Tight Blood Glucose Control Research Articles

8591 Tight Blood Glucose Control In Patients With Diabetes In The Icu Does Not Decrease Mortality: A Systematic Review And Meta-Analysis

Abstract Disclosure: M.L. Defante: None. B.X. Ximenes: None. B.A. Morais: None. O.C. Martins: None. V.M. Prizão: None. T.L. Correa: None. M.M. de Souza: None. Tight Blood Glucose Control in Patients with Diabetes in the ICU Does Not Decrease Mortality: A Systematic Review and Meta-Analysis Background: Dysglycemia is a common complication in critically ill patients admitted to the Intensive Care Unit (ICU). However, there is controversy among clinical trials and a lack of evidence for patients with diabetes on this matter. Therefore, we aimed to perform a meta-analysis comparing tight with liberal blood glucose control among patients with diabetes in the ICU. Hypothesis: Among patients with diabetes, tight blood glucose control is a safe option in the ICU to avoid hyperglycemia episodes. Methods: We searched PubMed, Cochrane Central, and EMBASE for studies comparing tight with liberal blood glucose control in critically ill patients with diabetes in the intensive care unit. The main outcome was mortality. Statistical analysis was performed using Review Manager 5.17 (Cochrane Collaboration) and RStudio 2023.12.0. Heterogeneity was assessed with I² statistics and Cochran's Q test. Quality assessment was performed with the Cochrane tool for assessing the risk of bias in randomized trials. Results: 6 randomized clinical trials with 3,775 patients were included. The frequency of mortality showed no statistically significant difference between patients under tight blood glucose control (385/1872; 20.56%) compared to those under liberal blood glucose control (345/1903; 18.12%) (OR 1.16; 95% CI 0.98-1.37; p= 0.09; I²= 0%). No further analysis was conducted due to a lack of outcome data for patients with diabetes in the trials. All studies were considered at low risk of bias. The funnel-plot showed no evidence of publication bias despite the small number of studies. Conclusion: The mortality outcome showed no statistically significant difference between the intervention and control groups. Observational studies suggest that hyperglycemia and hypoglycemia may have different physiological implications in patients with diabetes, making them poor markers of physiologic stress and risk of mortality. More randomized clinical trials are needed to make it possible to run more robust meta-analyses and clarify this clinical question. Presentation: 6/2/2024

Tight Versus Liberal Blood Glucose Control in Patients With Diabetes in the ICU: A Meta-Analysis of Randomized Controlled Trials.

Introduction: Glycemia is an important factor among critically ill patients in the intensive care unit (ICU). There is conflicting evidence on the preferred strategy of blood glucose control among patients with diabetes in the ICU. We aimed to conduct a meta-analysis comparing tight with liberal blood glucose in critically ill patients with diabetes in the ICU. Methods: We systematically searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing tight versus liberal blood glucose control in critically ill patients with diabetes from inception to December 2023. We pooled odds-ratios (OR) and 95% confidence intervals (CI) with a random-effects model for binary endpoints. We used the Review Manager 5.17 and R version 4.3.2 for statistical analyses. Risk of bias assessment was performed with the Cochrane tool for randomized trials (RoB2). Results: Eight RCTs with 4474 patients were included. There was no statistically significant difference in all-cause mortality (OR 1.11; 95% CI 0.95-1.28; P = .18; I² = 0%) between a tight and liberal blood glucose control. RoB2 identified all studies at low risk of bias and funnel plot suggested no evidence of publication bias. Conclusion: In patients with diabetes in the ICU, there was no statistically significant difference in all-cause mortality between a tight and liberal blood glucose control. PROSPERO registration: CRD42023485032.

Model predictive control of blood glucose in critically ill patients using Gaussian processes

Abstract Stress-induced hyperglycemia and high glycemic variability are common in intensive care patients. Several clinical studies show the benefits of tight blood glucose control, including lower mortality. This article presents an algorithm for blood glucose control in the intensive care unit. An Unscented Kalman Filter is developed to estimate the glucose metabolism state and time-varying insulin sensitivity from blood glucose measurements. Gaussian Processes are used to predict future insulin sensitivity changes based on previous measurements. A model predictive controller is designed to estimate optimal insulin infusion based on current state, predicted insulin sensitivity and planned nutrition. The developed control algorithm allows individualized blood glucose control with reduced glycemic variability and reduced risk of hypoglycemia in the intensive care unit.

