Journal Club ICU
|
|
- Cameron Cannon
- 5 years ago
- Views:
Transcription
1 Journal Club ICU
2 Crit Care Med Aug;46(8):
3 Introduction
4 Stress hyperglycemia SH SH >124 mg/dl or >200 mg/dl Lancet 2009;373:1798.
5 stress hyperglycemia Lancet 2009;373:1798.
6 SH Critical Care 2013;17:305.
7 SH etc. etc. Lancet 2009;373:1798.
8 20032 ICU Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc. 2003;78(12): retrospective cohort study P C C I C O 1
9 2005 g Admission hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma. 2005;59(1):80. P I B ICU 1003 (DM ) / C O d L ) )g g 0 Sd L 2 ) B g 2.2 ) g d m
10 ICU
11 1997 DIGAMI study Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group. BMJ 1997; P I C O DM >200 mg/dl AMI mg/dl ( 3.4 ) ARR 11% RR 0.72 (0.55 to 0.92) (<200mg/dL)
12 normoglycemia Intensive insulin therapy(iit)
13 2001 Leuven Intensive insulin therapy in critically ill patients. van den B,N Engl J Med Nov 8;345(19): P I C O ICU 1548 IIT BS mg/dL ( BS mg/dL (BS 215mg/dL ICU IIT 103 vs. 153 mg/dl ICU IIT 4.6 vs. 8.5 % ( P 0.04) IIT 5.1 vs. 0.8% IIT ICU
14 2006 Leuven Intensive insulin therapy in critically ill patients. van den B,N Engl J Med Nov 8;345(19): P I C ICU( >3 ) 1200 IIT BS mg/dL BS mg/dL (BS 215mg/dL O IIT 105 vs 160 mg/dl 37.3 vs (P 0.33) IIT IIT ICU
15 Leuven trial IIT g/ ( TPN) ( )
16 2008 VISEP Intensive insulin therapy and pentastarch resuscitation in severe sepsis Brunkhorst FM N Engl J Med Jan 10;358(2): factorial trial P I C O ICU 537 IIT BS mg/dL ( BS mg/dL 28 (SOFA) HES vs. Ringer IIT IIT (<40 mg/dl) (17.0% vs 4.0%) IIT
17 2009 Glucontrol A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units Preiser JC, Intensive Care Med Oct;35(10): P ICU 1101 I IIT BS mg/dL C ( BS mg/dL O ICU IIT 8.7 vs. 2.7%) ICU IIT
18 2009 NICE-SUGAR Intensive versus conventional glucose control in critically ill patients. NICE-SUGAR Study Investigators, N Engl J Med. 2009;360(13):1283. P I ICU 6022 IIT BS mg/dL C ( BS 180mg/dL O IIT (27.5 vs. 24.1%) (P 0.02) (BS 40mg/dL)IIT (6.8 vs. 0.5%) IIT
19 ICU (BG Target) (BG Target) Primary Outcome (%) ( ) Van den Berghe et al(leuven I) 2001 (n=1548) mg/dL mg/dL ICU 4.6 vs 8.0(p=0.04) 5 vs 0.7(p ) Van den Berghe et al(leuven II) 2006 (n=1200) mg/dL mg/dL ICU 24.2 vs 26.8(p=NS) 18.7 vs 3.1(p=0.001) Brunkhorst et al(visep) 2008 Preiser et al(glucontrol) 2009 Finfer et al(nice-sugar) 2009 (n=488) (n=1078) (n=6104) mg/dL mg/dL 28,SOFA 24.7 vs 26(p=NS) 17.0 vs 4.1(p=0.001) mg/dL mg/dL ICU 17.2 vs 15.3(p=NS) 8.7 vs 2.7(p=0.0001) mg/dL <180mg/dL vs 24.9(p=0.02) 6.8 vs 0.5(p=0.001) NS= IIT or
20 IIT OR 7.7 [95% CI ] IIT OR 0.95 [95% CI ] Toward Understanding Tight Glycemic Control in the ICU. A Systematic Review and Metaanalysis. Chest 2010;137:544.
21 AACE/ADA 2009 <180 mg/dl SFAR/SRLF ( ) 2010 <180 mg/dl ACP mg/dL SCCM mg/dl AACE/ACE mg/dl SSCG mg/dL SFAR French Society of Anesthesia and Resuscitation SRLF(=FICS) French Intensive care society AACE:American Asoosciation of Clinical Endocrinologist ACE American Collage of Endocrinology mg/dL
22 IIT IIT
23 41-70 mg/dl <40 mg/dl NICE-SUGAR, post hoc analysis HR 1.41 [95% CI ] HR 2.1 [95% CI ] OR 1.41 [95% CI ] N Engl J Med 2012;367: retrospective cohort study Crit Care Med. 2007;35:2262.
