Mean Daily Blood Glucose Levels Research Articles

Effect of dapagliflozin on 24-hour glycemic variables in Japanese patients with type 2 diabetes mellitus receiving basal insulin supported oral therapy (DBOT): a multicenter, randomized, open-label, parallel-group study

IntroductionThis study aimed to evaluate the impacts of dapagliflozin on 24-hour glucose variability and diabetes-related biochemical variables in Japanese patients with type 2 diabetes who had received basal insulin supported...

Efficacy and Safety of Empagliflozin Continuation in Patients with Type 2 Diabetes Hospitalised for Acute Decompensated Heart Failure.

There is little evidence on the use of sodium−glucose cotransporter 2 inhibitors in hospitalised patients. This work aims to analyse the glycaemic and clinical efficacy and safety of empagliflozin continuation in patients with type 2 diabetes hospitalised for acute decompensated heart failure. This real-world observational study includes patients treated using our in-hospital antihyperglycaemic regimens (basal-bolus insulin vs. empagliflozin-basal insulin) between 2017 and 2020. A propensity matching analysis was used to match a patient on one regimen with a patient on the other regimen. Our primary endpoints were the differences in glycaemic control, as measured via mean daily blood glucose levels, and differences in the visual analogue scale dyspnoea score, NT-proBNP levels, diuretic response, and cumulative urine output. Safety endpoints were also analysed. After a propensity matching analysis, 91 patients were included in each group. There were no differences in mean blood glucose levels (152.1 ± 17.8 vs. 155.2 ± 19.7 mg/dL, p = 0.289). At discharge, NT-proBNP levels were lower and cumulative urine output greater in the empagliflozin group versus the basal-bolus insulin group (1652 ± 501 vs. 2101 ± 522 pg/mL, p = 0.032 and 16,100 ± 1510 vs. 13,900 ± 1220 mL, p = 0.037, respectively). Patients who continued empagliflozin had a lower total number of hypoglycaemic episodes (36 vs. 64, p < 0.001). No differences were observed in adverse events, length of hospital stay, or in-hospital deaths. For patients with acute heart failure, an in-hospital antihyperglycaemic regimen that includes continuation of empagliflozin achieved effective glycaemic control, lower NT-proBNP, and greater urine output. It was also safer, as it reduced hypoglycaemic episodes without increasing other safety endpoints.

Management of older hospitalized patients with type 2 diabetes using linagliptin: Lina-Older study.

Older patients managed with intensive antidiabetic therapy are more likely to be harmed. Our study's primary endpoint was to analyze the safety and efficacy of linagliptin in combination with basal insulin versus basal-bolus insulin in patients with 75 years of age or older hospitalized in medicine and surgery departments in real-world clinical practice. We retrospectively enrolled non-critically patients ≥75 years with type 2 diabetes admitted to medicine and non-cardiac surgery departments with admission glycated hemoglobin <8%, admission blood glucose <240 mg/dL, and without at-home injectable therapies managed with our hospital's antihyperglycemic protocol (basal-bolus or linagliptin-basal regimens) between January 2016 and December 2018. To match each patient who started on the basal-bolus regimen with a patient who started on the linagliptin-basal regimen, a propensity matching analysis was used. Postmatching, 198 patients were included in each group. There were no significant differences in mean daily blood glucose levels after admission (P=0.203); patients with mean blood glucose 100-140mg/dL (P=0.134), 140-180mg/dL (P=0.109), or >200mg/dL (P=0.299); and number and day of treatment failure (P=0.159 and P=0.175, respectively). The total insulin dose and the number of daily injections were significantly lower in the linagliptin-basal group (both, P<0.001). Patients on the basal-bolus insulin regimen had more total hypoglycemic events than patients on the linagliptin-basal insulin regimen (P<0.001). The linagliptin-basal insulin regimen was an effective alternative with fewer hypoglycemic events and daily insulin injections than intensive basal-bolus insulin in very old patients with type 2 diabetes with mild-to-moderate hyperglycemia treated at home without injectable therapies.

