Journal of diabetes science and technology
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J Diabetes Sci Technol · Sep 2012
Glycemic levels in critically ill patients: are normoglycemia and low variability associated with improved outcomes?
Critically ill patients often experience high levels of insulin resistance and stress-induced hyperglycemia, which may negatively impact outcomes. In 2001, Van den Berghe and coauthors used intensive insulin therapy (IIT) to control blood glucose (BG) to normal levels and reported a reduction in intensive care unit (ICU) mortality from 8% to 4.6%. Many studies tried to replicate these results, with some showing reduced mortality, others failing to match these results, and many seeing no clinically significant difference. The interpretation of results is important when drawing conclusions about the benefits and risks of IIT. There is the potential for negative results to be falsely negative due to unintended patient crossover or cohort overlap. ⋯ Results show that OL are higher for patients with cTIB ≥ 0.3-0.7 than patients with cTIB < 0.3-0.7, irrespective of how cTIB was achieved. A cTIB threshold of 0.5 was found to be a minimum acceptable threshold based on outcome. If cTIB is used in similar BG studies in the future, cTIB ≥ 0.7 may be a good target for glycemic control to ensure outcomes and to separate patients with good BG control from patients with poor control.
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J Diabetes Sci Technol · Sep 2012
ReviewMobile health applications to assist patients with diabetes: lessons learned and design implications.
Self-management is critical to achieving diabetes treatment goals. Mobile phones and Bluetooth® can supportself-management and lifestyle changes for chronic diseases such as diabetes. A mobile health (mHealth) research platform--the Few Touch Application (FTA)--is a tool designed to support the self-management of diabetes. ⋯ From each of the 10 apps of FTA, respectively, we conclude: (1) automatic BG data transfer is easy to use and provides reassurance; (2) SMS-based education facilitates parent-child communication in T1DM; (3) the T2DM mobile phone diary encourages reflection; (4) the mobile phone diary enhances discussion between patients and HC professionals; (5) the T1DM mobile phone diary is useful and motivational; (6) the T1DM mobile phone picture diary is useful in identifying treatment obstacles; (7) the step counter with automatic data transfer promotes motivation and increases physical activity in T2DM; (8) food information on a phone for T2DM should not be at a detailed level; (9) context sensitivity has good prospects and is possible to implement on today's phones; and (10) BG modeling on mobile phones is promising for motivated T1DM users. We expect that the following elements will be important in future FTA designs: (A) automatic data transfer when possible; (B) motivational and visual user interfaces; (C) apps with considerable health benefits in relation to the effort required; (D) dynamic usage, e.g., both personal and together with HC personnel, long-/short-term perspective; and (E) inclusion of context sensitivity in apps. We conclude that mHealth apps will empower patients to take a more active role in managing their own health.
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J Diabetes Sci Technol · Sep 2012
Comparative StudyComparison of insulin pump therapy (continuous subcutaneous insulin infusion) to alternative methods for perioperative glycemic management in patients with planned postoperative admissions.
Patients with diabetes who use insulin pumps [continuous subcutaneous insulin infusion (CSII)] undergo surgeries that require postoperative hospital admission. There are no defined guidelines for CSII perioperative use. ⋯ In this limited sample, preliminary findings are consistent with similar intraoperative glycemic control between CSII continuation and CSII conversion to intravenous insulin infusions. Continuous subcutaneous insulin infusion suspension had a greater rate of hyperglycemia. Preoperative differences between insulin delivery groups complicate interpretations of findings.
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J Diabetes Sci Technol · Sep 2012
Outcomes of community-dwelling adults without diabetes mellitus who require ambulance services for hypoglycemia.
We evaluate the prevalence, etiology, and outcomes of hypoglycemia requiring emergency medical services (EMS) in patients without diabetes mellitus (non-DM). ⋯ There were multiple etiologies for hypoglycemic episodes in community-dwelling non-DM that required EMS. Critical illness, multifactorial causes, and alcohol/polysubstance abuse were common causes. Hospitalization and mortality were higher with critical illnesses.
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J Diabetes Sci Technol · Sep 2012
Insulin pump therapy in the perioperative period: a review of care after implementation of institutional guidelines.
An institutional policy was previously established for patients with diabetes on insulin pump therapy undergoing elective surgical procedures. ⋯ Although some processes still require improvement, preliminary data suggest that the policy for perioperative management of insulin pumps has provided useful structure for care of these cases. The data thus far indicate that insulin pump therapy can be continued safely during the perioperative period.