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glycemia management in critical care patients

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World Journal of Diabetes 2012年第7期3卷 130-134页

作者： Federico Bilotta Giovanni Rosa Department of Anesthesiology Critical Care and Pain Medicine Section of Neuroanesthesia and Neurocritical Care "Sapienza" University of Rome00199 Rome Italy Clinical Anesthesiology Albert Einstein College of MedicineNew York NY 10461 United States

Over the last decade, the approach to clinical management of blood glucose concentration (BGC) in critical care patients has dramatically changed. In this editorial, the risks related to hypo, hyperglycemia and high BGC variability, optimal BGC target range and BGC monitoring devices for patients in the intensive care unit (ICU) will be discussed. Hypoglycemia has an increased risk of death, even after the occurrence of a single episode of mild hypoglycemia (BGC glycemia (with a threshold value of 180 mg/dL) is associated with an increased risk of death, longer length of stay and higher infective morbidity in ICU patients. In ICU patients, insulin infusion aimed at maintaining BGC within a 140-180 mg/dL target range (NICE-SUGAR protocol) is considered to be the state-of-the-art. Recent evidence suggests that a lower BGC target range (129-145 mg/dL) is safe and associated with lower mortality. In trauma patients without traumatic brain injury, tight BGC (target glycemia and improve insulin titration. In conclusion, in ICU patients, safe and effective glycemia management is based on accurate glycemia monitoring and achievement of the optimal BGC target range by using insulin titration, along with an adequate nutritional protocol.

关键词： glycemia management Intensive insulin therapy Hyperglycemia Hypoglycemia Metabolism Intensive care

Association between Neck Circumference and glycemia in Adolescents

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Journal of Diabetes Mellitus 2018年第3期8卷 61-69页

作者： Cláudia Rucco Penteado Detregiachi Karina Quesada Sandra Maria Barbalho Deisiane de Cassia Mulato Mirela Moris Tassiana Minardi Vitoria Esborini Nogueira Fernanda Fioravanti Bernardo Department of Biochemistry and Nutrition University of Marília (UNIMAR) S&atildeo Paulo Brazil Department of Biochemistry and Nutrition Faculty of Food Technology of Marília (FATEC) S&atildeo Paulo Brazil

Background: The determination of glycemia is an essential element for the diagnosis of diabetes or possible glycemic alterations. The body composition and fat distribution are related to this parameter. The neck circumference (NC) is an anthropometric measure that has been used to evaluate the overweight and accumulation of subcutaneous fat in the upper body, regardless of age. It is also a useful tool to predict insulin resistance and other risk factors. This research aimed to study the relationship between the NC and glycemia in adolescents and, thus, to analyze the applicability of this anthropometric measure in the screening of glycemic alterations in this group. Methods: The study population consisted of 600 adolescents aged 10 to 19 years. Data on sex, birth date, NC, fasting blood glucose and stage of sexual maturation was collected. Results: The evolution of sexual maturation generated a significant difference in the NC in both sexes, but not affected glycemia. Thus, the association between NC and glycemia was investigated according to this parameter. Among the pre-pubertal adolescents, the NC was significantly higher among those who had glycemia within borderline values, and the opposite occurred among pubertal adolescents. Among post-pubertal adolescents, NC was similar between the two groups. A negative correlation was found in all adolescents, as well as among those who were in the pubertal and post-pubertal stages of sexual maturation. Differently, adolescents in the pre-pubertal stage showed a positive correlation between the NC and the biochemical parameters. Conclusion: This study showed that the relationship between the NC and glycemia varies according to the stage of sexual maturation. As this maturation factor is rarely considered in the glycemic alteration screening, the use of the NC in this age group is not safe and requires further investigations.

关键词： Adolescents glycemia Neck Circumference Sexual Maturation Puberty

Implication of neurohormonal-coupled mechanisms of gastric emptying and pancreatic secretory function in diabetic gastroparesis

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World Journal of Gastroenterology 2018年第34期24卷 3821-3833页

作者： Bashair M Mussa Sanjay Sood Anthony JM Verberne Department of Basic Medical Science College of Medicine University of Sharjah Department of Medicine Austin HealthUniversity of Melbourne