DPP4 Inhibitors in the Management of Hospitalized Patients With Type2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

We studied the effects of dipeptidyl peptidase4 (DPP4) inhibitors on glycemic control in non-critically ill patients admitted to hospital. We searched MEDLINE and EMBASE for published studies in English up to July 2019. We included randomized clinical trials (RCTs) that compared DPP4 inhibitors plus insulin supplementation versus basal-bolus insulin regimen in the management of hyperglycemia non-critically ill patients with type2 diabetes admitted to hospital. Mean difference (MD), relative risk (RR), and 95% confidence intervals (CI) were generated to interpret the data. Of 401 papers, four RCTs including 648 participants met inclusion criteria. There was no significant difference in mean daily blood glucose level between the two groups (MD 4.63; 95% CI = - 1.57, 10.83; p = 0.14) (I2 = 14%, p = 0.32). Total insulin dose per day was lower in patients receiving DPP4 inhibitors (MD - 14.27; CI = - 22.47, - 6.07; p = 0.001) (I2 = 92%, p = 0.001). Also, the number of insulin injection was significantly lower in patients receiving DPP4 inhibitors (MD - 0.79; CI = - 1.01, - 0.57; p = 0.001) (I2 = 0%, p = 0.68). The rate of hypoglycemia was not significantly different between the two groups (RR 0.60, CI = 0.34, 1.074; p = 0.08) (I2 = 37.3%, p = 0.18). Treatment failure was not significantly different between the two groups (RR 0.87, CI = 0.64, 4.8; p = 0.38) (I2 = 49%, p = 0.11). The results indicate that using DPP4 inhibitors plus basal or supplemental insulin in hospitalized patients is non-inferior to a standard basal-bolus insulin regimen and leads to a lower amount of insulin use and a lower rate of insulin injection. Limitations of this study were heterogeneity of baseline characteristics of included patients, small sample size, short duration, and non-uniformly defined outcome assessment parameters in the included studies.

OR05-5 AZP-3404, a 9-Amino Acid Peptide Analog of Insulin-Like Growth Factor-Binding Protein 2, Reverses Insulin Resistance in Leptin-Deficient ob/ob Mice

Insulin-like growth factor-binding protein-2 (IGFBP-2), one of six highly-conserved binding proteins that modulate circulating IGF1, has significant regulatory actions on carbohydrate, lipid and bone metabolism that are independent of its IGF-1 binding role. The metabolic activity of IGFBP-2 has been localized to a short peptide sequence within its unique heparin-binding domain, HBD-1, that is able to reproduce the metabolic actions of the full IGFBP-2 on bone and fat. Through structure-activity studies of this sequence, an acylated 9-amino acid peptide, AZP-3404, with enhanced stability and pharmacokinetics, has been developed that retains the activity of IGFBP-2 on fat and bone metabolism. As IGFBP-2 treatment has also been demonstrated to improve glucose homeostasis in animal models of severe insulin resistance, including the leptin-deficient ob/ob mouse, the present study was undertaken to determine whether AZP-3404 is able to reverse insulin resistance and improve glucose homeostasis in the ob/ob mouse. Male B6.Cg-Lepob/J mice were implanted with HD-XG telemetric devices (Data Sciences International), which allows continuous, wireless monitoring of carotid blood glucose under awake, unrestrained conditions. Animals were randomly assigned to groups (n=8) receiving either saline or AZP-3404 at 1 or 3 mg/kg, b.i.d. for four weeks. The mean daily blood glucose level prior to study initiation was 507 ± 102 mg/dL. Treatment with AZP-3404 dose-dependently decreased the average daily glucose concentration, such that by day 27, glucose levels were reduced by 64 ± 29 and 100 ± 16 mg/dL in the 1 and 3 mg/kg AZP-3404-treated groups, respectively, while slightly increased by 14 ± 29 mg/dL in the vehicle-treated group. On days 7, 14, 21 and 28, following a 24-hour fast, the mice were given an intraperitoneal glucose tolerance test (IPGTT: 1g glucose/kg) to evaluate the impact of AZP-3404 on glucose disposal which is impaired in ob/ob mice. By day 28, the fasting glucose level was reduced by 8% and 20% in the 1 and 3 mg/kg AZP-3404-treated groups, respectively, as compared with fasting levels on day 7. The IPGTTs revealed a progressive, dose-dependent reduction in glucose excursion that reached a decrease of 40% after 4 weeks of treatment with 3mg/kg AZP-3404. In related studies, we have observed that AZP-3404, both alone and in an additive manner with insulin, stimulates glucose transport in mouse C2C12 differentiated myotubes through activation of AMP-activated protein kinase (AMPK). These findings suggest that AZP- 3404 stimulates glucose uptake by muscle tissue in ob/ob mice thereby improving glucose homeostasis. The results from these studies confirm that AZP-3404 retains the ability of IGFBP-2 to restore glucose homeostasis and support the development of AZP-3404 as a novel therapeutic approach for syndromes of severe insulin resistance.

