Insulin最新文献

{"title":"Development and implementation of evidence-based guidelines for IV insulin: A statewide collaborative approach","authors":"Lawrence Stockton RPh,&nbsp;Marianne Baird RN,&nbsp;Curtiss B. Cook MD,&nbsp;Robert C. Osburne MD,&nbsp;Joyce Reid RN,&nbsp;Kathryn McGowan MPH,&nbsp;Sabrina Jarvis MS","doi":"10.1016/S1557-0843(08)80018-8","DOIUrl":"10.1016/S1557-0843(08)80018-8","url":null,"abstract":"<div><p><strong>Purpose:</strong> Recent studies have shown that the outcomes of hospitalized patients are greatly enhanced when steps are taken to improve control of their blood glucose levels. The Georgia Hospital Association Research and Education Foundation's Partnership for Health Accountability established a Diabetes Special Interest Group (D-SIG) in February 2003. Goals of the D-SIG were to enlighten health care professionals in Georgia hospitals about the benefits of controlling hyperglycemia in hospitalized patients and to develop processes to assist hospitals in the adoption of an IV insulin dosing algorithm, development of an IV insulin standing order set, and implementation of a hyperglycemia management plan.</p><p><strong>Methods:</strong> The D-SIG created an assessment tool titled “Key Elements of IV Insulin Guidelines” and evaluated numerous published IV insulin administration algorithms and protocols. After an extensive literature review, including international protocols and guidelines, user-friendly guidelines for subcutaneous and IV insulin were developed by a multidisciplinary work group, with members representing hospitals and other stakeholders from throughout the state. The group chose a well-researched method that was available in both computerized and hand-calculated formats and developed a Columnar Insulin Dosing Chart to assist with IV insulin infusions. This insulin-infusion table stems from mathematical formulas published by multiple investigators since the 1980s. The D-SIG guidelines and dosing chart were evaluated for ease of use, effectiveness, and safety in 3 settings: a small, rural critical-access hospital (CAH); an intensive care unit (ICU) in the trauma center of a large Georgia teaching hospital; and a surgical ICU in a midsize metropolitan hospital.</p><p><strong>Results:</strong> After implementation of the guidelines, the incidence of hypoglycemia (blood glucose level &lt;60 mg/dL) was 0.9% in the trauma center ICU and 0.6% in the surgical ICU. All hypoglycemic patients in these 2 settings were asymptomatic, remained hypoglycemic only for a short time, and experienced no complications attributable to hypoglycemia. Using a moderate insulin sensitivity level for dosing initiations resulted in a time to target blood glucose level (80–110 mg/dL) of 6.4 hours, whereas using the most conservative approach required 12.8 hours to attain target range. At the CAH, time to reach the target blood glucose level (90–140 mg/dL) was 5.8 hours, and no episodes of hypoglycemia were reported. Although not part of the pilot initiative, the surgical ICU also reported a 5-fold reduction in surgical infection rates. The success of the dosing chart and standing order set paralleled that of the computerized formula when similar initiation doses were used.</p><p><strong>Conclusions:</strong> The Columnar Insulin Dosing Chart and sample clinical guidelines were piloted at 3 different settings and found to be safe and effective. Fur","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 2","pages":"Pages 67-77"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80018-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76272553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CME test questions 67th american diabetes association annual scientific session updates","authors":"","doi":"10.1016/S1557-0843(08)80030-9","DOIUrl":"https://doi.org/10.1016/S1557-0843(08)80030-9","url":null,"abstract":"","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 ","pages":"Page 141"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80030-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134842316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of the ADA/EASD consensus algorithm for treatment of type 2 diabetes mellitus for primary care practitioners: Four pivotal points","authors":"Charles F. Shaefer Jr. MD, FACP, FCCP","doi":"10.1016/S1557-0843(08)80028-0","DOIUrl":"10.1016/S1557-0843(08)80028-0","url":null,"abstract":"<div><p><strong>Background:</strong> Type 2 diabetes mellitus (DM) is appearing in adults at an epidemic rate. Primary care clinicians will, out of necessity, provide diabetes care for most patients with type 2 DM. A systematic care plan will contribute to effective and cost-efficient management of the increasing number of diabetic patients presenting in the primary care setting.