Target Blood Glucose Research Articles

How to Achieve Sufficient Endogenous Insulin Suppression in Euglycemic Clamps Assessing the Pharmacokinetics and Pharmacodynamics of Long-Acting Insulin Preparations Employing Healthy Volunteers.

The therapeutic effect of basal insulin analogs will be sustained at a rather low insulin level. When employing healthy volunteers to assess the pharmacokinetics (PK) and pharmacodynamics (PD) of long-acting insulin preparations by euglycemic clamp techniques, endogenous insulin cannot be ignored and sufficient endogenous insulin inhibition is crucial for the PD and/or PK assessment. This study aimed to explore a way to sufficiently inhibit endogenous insulin secretion. Healthy Chinese male and female volunteers were enrolled. After a subcutaneous injection of insulin glargine (IGlar) (LY2963016 or Lantus) (0.5 IU/kg), they underwent a manual euglycemic clamp for up to 24 h where the target blood glucose (BG) was set as 0.28 mmol/L below the individual’s baseline. Blood samples were collected for analysis of PK/PD and C-peptide. The subjects fell into two groups according to the reduction extent of postdose C-peptide from baseline. After matching for the dosage proportion of Lantus, there were 52 subjects in group A (C-peptide reduction<50%) and 26 in group B (C-peptide reduction≥50%), respectively. No significant difference was detected in age, body mass index, the proportion of Latus treatment and female participants. A lower basal BG was observed in group B compared to group A (4.35 ± 0.26 vs. 4.59 ± 0.22 mmol/L, p < 0.05). The clamp studies were all conducted with high quality (where BG was consistently maintained around the target and exhibited a low variety). The binary logistic regression analysis indicated low basal BG as an independent factor for the success of sufficient endogenous insulin suppression. In conclusion, setting a lower sub-baseline target BG (e.g., 10% instead of 5% below baseline) might be an approach to help achieve sufficient endogenous insulin suppression in euglycemic clamps with higher basal BG levels (e.g., beyond 4.60 mmol/L).

Blood glucose targets in the critically ill: is one size fits all still appropriate?

In 2001, the paradigm for blood glucose control in hospitalised patients was challenged by a single-centre, randomised controlled trial (RCT). 1 van den Berghe G Wouters P Weekers F et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001; 345: 1359-1367 Crossref PubMed Scopus (8134) Google Scholar Conducted in mechanically ventilated surgical intensive care unit (ICU) patients (970 [63%] of 1548 following cardiovascular surgery and 1344 [87%] without a previous diagnosis of diabetes), this trial used intravenous insulin to target euglycaemia (blood glucose 80–110 mg/dL [4·4–6·1 mmol/L]) and dramatic reductions in mortality and morbidity were seen compared with patients in the control arm, in which intravenous insulin was administered only if blood glucose exceeded 215 mg/dL (11·9 mmol/L), with a target range of 180–200 mg/dL (10·0–11·1 mmol/L).

Update on glucose control during and after critical illness.

There is a complex bidirectional relationship between critical illness and disordered glucose metabolism. This review aims to provide a comprehensive summary of the recent evidence focused on the relationship between critical illness and disordered glucose metabolism through the distinct phases of prior to, during, and after an acute illness that requires admission to the intensive care unit (ICU). Recent data suggest that preexisting glucose metabolism affects the optimal blood glucose target during critical illness, with preliminary data suggesting that glucose targets should be 'personalized' based on preexisting glycemia. Because of the close association between critical illness and disordered glucose metabolism, there is a need to optimize glucose monitoring in the ICU with rapid, precise, and cost-efficient measurements at the bedside. Recent studies have evaluated the use of various methodologies, with a focus on the use of near-continuous glucose monitoring. For those patients with preexisting diabetes who survive ICU, nocturnal hypoglycemia may be an unrecognized and important issue when discharged to the ward. There is increasing evidence that patients with high blood glucose during their acute illness, so called 'stress hyperglycemia', are at increased risk of developing diabetes in the years following recovery from the inciting event. Critically ill patients with COVID-19 appear at greater risk. There have been important recent insights in the approach to glucose monitoring and glucose targets during critical illness, monitoring and administration of glucose-lowering drugs on discharge from the ICU, and longitudinal follow-up of patients with stress hyperglycemia.

