Meeting the Challenge of Inpatient Glycemic Management in the Non-Critical Care Setting
|
|
- Leo King
- 6 years ago
- Views:
Transcription
1
2 Meeting the Challenge of Inpatient Glycemic Management in the Non-Critical Care Setting Jane Jeffrie Seley, DNP, MPH, GNP, BC-ADM, CDE, CDTC, FAAN, FAADE Diabetes Nurse Practitioner, Inpatient Diabetes Team Division of Endocrinology, Diabetes & Metabolism NewYork-Presbyterian Hospital / Weill Cornell Medicine
3 Goals To review the current guidelines for the management of hyperglycemia in the non-critical care setting To discuss potential strategies to assist clinicians in meeting the current guidelines 3
4 Objectives At the end of this program the participant will be able to: List current glycemic targets in non-critical care Identify and apply the current American Diabetes Association guidelines for when to initiate blood glucose monitoring, A1c testing and insulin therapy in non-critical care setting Discuss strategies for initiating and intensifying subcutaneous insulin therapy Identify key strategies that lower risk of hypoglycemia 4
5 Scope of the Problem In 2002, close to 5 million hospital discharges in the US had diabetes listed as a diagnosis, with an estimated cost of $40 billion (Umpierrez et al, 2002) In 2008, Healthcare Cost and Utilization Project (HCUP) Statistical Brief estimated up to 24% of inpatients have diabetes, with longer length of stays and higher costs (Fraze et al, 2010) 38% of patients in US community hospitals have hyperglycemia and/ or diabetes (Umpierrez et al, 2012) Umpierrez, GE; Hellman, R; Korytkowski, M; Kosiborod, M; Maynard, G; Montori, VM, Seley, JJ; Van den Berghe, G. (2012). Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline. (2012). J Clin Endocrinol Metab 97: Fraze, T., Jiang, H. J., & Burgess, J. (2010). Hospital stays for patients with diabetes, Available at: Umpierrez, G. E., Isaacs, S. D., Bazargan, N., You, X., Thaler, L. M., & Kitabchi, A. E. (2002). Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. The Journal of Clinical Endocrinology & Metabolism, 87(3),
6 Polling Question What percentage of patients in the hospital with hyperglycemia have no history of diabetes? A) 8% B) 12% C) 24% D) 38% 6
7 Scope of the Problem Of the 38% of inpatients with hyperglycemia, 26% have pre-existing diabetes and the remaining 12% have new hyperglycemia Many patients learn that they have diabetes during hospitalization (~6%) This provides an opportunity to identify untreated diabetes and send these patients home on an individualized diabetes self-care regimen Umpierrez, GE; Hellman, R; Korytkowski, M; Kosiborod, M; Maynard, G; Montori, VM, Seley, JJ; Van den Berghe, G. (2012). Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline. (2012). J Clin Endocrinol Metab 97: Fraze, T., Jiang, H. J., & Burgess, J. (2010). Hospital stays for patients with diabetes, Available at: Umpierrez, G. E., Isaacs, S. D., Bazargan, N., You, X., Thaler, L. M., & Kitabchi, A. E. (2002). Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. The Journal of Clinical Endocrinology & Metabolism, 87(3),
8 Polling Question The pre-prandial blood glucose target range in the inpatient setting is the same as in the outpatient setting. A) True B) False 8
9 Glycemic Targets in Non-Critical Care Endocrine Society Guidelines for Management of Hyperglycemia Premeal blood glucose (BG) mg/dl ( mmol/l) Random BG <180 mg/dl (10 mmol/l) Some patients may be maintained with a BG range below and/or above these targets Hypoglycemia = BG <70 mg/dl (3.9 mmol/l) To avoid hypoglycemia, reassess insulin regimen if BG levels fall below 100 mg/dl (5.6 mmol/l) Umpierrez, GE; Hellman, R; Korytkowski, M; Kosiborod, M; Maynard, G; Montori, VM, Seley, JJ; Van den Berghe, G. (2012). Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline. (2012). J Clin Endocrinol Metab 97:
10 ADA Recommendations: Monitoring Obtain A1C for patients with diabetes or hyperglycemia if no result is available for the past 2-3 months Start insulin therapy for persistent hyperglycemia: BG >180 mg/dl (10 mmol/l) Once insulin is initiated, BG target range is mg/dl ( mmol/l) for noncritically ill patients Endocrine Society guidelines recommend mg/dl ( mmol/l) before meals for patients that are eating American Diabetes Association, Diabetes Care 2016 Jan; 39 (Supplement 1): S99-S Umpierrez, GE; Hellman, R; Korytkowski, M; Kosiborod, M; Maynard, G; Montori, VM, Seley, JJ; Van den Berghe, G. (2012). Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline. (2012). J Clin Endocrinol Metab 97:
11 Blood Glucose Monitoring: Strategies that Succeed American Diabetes Association, Diabetes Care 2016 Jan; 39 (Supplement 1): S99-S
12 Avoid Hyperglycemia: Identify High Risk Patients Patients likely to require BG monitoring and insulin therapy during hospital stay: History of diabetes BG >140 mg/dl (7.8 mmol/l) twice in 24 hrs: start BGM BG >180 mg/dl (10 mmol/l) twice in 24 hrs: start insulin Patients taking corticosteroids, enteral & parenteral nutrition American Diabetes Association, Diabetes Care 2016 Jan; 39 (Supplement 1): S99-S
13 Polling Question According to the American Diabetes Association 2016 guidelines, the best diabetes medication regimen for a person with type 2 diabetes in the non-critical care setting is: A) Oral agents and correction insulin B) GLP-1 RA and basal insulin injections C) Nutritional and correction insulin D) Basal, nutritional and correction insulin 13
