Glycemic Control in Adult Surgical Patients Receiving Regular Insulin Added to Parenteral Nutrition vs Insulin Glargine: A Retrospective Chart Review

2019 ◽  
Vol 34 (5) ◽  
pp. 775-782 ◽  
Author(s):  
Stephanie Truong ◽  
Annie Park ◽  
Salem Kamalay ◽  
Nancy Hung ◽  
Jesse G. Meyer ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Parenteral Nutrition ◽  
Insulin Glargine ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Regular Insulin ◽  
Surgical Patients

scholarly journals Switching from biosimilar (Basalin) to originator (Lantus) insulin glargine is effective in Chinese patients with diabetes mellitus: a retrospective chart review

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 477 ◽  
Author(s):  
Xia Hu ◽  
Lei Zhang ◽  
Yanhu Dong ◽  
Chao Dong ◽  
Jikang Jiang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Insulin Glargine ◽  
Hospital Discharge ◽  
Chart Review ◽  
Insulin Dose ◽  
Retrospective Chart Review ◽  
Chinese Patients ◽  
Time Points ◽  
Patients With Diabetes

Background: This study investigated the effectiveness and safety of switching from Basalin® to Lantus® in Chinese patients with diabetes mellitus (DM). Methods:  A retrospective chart review conducted using the electronic medical records of patients hospitalized at the Qingdao Endocrine and Diabetes Hospital from 2005 to 2016. All patients were diagnosed with DM and underwent switching of insulin from Basalin to Lantus during hospitalization. Data collected included fasting (FBG), pre- and post-prandial whole blood glucose, insulin dose, reasons for insulin switching and hypoglycemia. Four study time points were defined as: hospital admission, Basalin initiation, insulin switching (date of final dose of Basalin), and hospital discharge. Blood glucose measurements were imputed as the values recorded closest to the dates of these four time points for each patient. Results: Data from 73 patients (70 patients with type 2 diabetes, 2 with type 1, and 1 undisclosed) were analyzed. At admission, mean glycated hemoglobin (HbA1c) and FBG were 8.9% (SD=1.75) and 9.98 (3.22) mmol/L, respectively. Between Basalin initiation and insulin switch, mean FBG decreased from 9.68 mmol/L to 8.03 mmol/L (p<0.0001), over a mean 10.8 (SD=6.85) days of Basalin treatment, and reduced further to 7.30 mmol/L at discharge (p=0.0116) following a mean 6.6 (7.36) days of Lantus. The final doses of Basalin and Lantus were similar (0.23 vs. 0.24 IU/kg/day; p=0.2409). Furthermore, reductions in pre- and post-prandial blood glucose were also observed between Basalin initiation, insulin switch and hospital discharge. The incidence of confirmed hypoglycemia was low during Basalin (2 [2.4%]) and Lantus (1 [1.2%]) treatment, with no cases of severe hypoglycemia. Conclusion: In this study population, switching from Basalin to Lantus was associated with further reductions in blood glucose, although the dose of insulin glargine did not increase. Further studies are required to verify these findings and determine the reason for this phenomenon.

Assessment of Glycemic Control at St. Luke’s Free Medical Clinic: A Prospective-Retrospective Chart Review (Preprint)

2021 ◽  
Author(s):  
Wade Hopper ◽  
Justin Fox ◽  
JuliSu Dimucci-Ward
Keyword(s):  
Glycemic Control ◽  
Chart Review ◽  
Hemoglobin A1c ◽  
Care Delivery ◽  
Retrospective Chart Review ◽  
National Standards ◽  
Rank Test ◽  
Medical Clinic ◽  
Free Clinic ◽  
Uninsured Patients