Early effects of sodium-glucose co-transporter 2 inhibitors in type 2 diabetes: study based on continuous glucose monitoring

BackgroundInhibitors of sodium-glucose co-transporter 2 (SGLT2) have immediate glucose-lowering effects by promoting urinary glucose excretion, without altering insulin level. Only a few studies have evaluated blood glucose dynamics in the early period after administration. The present retrospective study was designed to determine the immediate effects of SGLT2 inhibitors on blood glucose dynamics.MethodsThe study subjects were 24 patients with type 2 diabetes whose blood glucose dynamics were evaluated with continuous glucose monitoring for 1 week before and after initiation of SGLT2 inhibitor therapy. Blood glucose dynamics were examined on days −1, 0 (treatment commencement day), 3, and 7 by evaluating different continuous glucose monitoring parameters and blood glucose before each meal. Furthermore, blood glucose levels at 1 and 2 h after each meal and daily urinary glucose levels were determined.ResultsA significant reduction in blood glucose levels 2 h after breakfast was observed between the day before treatment (249.8 mg/dL) and the day treatment started (218.9 mg/dL). The mean daily blood glucose level improved significantly from 201.4 to 142.3 mg/dL from the day the treatment started. Blood glucose variation also improved significantly by week 1, as demonstrated by changes in standard deviation and mean amplitude of glycemic excursions (from 39.6 to 31.7 and 106.9 to 87.4 mg/dL, respectively). The percent time at blood glucose <70 mg/dL remained unchanged while urinary glucose on day 7 correlated with minimum blood glucose level (r = 0.474, p = 0.022).ConclusionsThe results showed that the SGLT2 inhibitors lower blood glucose from 2 h after the first dose and improve blood glucose variation by week 1 after start of the treatment. Furthermore, SGLT2 inhibitors did not alter the incidence of hypoglycemic episodes at week 1, suggesting that SGLT2 protects against severe hypoglycemia by inhibiting urinary glucose excretion.

The Interactive Effect of Diabetes Family Conflict and Depression on Insulin Bolusing Behaviors for Youth.

Adherence to type 1 diabetes management declines as children enter adolescence. For youth, psychosocial variables including mood and interpersonal relationships play a large role in diabetes maintenance. The current study assessed the unique and interactive roles diabetes family conflict and depression have on insulin bolusing behaviors for youth ages 10-16 years. Ninety-one youth-parent dyads completed a survey assessing family conflict and depression. Mean daily blood glucose levels, mealtime insulin bolus scores ( BOLUS), and glycated hemoglobin (HbA1c) were collected from the medical record as outcome variables. Parent-reported diabetes-related family conflict and youths' endorsed depression both significantly predicted insulin bolusing behavior, R2 = .13, F(2, 88) = 6.66, P < .05. The interaction of diabetes family conflict and youth depression played a significant role in youths' bolusing behaviors, above and beyond that which was predicted by conflict and depression separately, R2 = .18, Fchange(1, 87) = 4.63, P < .05. BOLUS was negatively related to youths' hemoglobin A1c, r = -.556, P < .001 and mean daily blood glucose levels, r = -.428, P < .001. Among depressed youth, mealtime insulin BOLUS scores declined with greater diabetes-related family conflict, while there was no change in BOLUS scores among depressed youth living in families reporting less conflict. Findings underscore the importance of screening for depression and family conflict in youth experiencing or at risk for poor adherence to mealtime insulin and higher HbA1c levels.

Efficacy of a basal bolus insulin protocol to treat prednisolone-induced hyperglycaemia in hospitalised patients.

