Fasting hyperglycaemia and in-hospital mortality in elderly population

Iglesias, Pedro; Polini, Antonio; Muñoz, Angélica; Dardano, Angela; Prado, Florentino; Castiglioni, M; Guerrero, María Teresa; Tognini, Silvana; Macías, M. C.; Diez, J. M. Baena; Monzani, Fabio

doi:10.1111/j.1742-1241.2010.02514.x

Cited by 12 publications

(7 citation statements)

References 16 publications

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“…After midnight, the benefit of the closed-loop system was more prominent, with a doubling of glucose time in target and mean overnight plasma glucose levels (7.8 mmol/L) consistent with current recommended premeal targets (13). The average plasma glucose level during conventional therapy was higher (8.6 mmol/L), which is relevant because fasting hyperglycemia is independently associated with increased inpatient mortality (14). Overnight glycemic control achieved with the closed-loop system was comparable to that previously shown in adults with type 1 diabetes (time in target 78 vs. 76%) (4).…”

Section: Discussionsupporting

confidence: 58%

Feasibility of Closed-Loop Insulin Delivery in Type 2 Diabetes: A Randomized Controlled Study

et al. 2014

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OBJECTIVEClosed-loop insulin delivery offers a promising treatment option, but to date, it has only been evaluated in type 1 diabetes. Our aim was to evaluate the feasibility of fully closed-loop subcutaneous insulin delivery in insulin-naïve patients with type 2 diabetes. RESEARCH DESIGN AND METHODSTwelve subjects (seven males, age 57.2 years, BMI 30.5 kg/m 2 ) with noninsulintreated type 2 diabetes (HbA 1c 8.4% [68 mmol/mol], diabetes duration 7.6 years) underwent two 24-h visits (closed-loop and control) in a randomized crossover design. During closed-loop visits, the subjects' routine diabetes therapy was replaced with model predictive control algorithm-driven subcutaneous insulin pump delivery based on real-time continuous glucose monitoring. Meals were unannounced, and no additional insulin was administered for carbohydrates consumed. During control visits, the usual diabetes regimen was continued (metformin 92%, sulfonylureas 58%, dipeptidyl peptidase-4 inhibitors 33%). On both visits, subjects consumed matched 50-to 80-g carbohydrate meals and optional 15-g carbohydrate snacks and remained largely sedentary. Plasma glucose measurements evaluated closed-loop performance. RESULTSCompared with conventional therapy, 24 h of closed-loop insulin delivery increased overall the median time in target plasma glucose (3.9-8.0 mmol/L) from 24 to 40% (P = 0.016), despite sensor under-reading by a median of 1.2 mmol/L. The benefit of the closed-loop system was more prominent overnight, with greater time in target glucose (median 78 vs. 35%; P = 0.041) and less time in hyperglycemia (22 vs. 65%; P = 0.041). There was no hypoglycemia during either intervention. CONCLUSIONSA closed-loop system without meal announcement and using subcutaneous insulin delivery in insulin-naïve patients with type 2 diabetes appears feasible and safe. Improvement in postprandial glucose control may require further optimization of system performance.

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Section: Discussionsupporting

confidence: 58%

Feasibility of Closed-Loop Insulin Delivery in Type 2 Diabetes: A Randomized Controlled Study

et al. 2014

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“…It is known that hyperglycemia is a prognostic factor in the emergency room [4][5][6], being responsible for an increased rate of inhospital mortality in patients admitted with HC [7]. Among nondiabetic individuals, even modest amounts of hyperglycemia are associated with increased in-hospital mortality [8].…”

Section: Dear Editormentioning

confidence: 99%

Hyperglycemia in patients with hypertensive crisis: Response to “Hypertensive crisis: Comparison between diabetics and non-diabetics”

Vaz-de-Melo

Vilela-Martin

2012

International Journal of Cardiology

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“…[4][5][6] GIH is not without consequence, being associated with increased mortality and longer length of hospital stay, in patients with and without a diagnosis of diabetes and for patients both in general wards and in intensive care units. [7][8][9][10][11] There are no widely accepted or international guidelines for a specific treatment regimen for GIH. The use of oral hypoglycaemic agents and noninsulin injectables have been considered and trialled; however, there is limited evidence for their therapeutic efficacy.…”

Section: Introductionmentioning

confidence: 99%

“…The glycaemic impact of intermediate‐acting glucocorticoids such as prednisolone and methylprednisolone is characterised by a normal fasting blood glucose level (BGL) and hyperglycaemia that exerts a peak effect 4–8 hours after administration, particularly postprandially 4‐6 . GIH is not without consequence, being associated with increased mortality and longer length of hospital stay, in patients with and without a diagnosis of diabetes and for patients both in general wards and in intensive care units 7‐11 …”

Section: Introductionmentioning

confidence: 99%

Mixed insulin can improve control of prednisolone‐induced hyperglycaemia

Scholes

Bach

et al. 2023

Internal Medicine Journal

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BackgroundHyperglycaemia is a common side effect of prednisolone, although there are no widely accepted guidelines for the management of glucocorticoid‐induced hyperglycaemia (GIH). Our institution uses mixed insulin in a pre‐breakfast or pre‐breakfast and pre‐lunch regimen, with the rationale that this profile of insulin action matches the physiological effect of prednisolone on blood glucose levels (BGLs).AimEvaluate the use of the mixed insulin (NovoMix30) in a pre‐breakfast or pre‐breakfast and pre‐lunch regimen as management for GIH in a tertiary hospital setting.MethodWe retrospectively evaluated all inpatients coprescribed prednisolone ≥7.5 mg and NovoMix30 for at least 48 hours over a 19‐month period. BGLs were evaluated with repeated‐measures analysis within four time periods across the day, beginning from the day prior to NovoMix30 administration.ResultsA total of 53 patients were identified. NovoMix30 significantly reduced BGLs in the morning (mean 12.7 ± 4.5 vs. 9.2 ± 3.9 mmol/L, P < 0.001), afternoon (mean 13.6 ± 3.8 vs. 11.9 ± 3.8 mmol/L, P = 0.001) and evening (12.1 ± 3.8 vs. 10.8 ± 3.8 mmol/L, P = 0.01). With uptitration of insulin over 3 days, 43% of all BGLs were within the target range, compared with 23% on day 0 (P < 0.001). The final median dose of NovoMix30 was 0.15 (0.10–0.22) units/kg bodyweight, or 0.40 (0.23–0.69) units/mg of prednisolone, which is lower than our hospital guideline recommends. One overnight hypoglycaemic event was observed.ConclusionMixed insulin as a pre‐breakfast or pre‐breakfast and pre‐lunch regimen can target the hyperglycaemic pattern induced by prednisolone and minimise overnight hypoglycaemia. However, higher doses of insulin than those used in our study are likely required for optimal BGL control.

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Fasting hyperglycaemia and in-hospital mortality in elderly population

Abstract: In non-diabetic elderly patients admitted for acute disease, serum glucose concentration is an important, simple and independent predictor of hospital mortality.

Cited by 12 publications

References 16 publications

Feasibility of Closed-Loop Insulin Delivery in Type 2 Diabetes: A Randomized Controlled Study

Feasibility of Closed-Loop Insulin Delivery in Type 2 Diabetes: A Randomized Controlled Study

Hyperglycemia in patients with hypertensive crisis: Response to “Hypertensive crisis: Comparison between diabetics and non-diabetics”

Mixed insulin can improve control of prednisolone‐induced hyperglycaemia

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