BACKGROUND The free clinic is a health care delivery model that provides primary care and pharmaceutical services exclusively to uninsured patients. Using a multidisciplinary volunteer clinical staff which includes physicians, social workers, dieticians, and osteopathic medical students, St. Luke’s Free Medical Clinic (SLFMC) cares for over 1,700 patients annually in Spartanburg, SC. OBJECTIVE This study aims to measure the change, over time, in patient A1c measurements at SLFMC in order to quantify the success of the clinic’s diabetes treatment program. METHODS A prospective-retrospective chart review of patients enrolled at St. Luke’s between January 1, 2018, and January 1, 2021 (n=140) was performed. Patients were stratified as having controlled (<7.0 A1c, n=53) or uncontrolled (≥7.0 A1c, n=87) diabetes relative to a therapeutic A1c target of 7.0 recommended by the American Diabetic Association. For both controlled and uncontrolled groups, baseline A1c values were compared to subsequent readings using a Wilcoxon matched-pairs signed rank test. Results from the SLFMC population were compared to published A1c literature from other free clinics. RESULTS Patients with uncontrolled diabetes experienced significant reductions in median A1c at both 6 months (p=.006) and 1 year (p=.002) from baseline. Patients with controlled diabetes showed no significant changes. SLFMC’s wholly uninsured patient population showed a population rate of controlled diabetes (42%) that came close to recent national averages for adults with diabetes (51% to 56%) as published by the National Health and Nutrition Examination Survey (NHANES). The clinic’s Hispanic population (n=47) showed the greatest average improvement in A1c from baseline of any ethnic group. Additionally, 61% of SLFMC’s Black population (n=33) achieved an A1c under 7.0 by the end of the study window, which surpassed national averages for glycemic control. CONCLUSIONS We present free clinic hemoglobin A1c outcomes obtained through chart review. Uninsured patients treated for diabetes at SLFMC show a reduction in hemoglobin A1c that is comparable to national standards although average A1c levels were higher than national averages. Black and Hispanic populations that are more highly represented in the uninsured pool performed well under SLFMC management. These results represent some of the first in the literature to come from a free clinic that is not affiliated with a major medical school.

scholarly journals Assessment of an Unplanned Admission to the Intensive Care Unit as a Global Safety Indicator in Surgical Patients

2008 ◽  
Vol 36 (2) ◽  
pp. 190-200 ◽  
Author(s):  
G. Haller ◽  
P. S. Myles ◽  
M. Langley ◽  
J. Stoelwinder ◽  
J. Mcneil
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Chart Review ◽  
Surgical Care ◽  
Retrospective Chart Review ◽  
Surgical Patients ◽  
Anaesthetic Care ◽  
Iatrogenic Complications ◽  
Peer Reviewers ◽  
Global Indicator

An unplanned intensive care unit admission within 24 hours of a procedure with an anaesthetist in attendance (UIA) is a recommended clinical indicator. It is designed to identify preventable iatrogenic complications. Often understood as a specific anaesthetic outcome, its value has been repeatedly questioned. Iatrogenic complications however, often result from successive mishaps. In the specific context of an UIA these complications can be related both to anaesthesia and surgery. UIA is therefore probably more a global indicator of the safety of surgical care (anaesthetic and surgical) rather than a specific anaesthetic outcome. Its utility as such is however unknown. The purpose of this study was to assess the value of UIA as a global measure of avoidable iatrogenic complications in surgical patients. Using computerised patient records and medical charts, all patients with an UIA over a study period of five years were identified. The proportion, cause and preventability of iatrogenic complications amongst these patients were assessed. A total of 188 UIA patients were identified by peer reviewers. Of these, 87% to 92% had a complication caused by anaesthesia and/or surgery. Anaesthesia was found to be responsible for 24% to 31% of iatrogenic complications. All other cases related to the combination of anaesthesia and surgery or surgery alone. Of these, 74% to 92% of complications were found to be preventable. Despite intrinsic limitations of the retrospective chart review method, UIA can be considered as a valuable tool to detect avoidable iatrogenic complications related to both surgical and anaesthetic care.