Protocol paper: multi-Centre randomised controlled trial evaluating a pre-clinic diabetes assessment and mapped care planning intervention amongst adults with type 1, type 2 or pre-diabetes

BackgroundExisting therapeutic interventions to treat diabetes are well known, yet the majority of people with diabetes do not consistently achieve blood glucose targets (even individual therapy targets) for optimal health, despite the large range of treatment options available. Such outcomes have remained stubbornly poor for decades with <25% adults with diabetes achieving glycaemic targets. Patient behaviour, individually supported in routine clinical care, is an important missing component to improved outcomes, in a medical healthcare model not ideally suited to supporting successful diabetes management.MethodsA multi-centre, parallel group, individually randomised trial comparing consultation duration in adults with type 1, type 2 or pre-diabetes using the Spotlight Consultations pre-clinic assessment compared to usual care in the Spotlight-AQ study. Two hundred adults with type 1, type 2 or pre-diabetes attending routine care outpatient appointments across up to ten participating sites will be invited to participate.InterventionAn outpatient pre-clinic intervention delivered within 1 week prior to scheduled routine outpatient appointment.Primary outcome measureDuration of routine outpatient consultation.Secondary outcome measuresFunctional health statusDiabetes distressDepressionTreatment satisfactionImpact on self-care behavioursHCP burnoutHCP treatment satisfaction and burdenHypoglycaemia (time less than 70mg/dL)Hyperglycaemia (time above 180 mg/dL)Change in weightChange in HbA1cCost effectiveness of interventionDiscussionResults from the study will provide valuable insights into patient-professional communication practices within routine care and recommendations will be made, as necessary, for improvements to that. If the intervention is shown to be clinically and cost-effective, the feedback from participants and healthcare professionals will be used to make any improvements prior to its deployment to support improved communication and associated health outcomes.Ethics and disseminationThe trial was approved by the Wales REC7 Research Ethics Committee (21/WA/0020). Results will be disseminated through national and international conferences, scientific journals, newsletters, magazines and social media. Target audiences include consultants and other clinicians in diabetes, and medical professionals or scientists overall.Trial registrationISRCTN15511689. Registered on 10 November 2021

Efficacy and Safety of Intensive Versus Nonintensive Supplemental Insulin With a Basal-Bolus Insulin Regimen in Hospitalized Patients With Type 2 Diabetes: A Randomized Clinical Study.

Administration of supplemental sliding scale insulin for correction of hyperglycemia in non-intensive care unit (ICU) patients with type 2 diabetes is frequently used with basal-bolus insulin regimens. In this noninferiority randomized controlled trial we tested whether glycemic control is similar with and without aggressive sliding scale insulin treatment before meals and bedtime in patients treated with basal-bolus insulin regimens. Patients with type 2 diabetes with admission blood glucose (BG) 140-400 mg/dL treated with basal-bolus insulin were randomized to intensive (correction for BG >140 mg/dL, n = 108) or to nonintensive (correction for BG >260 mg/dL, n = 107) administration of rapid-acting sliding scale insulin before meals and bedtime. The groups received the same amount of sliding scale insulin for BG >260 mg/dL. Primary outcome was difference in mean daily BG levels between the groups during hospitalization. Mean daily BG in the nonintensive group was noninferior to BG in the intensive group with equivalence margin of 18 mg/dL (intensive 172 ± 38 mg/dL vs. nonintensive 173 ± 43 mg/dL, P = 0.001 for noninferiority). There were no differences in the proportion of target BG readings of 70-180 mg/dL, <70 or <54 mg/dL (hypoglycemia), or >350 mg/dL (severe hyperglycemia) or total, basal, or prandial insulin doses. Significantly fewer subjects received sliding scale insulin in the nonintensive (n = 36 [34%]) compared with the intensive (n = 98 [91%] [P < 0.0001]) group with no differences in sliding scale insulin doses between the groups among those who received sliding scale insulin (intensive 7 ± 4 units/day vs. nonintensive 8 ± 4 units/day, P = 0.34). Among non-ICU patients with type 2 diabetes on optimal basal-bolus insulin regimen with moderate hyperglycemia (BG <260 mg/dL), a less intensive sliding scale insulin treatment did not significantly affect glycemic control.