Recently, diabetic gastroparesis(DGP) has received much attention as its prevalence is increasing in a dramatic fashion and management of patients with DGP represents a challenge in the clinical practice due to the limited therapeutic options. DGP highlights an interrelationship between the gastric emptying and pancreatic secretory function that regulate a wide range of digestive and metabolic functions, respectively. It well documented that both gastric emptying and pancreatic secretion are under delicate control by multiple neurohormonal mechanisms including extrinsic parasympathetic pathways and gastrointestinal(GI) hormones. Interestingly, the latter released in response to various determinants that related to the rate and quality of gastric emptying. Others and we have provided strong evidence that the central autonomic nuclei send a dual output(excitatory and inhibitory) to the stomach and the pancreas in response to a variety of hormonal signals from the abdominal viscera. Most of these hormones released upon gastric emptying to provide feedback, and control this process and simultaneously regulate pancreatic secretion and postprandial glycemia. These findings emphasize an important link between gastric emptying and pancreatic secretion and its role in maintaining homeostatic processes within the GI tract. The present review deals with the neurohormonal-coupled mechanisms of gastric emptying and pancreatic secretory function that implicated in DGP and this provides new insights in our understanding of the pathophysiology of DGP. This also enhances the process of identifying potential therapeutic targets to treat DGP and limit the complications of current management practices.

关键词： Gastroparesis Gastric emptying Pancreatic secretion Postprandial glycemia Neurohormonal control

Prevalence of hypertension and diabetes in the population of Kosovo

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Frontiers of Nursing 2021年第3期8卷 261-267页

作者： Idriz Sopjani Shpend Elezi Nursing Faculty College AABPristineKosovo 10000Albania Medical Faculty University of PrishtinaPristineKosovo 10000Albania

Objectives:To observe the prevalence of arterial pressure and glycemia in Kosovo and to provide free screening service through health promotion.Methods:This prospective study was conducted over a 3-year period,during 2017–2019.All data were collected by AAB College staff in 11 Kosovo cities prior to a random sample with 7254 observations.Data included demographic information as well as blood pressure and glycemic level measurements.Results:The overall prevalence of arterial pressure was registered at 27.6%and diabetes mellitus at 9.2%.Arterial pressure in females had a tendency to increase with age(r=0.3552,Pglycemia had strong correlation with systolic ar terial pressure value(Pglycemia,the diastolic value increased by 0.19 mm Hg on average.Conclusions:This study concluded that at younger ages the values of ar terial pressure and glycemia remain within the commonly observed range,but over the years the probability for higher blood pressure or glicemia increases.Through continuous control of ar terial pressure and glycemia at an early age,it is possible to identify abnormal diagnostics,in order to address them in time.Educational nitiatives and screenings should take place in order to increase awareness of the citizens for checking themselves regularly.

关键词： arterial pressure glycemia nursing care promotion screening

Effectiveness of cognitive behavior therapy for sleep disturbance and glycemic control in persons with type 2 diabetes mellitus:A community-based randomized controlled trial in China

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World Journal of Diabetes 2021年第3期12卷 292-305页

作者： Huai-Zhong Zhang Pan Zhang Gui-Qiu Chang Quan-Yong Xiang Huan Cao Jin-Yi Zhou Zong-Mei Dong Cheng Qiao Chun-Rong Xu Yu Qin Pei-An Lou Department of Psychiatry Xuzhou Third People’s HospitalXuzhou 221000Jiangsu ProvinceChina Department of Control and Prevention of Chronic Non-communicable Diseases Xuzhou Center for Disease Control and PreventionXuzhou 221006Jiangsu ProvinceChina Department of Control and Prevention of Chronic Noncommunicable Diseases Jiangsu Provincial Center for Disease Control and PreventionNanjing 210009Jiangsu ProvinceChina Department of Epidemiology and Health Statistics Xuzhou Medical UniversityXuzhou 221006Jiangsu ProvinceChina