Few studies have specifically investigated treatment of prednisolone-induced hyperglycaemia. To determine if a basal bolus insulin (BBI) protocol for inpatient hyperglycaemia is effective in patients prescribed acute prednisolone for an inflammatory disease. In a cross-sectional study, 66 patients with type 2 diabetes admitted to a general medical ward and treated with BBI for up to 5 days were studied. Twenty-four patients were taking prednisolone ≥10 mg/day to treat an acute inflammatory disease. The remaining 42 patients were a control group. The primary outcome was mean daily blood glucose level. There were no significant differences in glycosylated haemoglobin (8.1 ± 1.0 vs 8.1 ± 1.6%, P = 0.88), age (77 ± 11 vs 75 ± 14 years, P = 0.57), male sex (63 vs 60%, P = 0.81) or body mass index (30.0 ± 5.3 vs 30.2 ± 11.5 kg/m(2) , P = 0.90) between patients taking prednisolone and controls. Mean daily glucose concentration was higher in patients taking prednisolone than in controls (12.2 ± 0.3 vs 10.0 ± 0.1 mmol/L, P < 0.001). Blood glucose level was higher in patients on prednisolone at 1700 h (14.6 ± 0.6 vs 10.3 ± 0.3 mmol/L, P < 0.001) and 2100 h (14.5 ± 0.6 vs 10.5 ± 0.3 mmol/L, P < 0.001), with no significant differences at 0700 h and 1200 h. These findings occurred despite patients taking prednisolone receiving a higher daily insulin dose than controls (0.67-0.70 vs 0.61-0.65 U/kg, P = 0.001) because of higher doses of ultra-rapid-acting insulin at 1200 h and 1700 h. Hospitalised patients taking prednisolone had substantial afternoon and evening hyperglycaemia despite receiving BBI via a protocol for inpatient hyperglycaemia. Specific insulin regimens for prednisolone-induced hyperglycaemia are needed that recommend more insulin during this time period.

Do we need another SGLT2 inhibitor?

Do we need another <scp>SGLT2</scp> inhibitor?

Pilot Study Results for a Novel Behavior Plus Nutrition Intervention for Caregivers of Young Children With Type 1 Diabetes

To present results for a parent-based educational intervention targeting mealtime behaviors plus nutrition among families of young children (mean age, 5.0 ± 1.2 years) with type 1 diabetes mellitus (T1DM). The researchers recruited 9 caregivers who participated in the 6-session intervention and completed baseline and posttreatment assessments, which included dietary intake, acceptability of diet changes, mealtime behavior, and mean blood glucose values. Children's mean daily blood glucose levels decreased from 185 ± 46 mg/dL to 159 ± 40 mg/dL (P < .001). There were also decreases in problematic parent and child mealtime behaviors. There was no change in children's dietary intake indicators that could be detected. It appears promising that this targeted behavior plus nutrition intervention can improve glycemic control and behavior for young children with type 1 diabetes mellitus. Larger, randomized controlled trials will clarify significant results, limitations, and sustainability. Techniques within the program may have application to current practice.

G198(P) Plasma Arginine Levels and Blood Glucose Control in Very Preterm Infants Receiving Two Different Parenteral Nutrition Regimens

Background and IntroductionWe have previously shown that improving early protein intake is associated with a reduction in insulin-treated hyperglycaemia in preterm infants <29 weeks gestation. The effect of amino acids...

Plasma Arginine Levels and Blood Glucose Control in Very Preterm Infants Receiving 2 Different Parenteral Nutrition Regimens

Improving parenteral nutrition (PN) amino acid (AA) intake in very preterm infants is associated with less hyperglycemia. AAs stimulate newborn insulin secretion with arginine, demonstrating a specific effect. We hypothesized that low arginine levels would be associated with increased insulin-treated hyperglycemia and higher mean daily blood glucose levels in very preterm infants. We performed a secondary analysis on previous study data comparing high-protein/calorie PN (HPC-PN) and control groups in infants <29 weeks' gestation. Infants were substratified (within original groups) according to high (highARG) and low (lowARG) plasma arginine levels on days 8-10 using a reference population-derived threshold for high/low arginine (57 µmol/L). Daily protein, arginine, carbohydrate intake, mean daily blood glucose, and insulin treatment data from the first 15 days of life were collected. Control group infants (n = 60) were stratified into lowARG (n = 41) and highARG (n = 19) groups. There were no differences in basic demographic data or carbohydrate intake. LowARG infants had higher mean daily blood glucose levels ( P .05) and a trend to more insulin treatment on days 610. HPC-PN group infants (n = 55) were stratified into lowARG (n = 33) and highARG (n = 22) GROUPS. LowARG infants had lower gestation and birth weight and were sicker than highARG infants. There were no differences in carbohydrate intake. LowARG infants had higher mean daily blood glucose levels (p .01) and more insulin treatment (p .01) on days 15 and 610. Insulin-treated hyperglycemia was also associated with low plasma glutamine levels. Low plasma arginine levels (≤57 µmol/L) in very preterm infants are associated with poorer blood glucose control.

