Effects of sliding scale insulin use on glycemic control and length of stay in hospitalized patients with Type 2 diabetes mellitus

Abstract

Aim of this work was to asses whether a novel 99mTc labeled Bombesin (BN) can play a clinical role in diagnosis and staging of prostate cancer. 14 patients were studied with trans-rectal ultrasonography-guided biopsy, CT and MRI and with 99mTc BN Scintigraphy. Five patients were also imaged by 111In Octreotide (O) scan. All the patients but one were submitted to surgery and final diagnosis was reached by pathology, taken as the gold standard method. Two patients showed benign adenoma and 12 patients showed cancer at biopsy. 99mTc BN SPECT was positive in all 12 patients with cancer. Four of these patients also showed pelvic focal uptake, referred to inguinal lymph-nodal involvement. MRI and CT provided similar findings in only three cases. Pathologic evaluation after operation confirmed the invasion of nodes in all four subjects. Both 99mTc BN and 111In O scans provided normal findings in the two subjects affected by benign adenoma, while 111In O was positive in only two of three patients with cancer and was always unable to detect nodal invasion. These preliminary data suggest that 99mTc BN SPECT scan could be useful to detect primary prostate cancer and to reveal loco-regional node involvement.

Predictors of sliding scale insulin use by housestaff physicians in the management of hospitalized patients with diabetes mellitus

“…This is consistent with previous studies, which generally examined more than 70% of hospitalized patients being treated with SSI [9,10]. Again, our data confirm that the use of a standing antidiabetic regimen, insulin and/or hypoglycemic agents, generally resulted in better glycemic control.…”

“…Data from our group and others [9,10,14] have shown, that the use of SSI resulted in significantly higher intra-hospital glycemia. SSI is usually practiced by housestaff physicians and generally transmitted as a tradition among trainees [11,12,14].…”

“…Sliding scale insulin (SSI) is a common practice in hospitalized patients with DM and is used in more than 70% of cases [8,9]. Data from our group and others [9,10,14] have shown, that the use of SSI resulted in significantly higher intra-hospital glycemia.…”

“…Finally, in a recent study by Baldwin and colleagues, authors optimistically affirmed that house staff can effectively be taught the management of in-patient DM, with the elimination of use of SSI from the current practice [9]. Interestingly, Baldwin's data revealed a decrease in the use of SSI by 60% among surgical staff, indicating that the rationale for physiological insulin therapy providing basal and preprandial coverage can be effectively imprinted into medical train- ing.…”

Molecular imaging of prostate cancer: translating molecular biology approaches into the clinical realm

“…Radiopharmaceuticals containing bombesin or its analogues, labeled with 99 mTechnetium, have been developed to target GRPR-expressing tumors for nuclear imaging, mainly with SPECT. Limited clinical studies have shown promise in detecting primary prostate cancer, nodal and bone metastases [58; 59]. Other labeling methods to obtain agents suitable for PET imaging are currently underway [60].…”