Intravenous Versus Subcutaneous Insulin in Management of Hyperglycaemia in Intensive Care Unit

Objective: To compare the efficacy and safety of intravenous Insulin infusion versus subcutaneous Insulin in the management of hyperglycaemia in intensive care.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Medical Intensive Care Unit of Combined Military Hospital Malir, from Jul to Sep 2021.&#x0D; Methodology: 68 individuals admitted to the Medical ICU with the blood sugar levels of more than 180 mg/dl were included. Patients on one side of Intensive Care Unit were administered intravenous Insulin infusion, and on the other side were administered subcutaneous Insulin to control blood sugars. Age, gender, previous history of diabetes and use of Insulin and glycosylated haemoglobin were recorded. Efficacy of regimen was judged based on ability to achieve target glucose levels, mean blood glucose levels and total days of ICU stay. Adverse events like hypoglycaemia and hypokalaemia were recorded.&#x0D; Results: Out of 68 individuals, 27 (39.70%) were administered intravenous Insulin infusion, and 41 (60.29%) were administered subcutaneous Insulin. In the intravenous Insulin group, 22 (81.5%) individuals achieved target blood glucose compared to 29 (70.7%) in the subcutaneous Insulin group. The mean blood sugars in the intravenous group were 157.11 ± 25.54 mg/dl, whereas 168.32 ± 30.49 mg/dl in the subcutaneous group (p-value=0.164). The frequency of hypoglycaemia and hypokalaemia was more in the intravenous group than in the subcutaneous group.&#x0D; Conclusion: Optimal blood sugar levels were better achieved with intravenous Insulin than with subcutaneous Insulin. However, the frequency of adverse effects was also more with intravenous Insulin, so better monitoring and management are..............

379-P: Patient and Physician Experience of Hypoglycemia during Basal Insulin (BI) Titration in Type 2 Diabetes (T2D) in the U.S.

Introduction: Hypoglycemia after BI initiation can negatively impact patient adherence to titration and glycemic target achievement. We report on 2 surveys to better understand patient and physician perspectives/experiences of hypoglycemia during BI titration. Methods: Adults with T2D and ≥2 claims (≥30 days apart in last 12 months) in the Optum Research Database who initiated BI (February-April 2021) , and physicians who treated ≥30 patients with T2D, ≥1 initiating BI (October 2020-March 2021) , completed a mailed survey. Results: Responders were 416 patients (51% male, 71% white, mean age 70 years, 72% &amp;gt;years T2D duration) and 386 physicians (45% general practice) . Most physicians reported discussing hypoglycemia signs/symptoms (93%) and how to titrate BI in response to blood glucose (BG) levels (81%) with patients. Among patients who experienced hypoglycemia (49%; Table) , 57% felt very/extremely confident titrating BI during hypoglycemia. Only 35% met fasting BG (FBG) targets. Diabetes Treatment Satisfaction Questionnaire hypoglycemia score (1.34/6) suggests patients felt hypoglycemia was infrequent. Conclusion: While physicians educate patients on hypoglycemia awareness and BI titration, nearly half of patients surveyed experienced hypoglycemia during titration, and only a third met FBG targets, suggesting new strategies and tools are needed for effective BI titration. Disclosure S.B.Harris: Consultant; Abbott, AstraZeneca, Eli Lilly and Company, Novo Nordisk, Sanofi, Other Relationship; Abbott, AstraZeneca, Bayer Inc., Dexcom, Eli Lilly and Company, HLS Therapeutics, Janssen Pharmaceuticals, Inc., Novo Nordisk, Sanofi, Research Support; Applied Therapeutics Inc., AstraZeneca, Canadian Institutes of Health Research, Juvenile Diabetes Research Foundation (JDRF) , Novo Nordisk, Sanofi, The Lawson Foundation. K.Mohammedi: Board Member; Lilly, Novo Nordisk, Sanofi, Research Support; Cyclerion Therapeutics, Inc., Speaker's Bureau; Abbott, AstraZeneca. M.Bertolini: Employee; Sanofi. V.Walker: Consultant; Sanofi-Aventis U.S. M.H.Carlyle: None. F.L.Zhou: Employee; Sanofi, Stock/Shareholder; Sanofi. J.Seufert: Advisory Panel; Abbott, Sanofi-Aventis Deutschland GmbH, Research Support; Boehringer Ingelheim International GmbH, Speaker's Bureau; Abbott Diabetes, AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Lilly, Novo Nordisk, Sanofi-Aventis Deutschland GmbH. J.E.Anderson: Advisory Panel; Abbott Diabetes, Consultant; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Gelesis, Novo Nordisk, Sanofi, Speaker's Bureau; Eli Lilly and Company. Funding Sanofi

