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Rationale for Maintaining Glycemic Control in the Hospital

Rationale for Maintaining Glycemic Control in the Hospital. Glucose targets for hospitalized patients. ADA. Diabetes Care . 2007;30:S4-41. ACE. Endocr Pract. 2004;10:77-82. Intensive IV insulin BG target: 80-110 mg/dL Conventional treatment BG target: 180-200 mg/dL Achieved morning BG

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Rationale for Maintaining Glycemic Control in the Hospital

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  1. Rationale for Maintaining Glycemic Control in the Hospital

  2. Glucose targets for hospitalized patients ADA. Diabetes Care. 2007;30:S4-41. ACE. Endocr Pract. 2004;10:77-82.

  3. Intensive IV insulin BG target: 80-110 mg/dL Conventional treatment BG target: 180-200 mg/dL Achieved morning BG 103 mg/dL vs 153 mg/dL Glycemic control in the ICU 100 96 92 88 84 80 0 N = 1548 surgical patients; 63% cardiac Intensive Conventional In-hospital survival(%) 0 50 100 150 200 250 Days after admission Van den Berghe G et al. N Engl J Med. 2001;345:1359-67.

  4. Intensive insulin therapy in surgical ICU reduces morbidity and mortality N = 1548 surgical ICU patients In-hospitalmortality Blood transfusions* Poly-neuropathy Sepsis Dialysis Reduction (%) P = 0.01 P = 0.007 P < 0.001 P = 0.003 P < 0.001 *Median number Van den Berghe G et al. N Engl J Med. 2001;345:1359-67.

  5. IV insulin infusion protocols: Comparison of targets and recommendations Wilson M et al. Diabetes Care. 2007;30:1005-11.

  6. Essential elements of an IV insulin protocol • Correct hyperglycemia safely and effectively • Adjust insulin infusion rate to attain and maintain BG target range • Correct insulin infusion rate without under- or overcompensation • Maintain rate adjustments as insulin sensitivity or nutritional status changes • Respond to hypoglycemia or rapid BG fall • Transition to sc insulin when appropriate Clement SC et al. Diabetes Care. 2004;27:553-591.

  7. ACC/AHA STEMI guidelines: Strict glucose control Class and level of evidence I IIa IIb III B Insulin infusion to normalize BG recommended for patients with STEMI + complicated courses During acute management of STEMI in patients with hyperglycemia, it is reasonable to administer insulin infusion to normalize BG, even in those with an uncomplicated course After acute phase of STEMI, individualize diabetes treatment; select combinations of agents that achieve optimal glycemic control and are well tolerated B C Antman EM et al. J Am Coll Cardiol. 2004;44:671-719.

  8. ACC/AHA NSTEMI guidelines: Diabetes Class and level of evidence I IIa IIb III A Diabetes is an independent risk factor in patients with UA/NSTEMI Medical treatment in the acute phase and decisions on whether to perform stress testing, angiography, and revascularization should be similar in diabetic and nondiabetic patients C Attention should be directed toward tight glucose control B Braunwald E et al. www.acc.org

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