14 Current Recommendations For Managing Hyperglycemia in Non-Critical Care Anti-hyperglycemic Therapy Subcutaneous Insulin Recommended for most non-critical care patients Oral Agents Not Generally Recommended Umpierrez, GE; Hellman, R; Korytkowski, M; Kosiborod, M; Maynard, G; Montori, VM, Seley, JJ; Van den Berghe, G. (2012). Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline. (2012). J Clin Endocrinol Metab 97:
15 Why Check A1c During Hospital Stay? To diagnose diabetes: in patients with stress hyperglycemia with no history of diabetes For patients with pre-existing diabetes: To identify patients who would benefit from intensive insulin therapy (e.g. need for basal insulin) For discharge planning: To determine which diabetes medications are needed to reach glycemic targets A1c can be auto-ordered in electronic medical record (EMR) if no result within 60 days Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline Umpierrez, G. E., Hellman, R., Korytkowski, M. T., Kosiborod, M., Maynard, G. A., Montori, V. M.,... & Van den Berghe, G. (2012). Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 97(1),
16 ADA Recommendations: Insulin Therapy (JAMA, 2009) Sliding scale insulin in the hospital setting is strongly discouraged An insulin regimen with basal, nutritional and correction components is the preferred treatment for non-critically ill patients American Diabetes Association, Diabetes Care 2016 Jan; 39 (Supplement 1): S99-S Hirsch, I. B. (2009). Sliding scale insulin time to stop sliding. Jama, 301(2), Mendez, C. E., & Umpierrez, G. E. (2014). Pharmacotherapy for hyperglycemia in noncritically ill hospitalized patients. Diabetes Spectrum, 27(3),
17 Insulin Therapy: Strategies that Succeed Hardwiring!!! American Diabetes Association, Diabetes Care 2016 Jan; 39 (Supplement 1): S99-S
18 Structured Insulin Order Sets in EMR NewYork-Presbyterian Hospital (NYPH) insulin aspart-glargine subcutaneous order set cull list (2016) Naina Sinha Gregory, Jane Jeffrie Seley, Linda M. Gerber, Chin Tang & David Brillon (2016): Decreased rates of hypoglycemia following implementation of a comprehensive computerized insulin order set and titration algorithm in the inpatient setting, Hospital Practice /
19 Hardwired Insulin Dosing Guidelines ( mmol/l) ( mmol/l) ( mmol/l) ( mmol/l) ( mmol/l) ( mmol/l) ( mmol/l) (22.2 mmol/l) ( mmol/l) ( mmol/l) ( mmol/l) (22.2 mmol/l) NewYork-Presbyterian Hospital (NYPH) insulin aspart-glargine subcutaneous order sets dosing guidelines (2016) Naina Sinha Gregory, Jane Jeffrie Seley, Linda M. Gerber, Chin Tang & David Brillon (2016): Decreased rates of hypoglycemia following implementation of a comprehensive computerized insulin order set and titration algorithm in the inpatient setting, Hospital Practice /
20 Adjusting Insulin Dose Based on Current BG Which Insulin Needs Adjustment: If AM fasting BG is too high or low: If pre-lunch, pre-dinner or bedtime BG is too high or low: Adjust Basal Adjust Bolus How to Adjust: If BG is less than 50 mg/dl (2.8 mmol/l): If BG is less than 70 mg/dl (3.9 mmol/l): Deduct 50% Deduct 20% If BG is mg/dl ( mmol/l): Deduct 10% If BG is mg/dl ( mmol/l): If BG is >250 mg/dl (13.9 mmol/l): Add 10% Add 20% NewYork-Presbyterian Hospital- Weill Cornell Campuses: Insulin Titration Algorithm Naina Sinha Gregory, Jane Jeffrie Seley, Linda M. Gerber, Chin Tang & David Brillon (2016): Decreased rates of hypoglycemia following implementation of a comprehensive computerized insulin order set and titration algorithm in the inpatient setting, Hospital Practice. 20
21 Registered Nurse Insulin Administration Holding insulin or reducing the dose without an order is a medication error Teach RNs to discuss any concerns about safety and/or efficacy of an insulin dose with the prescriber A new order must be written to hold or change the dose 21
22 ADA Recommendations: Hypoglycemia A hypoglycemia management protocol should be implemented by each hospital A plan for preventing and treating hypoglycemia should be established for each patient. American Diabetes Association, Diabetes Care 2016 Jan; 39 (Supplement 1): S99-S
23 ADA Recommendations: Hypoglycemia Prevention Episodes of hypoglycemia should be documented in the EMR including treatment given and outcome The treatment regimen should be reviewed and modified if needed to prevent further hypoglycemia American Diabetes Association, Diabetes Care 2016 Jan; 39 (Supplement 1): S99-S Society of Hospital Medicine. Maynard, G., Berg, K., Kulasa, K., O'Malley, C., Rogers, K. M. (Eds.) The Glycemic Control Implementation Guide: Improving Glycemic Control, Preventing Hypoglycemia and Optimizing Care of the Inpatient with Hyperglycemia and Diabetes. Society of Hospital Medicine Website, Glycemic Control Quality Improvement Implementation Toolkit available at 23
24 Hypoglycemia Prevention Strategies that Succeed Protocol should delineate specific steps for when and how to treat hypoglycemia Specify approved treatments e.g. 15 gm tube glucose gel, 4 oz juice Written nursing policy should state when to check pre-prandial BG and give insulin in relation to meal Review timing of BG re-checks post hypo events and monitor recurrence rates, educate staff if needed 24
