(pdf) The Performance Of Flash Glucose Monitoring In Critically Ill Patients With Diabetes
All content in this area was uploaded by Johan Mrtensson on Sep 04, 2017 Critical Care and Resuscitation Volume 19 Number 2 June 2017 Excessive glycaemic variability and hypoglycaemia are associated with increased mortality risk in critically ill patients.1,2 Achieving glycaemic stability is particularly challenging in critically ill patients with diabetes. In response to these challenges, there has been increasing interest in the use of subcutaneous or intravascular continuous glucose monitoring (CGM) devices. However, CGM systems require repeated calibrations and often need to be prematurely removed due to sensor or device-related problems. These issues cause prolonged data gaps.3-5 In addition, the tubing and attached monitors interfere with nursing management and patient mobilisation.5 Intravascular CGM sensors are also associated with thrombus formation and malfunction of the intravascular access, and may show limited accuracy when inserted in a peripheral vein.6-8 Finally, the use of an intravascular CGM device carries a theoretical risk of The minimally invasive FreeStyle Libre ash glucose monitoring system (Abbott Diabetes Care) was recently approved for use in patients with diabetes.9 The factory- calibrated subcutaneous sensor requires no additional calibrations and lasts 14 days. A handheld reader obtains glucose readings wirelessly by scanning the sensor up to every 15 minutes (hence the term ash glucose). Previous studies showed high accuracy for ash glucose monitoring when compared with capillary or venous glucose measurement in ambulatory patients with diabetes.9,10 In contrast, ash glucose monitoring appears to systematically underestimate arterial blood glucose levels in patients undergoing cardiac surgery.3 However, no study has assessed the performan Continue reading >>
Continuous Glucose Monitoring In The Icu: Clinical Considerations And Consensus
Abstract Glucose management in intensive care unit (ICU) patients has been a matter of debate for almost two decades. Compared to intermittent monitoring systems, continuous glucose monitoring (CGM) can offer benefit in the prevention of severe hyperglycemia and hypoglycemia by enabling insulin infusions to be adjusted more rapidly and potentially more accurately because trends in glucose concentrations can be more readily identified. Increasingly, it is apparent that a single glucose target/range may not be optimal for all patients at all times and, as with many other aspects of critical care patient management, a personalized approach to glucose control may be more appropriate. Here we consider some of the evidence supporting different glucose targets in various groups of patients, focusing on those with and without diabetes and neurological ICU patients. We also discuss some of the reasons why, despite evidence of benefit, CGM devices are still not widely employed in the ICU and propose areas of research needed to help move CGM from the research arena to routine clinical use. Background The story of tight glucose control in the intensive care unit (ICU) dates back to the publication of the first of the Leuven studies [1]. This study showed reduced mortality rates in surgical ICU patients who were managed according to a protocol that strictly controlled blood glucose levels using an insulin infusion. The study was conducted on a background of increasing evidence for a potentially harmful effect of stress hyperglycemia on morbidity and mortality, and triggered a surge of interest among intensivists worldwide who started to pay more attention to blood glucose concentrations. As with other parameters that are regularly monitored in the ICU, the concept of continuous moni Continue reading >>
Continuous Glucose Monitoring In Critically Ill Patients
You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Continuous Glucose Monitoring in Critically Ill Patients The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. ClinicalTrials.gov Identifier: NCT00494455 Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information The purpose of this study is to determine whether subcutaneous continuous glucose monitoring in critically ill patients is clinically feasible accurate and reliable. Device: continuous subcutaneous glucose monitoring Hyperglycemia is is associated with more complications and higher morbidity and mortality in critically ill patients. Therefore, strict glycemic control with a target blood glucose level between 80 and 110 mg/dl is recommended. Intensive insulin therapy requires continuous intravenous insulin infusion according to an algorithm and frequent blood glucose measurements. Implementation of intensive insulin therapy increases workload for both physicians and especially for nurses. Continuous glucose measurement would facilitate blood glucose control in critically ill patients. Numerous studies have shown accuracy of the subcutaneous continuous glucose monitoring derived glucose values compared to blood glucose measurements in diabetics. Studies evaluating the subcutaneous continuous glucose monitoring in an inpatient-population especially in an ICU-setting are rare. Therefore the aim of this study is the prospective evaluation of continuous subcutaneous glucose monitoring in critically ill patients Continue reading >>
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Bedside Blood Glucose Monitoring In Critically Ill Patients: Comparison Between Arterial And Capillary Glucose.