</p><p><strong>Objectives:</strong> The aims of this article were to review the consensus algorithm developed by the American Diabetes Association and the European Association for the Study of Diabetes (ADA/EASD) for the treatment of type 2 DM and to increase awareness of this document within the community that is most likely to manage patients with type 2 DM.</p><p><strong>Methods:</strong> Research was focused on the value of the consensus algorithm to primary care practitioners for the management of patients with type 2 DM.</p><p><strong>Results:</strong> Research revealed 4 aspects of the algorithm involving use of medications (including insulin) and measurement of glycosylated hemoglobin levels that would help health care providers construct a systematic and workable plan for aggressive treatment of type 2 DM.</p><p><strong>Conclusions:</strong> The 4 issues raised within the ADA/EASD consensus algorithm have a significant impact on primary care practitioners and challenge usual practices in the care of patients with type 2 DM.</p></div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 ","pages":"Pages 126-131"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80028-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75944065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cadre's “diabetes tactics”","authors":"","doi":"10.1016/S1557-0843(08)80023-1","DOIUrl":"https://doi.org/10.1016/S1557-0843(08)80023-1","url":null,"abstract":"","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 2","pages":"Pages 114-116"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80023-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136935328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Principios básicos para el conteo de carbohidratos","authors":"Jacqueline Gomes RD, MBA,&nbsp;Leonel Villa-Caballero MD, PhD","doi":"10.1016/S1557-0843(08)80025-5","DOIUrl":"10.1016/S1557-0843(08)80025-5","url":null,"abstract":"","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 2","pages":"Pages 119-120"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80025-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"98016168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Study Responses","authors":"Derek LeRoith MD, PhD","doi":"10.1016/S1557-0843(08)80021-8","DOIUrl":"https://doi.org/10.1016/S1557-0843(08)80021-8","url":null,"abstract":"","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 2","pages":"Pages 109-110"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80021-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136910228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postprandial physiology and the pathogenesis of type 2 diabetes mellitus","authors":"S. Davis","doi":"10.1016/S1557-0843(08)80029-2","DOIUrl":"https://doi.org/10.1016/S1557-0843(08)80029-2","url":null,"abstract":"","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"42 1","pages":"132-140"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86553454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weight management in basal-bolus insulin therapy for type 2 diabetes mellitus: The deep south diabetes program","authors":"JosAnn Duane PhD ,&nbsp;William Conway MD","doi":"10.1016/S1557-0843(08)80020-6","DOIUrl":"10.1016/S1557-0843(08)80020-6","url":null,"abstract":"<div><p><strong>Background:</strong> Weight gain is considered to be a standard clinical complication of insulin therapy. This complication bears heavily on patient populations at risk for obesity, such as those in the southeastern United States.</p><p><strong>Objective:</strong> This study was designed to evaluate the weight changes associated with intensive basal-bolus insulin therapy in the Deep South Diabetes Program. Effectiveness was assessed by evaluating the relationship between changes in glycosylated hemoglobin (A1C) and changes in body weight that occurred during therapy.</p><p><strong>Methods:</strong> The clinical setting was a safety-net, rural community health center for the uninsured and underinsured population in Hardin County, Tennessee. The patients were sick adults with significant, often disabling disease, typically on treatments that were ineffective or produced significant clinical toxicities. This study occurred during a period of retrenchment in the state health insurance program. In this retrospective observational study, information on body weight and A1C measurements was collected over a period of 4 years and analyzed using proprietary and customized database and analysis tools. All patients in the Deep South Diabetes Program who elected intensive basal-bolus insulin therapy and who sustained the treatment for up to 4 years were included in the study. Insulin glargine was used as the primary basal insulin, and insulin aspart was used as the primary bolus insulin. The correlations between net weight change and net A1C change, the duration of treatment, and the degree of reduction in A1C required to achieve normoglycemia and near-normoglycemia were analyzed. Glycemic variability and psychosocial variables were outside the scope of this study.