Normal Glucose Values Are Associated With a Lower Risk of Mortality in Hospitalized Patients

Bruno, Alberto; Gregori, Darío; Caropreso, A; Lazzarato, Fulvio; Petrinco, Michele; Pagano, Eva

doi:10.2337/dc08-0672

Cited by 58 publications

(37 citation statements)

References 12 publications

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“…While outpatient management of hyperglycemia has historically been the primary focus in this population, and has unquestionably reduced diabetic morbidity and mortality, mounting evidence suggests that inpatient glycemic control may impart a similar benefit [10], [11], [12], [13], [14], [15], [16], [17], [18].…”

Section: Introductionmentioning

confidence: 99%

Evaluation and Enhancement of an Intraoperative Insulin Infusion Protocol via In-Silico Simulation

Kohl

Chen

Mullen-Fortino

et al. 2013

2013 IEEE International Conference on Healthcare Informatics

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Intraoperative glycemic control, particularly in cardiac surgical patients, remains challenging. Patients with impaired insulin sensitivity and/or secretion (i.e., type 1 diabetes mellitus) often manifest extremely labile blood glucose measurements during periods of stress and inflammation. Most current insulin infusion protocols are developed based on clinical experiences and consensus among a local group of physicians. Recent advances in human glucose metabolism modeling have established a computer model that invokes algorithms representing many of the pathways involved in glucose dysregulation for patients with diabetes. In this study, we used an FDA approved glucose metabolism model to evaluate an existing institutional intraoperative insulin infusion protocol via closedloop simulation on the virtual diabetic population that comes with the computer model. A comparison of simulated responses to actual retrospective clinical data from 57 type 1 diabetic patients undergoing cardiac surgery managed by the institutional protocol was performed. We then designed a proportional-derivative controller that overcomes the weaknesses exhibited by our old protocol while preserving its strengths. In-silico evaluation results show that our proportionalderivative controller more effectively manages intraoperative hyperglycemia while simultaneously reducing hypoglycemia and glycemic variability. By performing insilico simulation on intraoperative glucose and insulin responses, robust and seemingly efficacious algorithms can be generated that warrant prospective evaluation in human subjects. KeywordsIntraoperative glycemic control, in-silico evaluation, proportional-derivative controller, insulin infusion protocol, computer model Abstract-Intraoperative glycemic control, particularly in cardiac surgical patients, remains challenging. Patients with impaired insulin sensitivity and/or secretion (i.e., type 1 diabetes mellitus) often manifest extremely labile blood glucose measurements during periods of stress and inflammation. Most current insulin infusion protocols are developed based on clinical experiences and consensus among a local group of physicians. Recent advances in human glucose metabolism modeling have established a computer model that invokes algorithms representing many of the pathways involved in glucose dysregulation for patients with diabetes. In this study, we used an FDA approved glucose metabolism model to evaluate an existing institutional intraoperative insulin infusion protocol via closedloop simulation on the virtual diabetic population that comes with the computer model. A comparison of simulated responses to actual retrospective clinical data from 57 type 1 diabetic patients undergoing cardiac surgery managed by the institutional protocol was performed. We then designed a proportional-derivative controller that overcomes the weaknesses exhibited by our old protocol while preserving its strengths. In-silico evaluation results show that our proportional-derivative controller more effectively manag...

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Section: Introductionmentioning

confidence: 99%

Evaluation and Enhancement of an Intraoperative Insulin Infusion Protocol via In-Silico Simulation

Kohl

Chen

Mullen-Fortino

et al. 2013

2013 IEEE International Conference on Healthcare Informatics

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show abstract

“…In summary, the main recommendations based on studies in the literature for the management of glycemic control in diabetic patients before surgery are [233][234][235][236][237][238][239] :…”

Section: Basal Scheme -Use Of Intermediate or Slow-acting Insulin Alonementioning

confidence: 99%

II Diretriz de Avaliação Perioperatória da Sociedade Brasileira de Cardiologia

Feitosa¹,

Marques²,

Caramelli³

et al. 2011

Arq. Bras. Cardiol.

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“…It is well recognised that there is no such thing as one perfect sliding scale, 2 but it does provide a good system of stabilising a patient's diabetes following the inter-current stresses of medical illness, surgery and metabolic imbalance. 3,4 Results from the National Diabetes Inpatient Audit over recent years have demonstrated that there is a great deal of variation in practice around the use of VRIII in terms of the appropriateness of its use, the individualised settings, its duration and effectiveness and the recurrent problem of general nursing and medical staff's reluctance to continue the administration of basal insulin alongside the insulin infusion. 5 The previous National Diabetes Inpatients Audit results from 2013-14 demonstrated 5 : 1 Inappropriate VRIII use: 6.5% of patients were thought to have been treated with a VRIII unnecessarily.…”

Section: Introductionmentioning

confidence: 99%

The Variable Rate Intravenous Insulin Infusion in Clinical Practice 2015: an audit against the new JBDS guidance

et al. 2016

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Background: Variable rate intravenous insulin infusion (VRIII) is an established method to achieve normoglycaemia in unwell or fasting patients. The Joint British Diabetes Societies (JBDS) released new guidance for the use of VRIII in medical inpatients in October 2014. This specifies the appropriate clinical circumstances in which a VRIII should be used and how it should be initiated, managed and discontinued safely. Methods: We developed an audit tool based on the guidelines and audited the current practice at the Royal Sussex County Hospital, Brighton, prior to the roll out of the new standards. We have audited 50 patients on VRIII under non-specialist medical and surgical care. Results: Several parameters were checked. VRIII prescription was signed appropriately as per the guidance in 98% of patients. Oral hypoglycaemic medications were omitted in 83%. Short-acting and mix insulins were omitted only in 88%. Long-acting insulin was administered only in 77% of the patients. Blood glucose was tested 1-2 hourly in 90% of patients. All patients with hypoglycaemic episodes were treated as per protocol. On the occasions where VRIII was discontinued, it was reinitiated within 20 min as per the guidelines only in 36% of cases. In patients with persistent hyperglycaemia, the rate was increased in 80% of cases. Discussion: Clinical practice surrounding the use, appropriate management and monitoring parameters appeared to fall short of the standards suggested by the latest JBDS guidance. Our audit outcome was to prepare a protocol for the trust summarising the indications for VRIII, target capillary blood glucose, how and when to stop VRIII for patients with diabetes and also a prompt to prescribe basal insulin for patients with diabetes and when a referral should be made to the diabetes inpatient team. Intro-

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Normal Glucose Values Are Associated With a Lower Risk of Mortality in Hospitalized Patients

Cited by 58 publications

References 12 publications

Evaluation and Enhancement of an Intraoperative Insulin Infusion Protocol via In-Silico Simulation

Evaluation and Enhancement of an Intraoperative Insulin Infusion Protocol via In-Silico Simulation

II Diretriz de Avaliação Perioperatória da Sociedade Brasileira de Cardiologia

The Variable Rate Intravenous Insulin Infusion in Clinical Practice 2015: an audit against the new JBDS guidance

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