72-LB: Blood Glucose Levels in High-Risk Type 2 Diabetes Users of a Digital Therapeutic Platform by Race/Ethnicity

Introduction: Significant racial and ethnic disparities in care have been observed in type 2 diabetes, including impairments in diagnosis, access to care and outcomes. Complex social and cultural factors drive these disparities, some of which might be mitigated through digital approaches. Digital therapeutic platforms assist users in achieving and maintaining target blood glucose levels. This study examines by race/ethnicity the differences in blood glucose levels among users of a digital health platform over a year based on real-world data. Method: A retrospective data study was performed on the Dario™ database. A group of Dario digital therapeutic users with type 2 diabetes started with average blood glucose above 180 mg/dL (“high-risk users”) and reported in the app ethnicity as one of the following: White, Latino, Black or Asian. This population was active during 2019-2021 and took &amp;gt;3 blood glucose measurements in the first and 12th months. A Statistical analysis (ANOVA) was used to evaluate the difference in average blood glucose level over a year. Results: A group of 1000 users was analyzed, 736 (74%) White; 122 (12%) Latino; 103 (10%) Black, and 39 (4%) Asian. The average glucose level significantly reduced in all users and per ethnic group over a year: All users by 14% (230±58 vs. 197±47) (p&amp;lt;0.001) ; respondents identifying as White reduced by 14% (229±58 vs. 197±47) ; Latino by 15% 237±59 vs. 202±48) (p&amp;lt;0.001) ; Black by 15% (230±63 vs. 196±48) (p&amp;lt;0.001) and Asian by 15% (229±55 vs.195±43) (p&amp;lt;0.001) . Finally, no significant differences in average blood glucose reductions between the races/ethnicities in the first month and in 12th month were observed (p=0.384) . Conclusion: Digital therapeutic platforms may promote behavior modification in high-risk patients with type 2 diabetes to create sustainable outcomes. While treatment, as usual, is generally associated with disparate outcomes by race/ethnicity, the present study suggests that digital therapeutics may improve compliance and diabetes management and therefore address some of the disparities seen in diabetes care. Disclosure Y. Hershcovitz: None. T. Gershoni: None. O. Manejwala: Employee; DarioHealth Corp., Stock/Shareholder; DarioHealth Corp.

1171-P: Food Insecurity and Glycemic Goals among Medicare Beneficiaries with Type 2 Diabetes

Food insecurity, a modifiable risk factor, has a significant impact on individuals' health and well-being. This study examined the association between food insecurity and glycemic goals among Medicare beneficiaries aged ≥65 years with type 2 diabetes (T2D) , using the 20Medicare Current Beneficiary Survey (n=1,340) . The binary dependent variable was whether beneficiaries' blood glucose (BG) was at target (i.e., having A1C ≤7.5% or average fasting BG of ≤140 mg/dL, all/most of the time) . Food insecurity, a binary variable, was defined as having ≥2 affirmative responses on 4 selected questions of the USDA's food security questionnaire. A survey-weighted multivariable logistic model, adjusted for socio-demographics and comorbidities, was conducted to estimate predictive margins for comparing prevalence of having higher than target BG levels across groups. Of study beneficiaries with T2D, 20.9% reported not achieving glycemic targets. Beneficiaries not meeting BG goals were more likely to be: female (60.5% vs. 49.1%, p=0.002) , less educated (&amp;lt;high school, 21.9% vs. 13.4%, p=0.013) , and experiencing food insecurity (20.4% vs. 8.9%, p&amp;lt;0.001) . In the adjusted analysis, the predictive marginal prevalence of having higher than target BG levels was significantly greater in females over males (23.8% [95% CI, 20.0-27.5] vs. 16.6% [13.4-19.8]) ; those with less than high school education over those with greater education (30.9% [23.6-38.3] vs. 18.5% [14.7-22.3]) ; and those reporting food insecurity over their counterparts (33.4% [24.5-42.3] vs. 19.1% [16.5-21.6]) . This study identified that females, those with low education levels, and those experiencing food insecurity may be less likely to achieve BG goals, placing them at-risk of developing potentially preventable complications and incurring higher overall healthcare costs. Routine screening and interventions to reduce these disparities should be considered by all healthcare team members caring for Medicare beneficiaries with T2D. Disclosure B.Ng: None. M.P.Stewart: None. J.B.Lamanna: None. C.Park: None.