scholarly journals Hyperglycemia Requiring Insulin Among Pediatric Patients Diagnosed With Hemophagocytic Lymphohistiocytosis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A451-A452
Author(s):  
Cintya Schweisberger ◽  
Nila Palaniappan ◽  
Nicole Wood ◽  
Lauren Amos ◽  
Kelsee Halpin
Keyword(s):  
Parenteral Nutrition ◽  
Insulin Therapy ◽  
T Cell Activation ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Cell Activation ◽  
Retrospective Chart Review ◽  
Regular Insulin ◽  
Severe Illness ◽  
Subcutaneous Insulin ◽  
Laboratory Findings

Abstract Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening disorder marked by massive cytokine release due to macrophage and T-cell activation. Hallmarks of the diagnosis include fever, splenomegaly, cytopenias, hypertriglyceridemia, hypofibrinogemia, and elevations in ferritin and soluble IL-2 receptor. Given HLH is associated with critical illness, elevation in inflammatory markers, and treated with glucocorticoids, the development of hyperglycemia during its course is not unexpected. However, detailed descriptions of the severity of hyperglycemia and strategies in insulin management among HLH patients are lacking. We describe 10 years’ experience at a single tertiary pediatric health center with HLH patients who developed insulin dependent hyperglycemia. Objectives: To describe the demographics, clinical and laboratory findings, treatment regimens, and outcomes for children with HLH treated with insulin due to hyperglycemia. Study Design: Retrospective chart review from 2010 through 2019 of youth 0 to 21 years of age who required insulin therapy during or shortly after a hospitalization where they were diagnosed with HLH using established criteria. Descriptive statistics were used to characterize the population of interest. Results: Of 30 patients diagnosed with HLH, 33% (n=10) required insulin therapy. Half (n=5) were female and half (n=5) male. The mean age was 8.4 years (7.8 months - 17 years). The majority (80%) were non-Hispanic white. Mean BMI at admission was 53rd percentile (5th - 87th percentile). Max serum glucose ranged from 267 to 725 mg/dL (mean 421 mg/dL). Marked inflammation was present (max CRP 2.6 - 44.9 mg/dL, max ferritin 1,091 - 90,219 ng/mL). All were treated with dexamethasone, doses ranging from 5 to 11 mg/m2/day and duration from 2 to 70 days. Most (90%) received parenteral nutrition (PN) with a mean max GIR of 8 mg/kg/min (SD=2.7). Intravenous infusions of regular insulin were used in 80% of patients, though 2 patients were later transitioned to long and short acting subcutaneous insulin. Mean duration of IV insulin therapy was 9.5 days (2–24 days); however, 2 patients died while on IV insulin therapy. The majority (70%) needed insulin within 5 days of starting steroids. Two patients (20%) were treated with subcutaneous insulin only (no IV). Only 1 patient was discharged home on insulin therapy. Mean hospital stay was 60 days (10–202 days). Mortality was 50% (n=5). Conclusions: One-third of pediatric HLH patients required insulin during their hospitalization for severe hyperglycemia likely secondary to multiple factors including glucocorticoid use, parenteral nutrition, inflammation, and severe illness. Insulin is typically started within 5 days of initiating steroid therapy, limited to IV infusions, and often is not needed by the time of discharge. Risk of mortality is very high.

scholarly journals Improving Glycemic Control of Diabetic Patients in an Outpatient Practice

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A333-A333
Author(s):  
Otto T Gibbs ◽  
Gene C Otuonye ◽  
Ahmed H Sammour ◽  
Marnie Aguasvivasbello ◽  
Karlene D Williams
Keyword(s):  
Glycemic Control ◽  
Low Income ◽  
Chart Review ◽  
Tracking System ◽  
Quality Care ◽  
Retrospective Chart Review ◽  
Economic Cost ◽  
Diabetic Patients ◽  
Documentation System ◽  
Electronic Prescription

