Evaluating Perioperative Glycemic Control of Non-cardiac Surgical Patients with Diabetes

2020 ◽  
Author(s):  
L Alan Todd ◽  
Robert A Vigersky
Keyword(s):  
Diabetes Mellitus ◽  
Cardiac Surgery ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Perioperative Period ◽  
Poor Glycemic Control ◽  
Surgical Patients ◽  
Patients With Diabetes

ABSTRACT Introduction Hyperglycemia during the perioperative period has generally been accepted as a contributor of poor outcomes in patients with diabetes mellitus undergoing surgery. Although an optimal glycemic range has not been clearly established in the literature, a consensus among national medical organizations generally recommends serum glucose levels to be maintained less than 180 mg/dL during the perioperative period. Materials and Methods The primary purpose of this evidence-based project was to identify the range of blood glucose values obtained from adult patients with diabetes mellitus undergoing non-cardiac surgery at a large military medical facility. The secondary purpose of this project was to assess the need for change in future practice. A retrospective review of the electronic medical record was conducted to identify adult surgical patients with diabetes scheduled for non-cardiac surgery. Preoperative and postoperative blood glucose values were obtained from the electronic medical record. The frequency of blood glucose values maintained within the recommended range of 140-180 mg/dL was recorded. Additional demographic data were collected to include age, height, weight, body mass index, length of surgery, and insulin/oral glycemic medications. Results Of the 9,449 surgeries performed between January 1, 2013, and December 31, 2013, there were 762 (8%) adult non-cardiac surgical patients identified with either a diagnosis of diabetes or a blood glucose value reported during the perioperative period. The recommended blood glucose range of 140-180 mg/dL was achieved in 31.3% (179 of 572) of patients before surgery and 28.6% (71 of 248) after surgery. A blood glucose value was not recorded before or after surgery in 24.9% (190 of 762) of patients identified as having pre-diabetes or diabetes. Conclusion Diabetes is a frequent finding in surgical patients. Monitoring blood glucose values during the perioperative period may allow for early treatment and prevent complications related to poor glycemic control. The results of this project revealed 2 potential areas of improvement in the care of non-cardiac surgical patients with diabetes: (1) improving compliance with obtaining blood glucose values before and after surgery and (2) reducing the incidence of postoperative hyperglycemia (>180 mg/dL) which potentially could prevent avoidable complications related to poor glycemic control.

scholarly journals Perioperative anesthetic management of patients with diabetes mellitus: focused on blood glucose control

2020 ◽  
Vol 63 (9) ◽  
pp. 526-531
Author(s):  
Hyungseok Seo
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Postoperative Complications ◽  
Surgical Stress ◽  
Anesthetic Management ◽  
Blood Glucose Control ◽  
Perioperative Period ◽  
Physiological Status ◽  
Diabetic Patients ◽  
Patients With Diabetes

Diabetes mellitus is the most common metabolic disease characterized by elevated blood glucose, which results in damage to the heart, blood vessels, eyes, kidney, and nervous system. The incidence of diabetes mellitus has increased in Korea due to longer life expectancy or lifestyle improvement. Since diabetes affects multiple organs including the cardiovascular, neuroendocrine, and autonomic nervous systems, the risk of postoperative complications such as wound infection and cardiovascular events might be increased in patients with diabetes. In addition to postoperative complications, hypoglycemia or hyperglycemia in diabetes may also cause serious problems during surgery. Preoperative fasting and surgical stress may contribute to the derangement of the patient’s physiological status. For appropriate management of diabetic patients in the perioperative period, patients should be evaluated in detail preoperatively and their blood glucose levels should be checked repeatedly during the surgery and even after surgery. The present paper reviews preoperative, intraoperative, and postoperative management of patients with diabetes.

scholarly journals Correction of stress hyperglycemia in surgical patients with metabolic syndrome

2020 ◽  
pp. 26-30
Author(s):  
I.G. Kryvorchuk ◽  
◽  
I.M. Leshchishin ◽  
◽  
◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Metabolic Syndrome ◽  
Intensive Care ◽  
Postoperative Period ◽  
Perioperative Period ◽  
Surgical Patients ◽  
Infusion Therapy ◽  
Control Group ◽  
Stress Hyperglycemia ◽  
Patients With Diabetes

