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Pan Y, Wang Q, Zhao F, Shen J, Zhong X. Effect of Continuous Subcutaneous Injection of Insulin Analogues in Pregnant Women with Diabetes Mellitus Complicated with Ketoacidosis. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:8670474. [PMID: 34956580 PMCID: PMC8694999 DOI: 10.1155/2021/8670474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/13/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the clinical effect of continuous subcutaneous injection of insulin analogues in pregnant women with diabetes mellitus complicated with ketoacidosis. METHODS A total of 92 pregnant patients with diabetes mellitus complicated with ketoacidosis from June 2014 to January 2021 were selected. All patients were randomly divided into an observation group and control group according to the method of random number. The control group received intravenous infusion of insulin, and the observation group received continuous subcutaneous infusion of quick-acting insulin analogues. The clinical effects of the two groups were observed. RESULTS The time needed to control blood glucose <13.8 mmol/L, the amount of insulin needed to control blood glucose <13.8 mmol/L, the time needed to correct DKA, and the amount of insulin needed to correct DKA in the observation group were significantly less than those in the control group (P < 0.05). Compared with the control group, the average occurrence times of hypoglycemia, the length of stay, the total amount of insulin in hospital, and the total amount of insulin used during pregnancy in the observation group were significantly less than those in the control group (P < 0.05). The values of SCr, CRP, BUN, arterial blood gas pH, and adiponectin in the two groups were significantly improved as compared with those before treatment, and the improvement in the observation group was significantly better than that in the control group (P < 0.05). After treatment, the fasting blood glucose, 2-hour postprandial blood glucose, carbon dioxide binding capacity, and glycosylated hemoglobin in the experimental group were significantly better than those in the routine group, and the difference was statistically significant (P < 0.05). CONCLUSION Continuous subcutaneous injection of insulin analogues is effective in the treatment of diabetic patients with ketoacidosis, which can effectively improve blood glucose, carbon dioxide binding capacity, and glycosylated hemoglobin and accelerate the negative conversion of urinary ketone body. It is worth popularizing to reduce the occurrence of hypoglycemia and the dose of insulin and shorten the time of hospitalization.
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Affiliation(s)
- Yunfei Pan
- General Medicine Department, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Qi Wang
- Infectious Disease Department, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Feimin Zhao
- General Medicine Department, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Jiaying Shen
- General Medicine Department, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Xiaojing Zhong
- Endocrinology Department, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
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Jinjing W, Kang C, Xufei L, Xueqiong L, Xinye J, Miao Y, Jinping Z, Zhaohui L, Jingtao D, Yaolong C, Linong J, Yiming M. Chinese clinical practice guidelines for perioperative blood glucose management. Diabetes Metab Res Rev 2021; 37:e3439. [PMID: 33605539 DOI: 10.1002/dmrr.3439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 12/20/2022]
Abstract
With the increased incidence of diabetes, the number of diabetic patients who require surgical treatment is also increasing. Unfortunately, practices in this area lack standardisation. The purpose of this multidisciplinary, evidence-based guidelines for perioperative blood glucose management is to provide a comprehensive set of recommendations for clinicians treating diabetes with different types of surgery. The intended audience comprises Chinese endocrinologists, surgeons, anaesthetists, clinical pharmacists, nurses and professionals involved in perioperative blood glucose management. The guidelines were formulated as follows. First, a multidisciplinary expert group was established to identify and formulate key research questions on topics of priority according to the Population, Intervention, Comparator and Outcomes (PICO) process. We conducted a meta-analysis of available studies using Review Manager version 5.3, as appropriate. We pooled crude estimates as odds ratios with 95% confidence intervals using a random-effects model, and used the Grading of Recommendations Assessment, Development, and Evaluation methods to assess the quality of the retrieved evidence. Finally, 32 recommendations were gathered that covered 11 fields-management and coordination, endocrinologists' consultation, diabetes diagnosis, surgery timing and anaesthesia method, blood glucose target values and monitoring frequency, hypoglycaemia treatment, oral administration of blood glucose lowering drugs, use of insulin, enteral and parenteral nutritional, postoperative treatment and medication and education and training. Twenty-five systematic reviews and meta-analyses were conducted for these guidelines to address the PICO questions. These guidelines are intended to improve perioperative blood glucose management and help doctors in specifying medical diagnosis and treatment, and will be implemented / disseminated extensively in China.