25 Controlled Carbohydrate Meal Plan Facilitates Matching the Insulin Dose to the Meal Ryan, D., Swift, C.. The mealtime challenge: Nutrition and glycemic control in the hospital. Diabetes Spectrum; 27: , Menu should include grams of carb to assist in insulin dosing & substitutions 25
26 ADA Recommendations: Transitional Care from Hospital to Home There should be a structured discharge plan tailored to the individual patient. American Diabetes Association, Diabetes Care 2016 Jan; 39 (Supplement 1): S99-S
27 Transitional Care: Strategies that Succeed American Diabetes Association, Diabetes Care 2016 Jan; 39 (Supplement 1): S99-S
28 Preventing Readmissions: Who s at high risk? Lower socio-economic status, minorities, multiple comorbidities, public insurance, recent and/or urgent hospitalization Readmission rates for patients with diabetes is % compared to % without diabetes Strategies known to reduce readmission: Diabetes self-management education, individualized diabetes specific discharge instructions, care coordination in and beyond hospitalization and specialty care Rubin, D. J. (2015). Hospital readmission of patients with diabetes. Current diabetes reports, 15(4),
29 Inpatient Survival Skills Education TOPICS Type 1 vs. type 2 diabetes How type of diabetes relates to current treatment Blood glucose monitoring skills, pre/post meal targets How and when to take diabetes medications, basics of how each medication works Basic meal planning: identifying foods that contain carbohydrates, appropriate portions, number of servings/meal Detecting, treating and preventing hypoglycemia and hyperglycemia, when and who to call Sick day management, when and who to call Follow up plan including who will review blood glucose records, make diabetes medication adjustments and continue education Umpierrez GE, Hellman R et al (2012). Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. Endocrine Society. J Clin Endocrinol Metab. Jan;97(1):
30 Diabetes Education Resources Teaching Checklist Practice Pens Handouts in Multiple Languages Take Home Meters Healy S.J., Black D., Harris C., Lorenz A., Dungan K.M.. Inpatient diabetes education is associated with less frequent hospital readmission among patients with poor glycemic control. Diabetes Care. 36; ,
31 Transitioning Medications from Hospital to Home A1c < 7% A1c 7-9% A1c > 9% Return to home regimen, if not contraindicated Restart home regimen if not contraindicated, start/keep basal at % of inpatient dose Best option: Basal insulin at % of current dose and bolus insulin with meals at fixed or calculated dose Other options: Basal Plus (basal once daily + bolus at largest meal) Pre-mixed insulin before breakfast & dinner Basal insulin once daily + repaglinide with meals Basal insulin daily and GLP-1 daily or weekly to cover prandial needs Adapted with permission from algorithm by Umpierrez, G. Diabetes Care 2014 Adapted with permission from algorithm by Umpierrez, G, Diabetes Care
32 Summary High risk patients should be started on blood glucose monitoring to evaluate need for insulin therapy An A1c should be obtained early in the admission if there is no result in the past 2-3 months to guide therapy in and out of the hospital To avoid hypoglycemia, reassess insulin regimen if BG levels fall below 100 mg/dl (5.6 mmol/l) Basal, prandial and correction insulin is the treatment of choice in the non-critical care setting Diabetes self-management education is a key strategy to prevent readmissions. Education should begin as soon as a learning need is identified to allow for ample time for practice. An individualized follow up plan should identify who will be reviewing blood glucose records, adjusting diabetes medication and continuing self-management education post discharge 32
33 For more information visit Become a member and opt in to be notified about our new programs, publications and more! The Johnson & Johnson Diabetes Institute is now on Twitter! Follow to receive timely and important updates about diabetes!
34
Inpatient Glycemic Management:
Disclosure to Participants Conflict of Interest (COI) and Financial Relationship Disclosures: Dr. Seley attended Advisory Board Meeting: Alliance (Boehringer-Ingelheim/Lilly) Bayer Diabetes Care Sanofi
More informationTopics in Inpatient Glycemic Control
Topics in Inpatient Glycemic Control Jane Jeffrie Seley DNP MPH MSN GNP BC-ADM CDE CDTC FAADE FAAN Diabetes Nurse Practitioner Program Manager, Inpatient Glycemic Control Program NewYork-Presbyterian/
More informationImplementing Hospital Policies & Protocols
Implementing Hospital Policies & Protocols Jane Jeffrie Seley DNP MPH GNP BC-ADM CDE CDTC FAADE FAAN Division of Endocrinology, Diabetes & Metabolism NewYork-Presbyterian Hospital Weill Cornell Medicine
More informationTransforming Diabetes Care
Transforming Diabetes Care Meeting the Challenge of Inpatient Glycemic Management in the Critical Care Setting Jane Jeffrie Seley, DNP, MSN, MPH, GNP, BC-ADM, CDE, CDTC, FAAN, FAADE Diabetes Nurse Practitioner,
More informationTransition of Care in Hospitalized Patients with Hyperglycemia and Diabetes
Transition of Care in Hospitalized Patients with Hyperglycemia and Diabetes Critically ill patients in the ICU Hospital Non-ICU Settings Home Guillermo E Umpierrez, MD, FACP, FACE Professor of Medicine
