Frequent Blood Glucose Monitoring Research Articles

Internet use, needs and expectations of web-based information and communication in childbearing women with type 1 diabetes

BackgroundIn the childbearing period women use the internet both to seek information and as an important source of communication. For women with type 1 diabetes, pregnancy and early motherhood constitute a more complex situation than for women in general. This implies need for support from various professionals and a way of bridging any discontinuity in care would be to develop a website providing complementary social support and information. The objective of this study was to explore internet use, needs, and expectations regarding web-based information and communication in childbearing women with type 1 diabetes.MethodsData were collected via a web-based survey with an explorative and descriptive design, in which 105 of 139 eligible mothers with type 1 diabetes and recent childbearing experience participated. The data were analyzed with descriptive and analytical statistics, and open answers with a directed content analysis.ResultsOf the 105 women, 22% never used the internet to search for information concerning pregnancy, childbirth, and parenthood. 12% searched for information every day, 29% one or more times a week, and 38% one or more times a month. Of the women 44% declared themselves to be passive participants on social websites, and 45% to be active participants. 45% had specific expectations of web-based support directed towards childbearing, especially those with higher educational level (P = .01). Expectations of instrumental and informational support included an expert-controlled website with reliable, updated, and information focused on childbearing and diabetes, improved access to diabetes care professionals and alternative ways to communicate and to receive childbearing-related support. The women also asked for online technical devices to manage the frequent monitoring of blood glucose during pregnancy. Informal, emotional, and appraisal support from women in similar situations was suggested as a way to provide an arena for belonging instead of creating feelings of alienation.ConclusionsOur results add important knowledge about the web-based needs of women with type 1 diabetes in relation to childbearing. This user directed study indicates specific areas of development for the provision of effective web-based support that includes facilities for reliable information, interactive support and social networking in this population.

Prediction of Adolescents' Glycemic Control 1 Year After Diabetes-Specific Family Conflict

To test adherence to blood glucose monitoring (BGM) as a mediator between diabetes-specific family conflict and glycemic control (hemoglobin A(1c) [HbA(1c)] levels) for 1 year. Three waves of prospective data spanning 1 year. Diabetes clinic in a large tertiary care children's hospital in the Midwestern United States. One hundred forty-five dyads composed of an adolescent (aged 13-18 years) with type 1 diabetes mellitus and a parent. Adolescent- and parent-rated diabetes-specific family conflict and mean daily BGM frequency obtained through meter downloads. Levels of HbA(1c), abstracted from the medical record. In separate general linear models, higher adolescent-rated family conflict scores at baseline predicted less frequent BGM at 6 months (β = -0.08 [P = .01]) and higher HbA(1c) levels at 12 months (β = 0.08 [P = .02]). In the multivariate model including baseline conflict and BGM as predictors of HbA(1c) levels, BGM was a significant predictor (β = -0.24 [P = .007]) and conflict was no longer significant (β = 0.05 [P = .11]), supporting the mediation hypothesis. Post hoc probing showed that BGM explained 24% of the variance in the conflict-HbA(1c) link. The mediation between parent-reported conflict and HbA(1c) levels via BGM adherence was partially supported (conflict predicting HbA(1c) in the zero-order equation, β = -0.24 [P = .004]; multivariate equation, β = 0.06 [P = .02]), and BGM frequency explained 16% of the conflict-HbA(1c) link. Diabetes-specific family conflict in adolescence predicts deteriorations in BGM and subsequent glycemic control for at least 1 year. Results support ongoing intervention research designed to reduce family conflict and thus prevent a trajectory of declining adherence and glycemic control across adolescence.