24 Glycemic variability J Diabetes Sci Technol. 2010;4:1382. Crit Care Resusc. 2014;16:13. standard deviation Anesthesiology. 2006;105:244. coefficient of variation (SD/average) >20% Nutrition July 12, in press Intensive Care Med, 2011;37:583. Endocr Pract. 2014;20:41. Crit Care. 2014;18:R86.
25 Crit Care Med. 2008;36:2316. Crit Care. 2013;17:229.
26 CGM Continuous Glucose Monitoring
27 CGM ( ) FGM(Freestyle ) flash glucose monitoring CGM ( 14 ) SAP( 620G/640G) sensor augmented pump CGM 6
28 Clinical Question CGM +
29 Crit Care Med Aug;46(8):
30 P ICU 77 I C CGM IGM O
31 BG Blood Glucose CGM IGM TIR TB70 Continuous glucose monitoring Intermittent Glucose monitoring Time in range (90-150mg/dL) The time spent with BG less than 70mh/dL BG 70mg/dL CV Coefficient of variation GLI Glycemic lability index
32 Methods
33 Study design ICU 35
34 Inclusion 18 APACHEII 10 3 ICU 6 BS 150mg/dL / ICU
35 Exclusion or (HIT) (=GlucoClear)
36 GlucoClear (Edwards Lifescience) 20G ICU Diabetes Technol Ther 2014;16:858.
37 Randomized in a crossover design 28 or 50 ICU ICU CGM (=IGM (=CGM ICU
38 CGM IGM CGM ICU ICU 72 /ICU / CGM mg / dl mg / dl IGM
39
40 Meynaar 4 BG BG Intensive Care Med 2007;33: / BG 2009
41 Table1a. ( ) NG OG NP OP (U/hr) NP (U/hr) OG BG (mmol/l) NG BG (mmol/l) BG mmol/l 18 mg/dl ~ ~81 81~ NG*OP/OG 81~135 ~81 OP 135~ NG<OG*0.9 2NG-OG OP 135~180 NG OG*0.9 MAX(OP*1.2 OP+0.4) 180~270 NG OG*0.9 MAX(OP*1.2 OP+1) 270~360 NG OG*0.9 MAX(OP*1.5 OP+1.5) 360~ NG OG*0.9 MAX(OP*2 OP+2) Table1b ( ) NG OG Bolus 0 162~ ~ ~ ~ ~ ( NG-OG) OP/6 Table1c NG OG 0 81~135 54~162 6 ~ ~ NP 25ml/h MAX(4,OP+1) 25ml/h MAX(8,OP+1) 10 Bolus 25ml/h 8 25ml/h 12 NG ml OG Dr
42 CGM 2 CGM >40mg/dL or CGM BG CGM 20mg/dL BG 20mg/dL CGM
43 Outcome Measures CV Coefficient of variation ) GLI Glycemic lability index TIR90-150(%) Time in range (90-150mg/dL) ( ( BG mg/dl) ( ( TB70(%) The time spent with BG less than 70mh/dL BG 70mg/dL 1)CV / 2)GLI Σ[{ glucose (mmol/l)} 2 hr -1 ] wk -1 3) BG 70mg/dL ( 12 Down time 32
44 Shapiro-Wilk t U SPSS p<0.05
45 Results
46 (11), (9) (2) (1) IGM 38 CGM 39
47 Baseline Characteristics CGM IGM n
48 CGM BS BS BS 4-6
49 Results CV GLI TIR
50 Results i. CGM20.5 vs IGM39.5 CGM (p ) ii. iii. TB70) % vs CGM (p 0.05 ) CGM IGM CGM
51 Discussion
52 CGM CGM TIR IGM TIR
53 GlucoClear down-time ICU FDA Limitation ICU
54 Conclusion CGM
55 GlucoClear GlucoClear Edwards Lifesciences 2015 DEXCOM
56 <180mg/dL CGM pilot study CGM
57
58 Stress hyperglycemia Stress hyperglycemia (SH) (glucose diffusion gradient) ( mg/dl ) Crit Care 2010;14:231. Crit Care 2013;17:305. stress hyperglycemia ICU J Crit Care 2012;27:153. Stress hyperglycemia
59 Stress hyperglycemia hypovolemia >220 mg/dl Crit Care 2013;17:305. Stress Hyperglycemia(SH) = moderate SH ahr 2.99; 95% CI, severe SH ahr 11.43; 95% CI, Am J Med 2012;125:1036.
60 one size fits all JC Preiser
61 DM non DM HbA1c >7% ICU diabetes paradox Crit Care Med 2011;39:105. relative hypoglycemia Lancet 2000;356:1970. glucose diffusion gradient mg/dl) Paul E Marik. Crit Care Med. 2016;44:1433.