More informationHAP PA-HEN Achieving More Together
HAP PA-HEN Achieving More Together Managing Hyperglycemia in the Hospital: Strategies for Safe and Effective Care Pennsylvania Patient Safety Authority Managing Hyperglycemia in the Hospital: Strategies
More informationGetting Off the Merry-Go-Round Reducing Readmissions for Patients with Diabetes
Getting Off the Merry-Go-Round Reducing Readmissions for Patients with Diabetes Kristi Kulasa, MD Associate Clinical Professor of Medicine Director, Inpatient Glycemic Control University of California
More informationManaging Diabetes and Hyperglycemia Safely in the Complex Hospital Setting
Managing Diabetes and Hyperglycemia Safely in the Complex Hospital Setting Greg Maynard MD, MSc Clinical Professor of Medicine and CQO, UC Davis Medical Center Sacramento, CA Greg Maynard Disclosure SHM
More informationAPPENDIX American Diabetes Association. Published online at
APPENDIX 1 INPATIENT MANAGEMENT OF TYPE 2 DIABETES No algorithm applies to all patients with diabetes. These guidelines apply to patients with type 2 diabetes who are not on glucocorticoids, have no
More informationManagement of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting:
T h e E n d o c r i n e S o c i e t y s Clinical Guidelines Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline Authors:
More informationSociety of Hospital Medicine. to Jumpstart Hospitals
Using Society of Hospital Medicine (SHM) Mentors to Jumpstart Hospitals to Improve Glycemic Control Society of Hospital Medicine Edited by: Pedro Ramos, MD, FHM Jane Jeffrie Seley, DNP, MPH, BC-ADM, CDE,
More informationImproving Glycemic Control and Insulin Ordering Efficiency for Hospitalized Patients With Diabetes Through Carbohydrate Counting
e1 Improving Glycemic Control and Insulin Ordering Efficiency for Hospitalized Patients With Diabetes Through Carbohydrate Counting Kristina K. Pearson, Sarah A. Reiland, John G. O Meara, Julie K. Brown,
More informationA Children s Bedtime Story
A Children s Bedtime Story Setting: University Medical Center, Big Town, USA Scenario: 0500, last admission of the night, 10 previous admissions, all tucked in for the night Patient: 75 year old male with
More informationIn - Hospital Diabetes Care. A review and personal experience
In - Hospital Diabetes Care A review and personal experience Hyperglycemia in the Hospital The Problem Hospitalizations with Diabetes http://www.cdc.gov/diabetes/statistics/dmany/fig1.htm Prevalence of
More information5/15/2018 DISCLOSURE OBJECTIVES. FLORIDA HOSPITAL ORLANDO Not for profit organization Acute care medical center 1,368 licensed beds BACKGROUND
DISCLOSURE PHARMACIST DIRECTED MANAGEMENT OF GLUCOCORTICOID INDUCED HYPERGLYCEMIA AT A LARGE COMMUNITY HOSPITAL Jill Zaccardelli, PharmD PGY1 Pharmacy Resident Florida Hospital Orlando Jill.Zaccardelli@flhosp.org
More information123 Are You Providing Evidence-Based Diabetes Care? - Martin
Donna Martin, DNP, RN, CDE, CMSRN Lewis University Learner will be able to: Identify current inpatient standards of care for patients with diabetes Describe causes of hyperglycemia / hypoglycemia in the
More informationWelcome Everyone. Monitoring, Sick Days, Inpatient Management - Objectives. Mrs. Jones has new diabetes. She asks you: Page 1
Welcome Everyone Sign-In Enjoy Breakfast Meet someone new Enter Raffle Pick a team name Please silence phones We start at 8:00am Monitoring, Sick Days, Inpatient Management - Objectives Objectives: Strategies
More informationINSULIN IN THE OBESE PATIENT JACQUELINE THOMPSON RN, MAS, CDE SYSTEM DIRECTOR, DIABETES SERVICE LINE SHARP HEALTHCARE
INSULIN IN THE OBESE PATIENT JACQUELINE THOMPSON RN, MAS, CDE SYSTEM DIRECTOR, DIABETES SERVICE LINE SHARP HEALTHCARE OBJECTIVES DESCRIBE INSULIN, INCLUDING WHERE IT COMES FROM AND WHAT IT DOES STATE THAT
More informationSection of Endocrinology, Rush University Medical Center, Chicago, Illinois.
ORIGINAL RESEARCH Treatment of Inpatient Hyperglycemia Beginning in the Emergency Department: A Randomized Trial Using Insulins Aspart and Detemir Compared With Usual Care Jennifer B. Bernard, MD Christina
More informationStroke Hyperglycemia Insulin Network Effort (SHINE) Trial Treatment Protocols. Askiel Bruno, MD, MS Protocol PI
Stroke Hyperglycemia Insulin Network Effort (SHINE) Trial Treatment Protocols Askiel Bruno, MD, MS Protocol PI SHINE Synopsis Acute ischemic stroke
More informationStarting and Helping People with Type 2 Diabetes on Insulin
Starting and Helping People with Type 2 Diabetes on Insulin Elaine Cooke, BSc(Pharm), RPh, CDE Pharmacist and Certified Diabetes Educator Maple Ridge, BC Objectives After attending this session, participants
More informationInpatient Diabetes Management: The Slippery Slope of Sliding Scale Insulin
Inpatient Diabetes Management: The Slippery Slope of Sliding Scale Insulin David Newman, MD University of North Dakota School of Medicine Sanford Health Big Sky Conference 2017 Dr. David Newman, Personal/Professional
More informationInpatient Management of Hyperglycemia Guillermo Umpierrez, MD, CDE Saturday, February 10, :30 a.m. 11:15 a.m.
Inpatient Management of Hyperglycemia Guillermo Umpierrez, MD, CDE Saturday, February 10, 2018 10:30 a.m. 11:15 a.m. There are over 7.5 million hospital admissions for patients with diabetes in the US.
