de la hiperglucemia en comparación con la práctica clínica habitual.

Cardona¹,

Rodríguez²,

Rodríguez³

et al. 2017

IBJ Plus

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Ensayo clínico multicéntrico, para la validación externa de una aplicación informática (GLIKAL) demostrando su superioridad frente a la práctica clínica habitual en el control de la hiperglucemia en urgencias. Los pacientes que no sean vistos por el equipo investigador, conformarían el grupo tratado por práctica clínica habitual (PCH) y los pacientes incluidos por el equipo investigador conformarían la cohorte de pacientes tratados por GLIKAL. Se recogieron 3 determinaciones de glucemia al día durante 48 horas tras el ingreso, además de los episodios de hipoglucemia y los días de ingreso de ambos grupos. Se reclutaron en total 183 pacientes, de entre 18 a 95 años de los cuales 86 fueron tratados con GLIKAL y 97 según la PCH. Las medias de las glucemias en las primeras 24 horas, fue de 178.56 (59.53) mg/dl del grupo GLIKAL y de 212.93 (68.23) mg/dl del grupo PCH (p<0.001). Mientras que en el segundo día, el grupo GLIKAL tuvo una media de glucemia de 173.86 (58.86) mg/dl y el grupo PCH de 196.37 (66.60) mg/dl (p=0.017). En ambos días, los pacientes que lograban mantener cifras de glucemia por debajo de 180 mg/dl, era de más del 60% para el grupo GLIKAL, mientras que el grupo PCH se mantenía entre el 33 y el 43%, siendo esta diferencia estadísticamente significativa para ambos días. Estos resultados demuestra la superioridad en resultados de disminución de glucemia de la aplicación GLIKAL frente a la práctica clínica habitual.

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Section: Discussionunclassified

Ensayo clínico multicéntrico para la validación de la aplicación Glikal en la ayuda al manejo de la hiperglucemia en comparación con la práctica clínica habitual.

Cardona¹,

Rodríguez²,

Rodríguez³

et al. 2017

IBJ Plus

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“…Order sets for basal-bolus-correction insulin regimens, insulin management algorithms (70,96,(99)(100)(101)(102), and computerized order entry systems (101,103) have been shown to improve glycemic control and/or reduce adverse outcomes in hospitalized people with diabetes. Computerized and mobile decision support systems (that provide suggestions for insulin dosing) have also been used and have been associated with lower mean BG levels (26,(104)(105)(106); hypoglycemia can be an unintended consequence of tighter glycemic control (70,105).…”

Section: Algorithms Order Sets and Decision Supportmentioning

confidence: 99%

In-Hospital Management of Diabetes

Malcolm¹,

Halperin²,

Miller³

et al. 2018

Canadian Journal of Diabetes

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is common in hospitalized people, even among those without a previous history of diabetes, and is associated with increased in-hospital complications, longer length of stay and mortality. • Insulin is the most appropriate pharmacologic agent for effectively controlling glycemia in hospital. A proactive approach to glycemic management using scheduled basal, bolus and correction (supplemental) insulin is the preferred method. The use of correction-only (supplemental) insulin, which treats hyperglycemia only after it has occurred, should be discouraged as the sole modality for treating elevated blood glucose levels. • For the majority of noncritically ill hospitalized people with diabetes, preprandial blood glucose targets should be 5.0 to 8.0 mmol/L, in conjunction with random blood glucose values <10.0 mmol/L, as long as these targets can be safely achieved. For critically ill hospitalized people with diabetes, blood glucose levels should be maintained between 6.0 and 10.0 mmol/L. • Hypoglycemia is a major barrier to achieving targeted glycemic control in the hospital setting. Health-care institutions should develop protocols for the assessment and treatment of hypoglycemia. KEY MESSAGES FOR PEOPLE WITH DIABETES • If your admission to hospital is planned, talk with your health-care providers (e.g. surgeon, anesthetist, primary care provider, diabetes health provider, etc.) before you are admitted in order to develop an in-hospital diabetes care plan that addresses such issues as: • Who will manage your diabetes in the hospital? • Will you be able to self-manage your diabetes? • What adjustments to your diabetes medications or insulin doses may be necessary before and after medical procedures or surgery? • If you use an insulin pump, are hospital staff familiar with pump therapy? • Your blood glucose levels may be higher in hospital than your usual target range due to a variety of factors, including the stress of your illness, medications, medical procedures and infections. • Your diabetes medications may need to be changed during your hospital stay to manage the changes in blood glucose, or if medical conditions develop that make some medications no longer safe to use. • When you are discharged, make sure that you have written instructions about: • Changes in your dosage of medications or insulin injections or any new medications or treatments • How often to check your blood glucose • Who to contact if you have difficulty managing your blood glucose levels. Screening for and Diagnosis of Diabetes and Hyperglycemia in the Hospital Setting A history of diabetes should be elicited in all patients admitted to hospital and, if present, should be clearly identified on the medical record. In view of the high prevalence of inpatient hyperglycemia with associated poor outcomes, an admission BG measurement of all patients would help identify people with diabetes, even in the absence of a prior diagnosis (1,5). In-hospital hyperglycemia is defined as any glucose value >7.8 mmol/L. For hospitalized people with known diabetes,...

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“…In these patients, continuous subcutaneous insulin infusion (CSII) with continuous monitoring of glucose (CGM) is most commonly used. This allows for good glycemic control and reducing the risk of hypoglycaemia [18,19]. Insulin analogues are usually used in these patients.…”

Section: Alleviation Of Disordersmentioning

confidence: 99%

Monitoring of glucose metabolism in patients receiving enteral nutrition

Dworzecka

Otto-Buczkowska

2018

Clinical Diabetology

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Hyperglycemia is frequently occurring in critically ill patients and the incidence is particularly high in patients receiving nutrition support. One of the forms of such nutrition is enteral nutrition, which is used particularly often. There are patients with type 1 diabetes, type 2 diabetes and other forms of diabetes as well as patients who have not previously been diagnosed with diabetes in this group of patients. The basis of pharmacotherapy in this case is an insulin therapy. The principles of such a therapy in patients with previously diagnosed diabetes are regulated by PTD guidelines. According to literature data, hyperglycemic patients with no previously diagnosed diabetes require special attention. The pathomechanism of these disorders is very complex and these patients require special care in determining the insulin therapy program. So far, there are no unambiguous guidelines in this area. (Clin

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Comparison of an Electronic Glycemic Management System Versus Provider-Managed Subcutaneous Basal Bolus Insulin Therapy in the Hospital Setting

Cited by 33 publications

References 18 publications

Ensayo clínico multicéntrico para la validación de la aplicación Glikal en la ayuda al manejo de la hiperglucemia en comparación con la práctica clínica habitual.

Ensayo clínico multicéntrico para la validación de la aplicación Glikal en la ayuda al manejo de la hiperglucemia en comparación con la práctica clínica habitual.

In-Hospital Management of Diabetes

Monitoring of glucose metabolism in patients receiving enteral nutrition

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