Fetal Anterior Wall Thickness and Amniotic Fluid Insulin Levels: an Interdependence?

Excessive fetal fat as the hallmark of GDM pregnancy complications is one consequence of fetal hyperinsulinism. Noninvasive methods for fetal surveillance and measurement of fetal fat are needed. The purpose of this study was to test the hypothesis that measurements of the fetal anterior abdominal wall thickness (AAWT) in women with GDM will allow early detection of fetal hyperinsulinism. Amniocentesis was performed between 28 and 32 weeks of gestation (wks) in 220 women with GDM (diagnosed by 75g oGTT at 24 to 28 wks). Amniotic fluid insulin levels (AFIL) were determined by a commercially available radioimmunoassay. Transabdominal ultrasound provided fetal biometric measurements following standard procedures and the AAWT including fetal skin and subcutaneous tissue at the time of amniocentesis. Maternal parameters (weight, BMI, oGTT blood glucose levels and mean daily blood glucose levels) were correlated with fetal biometric data and with AFIL. There was no difference in AAWT in women with GDM and no correlation with mean AFIL. AFIL also did not correlate with any other fetal measurement or with mean oGTT blood glucose levels. AFIL only showed a correlation with maternal weight (p=0.02) and maternal BMI (p=0.01). The correlation was present for values both before pregnancy and at the time of amniocentesis. In the early third trimester, AAWT measurements do not correlate with fetal insulin levels.

ヘモグロビンA1c (HbA1c) 生成反応速度定数を用いた1日平均空腹時血糖値の算定

ヘモグロビンA1c (HbA1c) 生成反応速度定数を用いた1日平均空腹時血糖値の算定

Pilot Study for Assessment of Optimal Frequency for Changing Catheters in Insulin Pump Therapy—Trouble Starts on Day 3

Continuous subcutaneous insulin infusion (CSII) by means of insulin pump devices is considered to be one of the most optimal therapies to achieve treatment targets in patients with diabetes mellitus. In CSII, the insulin is delivered through Teflon catheters or steel needle infusion sets, which need to be renewed on a regular basis. This pilot study was performed to investigate the optimal change frequency in daily practice and to explore potential problems that may occur when the sets are used for a more prolonged time than the recommended up to 72 hours of usage (Teflon catheters). Twelve patients with type 1 diabetes participated in the trial [age (mean +/- STD): 40.3 +/- 12.6 years, body mass index: 26.2 +/- 3.3 kg/m(2), hemoglobin A1c: 6.7 +/- 0.6%]. They were asked to wear their infusion set (Comfort or Silhouette) for increasing periods of 1, 2, 3, 4, and 5 days. After each use, patients completed standardized questionnaires regarding technical and medical issues associated with infusion set use. A health care professional investigated the infusion sites and infusion sets and completed an "infusion set inspection" questionnaire. Blood glucose was measured and recorded to assess a potential influence of duration of catheter use on glycemic control. Infusion set and injection site problems (itching, bruising, swelling, and pain) started to occur in measurable amounts on the 3rd day of catheter use, and about 40% of patients reported significant issues when using a catheter for 5 days. In parallel, there was a consistent increase in mean daily blood glucose levels that correlated with the number of days of catheter use (e.g., day 1: 7.5 +/- 3.8 mmol/liter, day 3: 8.4 +/- 4.2 mmol/liter, day 5: 9.0 +/- 4.0 mmol/liter, day 7: 11.6 +/- 2.2 mmol/liter, p < 0.05 vs day 1). Using the catheters for 2 days resulted in a safe and well-tolerated therapy. Clinically relevant adverse events started to occur during the 3rd day and their incidence increased constantly with longer use. This was associated with undesired changes in mean glycemic control. Data support the recommendation by the drug and device manufacturers that insulin pump catheters should only be used for 48-72 hours to avoid adverse events and potential metabolic deterioration.