More informationParticipants in the Program
Type 2 Diabetes Performance Improvement Initiative: Chart Reviews Participants in the Program 318 clinicians have registered 192 have started the program 126 have started their initial chart review 26
More informationBasal Bolus Insulin Therapy Frequently Asked Questions
1. What is Basal Bolus Insulin Therapy (BBIT)? 2. What evidence supports the use of subcutaneous Basal Bolus Insulin Therapy? 3. Does Basal Bolus Insulin Therapy apply to all patients? 4. What s wrong
More informationHYPERGLYCEMIA MANAGEMENT PROTOCOL A BASAL/BOLUS REGIMEN. Kacy Aderhold, MSN, APRN-CNS, CMSRN
HYPERGLYCEMIA MANAGEMENT PROTOCOL A BASAL/BOLUS REGIMEN Kacy Aderhold, MSN, APRN-CNS, CMSRN Hyperglycemia Management Protocol Mimics the body s normal pancreas function, releasing a slow steady amount
More informationDiabetes Survival Skills
Promoting Patient Survival with Diabetes Survival Skills Need to know skills for persons with diabetes Susan Zontine, NP-C WMC Diabetes Stewardship team Objectives: Review & understand basic diabetes survival
More information4/10/2015. Foundations to Managing Inpatient Hyperglycemia. Learning Objectives
Foundations to Managing Inpatient Hyperglycemia Module A 1 Learning Objectives Develop strategies to identify patients with hyperglycemia or diabetes in the inpatient setting Establish glycemic goals to
More informationDeepika Reddy MD Department of Endocrinology
Deepika Reddy MD Department of Endocrinology Management of hyperglycemic crisis Review need for inpatient glycemic control Brief overview of relevant trials Case based review of diabetes management strategies/review
More informationΑναγκαιότητα και τρόπος ρύθμισης του διαβήτη στους νοσηλευόμενους ασθενείς
Αναγκαιότητα και τρόπος ρύθμισης του διαβήτη στους νοσηλευόμενους ασθενείς Αναστασία Θανοπούλου Επίκουρη Καθηγήτρια Β Παθολογικής Κλινικής Πανεπιστημίου Αθηνών Διαβητολογικό Κέντρο, Ιπποκράτειο Νοσοκομείο
More information9/16/2013. No Conflict of Interest to Disclose
Catie Prinzing MSN, APRN, Clinical Nurse Specialist September 27, 2013 No Conflict of Interest to Disclose List key concepts to determining patient insulin doses during transitions in care Identify 5 points
More informationGlycemic Control IU Health Diabetes Centers
Glycemic Control IU Health Diabetes Centers Central Nursing Orientation 3/10/2014 1 Objectives Identify laboratory results that diagnosis diabetes and reflect glycemic control Describe glycemic control
More informationInpatient Management of Hyperglycemia Guillermo Umpierrez, MD, CDE Saturday, February 10, :30 a.m. 11:15 a.m.
Inpatient Management of Hyperglycemia Guillermo Umpierrez, MD, CDE Saturday, February 1, 218 1:3 a.m. 11:15 a.m. There are over 7.5 million hospital admissions for patients with diabetes in the US. About
More informationHow to manage type 2 diabetes in medical and surgical patients in the hospital
MEDICAL GRAND ROUNDS CME CREDIT EDUCATIONAL OBJECTIVE: Readers will learn the relationship between glycemic control and clinical outcomes in hospitalized medical and surgical patients who are not in an
More informationImproving Inpatient Glycemic Control: Expert Insights CME
Improving Inpatient Glycemic Control: Expert Insights CME Annabelle Rodriguez, MD Guillermo Umpierrez, MD Jane Jeffrie Seley, DNP, MSN, MPH, BC-ADM, CDE Supported by an educational grant from Eli Lilly
More informationNOT-SO-SWEET! THE STRAIGHT SCOOP ON DIABETES IN THE HOSPITAL SETTING
Sharp HealthCare s 2016 Diabetes Conference November 11, 2016 NOT-SO-SWEET! THE STRAIGHT SCOOP ON DIABETES IN THE HOSPITAL SETTING Tamara Swigert, MSN, RN, CDE Speaker Disclosure Tammy Swigert has no conflicts
More informationANNUAL MEETING 2 #FSHP2017
FSHP Disclosure Strategies for Glycemic Management in the Inpatient Setting: Guidelines vs. Reality Melissa Marshall, PharmD, BCPS Jeffrey Ruff, PharmD We do not have (nor does any immediate family member
More informationSelf-Monitoring Blood Glucose (SMBG) Frequency & Pattern Tool
Self-Monitoring Blood Glucose () Pattern Recommendation: Basal Insulin Only (To Target) NPH or long-acting analogue, typically given at. at least as often as is being given. Optional, less frequent can
More informationBlood Glucose Monitoring Clinical Applications
Blood Glucose Monitoring Clinical Applications Jane Jeffrie Seley DNP MSN MPH GNP BC- ADM CDE CDTC CEDT Diabetes Nurse Prac44oner New York Presbyterian Hospital Weill Cornell Medical College New York,
More informationDiabetes Survival Skills
Promoting Patient Survival with Diabetes Survival Skills Need to know skills for persons with diabetes Susan Zontine, NP-C WMC Diabetes Stewardship team May 18, 2015 Diabetes Chronic illness with serious
More informationImportant Stuff. Basal Bolus What Adjustments? Pt weighs 80kg
Diabetes Boot Camp Class 4 Beverly Dyck Thomassian, RN, MPH, BC ADM, CDE President, Diabetes Education Services Special Insulin and Pattern Management Diabetes Education Services 1998-2015. All rights
More informationPoll Question 2. Special Boot Camp Workshop Beverly Dyck Thomassian, RN, MPH, BC ADM, CDE President, Diabetes Education Services.
Special Boot Camp Workshop Beverly Dyck Thomassian, RN, MPH, BC ADM, CDE President, Diabetes Education Services Poll Question 1 Mary takes 6 units lispro (Humalog) before dinner. Which BG result reflects
More informationGuide to Starting and Adjusting Insulin for Type 2 Diabetes*
Guide to Starting and Adjusting Insulin for Type 2 Diabetes* www.cadth.ca * Adapted from Guide to Starting and Adjusting Insulin for Type 2 Diabetes, 2008 International Diabetes Center, Minneapolis, MN.