62 Closed loop systems CGM artificial pancreas
63 Closed loop Intensive IT mg/dL vs. intermediate IT mg/dl N=447 (<80mg/dL) SSI IIT 4.1 vs 9.8%
64 IIT mg/dL CGM Closed loop system
Control of Blood Glucose in the ICU: Reconciling the Conflicting Data
Control of Blood Glucose in the ICU: Reconciling the Conflicting Data Steven E. Nissen MD Disclosure Consulting: Many pharmaceutical companies Clinical Trials: AbbVie, Amgen, Astra Zeneca, Esperion, Eli
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 informationDisclosures. Glycemic Control in the Intensive Care Unit. Objectives. Hyperglycemia. Hyperglycemia. History. No disclosures
Disclosures Glycemic Control in the Intensive Care Unit No disclosures Jorie Frasiolas, Pharm.D., BCPS Clinical Pharmacy Manager, CTICU NewYork-Presbyterian Hospital Columbia University Medical Center
More informationWhat Should Be the Therapeutic Glycemic Target in Intensive Care Units?
What Should Be the Therapeutic Glycemic Target in Intensive Care Units? Irl B. Hirsch, M.D. Professor of Medicine University of Washington School of Medicine Disclosures Research/Grants: Sanofi, Halozyme
More informationControl of Glycemic Variability for Reducing Hypoglycemia Jae Hyeon Kim
Control of Glycemic Variability for Reducing Hypoglycemia Jae Hyeon Kim Division of Endocrinology and Metabolism, Samsung Medical Center, Sungkyunkwan University School of Medicine Conflict of interest
More informationPostoperative Glucose Control and SCIP Measures. Gorav Ailawadi, MD Chief, Adult Cardiac Surgery University of Virginia April 25, 2015
Postoperative Glucose Control and SCIP Measures Gorav Ailawadi, MD Chief, Adult Cardiac Surgery University of Virginia April 25, 2015 Diabetes in CABG Incidence of Diabetes in cardiac surgery increased
More informationINTENSIVE INSULIN THERAPY: A Long History of Conflicting Data.
INTENSIVE INSULIN THERAPY: A Long History of Conflicting Data. Candice Preslaski, PharmD BCPS Clinical Pharmacist Specialist SICU Denver Health Medical Center December 2014 OBJECTIVES Review the risk factors
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 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 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 informationand ICU - an update Michal Horácek
Glycemic control in perioperative period and ICU - an update Michal Horácek 73 The three Leuwen studies (1-3), especially the first one published in 2001 (1), caused a revolution in the approach to glucose
More informationC CONFERENCIAS MAGISTRALES Vol. 36. Supl. 1 Abril-Junio 2013 pp S61-S68 Management of hyperglycemia in the perioperative patient. 39 th Annual Refresher Course on Anesthesiology and Perioperative Medicine,
More informationWhat is a CGM? (Continuous Glucose Monitor) The Bionic Pancreas Is Coming
The Bionic Pancreas Is Coming Montana Diabetes Professional Conference October 23, 2014 H. Peter Chase, MD Professor of Pediatrics University of Colorado Barbara Davis Center Stanford: Bruce Buckingham,
More informationThe Long and Winding Road Toward Personalized Glycemic Control in the Critically Ill
728299DSTXXX10.1177/1932296817728299Journal of Diabetes Science and TechnologyKrinsley review-article2017 Symposium/Special Issue The Long and Winding Road Toward Personalized Glycemic Control in the Critically
More informationEndocrinology Emergencies & Glycemic Control in the ICU
Endocrinology Emergencies & Glycemic Control in the ICU Mark Franklin, MD Dartmouth-Hitchcock Medical Center - Lebanon, NH Avera Health eicu - Sioux Falls, SD Objectives Recognize and understand the treatment
More informationEndocrine and Metabolic Complications in the ICU
Endocrine and Metabolic Complications in the ICU Linda Liu, M.D. Associate Professor UCSF Department of Anesthesia UC SF 1 New Progress Discovery of complex neuro-endocrine adaptation to critical illness
More informationPREVENTION OF NOCTURNAL HYPOGLYCEMIA USING PREDICTIVE LOW GLUCOSE SUSPEND (PLGS)
PREVENTION OF NOCTURNAL HYPOGLYCEMIA USING PREDICTIVE LOW GLUCOSE SUSPEND (PLGS) Pathways for Future Treatment and Management of Diabetes H. Peter Chase, MD Carousel of Hope Symposium Beverly Hilton, Beverly
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 informationUpdate in Critical Care Medicine
Update in Critical Care Medicine Michael A. Gropper, MD, PhD Professor and Executive Vice Chair Department of Anesthesia and Perioperative Care Director, Critical Care Medicine UCSF Disclosure None Update
More informationVANDERBILT UNIVERSITY MEDICAL CENTER MULTIDISCIPLINARY SURGICAL CRITICAL CARE TRAUMA INTENSIVE CARE UNIT GLYCEMIC CONTROL PROTOCOL
VANDERBILT UNIVERSITY MEDICAL CENTER MULTIDISCIPLINARY SURGICAL CRITICAL CARE TRAUMA INTENSIVE CARE UNIT GLYCEMIC CONTROL PROTOCOL Background: For some time, the presence of diabetes and hyperglycemia
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 information10.4.a. Optimal glucose control: Insulin therapy March 2013
10.4.a. Optimal glucose control: Insulin therapy March 2013 2013 Recommendation: Based on 26 level 2 studies, we recommend that hyperglycemia (blood sugars > 10 mmol/l) be avoided in all critically ill
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 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 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 informationPeri-operative Glucose Control Is it Important?
