Journal of diabetes science and technology
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J Diabetes Sci Technol · Jan 2013
Clinical TrialTechnical challenges and clinical outcomes of using a closed-loop glycemic control system in the hospital.
According to large randomized trials, results suggest that maintaining normoglycemia postoperatively through tight glycemic control (TGC) and intensive insulin therapy (IIT) can improve surgical outcomes as well as reduce mortality and morbidity in critically ill patients. However, trials examining the effects of TGC have had conflicting results. Systematic reviews and meta-analyses have also led to differing conclusions. ⋯ The STG closed-loop glycemic control system was introduced to our department to be used and evaluated for strict serum glucose control with no hypoglycemic episodes during IIT in the surgical ICU, to reduce the workload of ICU nurses, and to decrease incidents related to the management of blood glucose levels according to manual conventional venous infusion insulin therapy. The goal of our team was to use the STG closed-loop glycemic control system for perioperative TGC in surgical patients to solve the complications of IIT and reduce risk of hypoglycemia. The challenge at our hospital demonstrated that the STG closed-loop glycemic control system can be expected to achieve TGC with no occurrence of hypoglycemia induced by IIT after surgery.
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J Diabetes Sci Technol · Jan 2013
Randomized Controlled TrialStepwise self-titration of oral glucose-lowering medication using a mobile telephone-based telehealth platform in type 2 diabetes: a feasibility trial in primary care.
Telehealth-supported clinical interventions may improve diabetes self-management. We explored the feasibility of stepwise self-titration of oral glucose-lowering medication guided by a mobile telephone-based telehealth platform for improving glycemic control in type 2 diabetes. ⋯ Self-titration of oral glucose-lowering medication in type 2 diabetes with self-monitoring and remote monitoring of glycemia is feasible, and further studies using adapted recruitment strategies are required to evaluate whether it improves clinical outcomes.
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J Diabetes Sci Technol · Nov 2012
In-vitro performance of the Enlite Sensor in various glucose concentrations during hypobaric and hyperbaric conditions.
There is a need for reliable methods of glucose measurement in different environmental conditions. The objective of this in vitro study was to evaluate the performance of the Enlite® Sensor when connected to either the iPro™ Continuous Glucose Monitor recording device or the Guardian® REAL-Time transmitting device, in hypobaric and hyperbaric conditions. ⋯ The Enlite Sensors connected to either the iPro or the Guardian REAL-Time device provided values continuously. In hyperbaric conditions, no significant differences were seen during changes in ambient pressure; however, during hypobaric conditions, the ISIG was significantly different in the low and high glucose concentrations.
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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.