Taking into account that stress and diabetic hyperglycemia is an independent risk factor for increased mortality in surgical patients with metabolic syndrome, an increase in the time spent by patients in intensive care units and the cost of treatment, it is important to carry out treatment, in particular, infusion therapy with the appointment of drugs that do not increase glucose levels and help to reduce the need for insulin in patients with diabetes mellitus in the postoperative period. Aim is to assess the effectiveness of the drug Xylat as an integral component of intensive care for patients with metabolic syndrome in perioperative period. Materials and methods. The study was conducted in 21 women with metabolic syndrome who underwent urgent surgical intervention for tumors in pelvic area. All patients received Xylat (Yuria-Pharm) – 5-6 ml/kg/day, 50-70 drops/min for 3 days in the postoperative period. The control group consisted of 15 women with metabolic syndrome, who underwent surgical treatment in the regional clinical hospital for ovarian tumors, but received alternative infusion therapy during the postoperative period (according to archived case histories). Results. The data of our study showed that the drug Xylatum (Yuria-Pharm) helps to reduce the risk of the severity of stress hyperglycemia, suppresses the risk of lactacidemia, provides energy support for postoperative patients with diabetes mellitus with an insulin+independent metabolism, and stimulates the production of endogenous insulin in critically ill patients. Conclusions. With the use of Xylate, the tolerance to carbohydrates increases. It has a very low glycemic index, antiketogenic properties, does not adversely affect the central nervous system, the exchange of hormones and neurotransmitters. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: surgical patients, diabetes mellitus, hyperglycemia, infusion therapy, metabolic syndrome, Xylatum.

scholarly journals Dates fruits effects on blood glucose among patients with diabetes mellitus: A review and meta-analysis

2021 ◽  
Vol 37 (4) ◽  
Author(s):  
Hyder Osman Mirghani
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Plasma Glucose ◽  
Meta Analysis ◽  
Postprandial Plasma Glucose ◽  
Creative Commons ◽  
Patients With Diabetes ◽  
Glycemic Indices ◽  
Open Access Article

Background & Objective: Dates fruit is known for its great nutritional value and two to three servings of dates fruit/day are beneficial for patients with diabetes. However, some may advice against this cheap and widely available fruit consumption. Besides, 12% of the population Worldwide are either suffering or are at risk of developing diabetes, but no previous meta-analysis has assessed this important issue. Thus, the study aimed to investigate the effects of date’s fruit on glycemia among patients with diabetes. Methods: A systematic literature search was conducted in PubMed, Medline, EBSCO, Cochrane, and Google Scholar databases for trials published in English from the first published article up to December 2020. The following keywords were used: “dates fruit and glycemic control”, “dates fruit and blood glucose”, “dates fruit and HbA1c” without limitations regarding the date of publication. Results: Out of the 942 references identified, only 10 cohorts from five full texts were included, a reduction of Fasting plasma glucose (FPG), odd ratio, -24.79, 95% CI=-34.75, -14.83 P =0.002. I2 for heterogeneity=79%, P <0.00001 and postprandial plasma glucose (PPPG), odd ratio -28.19, 95% CI=-60.66-4.29, P =<0.0001. I2 for heterogeneity=92%, P=0.09) was observed. While the effect on HbA1c was neutral, odd ratio, -.20, 95% CI=-.46 -.06, P=0.13. I2 for heterogeneity=0. %, P=0.55. Conclusion: Dates fruit was beneficial regarding glycemic control among patients with diabetes, physician may not need to restrict its use among patients with diabetes. The small number of the included studies and the heterogeneity observed in PPPG and FPG sub-analysis limited the current results. Further trials assessing the glycemic indices of various types of dates fruit are needed. doi: https://doi.org/10.12669/pjms.37.4.4112 How to cite this:Mirghani HO. Dates fruits effects on blood glucose among patients with diabetes mellitus: A review and meta-analysis. Pak J Med Sci. 2021;37(4):---------. doi: https://doi.org/10.12669/pjms.37.4.4112 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Hyperglycemic memory in diabetic cardiomyopathy

2021 ◽  
Author(s):  
Jiabing Zhan ◽  
Chen Chen ◽  
Dao Wen Wang ◽  
Huaping Li
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Blood Glucose ◽  
Cardiovascular Diseases ◽  
Glycemic Control ◽  
Diabetic Cardiomyopathy ◽  
Cardiovascular Complication ◽  
Diabetes Therapy ◽  
Patients With Diabetes ◽  
Underlying Mechanisms

