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Hyperglycemia

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Vitamin D and Stress Hyperglycaemia in the Critically Ill

Vitamin D deficiency is common in critically ill patients with stress-induced hyperglycemia. Can supplementation improve outcomes?  
medscape.com
about 4 years ago
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Australian paediatric guidelines already acknowledge hypoglycaemia as an indicator of good diabetes care

Rodriguez-Gutierrez and colleagues emphasise that diabetes guidelines in the UK and US, except for those from the US Department of Veterans Affairs, focus on hyperglycaemia as a quality measure at the expense of hypoglycaemia and re-iterate the adverse effects of hypoglycaemia on health.1  
feeds.bmj.com
over 4 years ago
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Selecting the right drug treatment for adults with type 2 diabetes

Clinicians prescribe one or more antihyperglycaemic drugs to prevent and treat symptomatic hyperglycaemia and to lower haemoglobin A1c levels in people with type 2 diabetes. The available agents differ in their efficacy and safety and in how they burden patients in terms of dosing, side effects, and cost. Comparative estimates across these outcomes are generally lacking, limiting the ability of patients and clinicians to make informed decisions.  
feeds.bmj.com
over 4 years ago
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Diabetes treatments and risk of amputation, blindness, severe kidney failure, hyperglycaemia, and hypoglycaemia: open cohort study in primary care

Objective To assess the risks of amputation, blindness, severe kidney failure, hyperglycaemia, and hypoglycaemia in patients with type 2 diabetes associated with prescribed diabetes drugs, particularly newer agents including gliptins or glitazones (thiazolidinediones).  
feeds.bmj.com
over 4 years ago
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1

Selecting the right drug treatment for adults with type 2 diabetes

Clinicians prescribe one or more antihyperglycaemic drugs to prevent and treat symptomatic hyperglycaemia and to lower haemoglobin A1c levels in people with type 2 diabetes. The available agents differ in their efficacy and safety and in how they burden patients in terms of dosing, side effects, and cost. Comparative estimates across these outcomes are generally lacking, limiting the ability of patients and clinicians to make informed decisions.  
feeds.bmj.com
over 4 years ago
Preview
0
1

Diabetes treatments and risk of amputation, blindness, severe kidney failure, hyperglycaemia, and hypoglycaemia: open cohort study in primary care

Objective To assess the risks of amputation, blindness, severe kidney failure, hyperglycaemia, and hypoglycaemia in patients with type 2 diabetes associated with prescribed diabetes drugs, particularly newer agents including gliptins or glitazones (thiazolidinediones).  
feeds.bmj.com
over 4 years ago
Preview
0
1

Selecting the right drug treatment for adults with type 2 diabetes

Clinicians prescribe one or more antihyperglycaemic drugs to prevent and treat symptomatic hyperglycaemia and to lower haemoglobin A1c levels in people with type 2 diabetes. The available agents differ in their efficacy and safety and in how they burden patients in terms of dosing, side effects, and cost. Comparative estimates across these outcomes are generally lacking, limiting the ability of patients and clinicians to make informed decisions.  
feeds.bmj.com
over 4 years ago
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Post-Cardiac-Surgery Hyperglycemia: Not One Size Fits All

This hypothesis-generating study suggests that "insulin-treated diabetic patients may benefit from a glucose-control approach that is more lenient than that applied to nondiabetic patients," say researchers.  
medscape.com
over 4 years ago
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Acute Hyperglycemia Affects Remote Ischemic Perconditioning

Gain a better understanding of how acute hyperglycemia impacts the cardioprotective effects of remote ischemic preconditioning.  
medscape.com
over 4 years ago
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Diabetes a Big Risk Factor for Surgical Site Infections

Patients with diabetes have over a 50% increased risk of surgical site infection and this remained the case even after controlling for hyperglycemia. The highest risk was seen for cardiac surgery.  
medscape.com
over 4 years ago
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Critical Care

Patients admitted to the intensive care unit often develop hyperglycaemia, but the underlying mechanisms have not been fully described. The incretin effect is reduced in patients with type 2 diabetes. Type 2 diabetes and critical illness have phenotypical similarities, such as hyperglycaemia, insulin resistance and systemic inflammation. Previous studies have shown beneficial effects of exogenous glucagon-like peptide (GLP)-1 on glycaemia in critically ill patients, a phenomenon also seen in patients with type 2 diabetes. In this study, we hypothesised that the incretin effect, which is mediated by the incretin hormones GLP-1 and glucose-dependent insulinotropic peptide (GIP), is impaired in critically ill patients.  
ccforum.com
over 4 years ago
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Pharmacist-Led Teams Improve Postsurgical Glycemic Control