Blood glucose control and metabolic dysfunction-associated steatotic liver disease in people with type 1 diabetes

PurposeMetabolic dysfunction-associated steatotic liver disease (MASLD) may have distinctive pathophysiological features in type 1 diabetes (T1D). We evaluated the independent role of blood glucose control on MASLD in T1D.MethodsIn a cross-sectional study on 659 T1D adult patients, MASLD was assessed by the Fatty Liver Index (FLI) and the Hepatic Steatosis Index (HSI). Anthropometric, biochemical, and clinical parameters were retrieved from electronic records. Blood glucose control status was evaluated by dividing participants into subgroups according to the median value of HbA1c [7.6% (60 mmol/mol)], and this analysis was repeated excluding overweight/obese patients.ResultsPatients with HbA1c above 7.6% (60 mmol/mol) showed significantly higher MASLD indices (HSI 38 ± 6 vs. 36 ± 5, p < 0.001; FLI 26 ± 26 vs.19 ± 19, p < 0.001), and higher proportions of MASLD identified by HSI (57 vs. 44%, p < 0.001) and FLI (14 vs. 7%, p < 0.001) than patients with HbA1c below 7.6% (60 mmol/mol). Similar results were obtained for HSI after the exclusion of overweight/obese patients. Stepwise linear regression analysis confirmed that HbA1c was independently associated with HSI (r = 0.496, p = 0.009) and FLI (r = 0.722, p = 0.007); waist circumference with HSI (r = 0.492, p < 0.001); and waist circumference (r = 0.700, p < 0.001), HDL cholesterol (r = 0.719, p < 0.001), and LDL cholesterol (r = 0.712, p < 0.001) with FLI.ConclusionsBlood glucose control is a main factor associated with MASLD in adults with T1D, also independently of overweight and obesity. Appropriate therapeutic strategies focused on tight blood glucose control may also be needed for the prevention and treatment of MASLD in T1D.

Tight Blood Glucose Control Doesn't Improve ICU Outcomes.

According to this study.

Review on Oral Insulin for Diabetics Mellitus

Oral insulin is one of the most exciting areas of diabetes therapy, due to the potential benefits of patient convenience, liver rapid insulination, appropriate insulin delivery to avoid hyperinsulin hypertension in the peripheral region, and the potential to avoid the harmful effects of weight gain and low blood sugar. Evidence is growing that early intensive insulin therapy leads to sustainable and tight blood glucose control and leads to serious complications, making effective oral insulin products even more important for the treatment of diabetic patients. Despite the knowledge of this medical need, insulin injections have failed due to several obstacles. For decades, researchers have tried to develop oral insulin with various technologies, but have not succeeded in clinical and commercial studies. The review summarizes the development status of oral insulin and indicates that it is under clinical trial

Tight Blood-Glucose Control without Early Parenteral Nutrition in the ICU

BackgroundRandomized, controlled trials have shown both benefit and harm from tight blood-glucose control in patients in the intensive care unit (ICU). Variation in the use of early parenteral nutrition and in insulin-induced severe hypoglycemia might explain this inconsistency.MethodsWe randomly assigned patients, on ICU admission, to liberal glucose control (insulin initiated only when the blood-glucose level was >215 mg per deciliter [>11.9 mmol per liter]) or to tight glucose control (blood-glucose level targeted with the use of the LOGIC-Insulin algorithm at 80 to 110 mg per deciliter [4.4 to 6.1 mmol per liter]); parenteral nutrition was withheld in both groups for 1 week. Protocol adherence was determined according to glucose metrics. The primary outcome was the length of time that ICU care was needed, calculated on the basis of time to discharge alive from the ICU, with death accounted for as a competing risk; 90-day mortality was the safety outcome.ResultsOf 9230 patients who underwent randomization, 4622 were assigned to liberal glucose control and 4608 to tight glucose control. The median morning blood-glucose level was 140 mg per deciliter (interquartile range, 122 to 161) with liberal glucose control and 107 mg per deciliter (interquartile range, 98 to 117) with tight glucose control. Severe hypoglycemia occurred in 31 patients (0.7%) in the liberal-control group and 47 patients (1.0%) in the tight-control group. The length of time that ICU care was needed was similar in the two groups (hazard ratio for earlier discharge alive with tight glucose control, 1.00; 95% confidence interval, 0.96 to 1.04; P=0.94). Mortality at 90 days was also similar (10.1% with liberal glucose control and 10.5% with tight glucose control, P=0.51). Analyses of eight prespecified secondary outcomes suggested that the incidence of new infections, the duration of respiratory and hemodynamic support, the time to discharge alive from the hospital, and mortality in the ICU and hospital were similar in the two groups, whereas severe acute kidney injury and cholestatic liver dysfunction appeared less prevalent with tight glucose control.ConclusionsIn critically ill patients who were not receiving early parenteral nutrition, tight glucose control did not affect the length of time that ICU care was needed or mortality. (Funded by the Research Foundation–Flanders and others; TGC-Fast ClinicalTrials.gov number, NCT03665207.)