Abstract Diabetes Mellitus (DM) is a devastating condition with premature mortality, poor quality of life, & vast economic cost contributing to substantial societal burden. More resources are allocated to DM than any other condition, & with an estimated worldwide prevalence of 350 million people by 2025, it remains an urgent epidemic. Providing standardized, high quality care (HQC) to improve DM control is a matter of utmost importance. Our residents receive primary care training in a federal funded healthcare system, with yearly reports from Medicare addressing compliance with current accepted standards, including but not limited to DM management. In this Quality Improvement (QI) project, we sought to directly address deficiencies in their management. A retrospective chart review was conducted over 1 year. Patients with uncontrolled (UC) DM were identified & a root cause analysis conducted. It was noted that over 40% of diabetics were UC, with a hemoglobin A1c (HbA1c) &gt;8%; 60% of whom did not have appropriate escalation of management (AEOM) in further encounters. A QI intervention was developed aiming to improve AEOM in patients. Plan-Do-Study-Act cycles focused on the creation of a standardized documentation system (SDS) for UC DM encounters, a tracking system & a designated “DM manager”, who ensured electronic prescription delivery & early follow-up (F/U) appointments. Clear metrics of AEOM were established & clinicians underwent small group educational sessions emphasizing each intervention, with review of updated ADA guidelines. Although prospective biweekly chart review is ongoing, Fisher’s exact test was used for statistical analysis of initial post interventional data. A total of 33 UC DM patient encounters were analyzed thus far. In January 2020, 31% of all encounters used the newly created SDS; of which 69% had AEOM. In February 2020, 57% of all encounters used the SDS; 71% of providers had AEOM. Of the encounters using the SDS, 83% had AEOM compared to 67% in those without (p:0.42). Average F/U time per patient was 6 weeks. Delivering standardized & HQC in DM patients presents a challenge dependent on a variety of system & patient factors. This becomes more apparent in rural & low-income populations as in our clinic. Although HbA1c is a well-established method of monitoring glycemic control, we propose that other uniform performance measures be used to dynamically assess overall DM management. Our metrics include standardized, replicable documentation, early F/U time & defined AEOM parameters such as timely addition of new medication, dose adjustments, & utilization of resources such as DM educators. Thus far, there appears to be a non-statistically significant trend towards improved standardization of provider documentation, F/U visits & AEOM. Further data is needed. We hope to see these measures translate into overall improved glycemic control.

scholarly journals Successful Tracheal Extubation within Eleven Minutes in the Post Anesthesia Care Unit in Children after Adenotonsillectomy

2020 ◽  
Author(s):  
Deepak Gupta ◽  
Matthew Ryan Tukel ◽  
Divya Mukhija ◽  
Edward Kaminski ◽  
Maria Markakis Zestos
Keyword(s):  
Standard Deviation ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Tracheal Extubation ◽  
Surgical Patients ◽  
Anesthesia Care ◽  
Post Anesthesia Care Unit ◽  
Anesthesia Providers

Background: Some pediatric centers prefer to extubate their patients in the operating rooms (ORs) while others prefer post-anesthesia care units (PACUs) for the same. Objectives: To share our retrospective experience of 214 pediatric adenotonsillectomy (T&A) patients cohort extubated in our pediatric PACU during a seven-month retrospective study-period. Materials and Methods: After institutional board approval for retrospective chart review, institutional electronic surgical database was used to identify patients who underwent T&A and the peri-anesthetic records were obtained from patients electronic medical records and/or from hospital paper records. Results: Patients tracheas were extubated in average 11 minutes (standard deviation 8 minutes) after arrival to PACU care and only one patient required tracheal re-intubation. Patients were ready for discharge from PACU in average 56 minutes (standard deviation 20 minutes) thus averaging only 44 minutes (standard deviation 20 minutes) after their tracheas had been extubated. Conclusion: Summarily for re-validating or refuting our results, institutions can prospectively create PACU extubation quality improvement projects to discern if tracheal extubation in PACU of all or some pediatric surgical patients is beneficial when their rapid turnover surgeries warrant anesthesia providers to not attempt their tracheal extubation in ORs.

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