Psychological screening in adolescents with type 1 diabetes predicts outcomes one year later

Aims Adolescents with type 1 diabetes are at increased risk for depression and anxiety, which can adversely affect diabetes management, glycemic control, and quality of life (QOL). However, systematic psychological screening is rarely employed. We hypothesized that higher depression and anxiety screener scores would predict higher HbA1c, less frequent blood glucose monitoring (BGM), and poorer QOL one year later. Raw screener scores were expected to be more robust predictors than cutoff scores. Methods 150 adolescents age 13–18 with type 1 diabetes completed depression and anxiety screeners. One year later, blood glucose meters were downloaded to assess BGM frequency, HbA1c values were obtained, and caregivers rated the participants’ QOL. Separate regressions were conducted for each outcome, including demographic and medical covariates. Results Higher depression scores predicted less frequent BGM ( b = −0.05, p < .05) and poorer QOL ( b = −0.71, p < .01), and higher state anxiety scores predicted higher HbA1c ( b = 0.07, p < .05). Continuous screener scores identified risk for 12-month outcomes more robustly than clinical cut-off scores. Conclusions Psychological screeners predict diabetes outcomes one year later. Future clinical research studies should explore whether psychological screening and referral for appropriate intervention can prevent deteriorations in diabetes management and control commonly seen during adolescence.

Depressive symptoms predict change in glycemic control in adolescents with type 1 diabetes: rates, magnitude, and moderators of change

To determine whether depressive symptoms in adolescents with type 1 diabetes predict change in glycemic control over time. A total of 145 adolescents (aged 13-18 yr) participated in two study visits (baseline and 6 months). They completed a measure of depressive symptoms (Children's Depression Inventory; CDI) and had their A1c values and adherence to blood glucose monitoring (BGM) documented. Three variables predicted A1c change over 6 months: CDI change score (B = 0.11; p < 0.001), BGM frequency at baseline (B = -0.21; p = 0.03), and A1c at baseline (B = -0.23; p = 0.002). A three-way interaction among these variables was significant (p < 0.01) and showed that adolescents with high adherence to BGM who were achieving optimal glycemic control (≤7.5%) at baseline were resistant to increasing A1c values, even if depressive symptoms worsened. However, as adherence to BGM declines, there is a synergistic effect with depressive symptoms to accelerate the increase of A1c values over time, making it more difficult to bring A1c back to optimal levels. Results suggest that depressive symptoms are important predictors of A1c change by themselves as well as when considered with adherence to BGM. There is a need to screen for depressive symptoms and expand and develop prevention and intervention strategies in order to put adolescents with type 1 diabetes in the best position for optimal glycemic control.

The frequency of blood glucose monitoring in septic patients in the intensive care unit: A retrospective audit

Introduction: Blood glucose levels (BGLs) are an important parameter in monitoring patients with sepsis in the intensive care unit (ICU). The use of insulin and glucose infusions are reliant upon these measurements to maintain normoglycaemia.

A focus on blood glucose monitoring: relation to glycemic control and determinants of frequency

To re-examine the relation of blood glucose monitoring to glycemic control among adolescents with type 1 diabetes and to evaluate the relation of demographic, behavioral, and psychosocial characteristics of adolescents who monitor more and less frequently. Participants were 132 adolescents with type 1 diabetes (average age = 12 yr) and their parents, recruited from Children's Hospital of Pittsburgh. Adolescents were interviewed annually for five consecutive years after routine clinic appointments. At each assessment, data from blood glucose meters were downloaded and glycosylated hemoglobin A1c was recorded from medical records. More frequent blood glucose monitoring was related to better glycemic control. Adolescents who monitored more frequently were younger, from higher social status families, on insulin pumps, and had higher self-efficacy. Age-related declines in blood glucose monitoring occurred among adolescents with low self-esteem, high stressful life events, and lower parental support. Given the importance of blood glucose monitoring for good glycemic control, future research should enhance adolescents' self-efficacy for monitoring and intervene with those who are at risk for age-related declines in blood glucose monitoring.