Nurse's knowledge and awareness regarding insulin therapy for diabetic patients in the emergency department at al diwaniyah teaching hospital

Background: Diabetes Mellitus has affected humans for many decades, and the descriptions of it are amazing important, which it's incidence is rising abruptly worldwide, Nowadays, the introduction of new insulin formulations and a new emphasis on tight blood glucose control make inpatient diabetes treatment has become more complicated, and it requires very careful monitoring by the nursing staff, while expanding their knowledge and practical skills to prevent dangerous side effects when giving insulin to patients. Objectives: The study aims to assess the nurse's knowledge and awareness regarding Insulin Therapy for Diabetic Patients in the emergency department at Al Diwaniyah Teaching Hospital, and finding the association between demographic data which as the gender, educational level, years of experiences in the emergency department, and training course and their level of nurse's knowledge. Materials and Methods: Descriptive study has been carried out to assess the nurse's knowledge and awareness regarding insulin therapy for diabetic patients in the emergency department at Al Diwaniyah Teaching Hospital for the period from 16 of January 2022 to 10 July of 2022. A purposive sample of (50) nurses who work in the emergency department at Al Diwaniyah Teaching Hospital. A questionnaire format was constructed to assess the knowledge of nurses about insulin therapy for diabetic Patients in the emergency department at Al Diwaniyah Teaching Hospital.The questionnaire was divide to two main parts: First Part: Demographic data of the sample include (Age, Gender, Educational level, Duration of work as a nurse, Years of experiences and training courses regarding management of diabetic patients and insulin therapy. Second Part: This part include 18 multiple questions to assess the knowledge of nurses and awareness about insulin therapy for diabetic Patients in the emergency department at Al Diwaniyah Teaching Hospital. Results: Results of the study shows the highest of nurses’ knowledge items are (Moderate). While (Bad) was the main nurses’ knowledge regarding to store insulin and perform a physical assessment to establish a baseline before beginning therapy. The majority of nurses 77.8% of nurses' knowledge have Moderate, while 11.1% of them have Bad and 11.1% of them have (Good) regarding to overall Assessment of nurses’ knowledge, there are a highly association between education level, and years of experience about management of diabetic Patients undergoing insulin therapy in the emergency department. Conclusion: The study concluded that the highest of nurses’ knowledge items are (Moderate). While (Bad) was the main nurses’ knowledge regarding to store insulin and perform a physical assessment to establish a baseline before beginning therapy. Also there are a highly association between level of education, and years of experience about insulin therapy for diabetic patients in the emergency department and their efficacy of nurses’ knowledge. Recommendations: Increasing the knowledge and awareness of nursing staff concerning insulin therapy for diabetic patients by improving training courses. Also establishing education programs to improve nurses' knowledge and awareness toward the newest issues related to insulin therapy in the emergency department.

Management of Type 2 Diabetes in Frail Older Adults.