AbstractCardiovascular diseases account for approximately 80% of deaths among individuals with diabetes mellitus, with diabetic cardiomyopathy as the major diabetic cardiovascular complication. Hyperglycemia is a symptom that abnormally activates multiple downstream pathways and contributes to cardiac hypertrophy, fibrosis, apoptosis, and other pathophysiological changes. Although glycemic control has long been at the center of diabetes therapy, multicenter randomized clinical studies have revealed that intensive glycemic control fails to reduce heart failure-associated hospitalization and mortality in patients with diabetes. This finding indicates that hyperglycemic stress persists in the cardiovascular system of patients with diabetes even if blood glucose level is tightly controlled to the normal level. This process is now referred to as hyperglycemic memory (HGM) phenomenon. We briefly reviewed herein the current advances that have been achieved in research on the underlying mechanisms of HGM in diabetic cardiomyopathy.

scholarly journals Relevance of self-control of blood glucose in the aspect of prevention of cardiovascular complications in patients with diabetes mellitus

2021 ◽  
pp. 104-109
Author(s):  
D. I. Trukhan
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Blood Glucose ◽  
Cardiovascular Diseases ◽  
Glycemic Control ◽  
Complications Of Diabetes ◽  
Glucose Levels ◽  
Risk Of Death ◽  
Increased Risk ◽  
Patients With Diabetes

There is a clear link between diabetes and cardiovascular disease. It is known that cardiovascular diseases in patients with diabetes mellitus occur 2–5 times more often than in people without diabetes. It is cardiovascular outcomes that are the main cause of death in patients with diabetes mellitus in both men and women. Diabetes mellitus has a high risk of coronary heart disease, myocardial infarction, arterial hypertension and acute cerebrovascular accident, and patients with diabetes mellitus may experience painless acute myocardial infarction associated with the presence of autonomic cardiac neuropathy. Various rhythm disturbances are much more common in diabetes mellitus, including paroxysmal forms of atrial fibrillation, which increase the risk of death by 1.8–2 times. The leading factor in the development of vascular complications of diabetes mellitus is hyperglycemia. In addition, early glycemic disorders - impaired glucose tolerance or impaired fasting glycemia - make a significant contribution to the increased risk of macrovascular complications. Improving glycemic control leads to a significant reduction in the risk of late macro- and microvascular complications of diabetes mellitus. Glycated hemoglobin is the gold standard for monitoring glycemic control, but it does not provide complete information on daily and intraday changes in glucose levels. Regular self-monitoring of glucose levels is important in the prevention of cardiovascular diseases in patients with diabetes mellitus. In addition, during the COVID-19 pandemic, all consensus documents and recommendations for the management of patients with diabetes indicate the need for regular monitoring of glucose levels. An important aspect of the technical impact on patients’ adherence to selfcontrol and diabetes therapy is the presence of a convenient communicative connection between the patient and the doctor, in particular, the possibility of contact remotely via a computer and a mobile phone. In conclusion, the possibilities of the new model of the line of blood glucose meters are considered.

scholarly journals Hemichorea Associated With Nonketotic Hyperglycemia: Rare Presentation of Uncontrolled Diabetes Mellitus

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A384-A385
Author(s):  
Rujuta Baban Katkar
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Basal Ganglia ◽  
Glycemic Control ◽  
Blood Sugar ◽  
Glucose Control ◽  
Blood Glucose Control ◽  
Poor Glycemic Control ◽  
Thyroid Function Tests ◽  
Function Tests

