Journal of diabetes science and technology
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J Diabetes Sci Technol · Mar 2009
Temporal and geographic patterns of hypoglycemia among hospitalized patients with diabetes mellitus.
Hypoglycemia is often cited as a barrier to achieving inpatient glycemic targets. We sought to characterize hypoglycemic events in our institution by work-shift cycle and by specific treatment area. ⋯ There are temporal and geographic patterns in the occurrence of hypoglycemia among patients with diabetes or hyperglycemia in our hospital. Further study should focus on the reasons underlying these variations so that specific interventions can address the risk of hypoglycemia during peak times and places.
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J Diabetes Sci Technol · Nov 2008
Blood glucose measurements in arterial blood of intensive care unit patients submitted to tight glycemic control: agreement between bedside tests.
Implementing tight glycemic control (TGC) in intensive care unit (ICU) patients requires accurate blood glucose (BG) monitoring. We evaluated the performance of two commercially available bedside glucometers, Accu-Chek and HemoCue, in patients admitted to the ICU and in whom TGC was applied. ⋯ When TGC is implemented in ICU practice, caution is warranted when adjusting insulin rates based only on BG readings obtained by the tested glucometers. ICU practitioners should weigh the advantages and disadvantages of such devices: a greater bias but with a more predictable error and measurement behavior versus a somewhat lower bias but with an unpredictable direction of the difference.
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J Diabetes Sci Technol · Sep 2008
An electronic protocol for translation of research results to clinical practice: a preliminary report.
We evaluated the feasibility of using an electronic protocol developed for research use (Research-eProtocol-insulin) for blood glucose management in usual intensive care unit clinical practice. ⋯ Our electronic blood glucose protocol enabled translation of a research decision-support tool (Research-eProtocol-insulin) to usual clinical practice (Clinical-eProtocol-insulin).
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J Diabetes Sci Technol · Sep 2008
Analysis, modeling, and simulation of the accuracy of continuous glucose sensors.
Continuous glucose monitors (CGMs) collect a detailed time series of consecutive observations of the underlying process of glucose fluctuations. To some extent, however, the high temporal resolution of the data is accompanied by increased probability of error in any single data point. Due to both physiological and technical reasons, the structure of these errors is complex and their analysis is not straightforward. In this article, we describe some of the methods needed to obtain a description of the sensor error that is detailed enough for simulation. ⋯ CGM accuracy was modeled via diffusion and additive ARMA noise, which allowed for designing a computer simulator of sensor errors. The simulator, a component of a larger simulation platform approved by the Food and Drug Administration in January 2008 for pre-clinical testing of closed-loop strategies, has been successfully applied to in silico testing of closed-loop control algorithms, resulting in an investigational device exemption for closed-loop trials at the University of Virginia.