Aging is one of the most important factors associated with the dramatic increase in the prevalence of type 2 diabetes mellitus (T2DM) globally. In addition to traditional micro- and macrovascular complications, diabetes mellitus (DM) in older adults is of great importance due to its independent relationship with frailty, which is defined as a decline in functional reserves and vulnerability to stressors. Frailty assessment enables the determination of biological age, thus predicting potential complications in older adults and identifying tailored treatment strategies. Although the latest guidelines have acknowledged the frailty concept and provided recommendations specific to this subgroup of older adults, frail older adults are particularly considered only as anorexic, malnourished people for whom relaxed treatment targets should be set. However, this approach bypasses other metabolic phenotypes in the context of diabetes and frailty. Recently, a spectrum of metabolic phenotypes in the context of frailty in DM was suggested, and the two edges of this spectrum were defined as "anorexic malnourished (AM)" and "sarcopenic obese (SO)." These two edges were suggested to require different strategies: Opposite to the AM phenotype requiring less stringent targets and de-intensification of treatments, tight blood glucose control with agents promoting weight loss was recommended in the SO group. Our suggestion is that, regardless of their phenotype, weight loss should not be the primary goal in DM management in older adults who are overweight or obese, because of the increased malnutrition prevalence in older adults suffering from DM compared with standard older adults. Furthermore, overweight older adults have been reported to have the lowest risk of mortality compared with other groups. On the other hand, obese older individuals may benefit from intensive lifestyle interventions including caloric restriction and regular exercise with the assurance of at least 1 g/kg/day high-quality protein intake. Besides metformin (MF), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) or glucagon-like peptide-1 receptor agonists (GLP-1RA) should be considered in appropriate SO cases, due to high evidence of cardiorenal benefits. MF should be avoided in the AM phenotype due to their weight loss property. Although weight loss is not desired in AM phenotype, SGLT-2i may still be preferred with close follow-up in certain individuals demonstrating high cardiovascular disease (CVD) risk. Of note, SGLT-2i should be considered earlier in the diabetes treatment in both groups due to their multiple benefits, i.e., organ protective effects, the potential to reduce polypharmacy, and improve frailty status. The concept of different metabolic phenotypes in frail older adults with diabetes once again shows "one size fits all" cannot be applied in geriatric medicine, and a tailored, individualized approach should be adopted to get the highest benefit from treatments.

Impact of tight blood glucose control within normal fasting ranges with insulin titration prescribed by the Leuven algorithm in adult critically ill patients: the TGC-fast randomized controlled trial

BackgroundIt remains controversial whether critical illness-related hyperglycemia should be treated or not, since randomized controlled trials (RCTs) have shown context-dependent outcome effects. Whereas pioneer RCTs found improved outcome by normalizing blood glucose in patients receiving early parenteral nutrition (PN), a multicenter RCT revealed increased mortality in patients not receiving early PN. Although withholding early PN has become the feeding standard, the multicenter RCT showing harm by tight glucose control in this context has been criticized for its potentially unreliable glucose control protocol. We hypothesize that tight glucose control is effective and safe using a validated protocol in adult critically ill patients not receiving early PN.MethodsThe TGC-fast study is an investigator-initiated, multicenter RCT. Patients unable to eat, with need for arterial and central venous line and without therapy restriction, are randomized upon ICU admission to tight (80–110 mg/dl) or liberal glucose control (only initiating insulin when hyperglycemia >215 mg/dl, and then targeting 180–215 mg/dl). Glucose measurements are performed on arterial blood by a blood gas analyzer, and if needed, insulin is only administered continuously through a central venous line. If the arterial line is no longer needed, glucose is measured on capillary blood. In the intervention group, tight control is guided by the validated LOGIC-Insulin software. In the control arm, a software alert is used to maximize protocol compliance. The intervention is continued until ICU discharge, until the patient is able to eat or no longer in need of a central venous line, whatever comes first. The study is powered to detect, with at least 80% power and a 5% alpha error rate, a 1-day difference in ICU dependency (primary endpoint), and a 1.5% increase in hospital mortality (safety endpoint), for which 9230 patients need to be included. Secondary endpoints include acute and long-term morbidity and mortality, and healthcare costs. Biological samples are collected to study potential mechanisms of organ protection.DiscussionThe ideal glucose target for critically ill patients remains debated. The trial will inform physicians on the optimal glucose control strategy in adult critically ill patients not receiving early PN.Trial registrationClinicalTrials.gov NCT03665207. Registered on 11 September 2018.

Comparative study between type 1 &amp; type 2 diabetes mellitus and its effect on the retina

Diabetic retinopathy (DR) remains the leading cause of vision loss and blindness in people of working age, in spite of the fact that current treatments are effective. Vision loss occurs in DR due to the development of maculopathy, especially diabetic macular edema, and due to proliferative diabetic retinopathy. Vision loss due to DR is preventable with the appropriate monitoring and timely treatment. Improved patient and health professional, education to encourage tight control of blood glucose and other systemic factors, and the establishment of readily available and appropriately timed eye examinations are necessary steps to further reduce visual impairment of people with diabetes. Material &amp; Method: In this work, the tests that we perform on diabetics will be described to see the effect of the disease on the retina. We also described the disease in a simplified manner. We conducted our tests on 40 patients suffering from retinal problems due to diabetes of all kinds. Results: There were patients with DM type I ,type II more occurring in age (&gt;50years ) and in type II more in male than female. Also there was significant different between DM types and gender group (P&lt; 0.05).