Abstract Introduction: Hemichorea is usually associated with a contralateral lesion in the central nervous system and can result from infection, genetic mutation, neoplasms, neurodegeneration, stroke, metabolic disease, drug-exposure, and autoimmune disease. Nonketotic hyperglycemic (NKH) hemichorea is mainly seen in elderly patients, especially females from East Asian origin with poor blood glucose control. The general treatment measures include improving control of blood glucose and the use of neuroleptic drugs. We report a unique case of hemichorea secondary to nonketotic hyperglycemia with negative imaging changes. Case Presentation: A 72-year-old woman with history of COPD, CKD stage III, CAD, diabetes type II for more than 30 years with poor glycemic control presented with sudden onset of uncontrolled involuntary dance like movements of left upper and lower extremities and left side of the face. These activities occurred while awake and disappeared during sleep. Neurological examination found that patient has a clear verbal ability, sanity, present involuntary dance-like movements of limbs, facial, jaw, and tongue. She had normal muscle strength and mild hypotonia. Other physical examination found no abnormalities. A CAT scan of the head showed high density in basal ganglia region and brain MRI(T1-weighted) showed and hyperintensity in the right basal ganglia. Laboratory tests showed that random blood sugar was 572 mg/dL, urine sugar (4+), and negative urine ketone, Hba1c was 14%. The patient’s subsequent thyroid function tests, autoantibodies, liver and kidney function tests, anti-neutrophilic cytoplasmic antibodies, ceruloplasmin, vitamins D and B12, and folic acid found to be normal. She was diagnosed with hemichorea associated with NKH. The treatments included improving blood glucose with IV insulin and symptomatic treatment of chorea with risperidone 2mg and clonazepam 1mg every night. On sixth day of admission patient’s involuntary movements improved. Blood sugar level normalized after a week. After 10 days, her dance-like symptoms disappeared completely. She tapered off risperidone and clonazepam within 3 months and continued to control blood sugar with premixed insulin after discharge. Conclusion: In conclusion, although uncommon, chorea/ballism associated with nonketotic hyperglycemia can be the first presenting sign of unknown diabetes mellitus or can occur after weeks or even months of poor glycemic control in diabetic patients. Timely neuro imaging examination and active blood glucose control can avoid misdiagnosis and delay in treatment.

scholarly journals Relation Between Tiroid Status with Glycemic Control of Type 2 DM Patients at RSPAD Gatot Soebroto

2020 ◽  
Author(s):  
Kartika Yulianti ◽  
◽  
Aris Wibudi ◽  
Mila Citrawati ◽  
◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Thyroid Dysfunction ◽  
Fasting Blood Glucose ◽  
Thyroid Stimulating Hormone ◽  
Poor Glycemic Control ◽  
Cross Sectional ◽  
Type 2 Dm

ABSTRACT Background: Diabetes Mellitus (DM) is a group of symptoms that arise due to increased blood sugar levels. Diabetes Mellitus type 2 has a higher risk of developing thyroid dysfunction. Thyroid dysfunction can affect various body metabolism and result in insulin resistance, significantly affecting glycemic control in DM patients. This study aimed to determine the relation between thyroid status as assessed by the level of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and glycemic control (HbA1c). Subjects and Method: A cross-sectional study. A sample of 38 DM patients was selected by purposive sampling. The dependent variable was glycemic control. The independent variables were TSH and FT4. Patients were classified into 4 quartiles (Q) based on their TSH and FT4 levels. Statistic test used was non parametric for category group of variables, which was Chi square test. Results: Mean of fasting blood glucose was 200,56 mg/dL (modus 137 mg/dL), mean of 2 hours post prandial blood glucose was 247 mg/dL (modus 305 mg/dL). Subjetcs with poor glycemic control dominated as much as 76%. Most subjects had TSH level at Q4 (36%), while most of the subjects had FT4 level at Q1 (34%). The results showed that 38 samples with poor glycemic control were 72% in the 4th quartile (Q4) (> 3.1750 mU / L) TSH, and 64.7% were in Q1 (≤ 11.8400) FT4. The analysis showed that there was a significant relation between TSH (p = 0.047) and FT4 (p = 0.041) with glycemic control in type 2 DM patients. Conclusion: FT4 and TSH levels relate to glycemic control in type 2 DM patients Keywords: TSH, FT4, HbA1c, Diabetes Mellitus Correspondence: Mila Citrawati. Department of Faal, Faculty of Medicine, UPN Veteran, Jakarta. Jl. RS Fatmawati, Pondok Labu, South Jakarta 12450, Telp. (021) 7656971. E-mail: [email protected]. Mobile: 081282990515 DOI: https://doi.org/10.26911/the7thicph.05.12

scholarly journals Diabetes Mellitus with Poor Glycemic Control as a Consequence of Inappropriate Injection Technique