Explaining the family conflict-glycemic control link through psychological variables in adolescents with type 1 diabetes

To examine whether individual psychological variables mediate the family conflict-glycemic control relationship. During three study visits spanning 9 months, 147 adolescents with type 1 diabetes completed questionnaires measuring anxiety and depressive symptoms, and diabetes-specific worry. Caregivers similarly completed a measure of diabetes-specific family conflict. Blood glucose monitoring frequency and glycemic control were also obtained during study visits. Separate mediation analyses revealed that anxiety was the only individual psychological variable that mediated the caregiver-reported family conflict-glycemic control link. Anxiety accounted for 20% of the family conflict-glycemic control link, compared to 8.5% for depression and 6% for diabetes-specific worry. Results suggest that anxiety symptoms may be promoted in a family environment characterized by conflict and these symptoms have detrimental effects on glycemic control. Continued monitoring of family functioning and adolescents' anxiety symptoms, as well as refinement of interventions, is needed to promote positive health outcomes.

Blood glucose monitoring and glycemic control in adolescents with type 1 diabetes: meter downloads versus self-report

Reported frequencies of blood glucose monitoring (BGM) by both adolescents and their caregivers serve as adherence proxies when meter downloads are not available. Yet, correlates of reported BGM frequencies and their predictive utility are understudied. To identify sociodemographic, psychological, and disease-specific correlates of reported BGM frequencies in adolescents with type 1 diabetes and to explore the predictive utility of BGM indices on glycemic control. Study participants included caregivers and adolescents with type 1 diabetes (N=143, 13-18 yr) receiving diabetes treatment at a tertiary care setting. At the initial visit, adolescents and caregivers reported on daily BGM frequencies. A sub-sample provided meter downloads. Adolescents also completed a depression inventory. Three months later, adolescents provided blood sampling for A1c assessment. Multivariate general linear modeling identified that older adolescent age and more depressive symptoms were associated with reports of less frequent BGM. Two stepwise multivariate regression models examined the predictive utility of BGM indices (i.e., adolescent-reported BGM, caregiver-reported BGM, meter download) on glycemic control. Caregiver-reported BGM frequency predicted glycemic control in the absence of meter download data (p<0.001). However, when clinical and contextual variables were included, meter download data were the most robust predictor of glycemic control (p<0.0001). Meter downloads have the most robust association with glycemic control when contextual variables are considered. Caregiver-reported BGM frequencies can serve as reliable substitutes in the absence of meter download, but they may not be as reliable in adolescents with depressive symptoms.

Knowledge, Attitude and Practices (KAP) on Disposal of Sharp Waste, Used for Home Management of Type-2 Diabetes Mellitus, in New Delhi, India

This was a cross-sectional study to explore the factors influencing practices about household sharp waste management among type 2 diabetics in Delhi, India. The study used self-administered questionnaires to find socio-demographic characteristics, diabetes management characteristics, and knowledge, attitude and practices (KAP) towards household sharp waste management. While there is a large amount of literature on sharp disposal practices in the healthcare setting, to the best of our knowledge sharp disposal at home and associated factors has not been studied in India before. A total of 303 type 2 diabetics, who were above 18 years of age and gave informed consent, were asked to fill a self-administered questionnaire stating their socio-demographic, diabetes management characteristics, and KAP on household sharp management. Information or education on sharp use and disposal by healthcare provider, pharmacist and sharp manufacturer was collected as influencing factors. Any past injury to self, family member or to pet was also collected as one of the potential influencing factors. The study did not find any association of socio-demographic factors, diabetes management characteristics (like duration of type 2 diabetes, duration and frequency of insulin use, number of needles and lancets used, reuse of sharps, frequency of blood glucose monitoring, frequency of physician visit etc.), knowledge and attitude with sharp disposal practices of respondents. Household waste bins were frequently used by majority (84.1%) of respondents to discard their sharps, whereas only a few (16.9%) had informed their garbage handlers about presence of sharps in their waste. In contrast, influencing factors like education form healthcare provider, pharmacist and friends were significantly associated with good sharp disposal practices.

The effectiveness of continuous subcutaneous insulin infusion on quality of life of families and glycaemic control among children with type 1 diabetes: A systematic review.