Evaluation of clinical efficacy of continuous care with improved insulin injection techniques on patients with diabetes mellitus: a randomized controlled trial.

ObjectiveTo investigate the clinical effect of continuous care with improved insulin injection techniques on patients with diabetes mellitus.MethodsThis randomized controlled trial enrolled patients with diabetes mellitus. They were randomly assigned to a control or observation group. Patients in the control group received conventional continuous nursing. Patients in the observation group were given optimized insulin injection education and continuous nursing on the same basis as the conventional nursing used in the control group. Blood glucose-related outcomes, knowledge of insulin injections and adverse events were recorded.ResultsA total of 96 patients with diabetes mellitus were enrolled in the study (n = 48 per group). There were no significant differences between the two groups in terms of sex, age and glycosylated haemoglobin (HbA1c). Compared with the control group, continuous care combined with optimized insulin injection techniques significantly reduced blood glucose target time, fasting blood glucose, 2-h postprandial blood glucose and HbA1c. The proportions of patients reporting a subcutaneous mass, insulin leakage and hypoglycaemic events were significantly lower in the observation group; and pain scores were significantly reduced compared with the control group.ConclusionsContinuous care and optimization of insulin injection techniques can help patients achieve better diabetes-related outcomes.Study Registration Number: ChiCTR2200057166.

Practice of hyperglycaemia control in intensive care units of the Military Hospital, Sudan-Needs of a protocol.

Hyperglycaemia is a major risk factor in critically ill patients leading to adverse outcomes and mortality in diabetic and non-diabetic patients. The target blood glucose remained controversial; this study aimed to contribute in assessing the practice of hyperglycaemia control in intensive care units of the Military Hospital. Furthermore, the study proposed a protocol for hyperglycaemia control based on findings. A hospital-based cross-sectional study assessed the awareness and practice towards hyperglycaemia management in a sample 83 healthcare staff selected through stratified random sampling technique. In addition, 55 patients were enrolled, through quota sampling, after excluding those with diabetic ketoacidosis, hyperosmolar-hyperglycaemic state and patients < 18 years. A self-administrated questionnaire enabled to collect data from health staff and patient data were extracted from the medical records. SPSS-23 was used to analyze the collected data. Chi-square and ANOVA tests assessed the association among variables, these tests were considered statistically significant when p ≤ 0.05. The training on hyperglycaemia control differed (p = 0.017) between doctors and nurses. The target glycaemic level (140-180 mg/dl) was known by 11.1% of the study participants. Neither the knowledge nor the practice of hyperglycaemia control methods differed among staff (p> 0.05). The use of sliding scale was prevalent (79.3%) across the ICUs (p = 0.002). 31.5% of the patients had received different glycaemic control methods, 11.8% were in the targeted blood glucose level. Sliding scale was the method used by doctors and nurses (71.4% and 81.6% respectively). Lack of awareness about hyperglycaemia management methods was prevalent among ICU healthcare staff. Use of obsolete methods was the common practice in the ICUS of the Military Hospital. Target blood glucose for patients were unmet. Development of a local protocol for glycaemic control in all ICUs is needed along with sustained training programs on hyperglycaemia control for ICU healthcare staff.

The Effect of a Liberal Approach to Glucose Control in Critically Ill Patients with Type 2 Diabetes: A Multicenter, Parallel-Group, Open-Label Randomized Clinical Trial.