</p><p><strong>Results:</strong> The mean weight for the study population did not change during intensive basal-bolus insulin therapy. When we examined the relationship between weight gain and decreases in A1C, no net weight gain for the patient population as a whole could be associated with lowering of A1C; 20% of the patients experienced no net weight change and 47% experienced a net weight change of &lt;7.5 lb during the 4-year study. An investigation of weight loss with treatment duration showed that patients in treatment &lt;1 year lost a mean of ~4 lb, whereas patients in treatment &gt;2 years gained a mean of ~2 lb. Significant variations in weight among the patients were attributed to the all-inclusive nature of the study; patients with weight-sensitive conditions, including cancer, depression, and congestive heart failure, were not excluded from the study.</p><p><strong>Conclusions:</strong> Providers and patients worked together, using a treatment algorithm and shared medical visits, to create a culture in which normoglycemia was an expected outcome. Results of this study showed that weight gain was not an inescapable clinical complication of basal-bolus insulin therapy.</p","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 2","pages":"Pages 95-108"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80020-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84546521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Study","authors":"Sameer Bansilal MD","doi":"10.1016/S1557-0843(08)80022-X","DOIUrl":"https://doi.org/10.1016/S1557-0843(08)80022-X","url":null,"abstract":"","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 2","pages":"Pages 111-112"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80022-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136935329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced Insulin Management program reduces A1C levels and regimen-related distress without weight gain in patients with type 1 diabetes mellitus","authors":"Lisa H. Fish MD,&nbsp;Harry P. Wetzler MD,&nbsp;Janet L. Davidson RN,&nbsp;Cori L. Ofstead MSPH,&nbsp;Mary L. Johnson RN","doi":"10.1016/S1557-0843(08)80017-6","DOIUrl":"https://doi.org/10.1016/S1557-0843(08)80017-6","url":null,"abstract":"<div><p><strong>Background:</strong> Despite the availability of effective treatments, many patients with diabetes have suboptimal glycemic control.</p><p><strong>Objective:</strong> This study was designed to determine whether the Advanced Insulin Management (AIM) program could help patients with type 1 diabetes mellitus (DM) reduce their A1C levels to ≤7.5% without weight gain, increased incidence of hypoglycemia, or increased diabetes-related distress.</p><p><strong>Methods:</strong> The AIM program, developed to intensify glycemic control in patients with type 1 DM, consisted of a screening visit and 3 to 6 interactive group sessions, depending on whether the patient elects multiple daily injections (MDIs) or an insulin pump. Patients who wanted to learn additional diabetes management skills were referred by their endocrinologist, and those with competent carbohydrate-counting skills and record-keeping practices were eligible to enroll. A nurse, dietitian, psychologist, and physician provided group instruction and supported individual goal setting. The program included depression screening, regimen adjustments, and problem-solving activities. Outcome measures, including blood glucose, A1C, weight, and diabetes-related distress, were tracked for 12 months.</p><p><strong>Results:</strong> The study included 113 adult patients with type 1 DM (59% female; mean age, 39 years). Twenty patients already had insulin pumps, 46 patients initiated pump therapy during the study, and 47 patients elected MDIs. Mean A1C declined by 0.5% (to 7.3%) after 12 months, without weight gain or increased hypoglycemia. A significant decrease in diabetes-related distress was observed.</p><p><strong>Conclusion:</strong> The AIM program was associated with important improvements in glycemic control in patients with type 1 DM, without weight gain or increased hypoglycemic episodes.</p></div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 2","pages":"Pages 59-66"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80017-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91756449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}