Review objective/question Objectives The main objectives of this systematic review are: 1. To assess the effectiveness of continuous subcutaneous insulin infusion (CSII) compared to multiple daily injections (MDI) on quality of life in families of children with type 1 diabetes. 2. To determine the clinical effectiveness of CSII compared to MDI in terms of glycaemic control expressed in the levels of glycated haemoglobin (HbA1c) in children. A secondary objective is: 1. To examine the health outcomes of CSII compared to MDI in terms of the episodes of severe hypoglycaemia and diabetic ketoacidosis. Review questions The specific review questions to be addressed are: 1. What is the effectiveness of CSII compared to MDI on quality of life in families of children with type 1 diabetes pertaining to physical, psychological, social and spiritual domains of life? 2. What is the effectiveness of CSII compared to MDI on glycaemic control in children with type 1 diabetes? 3. What is the effectiveness of CSII compared to MDI on reducing the episodes of severe hypoglycaemia and diabetic ketoacidosis in children with type 1 diabetes? Inclusion criteria Types of participants This review will consider all families of patients aged 18 years or below with type 1 diabetes taking insulin treatment. Families of patients who are critically ill or who are pregnant will be excluded. For the purposes of this review, 'family' is defined as “the body of persons who live in one house or under one head”, as per the definition given by the Oxford English Dictionary. Type I diabetes is defined as a metabolic disorder of multiple aetiology characterised by hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from destruction of the beta cells of the pancreas and insulin deficiency. Given the changes in classification and diagnostic criteria for type 1 diabetes over the years, this review will consider studies which based diagnosis on the valid diagnostic criteria for the illness at the time of the study.TRUNCATED AT 350 WORDS

Correlates of glycemic control and quality of life outcomes in adolescents with type 1 diabetes

A major focus of pediatric multidisciplinary diabetes care is promoting glycemic control (A1c) while ensuring high quality of life (QOL). The current study investigated factors associated with A1c and QOL using a methodology that considered these variables as simultaneous outcomes. A total of 261 adolescents (aged 13-18) with type 1 diabetes completed measures of blood glucose monitoring (BGM) frequency, diabetes-specific QOL, negative affect, and depression. Caregivers completed measures of demographic and disease characteristics, depression, and family conflict. A1c was negatively correlated with QOL (r = -0.18 to -0.29, p < 0.01) across all subscales. Based on clinical A1c goals and median QOL scores, adolescents fell into four glycemic control-QOL groups. Multinomial logistic regression determined correlates of group membership utilizing adolescents with suboptimal glycemic control-low QOL as the referent group. Adolescents with optimal glycemic control-high QOL reported increased BGM frequency (OR = 1.87), less negative affect (OR = 1.32), and were more likely to use CSII (OR = 5.41). Adolescents with optimal A1c-low QOL reported greater BGM frequency (OR = 1.91) and shorter disease duration (OR = 1.09). Adolescents with suboptimal glycemic control-high QOL reported greater BGM frequency (OR = 1.41), fewer depressive symptoms (OR = 1.13), and less negative affect (OR = 1.31). Results reveal disease, management, and psychosocial characteristics that differentiate glycemic control-QOL outcome groups and identify risk factors related to this relationship. Further appreciation of these characteristics may increase clinicians' understanding and attention to these important clinical outcomes and help tailor the most appropriate interventions (e.g., individual psychotherapy vs. family problem-solving interventions) to help adolescents achieve glycemic control without sacrificing QOL.