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Ramesh Sharma Poudel ◽  
Shakti Shrestha ◽  
Sushma Bhandari ◽  
Rano Mal Piryani ◽  
Shital Adhikari
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Blood Sugar ◽  
Basal Insulin ◽  
Blood Sugar Level ◽  
Insulin Injection ◽  
Poor Glycemic Control ◽  
Injection Technique ◽  
Premix Insulin ◽  
Patients With Diabetes

Majority of patients with diabetes mellitus (DM), who are on insulin therapy, use insulin pen for convenience, accuracy, and comfort. Some patients may require two different types of insulin preparations for better glycemic control. We have reported a case of poor glycemic control as a consequence of inappropriate insulin injection technique. A 57-year-old man with type 2 DM had been using premix insulin 30 : 70 for his glycemic control for the last 12 years. On follow-up visit, his blood sugar level (BSL) had increased; therefore the treating physician increased the dose of premix insulin and added basal insulin with the aim of controlling his blood sugar level. Despite these changes, his BSL was significantly higher than his previous level. On investigation, the cause of his poor glycemic control was found to be due to inadequate delivery of insulin (primarily premix) as a consequence of lack of priming and incompatibility of single insulin pen for two cartridges. His basal insulin was discontinued and the patient along with his grandson was instructed to administer insulin correctly. After correction of the errors, the patient had a better glycemic control.

scholarly journals Magnitude and predictors of poor glycemic control among patients with diabetes attending public hospitals of Western Ethiopia

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247634
Author(s):  
Adugna Oluma ◽  
Muktar Abadiga ◽  
Getu Mosisa ◽  
Werku Etafa
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Diabetes Complications ◽  
Poor Glycemic Control ◽  
Diabetic Patients ◽  
Duration Of Diabetes ◽  
Blood Glucose Test ◽  
Patients With Diabetes ◽  
Glucose Test ◽  
Western Ethiopia

Background Diabetes is one of the most prevalent non-communicable diseases globally, which rapidly is increasing in developing countries. Ethiopia is also facing growing morbidity and mortality related to diabetes complications. Thus, dealing with glycemic control is essential for controlling the development of devastating acute and chronic complications related to diabetes. Therefore, this study aims to assess the magnitude and predictors of poor glycemic control among diabetic patients in western Ethiopia. Methods The cross-sectional study design was employed on a sample of 423 diabetic patients. A systematic random sampling method was employed. An interviewer-administered structured questionnaire was used. The data entered into Epi data version 3.1 and exported into Statistical Package for the Social Sciences window version 24 for analysis. All variables significant at p-<0.25 in bivariate were entered into multivariate analysis. The multivariable logistic regressions were used to determine predictors’ poor glycemic control by considering the Adjusted Odds Ratio at CI 95% and the significance level was set at p <0.05. Results The magnitude of poor glycemic control was 64.1%. Being females (AOR = 1.684,95%CI = 1.066,2.662), duration of diabetes >8years (AOR = 2.552,95%CI = 1.397, 4.665), presence of diabetes complication (AOR = 2.806,95%CI = 1.594,4.941), negligence of blood glucose test at home (AOR = 1.720, 95%CI = 1.078, 2.743), poor self-care behavior (AOR = 1.787, 95%CI = 1.083,2.959) and poor self-efficacy (AOR = 1.934, 95%CI = 1.078,3.469) were significant predictors of poor glycemic control. Conclusion The proportion of poor glycemic control was high which was nearly comparable to that reported from many countries. This could be due to factors that were significantly associated with poor glycemic control like lack of home blood glucose test, increased duration of diabetes, presence of diabetes complications, poor self-efficacy, and poor self-care behaviors. Each were significant independent predictors of poor glycemic control. Thus, we recommend patients with diabetes and health care providers enhancing self-monitoring practices, and preventing potential complications should be a priority concern to improve blood glucose levels. Further studies are also recommended to explore important factors which were not identified by the current study.

Self-monitoring of blood glucose and perceived obstacles in Turkish patients with diabetes mellitus

2014 ◽  
Author(s):  
Ozlem Turhan Iyidir ◽  
Mustafa Unubol ◽  
Bulent Ogun Hatipoglu ◽  
Ceyla Konca Degertekin
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Self Monitoring ◽  
Patients With Diabetes ◽  
Turkish Patients
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