Therapeutic Advances in Diabetic Nephropathy.

Diabetic kidney disease (DKD) is the most common cause of end-stage kidney disease (ESKD) in the United States. Risk factor modification, such as tight control of blood glucose, management of hypertension and hyperlipidemia, and the use of renin–angiotensin–aldosterone system (RAAS) blockade have been proven to help delay the progression of DKD. In recent years, new therapeutics including sodium-glucose transport protein 2 (SGLT2) inhibitors, endothelin antagonists, glucagon like peptide-1 (GLP-1) agonists, and mineralocorticoid receptor antagonists (MRA), have provided additional treatment options for patients with DKD. This review discusses the various treatment options available to treat patients with diabetic kidney disease.

Coronavirus disease 2019 and diabetes mellitus

IntroductionIn late 2019, a new virus severe acute respiratory syndrome coronavirus-2, which causes a new serious disease called coronavirus disease 2019 (COVID-19), spread quickly all over the world. Many complications of diabetes mellitus (DM) such as microvascular and macrovascular complications increase the risk for COVID-19-related severity and mortality.ObjectiveTo assess the effect of DM on outcome and severity of COVID-19.Patients and methodsThis work was a retrospective observation that included confirmed COVID-19-infected patients (PCR positive for COVID-19) who were admitted to Shebin El-Kom Teaching Hospital, Menoufia, Egypt, from March 2021 to March 2022. Laboratory investigations such as age, sex, and sings of severity of COVID-19 were studied. In this study, patients were divided into three main groups as follows: group 1 diabetic patients had known DM, group 2 (hyperglycemic group) patients were without past history of DM but were known to have hyperglycemia with COVID-19, and group 3 (control) had normal blood glucose.ResultsA total of 300 patients were divided into diabetic and hyperglycemic groups and were compared with the control group. It was found that diabetic and hyperglycemic groups were significantly associated with severe and critical disease, long hospital stay, increased number of admissions in critical care unit, increased number of patients under mechanical ventilation, and increased mortality rate from COVID-19 compared with the control group.ConclusionsPatients with DM are more liable for severe acute respiratory syndrome coronavirus-2 infection, ICU admission, and increase in the rate of death. In addition, new hyperglycemia, even without history of DM, increased the severity of COVID-19 infection. Special care should be given for diabetic patients. Therefore, glucose monitoring and tight control of blood glucose are essential for all.

Impact of tight glucose control on circulating 3-hydroxybutyrate in critically ill patients

BackgroundRecent evidence suggests a potentially protective effect of increasing ketone body availability via accepting low macronutrient intake early after onset of critical illness. The impact of blood glucose control with insulin on circulating ketones is unclear. Whereas lowering blood glucose may activate ketogenesis, high insulin concentrations may have the opposite effect. We hypothesized that the previously reported protective effects of tight glucose control in critically ill patients receiving early parenteral nutrition may have been mediated in part by activation of ketogenesis.MethodsThis is a secondary analysis of 3 randomized controlled trials on tight versus liberal blood glucose control in the intensive care unit, including 700 critically ill children and 2748 critically ill adults. All patients received early parenteral nutrition as part of the contemporary standard of care. Before studying a potential mediator role of circulating ketones in improving outcome, we performed a time course analysis to investigate whether tight glucose control significantly affected ketogenesis and to identify a day of maximal effect, if any. We quantified plasma/serum 3-hydroxybutyrate concentrations from intensive care unit admission until day 3 in 2 matched subsets of 100 critically ill children and 100 critically ill adults. Univariable differences between groups were investigated by Kruskal-Wallis test. Differences in 3-hydroxybutyrate concentrations between study days were investigated by Wilcoxon signed-rank test.ResultsIn critically ill children and adults receiving early parenteral nutrition, tight glucose control, as compared with liberal glucose control, lowered mean morning blood glucose on days 1–3 (P < 0.0001) via infusing insulin at a higher dose (P < 0.0001). Throughout the study period, caloric intake was not different between groups. In both children and adults, tight glucose control did not affect 3-hydroxybutyrate concentrations, which were suppressed on ICU days 1–3 and significantly lower than the ICU admission values for both groups (P < 0.0001).ConclusionTight versus liberal glucose control in the context of early parenteral nutrition did not affect 3-hydroxybutyrate concentrations in critically ill patients. Hence, the protective effects of tight glucose control in this context cannot be attributed to increased ketone body availability.