Peri-operative Glucose Control Is it Important? Dr Ketan Dhatariya MSc MD MS FRCP Consultant in Diabetes and Endocrinology Norfolk and Norwich University Hospitals Do Peri-Operative High Glucose Levels
More informationResuscitation fluids in critical care
Resuscitation fluids in critical care John A Myburgh MBBCh PhD FCICM UNSW Professor of Critical Care Medicine The George Institute for Global Health University of New South Wales St George Hospitals, Sydney
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 informationArtificial Pancreas Device System (APDS)
Medical Policy Manual Durable Medical Equipment, Policy No. 77 Artificial Pancreas Device System (APDS) Next Review: October 2019 Last Review: October 2018 Effective: November 1, 2018 IMPORTANT REMINDER
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 informationHot Topics: The Future of Diabetes Management Cutting Edge Medication and Technology-Based Care
Hot Topics: The Future of Diabetes Management Cutting Edge Medication and Technology-Based Care Mary Jean Christian, MA, MBA, RD, CDE Diabetes Program Coordinator UC Irvine Health Hot Topics: Diabetes
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 informationEffective Health Care Program
Comparative Effectiveness Review Number 57 Effective Health Care Program Methods for Insulin Delivery and Glucose Monitoring: Comparative Effectiveness Executive Summary Background Diabetes mellitus is
More informationGlucose Management in Critically Ill Patients
Glucose Management in Critically Ill Patients October 15, 2016 Archana R. Sadhu, MD., FACE Director of System Diabetes Program Director of Transplant Endocrinology Assistant Professor, Weill Cornell Medical
More informationToday s Goals 10/6/2017. New Frontiers in Diabetes Technology. Disclosures
New Frontiers in Diabetes Technology Marie E. McDonnell, MD Director, Brigham and Women's Diabetes Program Division of Endocrinology, Diabetes and Hypertension Brigham and Women s Hospital Today s Goals
More informationThe Impact of Measurement Frequency on the Domains of Glycemic Control in the Critically Ill-A Monte Carlo Simulation
566507DSTXXX10.1177/1932296814566507Journal of Diabetes Science and TechnologyKrinsley et al research-article2015 Original Article The Impact of Measurement Frequency on the Domains of Glycemic Control
More informationAdvances in Technology in the Treatment of Diabetes Mellitus 2017 How far have we come-how far are we going? Is there a final frontier?
Advances in Technology in the Treatment of Diabetes Mellitus 2017 How far have we come-how far are we going? Is there a final frontier? Alan B Schorr DO FAAIM FACE www.sugardoc.com abs@sugardoc.com Disclosures
More informationArtificial Pancreas Device Systems. Populations Interventions Comparators Outcomes Individuals: With type 1 diabetes
Protocol Artificial Pancreas Device Systems Medical Benefit Effective Date: 07/01/18 Next Review Date: 01/20 Preauthorization Yes Review Dates: 03/15, 03/16, 03/17, 01/18, 05/18, 01/19 Preauthorization
More informationApril Dear (Editor):
April 2014 Dear (Editor): Registered Dietitians (RD) play an integral role in patient care in the medical intensive care unit. RD s have increased knowledge in blood glucose control and reducing adverse
More informationSEPSIS 2015 DISCLOSURES FINANCIAL DISCLOSURES 9/1/2015. William M. Johnson, MD Nebraska Pulmonary Specialties. William Johnson
SEPSIS 2015 William M. Johnson, MD Nebraska Pulmonary Specialties 1 DISCLOSURES William Johnson No financial interests related to this presentation 2 FINANCIAL DISCLOSURES I do however have 3 children
More informationInsulin sensitivity, its variability and glycaemic outcome:
MCBMS 2009 Insulin sensitivity, its variability and glycaemic outcome: A model-based analysis of the difficulty in achieving tight glycaemic control in critical care JG Chase et al Dept of Mechanical Engineering
More informationArtificial Pancreas Device Systems. Populations Interventions Comparators Outcomes. pump. pump
Protocol Artificial Pancreas Device Systems (10130) Medical Benefit Effective Date: 04/01/18 Next Review Date: 01/19 Preauthorization Yes Review Dates: 03/15, 03/16, 03/17, 01/18 Preauthorization is required.