Insulin Analogs Versus Human Insulin in the Treatment of Patients With Diabetic Ketoacidosis

OBJECTIVETo compare the safety and efficacy of insulin analogs and human insulins both during acute intravenous treatment and during the transition to subcutaneous insulin in patients with diabetic ketoacidosis (DKA).RESEARCH DESIGN AND METHODSIn a controlled multicenter and open-label trial, we randomly assigned patients with DKA to receive intravenous treatment with regular or glulisine insulin until resolution of DKA. After resolution of ketoacidosis, patients treated with intravenous regular insulin were transitioned to subcutaneous NPH and regular insulin twice daily (n = 34). Patients treated with intravenous glulisine insulin were transitioned to subcutaneous glargine once daily and glulisine before meals (n = 34).RESULTSThere were no differences in the mean duration of treatment or in the amount of insulin infusion until resolution of DKA between intravenous treatment with regular and glulisine insulin. After transition to subcutaneous insulin, there were no differences in mean daily blood glucose levels, but patients treated with NPH and regular insulin had a higher rate of hypoglycemia (blood glucose <70 mg/dl). Fourteen patients (41%) treated with NPH and regular insulin had 26 episodes of hypoglycemia and 5 patients (15%) in the glargine and glulisine group had 8 episodes of hypoglycemia (P = 0.03).CONCLUSIONSRegular and glulisine insulin are equally effective during the acute treatment of DKA. A transition to subcutaneous glargine and glulisine after resolution of DKA resulted in similar glycemic control but in a lower rate of hypoglycemia than with NPH and regular insulin. Thus, a basal bolus regimen with glargine and glulisine is safer and should be preferred over NPH and regular insulin after the resolution of DKA.

Pattern of High‐Dose Prednisolone‐Induced Hyperglycaemia in COPD Exacerbations

ABSTRACTBackgroundHigh‐dose prednisolone is the mainstay of treatment for acute exacerbations of chronic obstructive pulmonary disease (COPD). Hyperglycaemia is a dose‐related adverse effect of prednisolone. Recent evidence suggests that the presence of hyperglycaemia during COPD exacerbations may impair recovery. To develop a successful management strategy, more information is needed on the nature of prednisolone‐induced hyperglycaemia in COPD exacerbations.AimTo determine the characteristics of prednisolone‐induced hyperglycaemia in patients experiencing COPD exacerbations and receiving high‐dose prednisolone (20 mg or more daily).MethodA prospective study of patients hospitalised for COPD exacerbations and receiving high‐dose prednisolone. Eligible patients with COPD exacerbations and receiving highdose prednisolone were divided into 3 groups – diabetic, non‐diabetic and pre‐diabetic. The capillary blood glucose levels for the 3 groups were measured daily at 7 am, noon, 5 pm and 9 pm for up to 4 days of treatment. These blood glucose levels were compared with the retrospective blood glucose levels of diabetic patients hospitalised for reasons other than COPD exacerbations and not receiving prednisolone (control).ResultsCompared to the diabetic control group (n = 117), the mean daily blood glucose levels were 2 mmol/L higher in diabetic COPD patients receiving prednisolone (n = 7; p &lt; 0.05). Pre‐diabetic COPD patients receiving prednisolone (n = 6), experienced a mean daily blood glucose level similar to that of the diabetic control group, while the non‐diabetic COPD patients (n = 6) were largely unaffected. In both diabetic and pre‐diabetic COPD patients there was a delayed blood glucose level peak at 5 pm that was 4 mmol/L higher than the 7 am blood glucose level (p &lt; 0.05 for both). This pattern was not evident in the diabetic control group. In both the diabetic and pre‐diabetic COPD patients the recovery of blood glucose levels to baseline occurred within 24 hours.ConclusionPrednisolone‐induced hyperglycaemia influenced blood glucose levels in pre‐diabetic COPD patients to the same extent as diabetic COPD patients, while the non‐diabetic COPD patients were largely unaffected. The hyperglycaemic effect was transient, lasted for less than 24 hours and followed a distinct daily pattern.