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Affiliation(s)
- Wang Jinjing
- Department of Endocrinology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Endocrinology, Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Chen Kang
- Department of Endocrinology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Luo Xufei
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Li Xueqiong
- Department of Dry Therapy, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jin Xinye
- Department of Endocrinology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Nephrology, Hainan Hospital of Chinese PLA General Hospital, the Hainan Academician Team Innovation Center, Hainan, China
| | - Yu Miao
- Department of EndocrinologyKey Laboratory of EndocrinologyNational Health Commission, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhang Jinping
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Lv Zhaohui
- Department of Endocrinology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Dou Jingtao
- Department of Endocrinology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Chen Yaolong
- Institute of Health Data Science, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Ji Linong
- Department of Endocrinology and Metabolism, Peking University people's Hospital, Peking University Diabetes Center, Beijing, China
| | - Mu Yiming
- Department of Endocrinology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
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Grunberger G, Sherr J, Allende M, Blevins T, Bode B, Handelsman Y, Hellman R, Lajara R, Roberts VL, Rodbard D, Stec C, Unger J. American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus. Endocr Pract 2021; 27:505-537. [PMID: 34116789 DOI: 10.1016/j.eprac.2021.04.008] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To provide evidence-based recommendations regarding the use of advanced technology in the management of persons with diabetes mellitus to clinicians, diabetes-care teams, health care professionals, and other stakeholders. METHODS The American Association of Clinical Endocrinology (AACE) conducted literature searches for relevant articles published from 2012 to 2021. A task force of medical experts developed evidence-based guideline recommendations based on a review of clinical evidence, expertise, and informal consensus, according to established AACE protocol for guideline development. MAIN OUTCOME MEASURES Primary outcomes of interest included hemoglobin A1C, rates and severity of hypoglycemia, time in range, time above range, and time below range. RESULTS This guideline includes 37 evidence-based clinical practice recommendations for advanced diabetes technology and contains 357 citations that inform the evidence base. RECOMMENDATIONS Evidence-based recommendations were developed regarding the efficacy and safety of devices for the management of persons with diabetes mellitus, metrics used to aide with the assessment of advanced diabetes technology, and standards for the implementation of this technology. CONCLUSIONS Advanced diabetes technology can assist persons with diabetes to safely and effectively achieve glycemic targets, improve quality of life, add greater convenience, potentially reduce burden of care, and offer a personalized approach to self-management. Furthermore, diabetes technology can improve the efficiency and effectiveness of clinical decision-making. Successful integration of these technologies into care requires knowledge about the functionality of devices in this rapidly changing field. This information will allow health care professionals to provide necessary education and training to persons accessing these treatments and have the required expertise to interpret data and make appropriate treatment adjustments.
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Affiliation(s)
| | - Jennifer Sherr
- Yale University School of Medicine, New Haven, Connecticut
| | - Myriam Allende
- University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | | | - Bruce Bode
- Atlanta Diabetes Associates, Atlanta, Georgia
| | | | - Richard Hellman
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | | | | | - David Rodbard
- Biomedical Informatics Consultants, LLC, Potomac, Maryland
| | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | - Jeff Unger
- Unger Primary Care Concierge Medical Group, Rancho Cucamonga, California
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Suggested Canadian Standards for Perioperative/Periprocedure Glycemic Management in Patients With Type 1 and Type 2 Diabetes. Can J Diabetes 2021; 46:99-107.e5. [PMID: 34210609 DOI: 10.1016/j.jcjd.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 03/25/2021] [Accepted: 04/26/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The goal of this quality initiative was to develop consensus standards for glycemic management of patients with diabetes who undergo surgical procedures in Canada. METHODS A modified Delphi method was used to gather broad stakeholder input and arrive at a consensus for perioperative/periprocedure diabetes management. RESULTS Glycemic management standards were developed for the following categories: Organization of Care; Preoperative Assessment; Immediate Preoperative and Intraoperative; Postanesthesia Care Unit or Recovery Room; Postoperative Period; and Transition to Outpatient Care. CONCLUSIONS It is anticipated these standards will serve as a basis to develop clinical tools to support the recommendations.
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Carvalho RC, Nishi FA, Ribeiro TB, França GG, Aguiar PM. Association Between Intra-Hospital Uncontrolled Glycemia and Health Outcomes in Patients with Diabetes: A Systematic Review of Observational Studies. Curr Diabetes Rev 2021; 17:304-316. [PMID: 32000645 DOI: 10.2174/1573399816666200130093523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/26/2019] [Accepted: 01/09/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Many people are still getting affected by uncontrolled glycemic events during hospital admission, which encompasses hypoglycemia, hyperglycemia, and high glycemic variability. INTRODUCTION Primary studies have shown an association of glycemic dysregulation with increased length of hospital stay and mortality among overall patients, however, there is no systematic review of current evidence on the association between uncontrolled in-hospital glycemia in patients with diabetes and health outcomes. This study aimed to systematically review the current evidence on the association between uncontrolled in-hospital glycemia in patients with diabetes and health outcomes. METHODS The association between glycemic dysregulation and health outcomes for inpatients with diabetes was systematically reviewed. PubMed, Embase, and LILACS databases were searched. Two independent reviewers were involved in each of the following steps: screening titles, abstracts, and fulltexts; assessing the methodological quality; and extracting data from included reviews. Descriptive analysis method was used. RESULTS Seven cohort studies were included, and only two had a prospective design, consisting of 7,174 hospitalized patients with diabetes. In-hospital occurrence of hypoglycemia, hyperglycemia, and glycemic variability were assessed, and outcomes were mortality, infections, renal complications, and adverse events. Among the exposure and outcomes, an association was observed between severe hypoglycemia and mortality, hyperglycemia and infection, and hyperglycemia and adverse events. CONCLUSION In-hospital uncontrolled glycemia in patients with diabetes is associated with poor health outcomes. More studies should be conducted for proper investigation because diabetes is a complex condition. Effects of glycemic dysregulation should be investigated on the basis of overall health of a patient instead from only organ-target perspective, which makes the investigation difficult.