More informationEffects of Measurement Frequency on Analytical Quality Required for Glucose Measurements in Intensive Care Units: Assessments by Simulation Models
Clinical Chemistry 60:4 644 650 (2014) Endocrinology and Metabolism Effects of Measurement Frequency on Analytical Quality Required for Glucose Measurements in Intensive Care Units: Assessments by Simulation
More informationDiabetes Management with Continuous Glucose Monitoring & Multiple Daily Injections. Aaron Michels MD
Diabetes Management with Continuous Glucose Monitoring & Multiple Daily Injections Aaron Michels MD Outline SMBG & CGM by age group JDRF CGM Trial Sensor Augmented Insulin Pump Therapy for A1c Reduction
More informationMANAGEMENT OF HYPERGLYCEMIA IN CRITICALLY ILL SURGICAL (NON-CARDIAC) PATIENTS
DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care
More informationControversies in Hospital Medicine: Critical Care. Vasopressors, Steroids, and Insulin Therapy
Controversies in Hospital Medicine: Critical Care Vasopressors, Steroids, and Insulin Therapy Douglas Fish, Pharm.D. Professor of Pharmacy, University of Colorado Denver Clinical Specialist in Critical
More informationThe association of intravenous insulin and glucose infusion with intensive care unit and hospital mortality: a retrospective study
https://doi.org/10.1186/s13613-019-0507-x RESEARCH The association of intravenous insulin and glucose infusion with intensive care unit and hospital mortality: a retrospective study Sigrid C. van Steen
More informationPatient safety has become a major global social health problem.
REVIEWS IMAJ VOL 14 april 2012 Glycemic Control in the Intensive Care Unit: Between Safety and Benefit Alexander Samokhvalov MD 1, Raymond Farah MD 2 and Nicola Makhoul MD 1 1 Intensive Care Unit, Western
More informationESPEN Congress Madrid 2018
ESPEN Congress Madrid 2018 Dysglycaemia In Acute Patients With Nutritional Therapy Mechanisms And Consequences Of Dysglycaemia In Patients Receiving Nutritional Therapy M. León- Sanz (ES) Mechanisms and
More informationWhen Will CGM Replace SMBG? Roy W. Beck, MD, PhD. JAEB Center for Health Research Tampa, Florida
When Will CGM Replace SMBG? Roy W. Beck, MD, PhD JAEB Center for Health Research Tampa, Florida Financial Disclosures Dr. Beck does not have any personal conflicts of interest His employer, the JAEB Center
More informationThe Realities of Technology in Type 1 Diabetes
The Realities of Technology in Type 1 Diabetes May 6, 2017 Rosanna Fiallo-scharer, MD Margaret Frederick, RN Disclosures I have no conflicts of interest to disclose I will discuss some unapproved treatments
More informationInsulin Pumps - External
Insulin Pumps - External Policy Number: Original Effective Date: MM.01.004 04/01/2011 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 04/01/20174/1/2018 Section: DME Place(s) of
More informationUS Endocrinology. Volume 5 Extract. Glucose Control in the Critically Ill Patient Utilizing Computerized Intravenous Insulin Dosing
US Endocrinology Volume 5 Extract Glucose Control in the Critically Ill Patient Utilizing Computerized Intravenous Insulin Dosing Samuel E Crockett, MD Associate Professor of Medicine, Department of Medical
More informationHyperglycemia in ACS. Dr. Imhemed Eljazwi
Hyperglycemia in ACS 2012-5-8 Dr. Imhemed Eljazwi Percentage of Population (n = 1181) Prevalence of Hyperglycemia in 181 Cardiac Patients Without Known Diabetes 100% 75% 50% 66% of AMI patients have
More informationThe Diabetes Link to Heart Disease
The Diabetes Link to Heart Disease Anthony Abe DeSantis, MD September 18, 2015 University of WA Division of Metabolism, Endocrinology and Nutrition Oswald Toosweet Case #1 68 yo M with T2DM Diagnosed DM
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 informationMEDICAL POLICY SUBJECT: CONTINUOUS GLUCOSE MONITORING SYSTEMS/ EXTERNAL INSULIN PUMP THERAPY FOR DIABETES EFFECTIVE DATE: 08/17/17, 08/16/18
MEDICAL POLICY SUBJECT: CONTINUOUS GLUCOSE MONITORING PAGE: 1 OF: 12 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product (including
More informationComputer-assisted glucose control in critically ill patients
Chapter 8 Computer-assisted glucose control in critically ill patients Mathijs Vogelzang, Bert G. Loef, Joost G. Regtien, Iwan C. C. van der Horst, Hein van Assen, Felix Zijlstra, Maarten W. N. Nijsten
More informationDiabetic Emergencies DKA, HHS, Hypoglycemia. Disclosure. Learning Objectives
Diabetic Emergencies DKA, HHS, Hypoglycemia October 2018 Michael T. McDermott MD Director, Endocrinology and Diabetes Practice University of Colorado Hospital Disclosure Michael McDermott has no conflict
