Development and implementation of evidence-based guidelines for IV insulin: A statewide collaborative approach

Stockton, Lawrence; Baird, Marianne; Cook, Curtiss B.; Osburne, Robert C.; Reid, Joyce; McGowan, Kathryn A.; Jarvis, Sabrina

doi:10.1016/s1557-0843(08)80018-8

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…Recently published reports demonstrate that hypoglycemic events can be kept very low during treatment with an intensive insulin infusion protocol if expert rules are built into the algorithm that address hypoglycemia. 37,38 Thus, rather than abandon efforts at improving inpatient hyperglycemia over concerns about hypoglycemia, hospitals will need to develop methods to change their hypoglycemia policies from ones that typically just guide treatment to ones that incorporate preventive strategies.…”

Section: Discussionmentioning

confidence: 99%

Inpatient glucose control: a glycemic survey of 126 U.S. hospitals

Cook

Kongable

Potter

et al. 2009

Journal of Hospital Medicine

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187

136

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was used to extract inpatient point-of-care bedside glucose (POC-BG) tests from 126 hospitals for the period January to December 2007. Patient-day-weighted mean POC-BG and hypoglycemia/hyperglycemia rates were calculated for intensive care unit (ICU) and non-ICU areas. The relationship of POC-BG levels with hospital characteristics was determined. RESULTS:A total of 12,559,305 POC-BG measurements were analyzed: 2,935,167 from the ICU and 9,624,138 from the non-ICU. Patient-day-weighted mean POC-BG was 165 mg/dL for ICU and 166 mg/dL for non-ICU. Hospital hyperglycemia (>180 mg/dL) prevalence was 46.0% for ICU and 31.7% for non-ICU. Hospital hypoglycemia (<70 mg/dL) prevalence was low at 10.1% for ICU and 3.5% for non-ICU. For ICU and non-ICU there was a significant relationship between number of beds and patient-day-weighted mean POC-BG levels, with larger hospitals (!400 beds) having lower patient-day weighted mean POC-BG per patient day than smaller hospitals (<200 beds, P < 0.001). Rural hospitals had higher POC-BG levels compared to urban and academic hospitals (P < 0.05), and hospitals in the West had the lowest values.CONCLUSIONS: POC-BG data captured through automated data management software can support hospital efforts to monitor the status of inpatient glycemic control. From these data, hospital hyperglycemia is common, hypoglycemia prevalence is low, and POC-BG levels vary by hospital characteristics. Increased hospital participation in data collection and reporting may facilitate the creation of a national benchmarking process for the development of best practices and improved inpatient hyperglycemia management.

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Section: Discussionmentioning

confidence: 99%

Inpatient glucose control: a glycemic survey of 126 U.S. hospitals

Cook

Kongable

Potter

et al. 2009

Journal of Hospital Medicine

Self Cite

187

136

View full text Add to dashboard Cite

show abstract

“…Inpatient tight glycemic control initiatives cannot be instituted unless they are coupled with efforts to understand and correct system‐based problems that increase the risk of hypoglycemia. Recently published reports demonstrate that hypoglycemic events can be kept very low during treatment with an intensive insulin infusion protocol if expert rules are built into the algorithm that address hypoglycemia 37, 38. Thus, rather than abandon efforts at improving inpatient hyperglycemia over concerns about hypoglycemia, hospitals will need to develop methods to change their hypoglycemia policies from ones that typically just guide treatment to ones that incorporate preventive strategies.…”

Section: Discussionmentioning

confidence: 99%

Enzymatic Thioxyloside Synthesis: Characterization of Thioglycoligase Variants Identified from A Site‐Saturation Mutagenesis Library of Bacillus Circulans Xylanase

et al. 2010

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Thioglycoligases are engineered enzymes for the synthesis of thioglycosides that are derived from retaining glycosidases by replacing the acid/base catalyst. The optimal choice of substitution for the acid/base mutant is currently unknown, so to investigate this question a complete acid/base library of the model glycosidase Bacillus circulans xylanase (Bcx) was generated by using site-saturation mutagenesis. A novel screening approach combining active site titration with semiquantitative product analysis by thin layer chromatography was established and used to evaluate specific activities of each mutant enzyme within crude cell lysates. The six most active Bcx variants were analyzed in more detail, a pH optimum of 8.5 was established and the identity of reaction products was confirmed. Optimal choices for substitution were small, preferably polar amino acids such as threonine, cysteine, and serine. We discuss the resultant data in the context of previously published studies on thioglycoligases.

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“…In patients with type 1 diabetes the insulin infusion rate begins at roughly 0.5–1 U/hour (mix 100 U short-acting insulin in 100 mL normal saline; i.e., 1 U = 1 mL), whereas infusion rates are typically increased in type 2 diabetics to approximately 2-3 U/hour or higher [ 20 ]. There are a number of both static [ 73 , 74 ] and adjustable [ 75 ] algorithms that can be used to adjust the rate of insulin infusion. It should be noted that there exists a continuous Glucose-Insulin-Potassium (GIK) infusion technique, which has been supported as an inotropic and metabolic therapy in several critical disease states [ 76 ].…”

Section: Intraoperative Glycemic Managementmentioning

confidence: 99%

Guidelines for Perioperative Management of the Diabetic Patient

Sudhakaran

Surani

2015

Surgery Research and Practice

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Management of glycemic levels in the perioperative setting is critical, especially in diabetic patients. The effects of surgical stress and anesthesia have unique effects on blood glucose levels, which should be taken into consideration to maintain optimum glycemic control. Each stage of surgery presents unique challenges in keeping glucose levels within target range. Additionally, there are special operative conditions that require distinctive glucose management protocols. Interestingly, the literature still does not report a consensus perioperative glucose management strategy for diabetic patients. We hope to outline the most important factors required in formulating a perioperative diabetic regimen, while still allowing for specific adjustments using prudent clinical judgment. Overall, through careful glycemic management in perioperative patients, we may reduce morbidity and mortality and improve surgical outcomes.

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Development and implementation of evidence-based guidelines for IV insulin: A statewide collaborative approach

Cited by 5 publications

References 12 publications

Inpatient glucose control: a glycemic survey of 126 U.S. hospitals

Inpatient glucose control: a glycemic survey of 126 U.S. hospitals

Enzymatic Thioxyloside Synthesis: Characterization of Thioglycoligase Variants Identified from A Site‐Saturation Mutagenesis Library of Bacillus Circulans Xylanase

Guidelines for Perioperative Management of the Diabetic Patient

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