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Affiliation(s)
- Renata Cunha Carvalho
- Division of Pharmacy of University Hospital, University of São Paulo, São Paulo, Brazil
| | - Fernanda Ayache Nishi
- Department of Nursing of University Hospital, University of São Paulo, São Paulo, Brazil
| | - Tatiane Bomfim Ribeiro
- Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Gustavo Galvão França
- Division of Pharmacy of University Hospital, University of São Paulo, São Paulo, Brazil
| | - Patricia Melo Aguiar
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
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Kaisen AR, Parkosewich JA, McAvoy KH, Bak LB, Knobf MT. "Finding the Balance": A Qualitative Study of the Experience of Nurses and Patients with Diabetes on an Insulin Pump in the Hospital. DIABETES EDUCATOR 2020; 46:587-596. [PMID: 33063643 DOI: 10.1177/0145721720964587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to explore experiences of hospitalized patients as they transition insulin pump self-management from home to hospital and the experience of nurses caring for them. Patients are often more knowledgeable about the pump than their nurses, which could lead to undiscovered challenges. Little is known about the hospital experience related to insulin pump therapy from nurses' and patients' perspectives. METHODS A qualitative approach with interpretive descriptive design and purposive sampling was used. Eligible patients were ≥18 years of age, able to read and speak English, and admitted to non-ICU settings ≥20 hours. Eligible nurses cared for at least 1 patient using an insulin pump. Patients and nurses were interviewed separately. Interviews were audiotaped and transcribed verbatim. Data were analyzed using a constant comparative method. Coding was performed independently and jointly to reach consensus on emerging themes. RESULTS Hospitalized patients and nurses had an array of perceptions highlighting challenges and adaption to "finding the balance" in managing diabetes when patients wore their insulin pumps. There were 4 interrelated themes representing a continuum of trust to lack of trust, control versus lack of control, effective communication to limited communication, and staff knowledge to lack of knowledge. CONCLUSIONS Results of this study provide valuable insights into the challenges for both patients and nurses. A standardized approach to caring for this population is necessary. These findings can inform the development of nursing education programs and policies aimed at improving their experiences.
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Affiliation(s)
| | | | | | - Leigh B Bak
- Yale New Haven Hospital, New Haven, Connecticut
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Caines CM, Shaw A, Solomon AM. A project identifying potential risk factors leading to diabetic ketoacidosis in patients with type 1 diabetes treated with an insulin pump. Clin Med (Lond) 2020; 20:233-234. [DOI: 10.7861/clinmed.2019-0495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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He J, Zhang G, Zhang Q, Chen J, Zhang Y, An X, Wang P, Xie S, Fang F, Zheng J, Tang Y, Zhu J, Yu Y, Chen X, Lu Y. Evaluation of inhaled recombinant human insulin dry powders: pharmacokinetics, pharmacodynamics and 14-day inhalation. J Pharm Pharmacol 2018; 71:176-184. [PMID: 30324757 DOI: 10.1111/jphp.13026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/17/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The present study was designed to assess the pharmacokinetic and pharmacodynamic performance of inhaled recombinant human insulin (rh-insulin) dry powders together with their safety profiles after 14-day inhalation. METHODS In the pharmacokinetic and pharmacodynamic study, pulmonary surfactant (PS)-loaded and phospholipid hexadecanol tyloxapol (PHT)-loaded rh-insulin dry powders were intratracheally administered to male rats at the dose of 20 U/kg. Novolin R was used as control. Serum glucose and rh-insulin concentrations were determined by glucose oxidase method and human rh-insulin CLIA kit, respectively. For the safety study, rats were exposed to rh-insulin dry powders or air for 14-day by nose-only inhalation chambers. Bronchoalveolar lavage and histopathology examinations were performed after inhalation. KEY FINDINGS There were no significant differences in the major pharmacokinetic and pharmacodynamic parameters between PS-loaded and PHT-loaded rh-insulin dry powders. The relative bioavailabilities and pharmacodynamic availabilities were 39.9%, 25.6% for PS-loaded dry powders and 30.1%, 23% for PHT-loaded dry powders, respectively. Total protein was the only injury marker that was significantly altered. Histopathology examinations showed the ranking of irritations (from slight to severe) were PHT-loaded rh-insulin, negative air control and PS-loaded rh-insulin. CONCLUSIONS Both PS- and PHT-loaded rh-insulin dry powders were able to deliver rh-insulin systemically with appropriate pharmacokinetic, pharmacodynamic and safety profiles.
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Affiliation(s)
- Jiake He
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China.,Department of Pharmacy, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ge Zhang
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Qiuyang Zhang
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jiayin Chen
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yongjie Zhang
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xiaoxia An
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Pan Wang
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Shan Xie
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Fang Fang
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jianheng Zheng
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yue Tang
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jiabi Zhu
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yang Yu
- Department of Pharmacy, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xijing Chen
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yang Lu
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
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