More informationExercise Prescription in Type 1 Diabetes
Exercise Prescription in Type 1 Diabetes Michael Riddell, PhD Professor, Muscle Health Research Centre and School of Kinesiology & Health Science, York University Senior Scientist, LMC Diabetes & Endocrinology,
More informationFluid Treatments in Sepsis: Meta-Analyses
Fluid Treatments in Sepsis: Recent Trials and Meta-Analyses Lauralyn McIntyre MD, FRCP(C), MSc Scientist, Ottawa Hospital Research Institute Assistant Professor, University of Ottawa Department of Epidemiology
More informationPeri-operative Glucose Control Is it Important?
Peri-operative Glucose Control Is it Important? Dr Ketan Dhatariya MSc MD MS FRCP Consultant in Diabetes and Endocrinology Norfolk and Norwich University Hospitals Dr Nicholas Levy MBBS FRCA FICM Consultant
More informationDiabetes and Technology. Saturday, September 9, 2017 Aimee G sell, APRN, ANP-C, CDE
Diabetes and Technology Saturday, September 9, 2017 Aimee G sell, APRN, ANP-C, CDE Disclosure Speaker s Bureau: Janssan Pharmaceuticals Current Technology V-Go by Valeritas Continuous Sensors (personal
More informationDIABETES TECHNOLOGY: WHERE ARE WE NOW AND WHERE ARE WE GOING? Presented by: Tom Brobson
DIABETES TECHNOLOGY: WHERE ARE WE NOW AND WHERE ARE WE GOING? Presented by: Tom Brobson March 3 rd, 2018 Who is this guy? Accelerating Progress 1 Oh that guy! Accelerating Progress 2 STATE OF T1D CARE
More informationHypoglycemia a barrier to normoglycemia Are long acting analogues and pumps the answer to the barrier??
Hypoglycemia a barrier to normoglycemia Are long acting analogues and pumps the answer to the barrier?? Moshe Phillip Institute of Endocrinology and Diabetes National Center of Childhood Diabetes Schneider
More informationContinuous Glucose Monitoring (CGM)
Continuous Glucose Monitoring (CGM) Background Info A1c Average glucose levels over previous 2-3 months Currently remains gold standard for determining control Indicator of risk for development of complications
More informationAdvances in Diabetes Care Technologies
Advances in Diabetes Care Technologies 1979 2015 Introduction Roughly 20% to 30% of patients with T1DM and fewer than 1% of insulin-treated patients with T2DM use an insulin pump In 2007, the U.S. FDA
More informationInsulin Pumps and Glucose Sensors in Diabetes Management
Diabetes Update+ 2014 Congress Whistler, British Columbia Friday March 21, 2014ǀ 8:15 8:45 am Insulin Pumps and Glucose Sensors in Diabetes Management Bruce A Perkins MD MPH Division of Endocrinology Associate
More informationClinical News and Innovation in Type 1 Diabetes and Technology. Parth Narendran University Hospitals Birmingham
Clinical News and Innovation in Type 1 Diabetes and Technology Parth Narendran University Hospitals Birmingham Adjunctive therapy to insulin Accurate diagnosis of T1D Early intensive treatment Technology
More informationESPEN Congress Lisbon Water and electrolytes. Hyperglycemia management. G Van Den Berghe
ESPEN Congress Lisbon 2004 Water and electrolytes Hyperglycemia management G Van Den Berghe Intensive Insulin Therapy in ICU G. Van den Berghe M.D., Ph.D. Department of Intensive Care Medicine University
More informationWhat s so sweet about glycemic control? June 3, 2016
What s so sweet about glycemic control? June 3, 2016 Objectives Provide an overview of why glucose control is important in surgical patient outcomes. Demonstrate an understanding of how anesthetics and
More informationName of Policy: Continuous or Intermittent Monitoring of Glucose in the Interstitial Fluid
Name of Policy: Continuous or Intermittent Monitoring of Glucose in the Interstitial Fluid Policy #: 038 Latest Review Date: December 2016 Category: DME Policy Grade: B Background/Definitions: As a general
More informationThe Diabetes Guidelines Trek: The Next Generation. Inpatient Diabetes Guidelines. Learning Objectives. Current Inpatient Guidelines
The Diabetes Guidelines Trek: The Next Generation J. Christopher Lynch, PharmD, BCACP Southern Illinois University Edwardsville School of Pharmacy Susan Cornell BS, PharmD, CDE, FAPhA, FAADE Midwestern
More informationGlycaemic variability, infections and mortality in a medical surgical intensive care unit
Glycaemic variability, infections and mortality in a medical surgical intensive care unit Abele Donati, Elisa Damiani, Roberta Domizi, Laura Botticelli, Roberta Castagnani, Vincenzo Gabbanelli, Simonetta
More informationEdwards Lifesciences 2012 Investor Conference 12/4/2012