Rationale: Blood glucose concentrations affect outcomes in critically ill patients, but the optimal target blood glucose range in those with type 2 diabetes is unknown. Objectives: To evaluate the effects of a "liberal" approach to targeted blood glucose range during ICU admission. Methods: This mutlicenter, parallel-group, open-label randomized clinical trial included 419 adult patients with type 2 diabetes expected to be in the ICU on at least three consecutive days. In the intervention group intravenous insulin was commenced at a blood glucose >252 mg/dl and titrated to a target range of 180-252 mg/dl. In the comparator group insulin was commenced at a blood glucose >180 mg/dl and titrated to a target range of 108-180 mg/dl. The primary outcome was incident hypoglycemia (<72 mg/dl). Secondary outcomes included glucose metrics and clinical outcomes. Measurements and Main Results: By Day 28, at least one episode of hypoglycemia occurred in 10 of 210 (5%) patients assigned the intervention and 38 of 209 (18%) patients assigned the comparator (incident rate ratio, 0.21 [95% confidence interval (CI), 0.09 to 0.49]; P < 0.001). Those assigned the intervention had greater blood glucose concentrations (daily mean, minimum, maximum), less glucose variability, and less relative hypoglycemia (P < 0.001 for all comparisons). By Day 90, 62 of 210 (29.5%) in the intervention and 52 of 209 (24.9%) in the comparator group had died (absolute difference, 4.6 percentage points [95% CI, -3.9% to 13.2%]; P = 0.29). Conclusions: A liberal approach to blood glucose targets reduced incident hypoglycemia but did not improve patient-centered outcomes. Clinical trial registered with Australian New Zealand Clinical Trials Registry (ACTRN 12616001135404).

Effect of hyperglycaemia in combination with moxifloxacin on cardiac repolarization in male and female patients with type I diabetes

BackgroundPatients with Type 1 diabetes mellitus have been shown to be at a two to ten-fold higher risk of sudden cardiac death (SCD) (Svane et al., Curr Cardiol 2020; 22:112) than the general population, but the underlying mechanism is unclear. Hyperglycaemia is a recognised cause of QTc prolongation; a state patients with type 1 diabetes are more prone to, potentially increasing their risk of ventricular arrhythmia. Understanding the QTc prolongation effect of both hyperglycaemia and the concomitant additive risk of commonly prescribed QTc-prolonging drugs such as Moxifloxacin may help to elucidate the mechanism of sudden cardiac death in this cohort. This single-blinded, placebo-controlled study investigated the extent to which hyperglycaemia prolongs the QTc in controlled conditions, and the potential additive risk of QTc-prolonging medications.Methods21 patients with type 1 diabetes mellitus were enrolled to a placebo-controlled crossover study at a single clinical trials unit. Patients underwent thorough QTc assessment throughout the study. A ‘hyperglycaemic clamp’ of oral and intravenous glucose was administered with a target blood glucose of > 25 mM and maintained for 2 h on day 1 and day 3, alongside placebo on day 1 and moxifloxacin on day 3. Day 2 served as a control day between the two active treatment days.Thorough QTc assessment was conducted at matched time points over 3 days, and regular blood sampling was undertaken at matched time intervals for glucose levels and moxifloxacin exposure.ResultsConcentration-effect modelling showed that acute hyperglycaemia prolonged the QTc interval in female and male volunteers with type 1 diabetes by a peak mean increase of 13 ms at 2 h. Peak mean QTc intervals after the administration of intravenous Moxifloxacin during the hyperglycaemic state were increased by a further 9 ms at 2 h, to 22 ms across the entire study population. Regression analysis suggested this additional increase was additive, not exponential.Hyperglycaemia was associated with a significantly greater mean QTc-prolonging effect in females, but the mean peak increase with the addition of moxifloxacin was the same for males and females. This apparent sex difference was likely due to the exclusive use of basal insulin in the male patients, which provided a low level of exogenous insulin during the study assessments thereby mitigating the effects of hyperglycaemia on QTc. This effect was partially overcome by Moxifloxacin administration, suggesting both hyperglycaemia and moxifloxacin prolong QTc by different mechanisms, based on subinterval analysis.ConclusionsHyperglycaemia was found to be a significant cause of QTc prolongation and the additional effect of a QTc-prolonging positive control (moxifloxacin) was found to be additive. Given the high risk of sudden cardiac death in type 1 diabetes mellitus, extra caution should be exercised when prescribing any medication in this cohort for QTc effects, and further research needs to be undertaken to elucidate the exact mechanism underlying this finding and explore the potential prescribing risk in diabetes.Trial RegistrationNCT number: NCT01984827.Graphical abstract

Evaluation of glycemic control in critically ill patients with bacteremia: a retrospective, single-center cohort study

Dysglycemia is a common complication in hospitalized patients and has been suggested to play a significant role in the pathology and virulence of patients with bacteremia. The literature evaluating this...