BACKGROUND Poor sleep quality is a common clinical feature in patients with type 2 diabetes mellitus(T2DM),and often negatively related with glycemic control.Cognitive behavioral therapy(CBT)may improve sleep quality and reduce blood sugar levels in patients with T2DM.However,it is not entirely clear whether CBT delivered by general practitioners is effective for poor sleep quality in T2DM patients in community settings.AIM To test the effect of CBT delivered by general practitioners in improving sleep quality and reducing glycemic levels in patients with T2DM in community.METHODS A cluster randomized controlled trial was conducted from September 2018 to October 2019 in communities of China.Overall 1033 persons with T2DM and poor sleep quality received CBT plus usual care or usual care.Glycosylated hemoglobin A1c(HbAlc)and sleep quality[Pittsburgh Sleep Quality Index(PSQI)]were assessed.Repeated measures analysis of variance and generalized linear mixed effects models were used to estimate the intervention effects on hemoglobin A1c and sleep quality.RESULTS The CBT group had 0.64,0.50,and 0.9 lower PSQI scores than the control group at 2 mo,6 mo,and 12 mo,respectively.The CBT group showed 0.17 and 0.43 lower HbAlc values than the control group at 6 mo and 12 mo.The intervention on meanΔHbAlc values was significant at 12 mo(t=3.68,P<0.01)and that meanΔPSQI scores were closely related toΔHbAlc values(t=7.02,P<0.01).Intentionto-treat analysis for primary and secondary outcomes showed identical results with completed samples.No adverse events were reported.CONCLUSION CBT delivered by general practitioners,as an effective and practical method,could reduce glycemic levels and improve sleep quality for patients with T2DM in community.

关键词： Cognitive behavior therapy glycemia Sleep quality Type 2 diabetes mellitus Intervention Community-based randomized controlled trial

Short acting insulin analogues in intensive care unit patients

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World Journal of Diabetes 2014年第3期5卷 230-234页

作者： Federico Bilotta Carolina Guerra Rafael Badenes Simona Lolli Giovanni Rosa Department of Anesthesiology and Intensive Care Section of Neurosurgery "Sapienza" University of Rome

Blood glucose control in intensive care unit(ICU) patients, addressed to actively maintain blood glucose concentration within defined thresholds, is based on two major therapeutic interventions: to supply an adequate calories load and, when necessary, to continuously infuse insulin titrated to patients needs: intensive insulin therapy(IIT). Short acting insulin analogues(SAIA) have been synthesized to improve the chronic treatment of patients with diabetes but, because of the pharmacokinetic characteristics that include shorter onset and off-set, they can be effectively used also in ICU patients and have the potential to be associated with a more limited risk of inducing episodes of iatrogenic hypoglycemia. Medical therapies carry an intrinsic risk for collateral effects; this can be more harmful in patients with unstable clinical conditions like ICU patients. To minimize these risks, the use of short acting drugs in ICU patients have gained a progressively larger room in ICU and now pharmaceutical companies and researchers design drugs dedicated to this subset of medical practice. In this article we report the rationale of using short acting drugs in ICU patients(i.e., sedation and treatment of arterial hypertension) and we also describe SAIA and their therapeutic use in ICU with the potential to minimize iatrogenic hypoglycemia relatedto IIT. The pharmacodynamic and pharmachokinetic characteristics of SAIA will be also discussed.

关键词： Insulin analogues Short acting drugs Intensive insulin therapy glycemia management Intensive care

Prevalence and Risk of Anemia in Type-2 Diabetic Patients

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Health 2014年第12期6卷 1415-1419页

作者： Ayesha Sharif Shahnila Younus Kanwal Baig Nafisa Hassan Ali Dow Institute of Medical Technology Clinical Laboratory Sciences Department Dow University of Health Sci-ences Karachi Pakistan

Aim: To determine the prevalence and risk of anemia in type-2 diabetes mellitus. In addition, the incidence and risk of anemia in these patients were assessed according to gender and glycemic control status. Methods: The study group comprised 200 patients with type-2 diabetes. Patients were divided into groups according to glycemic control and gender. Glycated hemoglobin (HbA1c), blood glucose level, hemoglobin concentration, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) of subjects were evaluated. The presence of anemia was defined by a hemoglobin level 6.5%, fasting blood glucose >126 mg/dl and random blood glucose >200 mg/dl. Result: 63% of diabetic patients had anemia. There was higher incidence and risk of anemia in females (36%) as compared to males (27%) (p 7.5% (49.5%) compared to those with controlled diabetes HbA1C < 7.5% (13.5%) (p < 0.05). Conclusion: This study indicated that poor glycemic control and gender difference are associated with the incidence of anemia in type II diabetes. Our findings suggest the need of screening for anemia in diabetes out-patient clinics. Routine hematological tests along with blood glucose level should be mandatory in order to make therapeutic decisions for the treatment of anemia in type II diabetes mellitus.