More informationLIBERTYHEALTH. Jersey City Medical Center Department of Patient Care Services. Approved by Policy Committee:
LIBERTYHEALTH Jersey City Medical Center Department of Patient Care Services Guidelines: CRITICAL CARE INSULIN PROTOCOL (MICU/SICU, CCU, ED) Developed by: Pharmacy Dept Approved by: Rita Smith, DNP Senior
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationSHINE Study PowerChart Order Set CONTROL
SHINE Study PowerChart Order Set CONTROL Orders Patient Care Component Blood Glucose Details Hypoglycemia: For BG
More informationTimely!Insulinization In!Type!2! Diabetes,!When!and!How
Timely!Insulinization In!Type!2! Diabetes,!When!and!How, FACP, FACE, CDE Professor of Internal Medicine UT Southwestern Medical Center Dallas, Texas Current Control and Targets 1 Treatment Guidelines for
More informationInpatient and perioperative management of hyperglycemia
Inpatient and perioperative management of hyperglycemia Department of Internal Medicine Grand Rounds July 7, 2017 Luigi Meneghini discloses that he has served on advisory boards and as consultant for both
More informationGlycemic Control Insulin In The Hospital Setting
Glycemic Control Insulin In The Hospital Setting Glycemic Control The Evidence For Insulin s s Benefit The Mechanism of Insulin s s Benefit The Achievement of Insulin s s Benefit A Few Cases Hyperglycemia
More informationUpdate on New Basal Insulins and Combinations: Starting, Titrating and Adding to Therapy
Update on New Basal Insulins and Combinations: Starting, Titrating and Adding to Therapy Jerry Meece, BPharm, CDE, FACA, FAADE Director of Clinical Services Plaza Pharmacy and Wellness Center Gainesville,
More informationIS THERE A "JULY EFFECT" FOR INPATIENT GLYCEMIC CONTROL?
ENDOCRINE PRACTICE Rapid Electronic Article in Press Rapid Electronic Articles in Press are preprinted manuscripts that have been reviewed and accepted for publication, but have yet to be edited, typeset
More informationEvidence for Basal Bolus Insulin Versus Slide Scale Insulin
Curr Emerg Hosp Med Rep (2014) 2:26 34 DOI 10.1007/s40138-013-0032-4 DIABETES AND METABOLIC DISEASE (W FORD, SECTION EDITOR) Evidence for Basal Bolus Insulin Versus Slide Scale Insulin Sameer Badlani William
More informationSixth International Hospital Diabetes Meeting
Sixth International Hospital Diabetes Meeting May 19-20, 2017 Georgia Tech Hotel & Conference Center, Atlanta, Georgia Friday May 19, 2017 08:00 Welcome David C. Klonoff, MD, FACP, FRCP (Edin), Fellow
More informationManagement of Inpatient Hyperglycemia: 2011 Endocrine Society Meeting Hyperglycemia in Critically ill patients in ICU Settings.
Management of Inpatient Hyperglycemia: 2011 Endocrine Society Meeting Guillermo E. Umpierrez, MD, Emory University School of Medicine and Jack Leahy, MD, University of Connecticut Hyperglycemia in Critically
More informationAgenda. Indications Different insulin preparations Insulin initiation Insulin intensification
Insulin Therapy F. Hosseinpanah Obesity Research Center Research Institute for Endocrine sciences Shahid Beheshti University of Medical Sciences November 11, 2017 Agenda Indications Different insulin preparations
More informationprolonged hospital stay, infections, and disability after hospital discharge, and death (1 3). Several clinical trials in
Clinical Care/Education/Nutrition/Psychosocial Research O R I G I N A L A R T I C L E Randomized Study Comparing a Basal Bolus With a Basal Plus Correction Insulin Regimen for the Hospital Management of
More informationReviewing Diabetes Guidelines. Newsletter compiled by Danny Jaek, Pharm.D. Candidate
Reviewing Diabetes Guidelines Newsletter compiled by Danny Jaek, Pharm.D. Candidate AL AS KA N AT IV E DI AB ET ES TE A M Volume 6, Issue 1 Spring 2011 Dia bet es Dis pat ch There are nearly 24 million
More informationType 2 Diabetes Mellitus Insulin Therapy 2012
Type 2 Diabetes Mellitus Therapy 2012 Michael T. McDermott MD Director, Endocrinology and Diabetes Practice University of Colorado Hospital Michael.mcdermott@ucdenver.edu Preparations Onset Peak Duration
More informationJulie White, MS Administrative Director Boston University School of Medicine Continuing Medical Education
MENTOR QI Diabetes Performance Improvement Initiative, Getting Patients to Goal in Glycemic Control: Current Data Julie White, MS Administrative Director Boston University School of Medicine Continuing
More information4/16/2018. Flexible Intensive Insulin Therapy (FIIT) in People with Type 2 Diabetes: A Viable Option. Disclosures. Outline. No financial disclosures
Flexible Intensive Insulin Therapy (FIIT) in People with Type Diabetes: A Viable Option Kim Bisanz, MFCS, RDN, LDN, CDE Minnesota Academy of Nutrition & Dietetics Annual Meeting April 19, 18 18 MFMER slide-1
More informationFine-tuning of The Dose of Insulin Pump
Fine-tuning of The Dose of Insulin Pump The manual does not guarantee specific individual or specific applicability of the environment, there is no express or implied warranties. Contents of this manual
More informationInpatient Glycemic Management: How We Get Others To Follow Our Lead
Robert J. Rushakoff, MD Medical Director, Inpatient Diabetes Professor of Medicine Division of Endocrinology and Metabolism University of California, San Francisco San Francisco, CA 94115 robert.rushakoff@ucsf.edu
More informationManaging Diabetes and Hyperglycemia Safely in the Complex Hospital Setting
Managing Diabetes and Hyperglycemia Safely in the Complex Hospital Setting Greg Maynard MD, MSc Clinical Professor of Medicine and CQO, UC Davis Medical Center Sacramento, CA Greg Maynard Disclosure SHM