Impact of prolonged requirement for insulin on 90-day mortality in critically ill patients without previous diabetic treatments: a post hoc analysis of the CONTROLING randomized control trial

BackgroundStress hyperglycemia can persist during an intensive care unit (ICU) stay and result in prolonged requirement for insulin (PRI). The impact of PRI on ICU patient outcomes is not known. We evaluated the relationship between PRI and Day 90 mortality in ICU patients without previous diabetic treatments.MethodsThis is a post hoc analysis of the CONTROLING trial, involving 12 French ICUs. Patients in the personalized glucose control arm with an ICU length of stay ≥ 5 days and who had never previously received diabetic treatments (oral drugs or insulin) were included. Personalized blood glucose targets were estimated on their preadmission usual glycemia as estimated by their glycated A1c hemoglobin (HbA1C). PRI was defined by insulin requirement. The relationship between PRI on Day 5 and 90-day mortality was assessed by Cox survival models with inverse probability of treatment weighting (IPTW). Glycemic control was defined as at least one blood glucose value below the blood glucose target value on Day 5.ResultsA total of 476 patients were included, of whom 62.4% were male, with a median age of 66 (54–76) years. Median values for SAPS II and HbA1C were 50 (37.5–64) and 5.7 (5.4–6.1)%, respectively. PRI was observed in 364/476 (72.5%) patients on Day 5. 90-day mortality was 23.1% in the whole cohort, 25.3% in the PRI group and 16.1% in the non-PRI group (p < 0.01). IPTW analysis showed that PRI on Day 5 was not associated with Day 90 mortality (IPTWHR = 1.22; CI 95% 0.84–1.75; p = 0.29), whereas PRI without glycemic control was associated with an increased risk of death at Day 90 (IPTWHR = 3.34; CI 95% 1.26–8.83; p < 0.01).ConclusionIn ICU patients without previous diabetic treatments, only PRI without glycemic control on Day 5 was associated with an increased risk of death. Additional studies are required to determine the factors contributing to these results.

Investigating the relationship between harm and over‐ or under‐treatment of frail patients living with diabetes, admitted to hospital

AbstractOlder people living with diabetes have higher rates of mortality, functional disability and comorbidities, and are at greater risk of falls, cognitive impairment and polypharmacy. Despite recent guidelines, there is still a general lack of recognition of the need to tailor diabetes care for older people.Aim: To investigate if older patients, who are frail and have diabetes when admitted to hospital, are being treated to the correct blood glucose targets and to observe if those over‐ or under‐treated suffer any harm.Method: Data from 101 patients ≥65 years with a diagnosis of type 2 diabetes mellitus and assessed as frail on admission were analysed. The primary outcome was to assess if the patients’ most recent HbA1c was in the correct target range for their level of frailty.Results: Forty‐six (46%) patients were deemed to be over‐treated. Patients with a higher HbA1c had increased length of stay (p = 0.036) and re‐admission rates (p = 0.008). Under‐treated patients were significantly more likely to have a higher blood glucose on admission (p = 0.0002).Conclusion: Frail older patients living with diabetes are often not treated within the correct target HbA1c range, which can lead to harm, highlighting the need for individualised care and regular review. Copyright © 2022 John Wiley &amp; Sons.

Unmet Needs of Glycaemic Control and Risk Factors of Residual Hyperglycaemia ina Chinese Population with Type2 Diabetes Initiating Basal Insulin: A Post Hoc Analysis of the FPG GOAL Study.