Carlyn D. Solomon Corporate Vice President, Critical Care Executive Summary Edwards is extending its leadership in global hemodynamic monitoring We expect continued growth of our gold standard products,
More informationPump and Sensor Data Interpretation. Irl B. Hirsch, MD University of Washington School of Medicine
Pump and Sensor Data Interpretation Irl B. Hirsch, MD University of Washington School of Medicine Dualities Research: Medtronic Diabetes Consulting: Abbott Diabetes Care, BD, Bigfoot, Roche Raise Your
More information1. Continuous Glucose Monitoring
1. Continuous Glucose Monitoring 1. Physiology of interstitial fluid glucose 2. Comparison of CGM and self-monitored blood glucose (SMBG) data 3. Insulin dosing indication in BGM vs. CGM & the FDA 4. Protection
More informationCGM and Closing The Loop
CGM and Closing The Loop Dualities Research: Helmsely Charitable Trust, ADA, JDRF, NIDDK Consulting: Abbott Diabetes Care, Roche, Intarcia, Valeritas, Adocia, Big Foot Like With Pumps, We ve Come A Long
More informationPreventing Hypoglycemia Using Predictive Alarm Algorithms and Insulin Pump Suspension
DIABETES TECHNOLOGY & THERAPEUTICS Volume 11, Number 2, 29 Mary Ann Liebert, Inc. DOI: 1.189/dia.28.32 Preventing Hypoglycemia Using Predictive Alarm Algorithms and Insulin Pump Suspension Bruce Buckingham,
More informationTight Glycemic Control in Critical Care - The leading role of insulin sensitivity and patient variability A review and model-based analysis
Tight Glycemic Control in Critical Care - The leading role of insulin sensitivity and patient variability A review and model-based analysis J. Geoffrey Chase*, Aaron J. Le Compte*, Fatanah Suhaimi*, Geoffrey
More informationHyperglycemia is common among medical and surgical. Clinical Guideline
Clinical Guideline Annals of Internal Medicine Intensive Insulin Therapy in Hospitalized Patients: A Systematic Review Devan Kansagara, MD, MCR; Rongwei Fu, PhD; Michele Freeman, MPH; Fawn Wolf, MD; and
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 informationHarm by hyperglycemia, early (parenteral) nutrition or both? from bed to bench and back
Harm by hyperglycemia, early (parenteral) nutrition or both? from bed to bench and back G. Van den Berghe MD, PhD Department of Intensive Care Medicine University of Leuven (KU Leuven) Leuven, Belgium
More informationContinuous or Intermittent Glucose Monitoring in Interstitial Fluid
Continuous or Intermittent Glucose Monitoring in Interstitial Fluid Policy Number: 1.01.20 Last Review: 9/2018 Origination: 11/2001 Next Review: 9/2019 Policy Blue Cross and Blue Shield of Kansas City
More informationEmerging Automated Insulin Delivery Systems
Emerging Automated Insulin Delivery Systems Richard M. Bergenstal, MD International Diabetes Center Park Nicollet & HealthPartners Minneapolis, MN Presenter Name 1 Dualities: Richard M. Bergenstal, MD
More informationPaolo Di Bartolo U.O di Diabetologia Dip. Malattie Digestive & Metaboliche AULS Prov. di Ravenna. Ipoglicemie e Monitoraggio Glicemico
Paolo Di Bartolo U.O di Diabetologia Dip. Malattie Digestive & Metaboliche AULS Prov. di Ravenna Ipoglicemie e Monitoraggio Glicemico Management of Hypoglycaemia.if hypoglycemia is a problem, the principles
More informationRelationship between glucose meter error and glycemic control efficacy
Relationship between glucose meter error and glycemic control efficacy Brad S. Karon, M.D., Ph.D. Professor of Laboratory Medicine and Pathology Department of Laboratory Medicine and Pathology Mayo Clinic
More informationMore Than 1 Year of Hybrid Closed Loop in Pediatrics. Gregory P. Forlenza, MD Assistant Professor Barbara Davis Center
More Than 1 Year of Hybrid Closed Loop in Pediatrics Gregory P. Forlenza, MD Assistant Professor Barbara Davis Center Disclosure Dr. Forlenza has served as a consultant for Abbott Diabetes Care and conducts
More informationTechnology in Diabetes Management Irl B. Hirsch, MD University of Washington
Technology in Diabetes Management 2016 Irl B. Hirsch, MD University of Washington Dualities Research: Helmsley Charitable Trust, JDRF, ADA, NIDDK, CDC Consulting: Abbott, Roche, Intarcia Raise Your Hand
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Continuous or Intermittent Monitoring of Glucose in Interstitial Fluid Page 1 of 26 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Continuous or Intermittent Monitoring
More informationQUESTION 4. WHAT CLINICAL DATA ARE CURRENTLY AVAILABLE TO SUPPORT EXPANDED CGM COVERAGE BY PAYERS AS PERTAINS TO QUESTIONS 1 AND 3?