More informationLOW SUGAR: CAUSES, COMPLICATIONS AND MANAGEMENT OF HYPOGLYCEMIA
LOW SUGAR: CAUSES, COMPLICATIONS AND MANAGEMENT OF HYPOGLYCEMIA Anne Leake, PhD, APRN-Rx, BC-ADM ECHO Diabetes Learning Group 3/28/2018 Objectives 1. Identify common preventable causes of hypoglycemia
More informationPharmacy Plan Guidance
Pharmacy Plan Guidance The pharmacy plan is a tool used during the site readiness process to develop and document the site-specific procedures for study drug ordering, labeling and dispensing for the SHINE
More informationBeyond Basal Insulin: Intensification of Therapy Jennifer D Souza, PharmD, CDE, BC-ADM
Beyond Basal Insulin: Intensification of Therapy Jennifer D Souza, PharmD, CDE, BC-ADM Disclosures Jennifer D Souza has no conflicts of interest to disclose. 2 When Basal Insulin Is Not Enough Learning
More informationHow to BBIT An Educational Resource for Prescribers AHS Adult Subcutaneous Basal Bolus Insulin Therapy (BBIT)
How to BBIT An Educational Resource for Prescribers AHS Adult Subcutaneous Basal Bolus Insulin Therapy (BBIT) The Basics, New Concepts and Practical Pearls for Basal Bolus Insulin Therapy February 2018
More informationLearning Objectives. Impact of Diabetes II UPDATES IN TYPE 2 DIABETES. David Doriguzzi, PA-C
UPDATES IN TYPE 2 DIABETES David Doriguzzi, PA-C Learning Objectives Upon completion of this educational activity, the participant should be able to: Overcome barriers and attitudes that limit Clinician/Patient
More informationKacy Aderhold, MSN, APRN-CNS, CMSRN
Kacy Aderhold, MSN, APRN-CNS, CMSRN Promote and support healthy eating patterns Attain individualized glycemic, blood pressure, and lipid goals Achieve and maintain body weight goals Delay or prevent complications
More informationApplication of the Diabetes Algorithm to a Patient
Application of the Diabetes Algorithm to a Patient Apply knowledge gained from this activity to improve disease management and outcomes for patients with T2DM and obesity Note: The cases in this deck represent
More informationInitiation and Titration of Insulin in Diabetes Mellitus Type 2
Initiation and Titration of Insulin in Diabetes Mellitus Type 2 Greg Doelle MD, MS April 6, 2016 Disclosure I have no actual or potential conflicts of interest in relation to the content of this lecture.
More informationReport Reference Guide
Report Reference Guide How to use this guide Each type of CareLink report and its components are described in the following sections. Report data used to generate the sample reports was from sample patient
More informationInpatient Management of Diabetes Mellitus. Jessica Garza, Pharm.D. PGY-1 Pharmacotherapy Resident TTUHSC School of Pharmacy
Inpatient Management of Diabetes Mellitus Jessica Garza, Pharm.D. PGY-1 Pharmacotherapy Resident TTUHSC School of Pharmacy 2 Disclosure Jessica Garza does not have any actual or potential conflicts of
More informationSafety and Efficacy of Continuous Insulin Infusion in Noncritical Care Settings
ORIGINAL RESEARCH Safety and Efficacy of Continuous Insulin Infusion in Noncritical Care Settings Dawn Smiley, MD 1 Mary Rhee, MD 1 Limin Peng, PhD 2 Laurian Roediger, BS 1 Patrick Mulligan, BS 1 Lewis
More informationDiabetes Update: Intensifying Insulin Therapy Nuts, Bolts and Other Items
Diabetes Update: Intensifying Insulin Therapy Nuts, Bolts and Other Items Hayley A. Miller, MD Physician, Internal Medicine, Diabetes and Metabolism, Sandy Clinic, Intermountain Healthcare Objectives:
More informationIn-hospital management of diabetes
Dr. Tom Elliott MBBS, FRCPC Medical Director 400-210 W Broadway phone: 604.683.3734 Vancouver, BC fax: 604.628.3821 V5Y 3W2 Canada email: moa@bcdiabetes.ca In-hospital management of diabetes General Management
More informationOptimizing Care of the Inpatient with Hyperglycemia and Diabetes: Case Studies in Action
Optimizing Care of the Inpatient with Hyperglycemia and Diabetes: Case Studies in Action Learning Objectives Identify patient situations where specific attention to glycemic control is warranted Determine
More information9/23/09. What are the key components of preoperative, intraoperative, & postoperative care of diabetes management? Rebecca L. Sturges, M.D.
RMHS Perioperative Summit: Perioperative Diabetes Management Rebecca L. Sturges, M.D. Oct 6, 2009 Mrs. B was referred by her orthopedic surgeon to your preoperative clinic to discuss medical management
More informationIn-Hospital Management of Diabetes
In-Hospital Management of Diabetes Clinical order sets guidelines.diabetes.ca diabetes.ca 1-800-BANTING (226-8464) Table of Contents Key elements from the Canadian Diabetes Association 2013 Clinical Practice
More informationInsulin Initiation and Intensification. Disclosure. Objectives
Insulin Initiation and Intensification Neil Skolnik, M.D. Associate Director Family Medicine Residency Program Abington Memorial Hospital Professor of Family and Community Medicine Temple University School
More informationParenteral Nutrition The Sweet and Sour Truth. From: Division of Endocrinology, Diabetes and Bone Disease Icahn School of Medicine at Mount Sinai
ENDOCRINE PRACTICE Rapid Electronic Article in Press Rapid Electronic Articles in Press are preprinted manuscripts that have been reviewed and accepted for publication, but have yet to be edited, typeset
More informationHypoglycemia Prevention and Management - Measurement that Matters and the Power of Collaboration
Hypoglycemia Prevention and Management - Measurement that Matters and the Power of Collaboration Greg Maynard M.D., Clinical Professor of Medicine Director, UCSD Center for Innovation and Improvement Science