Inpatient pharmacy-led team was associated with postsurgical improvements in glycemic control and healthcare utilization among patients with diabetes or hyperglycemia at 2 years.  
medscape.com
over 4 years ago
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Hyperglycaemia in acute coronary syndromes: management | Guidance and guidelines | NICE

This guideline will shortly be checked to see if it needs updating, please register as a stakeholder to be informed about the decision.  
nice.org.uk
over 4 years ago
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Hyperglycemia and Catheter-Associated Bloodstream Infections

Should blood glucose be controlled before placing central lines in criticall ill children?  
medscape.com
over 4 years ago
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Rachel Clark and colleagues reply to Eleanor Barry and colleagues

Eleanor Barry and colleagues’ editorial relays their concerns about the NHS Diabetes Prevention Programme (DPP).1 Key concerns are dealt with here. The NHS DPP will offer people already identified as being at high risk of developing type 2 diabetes an opportunity to lower their risk through provision of an evidence based behavioural intervention. By failing to implement such a programme, people with known non-diabetic hyperglycaemia are deprived of consistent and evidence based support that would empower them to reduce their risk of type 2 diabetes, questioning our commitment to the public’s health and wellbeing.  
feeds.bmj.com
over 4 years ago
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Critical Care

Elevated blood glucose levels during intensive care unit (ICU) stay, so-called stress hyperglycaemia (SH), is a common finding. Its relation with a future diabetes risk is unclear. Our objective was to determine the incidence of disturbed glucose metabolism (DGM) post ICU admission and to identify predictors for future diabetes risk with a focus on stress hyperglycaemia.  
ccforum.com
almost 5 years ago
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Grand Rounds Recap 9/16

Air Care Grand Rounds What do I need to assess before I load this patient in the heli? *  Does your patient need plastic? (ETT, needle/finger thoracostomy) o Get breath sounds / anticipate your possible interventions you may need * Is your patient in shock? o Don't have a lactate? Hyperglycemia in the absence of…  
prehospitalmed.com
almost 5 years ago
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Postprandial Hyperglycemia Interferes With Work Productivity

A Novo Nordisk survey finds that postprandial hyperglycemia is common among working adults, and often interferes with their ability to carry out their job responsibilities.  
medscape.com
almost 5 years ago
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Time to question the NHS diabetes prevention programme

A new Public Health England report on the rising prevalence of type 2 diabetes proposes targeting people with non-diabetic hyperglycaemia (defined as an HbA1c concentration of 42-47 mmol/mol) with behavioural interventions (diet and exercise). 1 Action for this group (10.7% of the adult population) is to be the cornerstone of the NHS Diabetes Prevention Programme, which will be rolled out nationally from 2016.2  
feeds.bmj.com
almost 5 years ago
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Critical Care

A substantial number of patients admitted to the ICU because of an acute illness, complicated surgery, severe trauma, or burn injury will develop a de novo form of muscle weakness during the ICU stay that is referred to as “intensive care unit acquired weakness” (ICUAW). This ICUAW evoked by critical illness can be due to axonal neuropathy, primary myopathy, or both. Underlying pathophysiological mechanisms comprise microvascular, electrical, metabolic, and bioenergetic alterations, interacting in a complex way and culminating in loss of muscle strength and/or muscle atrophy. ICUAW is typically symmetrical and affects predominantly proximal limb muscles and respiratory muscles, whereas facial and ocular muscles are often spared. The main risk factors for ICUAW include high severity of illness upon admission, sepsis, multiple organ failure, prolonged immobilization, and hyperglycemia, and also older patients have a higher risk. The role of corticosteroids and neuromuscular blocking agents remains unclear. ICUAW is diagnosed in awake and cooperative patients by bedside manual testing of muscle strength and the severity is scored by the Medical Research Council sum score. In cases of atypical clinical presentation or evolution, additional electrophysiological testing may be required for differential diagnosis. The cornerstones of prevention are aggressive treatment of sepsis, early mobilization, preventing hyperglycemia with insulin, and avoiding the use parenteral nutrition during the first week of critical illness. Weak patients clearly have worse acute outcomes and consume more healthcare resources. Recovery usually occurs within weeks or months, although it may be incomplete with weakness persisting up to 2 years after ICU discharge. Prognosis appears compromised when the cause of ICUAW involves critical illness polyneuropathy, whereas isolated critical illness myopathy may have a better prognosis. In addition, ICUAW has shown to contribute to the risk of 1-year mortality. Future research should focus on new preventive and/or therapeutic strategies for this detrimental complication of critical illness and on clarifying how ICUAW contributes to poor longer-term prognosis.  
ccforum.com
almost 5 years ago