43 Predictors of Adherence in Small Children with Type 1 Diabetes

Aims: Although type 1 diabetes incidence is increasing in younger children, they are neglected in paediatric adherence research despite the fact that younger children are more vulnerable medically, less capable of managing their disease, and parents have enormous caretaking responsibilities. We investigated the predictors of treatment adherence in young children with type 1 diabetes. Methods: Mothers of 65 children aged 2 to 8 years were interviewed about children's diabetes care (e.g., injections, diet). Nutritional analyses were conducted to assess children's extrinsic sugar consumption (e.g., confectionary). Mothers completed assessments of diabetes knowledge, parenting stress, family functioning and child psychological adjustment. Demographic and medical information was also collected. Results: More relationship difficulties and less frequent blood glucose monitoring predicted higher % energy intake from extrinsic sugars. The blood glucose monitoring and dietary regimens showed greater adherence variability than medical treatment components such as injection frequency. Better maternal diabetes knowledge correlated with less injection time variability, more frequent blood glucose monitoring, lower % energy intake from extrinsic sugars, lower HbA1c levels, and fewer relationship difficulties. Longer diabetes duration, greater injection time variability, and higher % energy intake from extrinsic sugars predicted less frequent blood glucose monitoring. Conclusion: Healthcare professionals can facilitate treatment adherence through provision of socioemotional, educational, and practical support. Findings show that

Interventions With Adherence-Promoting Components in Pediatric Type 1 Diabetes

OBJECTIVETo review interventions with adherence-promoting components and document their impact on glycemic control via meta-analysis.RESEARCH DESIGN AND METHODSData from 15 studies that met the following criteria were subjected to meta-analysis: 1) randomized, controlled trial, 2) study sample included youth aged <19 years, 3) youth had type 1 diabetes, 4) study reported results on glycemic control; and 5) study reported use of adherence- or self-management–promoting components.RESULTSThe 15 studies included 997 youth with type 1 diabetes. The mean effect size for pre- to posttreatment change for the intervention versus control group comparison was 0.11 (95% CI −0.01 to 0.23). This is a small effect, demonstrating very modest improvements in glycemic control. However, analysis for the pre- to posttreatment effects for the intervention group alone did show significant variability [Q(14) = 33.11; P < 0.05]. Multicomponent interventions, those that targeted emotional, social, or family processes that facilitate diabetes management, were more potent than interventions just targeting a direct, behavioral process (e.g., increase in blood glucose monitoring frequency).CONCLUSIONSInterventions that focus on direct, behavioral processes and neglect emotional, social, and family processes are unlikely to have an impact on glycemic control; multicomponent interventions showed more robust effects on A1C. Future clinical research should focus on refining interventions and gathering more efficacy and effectiveness data on health outcomes of the pediatric patients treated with these interventions.

Lantus Insulin Overdose: A Case Report

Background: Insulin glargine is a relatively new medication in the treatment of diabetes mellitus, and there have only been six case reports of overdoses in the literature with this specific insulin. Objectives: We present a unique case of insulin glargine overdose that presented with persistent hypoglycemia and required prolonged in-hospital treatment. Case Report: A 51-year-old woman with insulin-dependent diabetes and a history of suicide attempts by medication overdose presented to the Emergency Department the morning after she had self-administered 2700 units of her insulin glargine in an attempted suicide. She was treated with continuous intravenous dextrose infusion with liberal oral intake, and continued to have recurrent hypoglycemic episodes 96 h into her hospital stay. She was discharged on hospital day 5 after psychiatric clearance without any permanent complications. Conclusions: A single massive overdose of insulin glargine can present with prolonged hypoglycemia. Emergency physicians should have a low threshold for initiating continuous dextrose infusions and admitting these patients for frequent blood glucose and serum electrolyte monitoring, preferably in an intensive care setting.

Depressive symptoms in adolescents with type 1 diabetes: Associations with longitudinal outcomes

Associations between depressive symptoms, blood glucose monitoring (BGM) frequency, and glycemic control (A1c values) were examined in adolescents with type 1 diabetes. Increased depressive symptoms were associated with lower BGM frequency and higher A1c values. Symptoms of ineffectiveness and negative mood were most commonly endorsed, representing targets for clinical interventions.