关键词： Anemia Erythropoietin Gender glycemia Insulin Type-2 Diabetes Mellitus

Glycated Haemoglobin Determination in the Biological Follow-Up of Diabetic Subjects Admitted to the Endocrinology Department of the CNHU-HKM of Cotonou

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Journal of Diabetes Mellitus 2023年第1期13卷 36-44页

作者： Annelie Kerekou Hode Hubert Dedjan Nesme Aboudou Department of Endocrinology Metabolism and Nutrition CNHU-HKM Cotonou Benin

Introduction: One of the biological markers for monitoring glycaemic control in diabetic patients is glycated protein. The definition of a reference method to improve the accuracy of measurement tools is necessary. The aim of our study was to assess the glycemic control of diabetic patients based on glycated hemoglobin. Patients and Method: This is a descriptive cross-sectional study conducted in April 2021 at the national university hospital center (CNHU-HKM) of Cotonou. All patients who consulted during the period and who gave their consent were included. After collecting the blood samples according to the classical standards of the pre-analytical phase, we measured the blood glucose level and the HbA1c. Results: The mean blood glucose level of the patients was 1.52 ± 0.16 g/L with extremes of 0.80 g/L and 3.5 g/L. The mean HbA1c proportion was 8.39% ± 0.60% with a minimum and maximum value of 5.40% and 16% respectively. We also noted that the mean body mass index (BMI) of the patients was 28.61 ± 1.46 Kg/m2 with extremes of 17.50 Kg/m2 and 46.02 Kg/m2. Oral anti diabetic and hygienic-dietary measures were used by 44 patients (80%) and hygienic-dietary measures (HDM) only used by 9.09%. A frequency of 87.53% of patients had at least one degenerative complication. Retinopathy was the most observed degenerative disease (36.36%) followed by cardiovascular disease (25.45%). Conclusion: This study showed that there is a poor correlation between fasting blood glucose and glycated haemoglobin levels, which could be due to several biological and clinical reasons. It also showed that despite the respect of hygienic dietary measures and a well conducted treatment, it is difficult to obtain a satisfactory glycemic balance in obese patients.

关键词： glycemia Glycated Haemoglobin Diabetes Benin

Association of Vitamin D Levels with the Metabolic Profile and Sexual Maturation Stage of Adolescents

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Journal of Diabetes Mellitus 2018年第4期8卷 114-124页

作者： Jesselina Francisco Dos Santos Haber Karina Quesada Renata Nunes Lopes Daniela Oliveira Silva Juliana Medeiros Silva Sabrina Antonelli Cardoso Thiago Fernando Luz Cláudia Rucco Penteado Detregiachi Sandra Maria Barbalho Department of Nutrition and Biochemistry School of Medicine University of Marília (UNIMAR) S&atilde o Paulo Brazil Departme of Biochemistry and Nutrition Faculty of Food Technology of Marília (FATEC) S&atilde o Paulo Brazil

The deficiency of Vitamin D (VD) is widely prevalent worldwide in adults, but many studies show that this deficiency also affects adolescents and may be considered a global public health problem. The VD levels are particularly significant in adolescents since it influences several aspects of growth, development, and puberty. During this phase of life, both girls and boys develop reproductive aspects, and secondary sexual characteristics and the adequate nutritional status appear to be the prerequisite for normal pubertal development. Due to the importance of VD in adolescents, the objective of this study was to investigate the association of the levels of this vitamin with glycemic, lipid, and anthropometric profile and sexual maturation stages of adolescents. Anthropometric (weight and height) and biochemical (fasting glycemia, total cholesterol, HDL-c, LDL-c, and triglycerides) data and VD levels were collected in 67 adolescents. 66% of the adolescents showed VD sufficiency, 28% insufficiency, and 6% showed the deficiency. There was a significant difference in VD levels between the stages of sexual maturation for boys and girls. Overweight patients had lower serum VD levels. The correlation analysis indicated a positive correlation between VD and fasting glycemia and HDL-c, but with no significant difference. A negative correlation was observed between VD and cholesterol, LDL-c and triglycerides, but also with no significant difference. Once VD is crucial for bone health, and as it seems it is necessary to the homeostasis of glycemia, lipids, and body weight, we suggest that more studies should be conducted to confirm the precise role of this vitamin in the promotion and maintenance of health in this population.

关键词： Adolescents Vitamin D glycemia Lipids Obesity