Degree of Control of Type II DM in Kirkuk City Using HbA1c

Background: Diabetes mellitus is a major cause of morbidity and mortality. In the Arab region, the overall prevalence of DM in the Kingdom of Saudi Arabia is (23.7%) among people with age between 30 and 70 years. The prevalence of diabetes in the United Arab Emirates, Bahrain, and Kuwait were (20.1%), (14.9%) and (12.8%), respectively. Several large clinical trials have demonstrated that tight blood glucose control correlates with a reduction in the microvascular complications of diabetes. The American Diabetes Association (ADA) has designated HbA1c level of ≤ (7%) as a goal of optimal blood glucose control, and the American Association of Clinical Endocrinologist has further recommended HbA1c level of ≤ (6.5%). Despite the evidence from large randomized controlled trials establishing the benefit of intensive diabetes management in reducing microvascular and macrovascular complications, high proportion of patients remain poorly controlled. Poor and inadequate glycemic control among patients with type 2 diabetes constitutes a major public health problem and major risk factor for the development of diabetes complications. Glycemic control remains the major therapeutic objective for prevention of target organ damage and other complications arising from diabetes. Aim of the study: To estimate the proportion of the patients with poor glycemic control and determine factors associated with poor glycemic control among patients with type 2 diabetes in Kirkuk city. Materials and Methods:A cross-sectional study conducted on 500 patients with type 2 DM, were randomly selected who were attended outpatient clinic in Azadi teaching hospital or private clinic over a period of 12month in 2014. A pre-structured questionnaire sought information about sociodemographic, clinical characteristics, self-care management behaviors, medication adherence, and attitude towards diabetes. Weight, and height were measured. Available last readings of hemoglobin A1c(HbA1c), were abstracted from patients' records. Poor glycemic control was defined as HbA1c ˃ (7%). Results:Of the total 500 patients, (74.2%) had HbA1c ˃ (7%). In the multivariate analysis, increased duration of diabetes,increased Body Mass Index(BMI),low education level,hypertension,type of treatment, non-adherence to diabetes self- care management behavior,poor medication adherence, were significantly associated with increased odds of poor glycemic control.(pvalue<0.005). Conclusions and recommendations: Results indicate that duration of diabetes, age, obesity and morbidity are risk factors for poor glycemic control. Patients with these characteristics may need additional therapies and targeted interventions to improve glycemic control. Regular checking of RBS, adherence to treatment, 30 minute exercise and followinghealthy diet are important attitude of patients towards DM for good glycemic control. An educational program that emphasizes lifestyle modification with importance of adherence totreatment regimen, regular exercise and dietary regimen would be of great benefit in glycemic control.

Does inpatient hyperglycemia predict a worse outcome in COVID-19 intensive care unit patients?

BackgroundWe undertook this study to evaluate the association between hyperglycemia and outcomes in patients with coronavirus disease 2019 (COVID‐19) admitted to the intensive care unit (ICU).MethodsWe conducted a multicenter retrospective study involving all adults with COVID‐19 admitted to the ICU between March and May 2020. Patients were divided into normoglycemic (average blood glucose <140 mg/dL) and hyperglycemic (average blood glucose ≥140 mg/dL) groups. Outcomes such as mortality, need and duration of mechanical ventilation, and length of hospital and ICU stays were measured.ResultsAmong 495 patients, 58.4% were male with a median age of 68 years (interquartile range [IQR]: 58.00‐77.00), and baseline average blood glucose was 186.6 (SD ± 130.8). Preexisting diabetes was present in 35.8% of the studied cohort. Combined ICU and hospital mortality rates were 23.8%; mortality and mechanical ventilation rates were significantly higher in the hyperglycemic group with 31.4% vs 16.6% (P = .001) and 50.0% vs 37.2% (P = .004), respectively. Age above 60 years (hazard ratio [HR] 3.21; 95% CI 1.78, 5.78) and hyperglycemia (HR 1.79; 95% CI 1.14, 2.82) were the only significant predictors of in‐hospital mortality. Increased risk for hyperglycemia was found in patients with steroid use (odds ratio [OR] 1.521; 95% CI 1.054, 2.194), triglycerides ≥150 mg/dL (OR 1.62; 95% CI 1.109, 2.379), and African American race (OR 0.79; 95% CI 0.65, 0.95).ConclusionsHyperglycemia in patients with COVID‐19 is significantly associated with a prolonged ICU length of stay, higher need of mechanical ventilation, and increased risk of mortality in the critical care setting. Tighter blood glucose control (≤140 mg/dL) might improve outcomes in COVID‐19 critically ill patients; evidence from ongoing clinical trials is needed.