Responsibility Sharing between Adolescents with Type 1 Diabetes and Their Caregivers: Importance of Adolescent Perceptions on Diabetes Management and Control

To analyze associations between factor scores for caregiver responsibility for direct and indirect diabetes management tasks with glycemic control and blood glucose monitoring (BGM) frequency. Two hundred and sixty one adolescents with type 1 diabetes and their caregivers completed the Diabetes Family Responsibility Questionnaire (DFRQ). Data on diabetes management (e.g., BGM frequency) and glycemic control (e.g., A1c values) were obtained. Confirmatory factor analysis of the DFRQ revealed two factors-direct and indirect management tasks. Multivariate analyses demonstrated that adolescent perception of greater responsibility sharing with caregivers on direct management tasks was significantly associated with higher BGM frequency. Adolescents who perceive greater caregiver responsibility, particularly around direct management tasks, engage in better diabetes management. Implications of these findings include designing interventions that encourage and sustain caregiver responsibility through adolescence and make explicit the contribution of caregivers.

Occurrence of microalbuminuria in young people with Type 1 diabetes: importance of age and diabetes duration

To determine the occurrence of microalbuminuria in young people with Type 1 diabetes mellitus followed prospectively for 2 years and to relate the presence of persistent elevations in urinary albumin excretion (UAE) to age, diabetes duration, puberty and other factors. During a 2 year period, random urine samples were obtained from 471 patients, aged 8-18 years (mean +/-sd 12.9 +/- 2.3 years) with Type 1 diabetes duration 5.6 +/- 3.0 years, as part of routine clinical care. Urine albumin and creatinine concentrations were measured in 1310 samples (median, 3 samples per patient) and the albumin:creatinine ratio was calculated (in micrograms albumin per milligram creatinine). Height, weight, blood pressure (BP), glycated haemoglobin (HbA(1c)), blood glucose monitoring frequency and Tanner staging were collected from patients' medical records. Twenty-three per cent of patients had one or more sample with elevated UAE (> or =20 microg/mg) and 9.3% had persistent elevations (> or =2 samples > or =20 microg/mg). Those with and without persistent microalbuminuria did not differ significantly in age, diabetes duration, z-score for body mass index, pubertal status or BP percentile. Ten per cent of children <13 years old and 9% of children > or =13 years old had persistent microalbuminuria. Persistent microalbuminuria was significantly associated with diabetes duration only in older children (duration 0.5-3 years, 4%; 4-6 years, 8%; > or =7 years, 14%; P = 0.02, trend test). Mean HbA(1c) over the 2 years was 8.7 +/- 1.2%. In a logistic regression model, mean HbA(1c) was the only significant predictor of persistent microalbuminuria (odds ratio 1.3, 95% confidence interval 1.0-1.6, P = 0.05). Microalbuminuria in older children with Type 1 diabetes is likely to be clinically significant. In younger children, it may reflect functional, reversible renal changes. Longitudinal analysis is needed to confirm the probable transient nature of microalbuminuria in young patients with Type 1 diabetes.

Blood Glucose Monitoring and Glycemic Control in Adolescence: Contribution of Diabetes-Specific Responsibility and Family Conflict

To examine age and time trends in responsibility for diabetes management tasks and diabetes-specific family conflict and their relationship to blood glucose monitoring (BGM) frequency and blood glucose control (HbA1c). A sample of 147 adolescents (mean = 15.5 +/- 1.4 years) with type 1 diabetes and their caregivers completed measures of diabetes-specific responsibility and family conflict at baseline and 6 months. BGM frequency and HbA1c were measured during outpatient clinic appointments. Responsibility for diabetes management tasks shifted from caregivers to adolescents with increasing age by adolescent and caregiver report. Diabetes-specific conflict was stable. Similar trends in responsibility and conflict were seen over the 6-month follow-up period. Less frequent BGM and higher HbA1c were also observed with increasing adolescent age. Multivariate analyses demonstrated adolescents taking greater responsibility for management tasks and experiencing greater family conflict at baseline reported lower BGM at 6 months. Family, demographic, psychosocial, and disease-specific variables accounted for 26% of the variance in BGM frequency by both adolescent and caregiver report. Adolescents reporting greater diabetes-specific family conflict at baseline experienced higher HbA1c values at 6 months. Variables accounted for 23% and 28% of the variance in HBA1c by adolescent and caregiver report respectively. Diabetes-specific responsibility and conflict have important implications for improving disease outcomes. Interventions targeting responsibility and conflict (i.e., reducing conflict while keeping caregivers involved in diabetes management) may help prevent the deterioration in BGM and HbA1c frequently seen during adolescence.