IntroductionTo aim of this analysis was to investigate the extent and evaluate risk factors of residual hyperglycaemia in Chinese individuals with type 2 diabetes (T2D) initiating basal insulin.MethodsFPG GOAL was a 24-week, open-label, treat-to-target randomised controlled trial in Chinese individuals with T2D inadequately controlled with oral anti-hyperglycaemic drugs initiating treatment with basal insulin. This analysis categorised participants into the following glycaemic control categories: hyperglycaemia [glycated haemoglobin (HbA1c) ≥ 53 mmol/mol (≥ 7%), fasting plasma glucose (FPG) ≥ 7.0 mmol/L], residual hyperglycaemia [HbA1c ≥ 53 mmol/mol (≥ 7%), FPG < 7.0 mmol/L], discordant [HbA1c < 53 mmol/mol (< 7%), FPG ≥ 7.0 mmol/L] and at target [HbA1c < 53 mmol/mol (< 7%), FPG < 7.0 mmol/L]. The proportion of participants in each glycaemic control category was assessed at weeks 12 and 24. Multivariable regression analyses were conducted to evaluate risk factors for residual hyperglycaemia.ResultsOf the 914 participants included, 22.1% had residual hyperglycaemia, 31.9% had hyperglycaemia, 11.1% were discordant and 29.3% were at target at week 24. More participants who were randomised to a fasting blood glucose (FBG) target of > 3.9 to ≤ 5.6 mmol/L had residual hyperglycaemia compared with participants randomised to a FBG target of > 3.9 to ≤ 6.1 mmol/L or > 3.9 to ≤ 7.0 mmol/L. Multivariable analysis indicated that higher HbA1c and lower FPG levels at baseline were associated with greater proportion of residual hyperglycaemia.ConclusionSome Chinese individuals with T2D may have residual hyperglycaemia 3–6 months after initiating basal insulin treatment and require further intensified treatment. Higher HbA1c and lower FPG levels could be risk factors for residual hyperglycaemia.Trial RegistrationClinicalTrials.gov identifier NCT02545842.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02128-y.

EVALUASI KADAR GLUKOSA DARAH PASIEN DIABETES MELITUS TIPE 2 DENGAN HIPERTENSI DI RUANG CEMPAKA RUMAH SAKIT PANTI WILASA CITARUM SEMARANG

Diabetes mellitus is a degenerative disease that increases every year in the world. The most common case of DM is a case of type 2 DM (90%). Type 2 DM with hypertension is one of the ten biggest diseases in Panti Wilasa Citarum Hospital Semarang. The purpose of this study was to evaluate and calculate the value of decreasing blood glucose levels. The type of research conducted was descriptive observational using a prospective method. The study was conducted in Cempaka Room at Panti Wilasa Citarum Hospital Semarang in the period March-April 2019. The research subjects were patients aged 18-60 years with National Health Insurance who met the inclusion-exclusion criteria who were willing to be respondents in this study. Data is processed and analyzed qualitatively and quantitatively. The results showed that the target blood glucose level of type 2 DM patients with hypertension at Panti Wilasa Citarum Hospital Semarang was achieved. Patients experienced a decrease in GD2JPP and GDP levels in single antidiabetic therapy of 73.68%, two combinations of antidiabetic 95%, three combinations of antidiabetic 100%.&#x0D;

Glycemic control in the critically ill: Less is more.

Hyperglycemia is associated with poor clinical outcomes in critically ill patients. Initial clinical trials of intensive insulin therapy targeting blood glucose levels of 80 to 110 mg/dL showed improved outcomes, but subsequent trials found no benefits and even increased harm with this approach. Emerging literature has evaluated other glycemic indices including time-in-target blood glucose range, glycemic variability, and stress hyperglycemia ratio. These indices, while well described in observational studies, have not been addressed in the initial trials. Additionally, the patient's pre existing diabetes status and preadmission diabetic control may modulate the outcomes of stringent glycemic control, with worse outcomes of hyperglycemia being observed in patients without diabetes and in those with well-controlled diabetes. Most medical societies recommend less stringent glucose control in the range of 140 to 180 mg/dL for critically ill patients.

IDF21-0621 Association of the Time in Targeted Blood Glucose Range of 3.9–10 mmol/L with the Mortality of Critically Ill Patients

Background: In addition to hyperglycemia, hypoglycemia, and glycemic variability, a decrease in the time in targeted blood glucose range (TIR) may be associated with an increased risk of death for critically ill patients. However, the relationship between the TIR and mortality may be influenced by the presence of diabetes and glycemic variability.