Comparison of the Effects of Standard and Diabetesspecific Dietary Products on Tight Blood Glucose Control in Critically Ill Patients

Comparison of the Effects of Standard and Diabetesspecific Dietary Products on Tight Blood Glucose Control in Critically Ill Patients

Palliative and End-of-Life Care: Vital Aspects of Holistic Diabetes Care of Older People With Diabetes.

Palliative and end-of-life care and advance care planning are important components of holistic diabetes management, especially for older people with a long duration of diabetes and comorbidities who experience unpleasant symptoms and remediable suffering. Many diabetes clinicians do not have conversations about advance care planning with people with diabetes, often because they are reluctant to discuss these issues and are not familiar with palliative care. This article outlines palliative, terminal, and end-of-life care for older people with type 1 or type 2 diabetes and suggests when to consider changing the focus on tight blood glucose control to a focus on safety and comfort. It proposes strategies to incorporate palliative and end-of-life care into personalized holistic diabetes care, determined with older people with diabetes and their families through shared decision-making.

High-sensitivity C-reactive protein, Malondialdehyde and their association with Glycated hemoglobin (HbA1c)in type 2 diabetes patients

Type 2 diabetes mellitus is a major public health problem worldwide and accompanied by enduring vascular complications, which leads to morbidity and mortality. Inflammation play major role in the pathogenesis of type 2 diabetes mellitus. High sensitivity C-reactive protein is an acute phase protein synthesized by the liver and has been revealed as sensitive, systemic inflammatory marker . Oxidative stress, low grade systemic inflammation contributes to insulin resistance and is linked to the characteristics of metabolic syndrome and type 2 diabetes mellitus. The present study was to evaluate hs - CRP, malondialdehyde (MDA) levels in type 2 diabetic patients compare with healthy controls and correlate these levels with glycated hemoglobin (HbA1C) and insulin resistance Fifty type 2 diabetic patients with age group of 35 to 45 years were selected for this study and 50 age matched healthy subjects were selected as controls. Ser um hs- CRP and insulin was assessed by ELISA, malondialdehyde (MDA) was assessed by Thiobarbituric Acid Reactive Substances (TBARS) method and other routine investigations were carried out by standardized protocols with ERBA EM-360 fully automated analyzer. The mean serum hs - CRP and MDA levels were significantly increa sed in type 2 diabetic patients com pared with healthy controls. Hs-CRP and MDA levels w ere shown significant positive correlation with glyc osylated hemoglobin (HbA1C), insulin resistance, triglycerides and negative correlation with HDL cholesterol. Elevated hs - CRP, MDA levels are potentially important diagnostic markers for the assessment of endothelial dysfunction in type 2 diabetic patients. Tight blood glucose control, regular monitoring of hs-CRP, MDA levels within normal range might be useful for reduction of vascular complications in type 2 diabetic patients.

Glucose Metabolism on Gastrulation: Interference Causes Morphological and Gene Expression Defects in Embryoid Bodies

Tight blood glucose control is important during pregnancy for the conceptus. Studies have found high incidences of severe drops in blood glucose level (hypoglycemia) in pregnant women during the first trimester, the most crucial period to embryo development and when the conceptus is most vulnerable to maternal environment. Here, we utilized aggregated P19C5 mouse embryonal carcinoma stem cells or embryoid bodies (EBs) to investigate changes during gastrulation when glucose metabolism is altered. We used morphometrics and real‐time quantitative reverse transcription polymerase chain reaction (qRT‐PCR) and detected differential shape and gene expression in EBs which glucose metabolism pathways were targeted. We found evidence that glucose metabolism is essential for posterior elongation of the axis. Our results implicate glucose metabolism in germ layer formation by acting on Wnt and Nodal signaling. In the future, we want to elucidate the mechanism glucose metabolism mediates gastrulation and to establish whether our conclusions of the model system are similar to that of other mammalian species.Support or Funding InformationNational Institutes of Health