500 1 QUESTION 4. WHAT CLINICAL DATA ARE CURRENTLY AVAILABLE TO SUPPORT EXPANDED CGM COVERAGE BY PAYERS AS PERTAINS TO QUESTIONS 1 AND 3? WHAT ADDITIONAL DATA ARE NEEDED? AACE/ACE CGM Consensus Conference:
More informationDoes Technology helps adolescents with type 1 diabetes in fasting Ramadan?
Does Technology helps adolescents with type 1 diabetes in fasting Ramadan? Abdulmoein Al-Agha, FRCPCH Professor of Paediatric Endocrinology, King Abdulaziz University Hospital, http://aagha.kau.edu.sa
More informationDEMYSTIFYING INSULIN THERAPY
DEMYSTIFYING INSULIN THERAPY ASHLYN SMITH, PA-C ENDOCRINOLOGY ASSOCIATES SCOTTSDALE, AZ SECRETARY, AMERICAN SOCIETY OF ENDOCRINE PHYSICIAN ASSISTANTS ARIZONA STATE ASSOCIATION OF PHYSICIAN ASSISTANTS SPRING
More informationSpecial Situations 1
Special Situations 1 Outline Continuous Nutrition Tube feeds TPN Steroids Pumps Perioperative BG Control 2 Patient receiving continuous TF or TPN Continuous nutrition coverage options: Analog q4hr Regular
More informationDIABETES & ENDOCRINE DIABETES TECHNOLOGY: HOW TO STAY CURRENT WITH ONGOING TECHNOLOGY ADVANCEMENT
DIABETES TECHNOLOGY: HOW TO STAY CURRENT WITH ONGOING TECHNOLOGY ADVANCEMENT Min-Jye Chen, MD Endocrinology Diabetes Management of the School-Aged Child Provided by Texas Children s Hospital Provider #18-267764-A
More informationADVANCES IN DIABETES TECHNOLOGY: A FOCUS ON CONTINUOUS GLUCOSE MONITORING 9:15 10:15 AM
ADVANCES IN DIABETES TECHNOLOGY: A FOCUS ON CONTINUOUS GLUCOSE MONITORING 9:15 10:15 AM ACPE UAN: 0107-9999-18-124-L01-P 0.1 CEU/1 hr Activity Type: Knowledge-Based Learning Objectives for Pharmacists:
More informationACUTE ABDOMEN IN DIABETIC PATIENTS ANALYSIS OF COMPLICATIONS AND MORTALITY
2014 ILEX PUBLISHING HOUSE, Bucharest, Roumania http://www.jrdiabet.ro Rom J Diabetes Nutr Metab Dis. 21(4):277-284 doi: 10.2478/rjdnmd-2014-0034 ACUTE ABDOMEN IN DIABETIC PATIENTS ANALYSIS OF COMPLICATIONS
More informationSupplementary Data. Correlation analysis. Importance of normalizing indices before applying SPCA
Supplementary Data Correlation analysis The correlation matrix R of the m = 25 GV indices calculated for each dataset is reported below (Tables S1 S3). R is an m m symmetric matrix, whose entries r ij
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 informationPumps & Sensors made easy. OPADA ALZOHAILI MD FACE Endocrinology Assistant Professor Wayne State University
Pumps & Sensors made easy OPADA ALZOHAILI MD FACE Endocrinology Assistant Professor Wayne State University DeFronzo RA. Diabetes. 2009;58:773-795. Ominous Octet Relationship of b-cell Dysfunction and Development
More information