Safety and Efficacy of an Intensive Insulin Protocol in a Burn-Trauma Intensive Care Unit

Aggressive glycemic management in critically ill patients with acute burn injury or life-threatening soft-tissue infections has not been thoroughly evaluated. An intensive insulin protocol with target glucose values of less than 120 mg/dl was implemented in October 2005 in our regional Burn-Trauma intensive care unit. We reviewed our initial experience with this protocol to evaluate the safety and efficacy of aggressive glycemic control in these patient groups. Patients were placed on the intensive insulin protocol based upon the need for glycemic management during their hospitalization for burn or soft-tissue disease. Patient information prospectively collected while on protocol included all measured blood glucose values, total daily insulin use, and incidence of hypoglycemic episodes, defined as serum glucose <60 mg/dl. Thirty patients (17 burns, 13 soft-tissue infections) were placed on the intensive insulin protocol during the first 16 months of use. The mean daily blood glucose level for burn patients was 115.9 mg/dl and for soft-tissue disease patients was 119.5 mg/dl. There was a 5% incidence of hypoglycemic episodes per protocol day. All hypoglycemic episodes were treated by holding the insulin infusion, and no episode had known adverse effects. Hyperglycemia in critically ill patients with burns and extensive soft-tissue disease can be effectively managed with an insulin protocol that targets blood glucose values of less than 120 mg/dl with minimal incidence of hypoglycemia. A multicenter prospective randomized trial would provide the ideal forum for evaluating clinical outcome benefits of using an intensive insulin protocol.

Parental fear of hypoglycemia: young children treated with continuous subcutaneous insulin infusion

The objective of this study was to examine the association between parental fear of hypoglycemia and average daily blood glucose control of young children with type 1 diabetes receiving continuous subcutaneous insulin infusion (CSII). We hypothesized that parental fear of hypoglycemia would correlate positively with children's average daily blood glucose control. Twenty-four families of children with type 1 diabetes who were receiving CSII were recruited from a pediatric hospital. Children had a mean age of 5.7 +/- 1.8 yr (range 2-8 yr) and were evenly split on gender. Parents completed a modified version of the Hypoglycemia Fear Survey - Parents of Young Children (HFS-PYC), a measure designed to assess fear and avoidance behaviors associated with hypoglycemia. Blood glucose was assessed for the 2 wk following completion of the HFS-PYC using a standard home blood glucose meter. Parents of young children obtained a mean total HFS-PYC score of 81 +/- 14.1 (possible range 26-130), suggesting a moderate level of fear. The HFS-PYC was found to be internally consistent and had good test-retest reliability. For parents of young children receiving CSII, fear of hypoglycemia correlated positively with children's mean daily blood glucose levels (r = 0.41, p = 0.05). Parents of young children with type 1 diabetes who are receiving CSII report significant fear of hypoglycemia. Parental fear of hypoglycemia may be a barrier to prevent optimal glycemic control.

Dietary Adherence and Associated Glycemic Control in Families of Young Children with Type 1 Diabetes

Objective This study examined the dietary intake, dietary adherence, and associated daily glycemic control of young children (mean age 5.6±1.6 years) with type 1 diabetes in 33 families. Design This was a one-sample cross-sectional study. Children’s nutrient and energy intakes were measured using 3-day diet diaries. Children’s mean daily blood glucose levels were assessed prospectively for 2 weeks using the FreeStyle (TheraSense, Inc, Alameda, CA) home blood glucose meter. Statistical analysis Means, standard deviations, and frequencies described the sample. Associations between dietary adherence and glycemic control were examined by one-tailed Pearson correlations. Results Mean nutrient intakes were less than the Dietary Reference Intake for children’s intake of vitamin B-12 and calcium. Children’s dietary deviations revealed better-than-predicted adherence to the number and timing of feedings per day and number of carbohydrate units consumed per meal. In contrast, children’s daily carbohydrate intake was approximately 80%±21% of the recommended levels based on their weight and age. In addition, children’s energy intake was only 78%±18% of the recommended levels based on age. Correlations revealed a positive association between poor dietary adherence and higher blood glucose levels. Conclusions Young children with type 1 diabetes are likely to have adequate dietary intake of most micronutrients. However, their adherence to specific carbohydrate and energy intake recommendations may be lower. Because the preschool years represent a period of rapid growth, diet plans for preschoolers with diabetes need to be revised often for optimal management of type 1 diabetes. Close adherence to dietary recommendations is one behavior that may improve blood glucose control in young children with diabetes.