More informationDiabetes Technology Continuous Subcutaneous Insulin Infusion Therapy And Continuous Glucose Monitoring In Adults: An Endocrine Society Clinical
Diabetes Technology Continuous Subcutaneous Insulin Infusion Therapy And Continuous Glucose Monitoring In Adults: An Endocrine Society Clinical Practice Guideline Task Force Members Anne Peters, MD (Chair)
More informationBrigham and Women s Hospital Type 2 Diabetes Management Program Physician Pharmacist Collaborative Drug Therapy Management Protocol
Brigham and Women s Hospital Type 2 Diabetes Management Program Physician Pharmacist Collaborative Drug Therapy Management Protocol *Please note that this guideline may not be appropriate for all patients
More informationGlucose Management in the ICU: The Role of the Pharmacist
Objectives Glucose Management in the ICU: The Role of the Pharmacist James Gilmore PharmD, BCPS Senior Pharmacist- Surgical Intensive Care Unit Brigham and Women s Hospital Boston, MA Evaluate primary
More informationImproving Glycemic Control in the Critical Care
Improving Glycemic Control in the Critical Care Setting /Hospitalists Outline Review current guidelines Review current glycemic targets DKA Treatment Building a perfect glycemic control protocol Transition
More informationDiabetes Care and Education Dietetic Practice Group (DCE DPG) members
Memorandum TO: FROM: Diabetes Care and Education Dietetic Practice Group (DCE DPG) members Patti Urbanski, MEd, RD, LD, CDE DCE Chair 2008-2009 Gretchen Benson, RD, LD, CDE DCE Publications Committee Chair
More informationStroke Hyperglycemia Insulin Network Effort (SHINE) Trial
Stroke Hyperglycemia Insulin Network Effort (SHINE) Trial Treatment Protocols Askiel Bruno, MD, MS Protocol PI Agenda General protocol for control group/ intervention group Discussion of meals Hypoglycemia
More informationImplementing Glucose Control in 2009 and Beyond: Changes in Patterns and Perceptions
Implementing Glucose Control in 2009 and Beyond: Changes in Patterns and Perceptions Charles C. Reed MSN, RN, CNRN Patient Care Coordinator Surgical Trauma ICU University Hospital San Antonio, Texas Relationships
More informationLessons Learned: Interdisciplinary collaboration to reduce hypoglycemic events
Lessons Learned: Interdisciplinary collaboration to reduce hypoglycemic events Ryan ull, Pharm.., BCPS ssistant Professor of Pharmacy Practice Creighton niversity School of Pharmacy legent Health Lakeside
More informationKathleen Dunn, RN CDE Jason Pelzek, RN CDE Ksenia Tonyushkina, MD Baystate Pediatric Endocrinology June, 2018
Kathleen Dunn, RN CDE Jason Pelzek, RN CDE Ksenia Tonyushkina, MD Baystate Pediatric Endocrinology June, 2018 Ksenia Tonyushkina, MD 1 Objectives What does it mean to live with T1DM? Why exercise is important?
More informationDiabetes and Kids- Keeping them Safe at School. Presented by Vanessa Skolness, DNP, APRN-CNP, CDE March 30 th, Diabetes Summit
Diabetes and Kids- Keeping them Safe at School Presented by Vanessa Skolness, DNP, APRN-CNP, CDE March 30 th, 2017- Diabetes Summit Objectives Brief review of type 1 and type 2 diabetes in children Discuss
More informationLive life, less complicated. InPen MOBILE APP. Healthcare Provider INSTRUCTIONS FOR USE. CompanionMedical.com
InPen MOBILE APP Healthcare Provider INSTRUCTIONS FOR USE TABLE OF CONTENTS Introduction...3 InPen Mobile App...3 Intended Use...3 Indications for Use...3 Contraindications...3 Start Orders...4 General
More informationnocturnal hypoglycemia percentage of Hispanics in the insulin glargine than NPH during forced patients who previously This study excluded
Clinical Trial Design/ Primary Objective Insulin glargine Treat-to-Target Trial, Riddle et al., 2003 (23) AT.LANTUS trial, Davies et al., 2005 (24) INSIGHT trial, Gerstein et al., 2006 (25) multicenter,
More informationLearning Objectives. Perioperative SWEET Success
Perioperative SWEET Success PERIOPERATIVE SWEET SUCCESS PRESENTED BY: KENDRA MARTIN, RN, BSN, CDE JENNIFER SIMPSON, RN, BC-ADM, MSN, CNS Disclosure to Participants Notice of Requirements For Successful
More informationIn Hospital Management of Diabetes Mellitus
C H A P T E R 46 In Hospital Management of Diabetes Mellitus Jothydev Kesavadev INTRODUCTION Diabetes and its complications are a major cause of hospitalizations. Number of diabetes related deaths in India
More informationTHERAPY MANAGEMENT SOFTWARE FOR DIABETES
THERAPY MANAGEMENT SOFTWARE FOR DIABETES Report Report Interpretation Reference Guide Guide 2009 Medtronic MiniMed. All rights reserved. 6025274-012_a CareLink Pro Report Reference Guide 0 p.2 Adherence
More informationStroke Hyperglycemia Insulin Network Effort (SHINE) Trial Treatment Protocols Special Situations. Askiel Bruno, MD, MS Protocol PI
Stroke Hyperglycemia Insulin Network Effort (SHINE) Trial Treatment Protocols Special Situations Askiel Bruno, MD, MS Protocol PI Hypoglycemia Protocol General Concepts The hypoglycemia prevention protocol
More informationStandards of Care in Diabetes What's New? Veronica Brady, FNP-BC, PhD, BC-ADM,CDE Karmella Thomas, RD, LD,CDE
Standards of Care in Diabetes 2016-- What's New? Veronica Brady, FNP-BC, PhD, BC-ADM,CDE Karmella Thomas, RD, LD,CDE Terminology No longer using the term diabetic. Diabetes does not define people. People
More informationMartin J Stevens MD, FRCP, Endocrinologist and Professor of Medicine
The Approach to Inpatient Hyperglycemia Martin J Stevens MD, FRCP, Endocrinologist and Professor of Medicine Great Lakes Hospital Medical Symposium May 7th 2010 Further Increases in the Prevalence of Diabetes
More information