Predictors of glycaemic control in patients with Type 1 diabetes commencing continuous subcutaneous insulin infusion therapy

To identify variables that predict glycaemic control in Type 1 diabetic patients switched to a continuous subcutaneous insulin infusion (CSII) regimen, in order to improve patient selection for this treatment. The notes of 421 Type 1 diabetic patients aged 2.6-39.8 years (median 19.4) who initiated CSII treatment in 1998-2007 and used it for > or = 1 year were reviewed. Details about their background and disease-related and treatment-related variables were recorded. At pump initiation, the mean age was 15.9 +/- 7.2 years, mean diabetes duration 6.4 +/- 5.8 years. Mean time of CSII use was 4.1 +/- 2.1 years. Good glycaemic control was defined by glycated haemoglobin (HbA(1c)) stratified by age (American Diabetes Association target levels). Improvement in glycaemic control was defined as a reduction of > or = 0.5% in HbA(1c) from baseline. The change in the rate of severe hypoglycaemic or diabetic ketoacidosis events was also determined. There was a significant sustained decrease in HbA(1c) with CSII for an average of 6 years, without increased rates of hypoglycaemia. Achievement of target HbA(1c) was significantly associated with the following parameters at pump initiation: lower HbA(1c) (P < 0.001), younger age (< 12 years), shorter diabetes duration (P < 0.001) and more frequent daily self blood glucose monitoring (SBGM) (P < 0.01). Improved glycaemic control was associated with longer CSII use (P = 0.032) and higher HbA(1c) at CSII initiation (P < 0.001). Switching patients to CSII resulted in sustained decrease in HbA(1c) and improved glycaemic control in patients with high HbA(1c). Young age, frequent SBGM and lower HbA(1c) at pump initiation were identified as predictors of achieving glycaemic targets with CSII.

Efficacy and safety of an insulin infusion protocol during and after cardiac surgery

Perioperative tight blood glucose (BG) control using insulin therapy after major surgery is a difficult, time-consuming task that also raises some concerns over the risk of severe hypoglycaemia. The aim of the present prospective study was to evaluate the efficacy and safety of an insulin therapy protocol in use at our institution. A total of 230 consecutive patients (mean+/-SD age: 67+/-11 years; diabetic patients: n=62) undergoing cardiac surgery (coronary artery bypass grafting: n=137; 20% off-pump) or intrathoracic aortic (n=10) surgery were included. BG control was managed according to an insulin therapy protocol, described by Goldberg et al. (2004) [11], in use for 6 months in our intensive care unit. Insulin infusion rate and frequency of BG monitoring were both adjusted according to: (1) the current BG value; (2) the previous BG value; and (3) the current insulin infusion rate. Efficacy was assessed by the percentage of time spent at the target BG level (100-139 mg/dL) intraoperatively and during the first 2 postoperative days (POD). All patients received postoperative insulin therapy. Patients spent 57.3% and 69.7% of time within the BG target range on POD 1 and 2, respectively. The percentage of time was significantly higher in nondiabetics than in diabetics. Mean BG measurements per patient intraoperatively, on POD 1 and on POD 2 were 4+/-1, 10+/-2 and 7+/-2, respectively. No patient experienced any severe hypoglycaemic events (BG<50mg/dL). This study showed that a BG target of 100-139 mg/dL can be safely achieved with an insulin therapy protocol that can be routinely used in everyday clinical practice.