Bedside Blood Glucose Monitoring in Critically Ill Patients: Comparison Between Arterial and Capillary Glucose. Department of Intensive Care Unit, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, P.R. China. Electronic address: [email protected] Department of Intensive Care Unit, General Hospital of Panjin Oilfield, Panjin, Liaoning, P.R. China. Department of Intensive Care Unit, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, P.R. China. Department of Intensive Care Unit, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, P.R. China. Electronic address: [email protected] Am J Med Sci. 2017 Nov;354(5):458-461. doi: 10.1016/j.amjms.2017.05.005. Epub 2017 May 13. BACKGROUND: Critically ill patients are at high risk of hypoglycemia and are particularly vulnerable to unrecognized hypoglycemia. Close blood glucose monitoring is therefore crucial. There are several options to conduct frequent blood glucose measurement and a number of conditions in intensive care unit patients may affect the accuracy of blood glucose measurement. The aim of the study was to compare the accuracy of capillary glucose by bedside glucometer with arterial samples by bedside glucometer and arterial samples by blood gas analyzer in critically ill patients through a prospective case-control study. MATERIALS AND METHODS: Arterial and capillary samples from 60 patients were taken simultaneously and were tested immediately at the bedside. Results of the paired measurements were compared and expressed as a correlation coefficient. RESULTS: Capillary glucose in the study group and control group were 9.73 2.28mmol/L and 8.9 1.86mmol/L, respectively; mean arterial glucose measured by glucometer in the study group an Continue reading >>
- Diagnostic accuracy of resting systolic toe pressure for diagnosis of peripheral arterial disease in people with and without diabetes: a cross-sectional retrospective case-control study
- Consumer Driven Innovation for Continuous Glucose Monitoring in Diabetes Patients
- Abbott's Revolutionary Continuous Glucose Monitoring System, FreeStyle Libre, Now Available To Medicare Patients - Jan 4, 2018
Novel Device Provides Real-time Glucose Monitoring Of Critically Ill
Novel device provides real-time glucose monitoring of critically ill WAIKOLOA, HAWAII Use of an automated bedside blood monitoring platform was safe and effective in measuring glucose in critically ill patients, results from a pivotal, prospective multicenter trial demonstrated. The hypermetabolic stress response to injury is a well-known entity following injury, Grant V. Bochicchio, MD, FACS, said at the annual meeting of the American Association for the Surgery of Trauma. Hyperglycemia has been shown to be intimately associated with this response. Numerous studies have reported that hyperglycemia has been associated with increased infection and worse outcome in critically injured trauma patients. In addition, several studies have demonstrated that the glucose meters used for trauma patients are inaccurate, whether in relation to anemia or other factors, said Dr. Bochicchio , chief of acute and critical care surgery at Washington University, St. Louis. He presented results from a trial that evaluated the safety and accuracy of a continuous inline glucose monitor in 200 critically ill and trauma patients. The OptiScanner , an investigational device manufactured by OptiScan Biomedical, automatically measures plasma-based glucose levels to enable early detection of hypoglycemia, hyperglycemia, or glucose variability. The OptiScanner has yet to be cleared by the Food and Drug Administration, but Dr. Bochicchio said that he expects a decision from the agency in the next several months. The system includes the device itself as well as a single-use, disposable cartridge, which is the only point of contact with the patients blood. A proprietary zero-depth space connector seamlessly attaches a disposable cartridge to the patients IV line, to ensure that blood flows smoothly wi Continue reading >>
Bedside Blood Glucose Monitoring In Critically Ill Patients: Comparison Between Arterial And Capillary Glucose - Sciencedirect
Volume 354, Issue 5 , November 2017, Pages 458-461 Bedside Blood Glucose Monitoring in Critically Ill Patients: Comparison Between Arterial and Capillary Glucose Critically ill patients are at high risk of hypoglycemia and are particularly vulnerable to unrecognized hypoglycemia. Close blood glucose monitoring is therefore crucial. There are several options to conduct frequent blood glucose measurement and a number of conditions in intensive care unit patients may affect the accuracy of blood glucose measurement. The aim of the study was to compare the accuracy of capillary glucose by bedside glucometer with arterial samples by bedside glucometer and arterial samples by blood gas analyzer in critically ill patients through a prospective case-control study. Arterial and capillary samples from 60 patients were taken simultaneously and were tested immediately at the bedside. Results of the paired measurements were compared and expressed as a correlation coefficient. Capillary glucose in the study group and control group were 9.73 2.28mmol/L and 8.9 1.86mmol/L, respectively; mean arterial glucose measured by glucometer in the study group and control group were 9.25 2.05mmol/L and 8.4 1.89mmol/L, respectively; and mean arterial glucose measured by blood gas analyzer in the study group and control group were 8.41 1.9mmol/L and 8.24 1.5mmol/L, respectively. Correlation between capillary values and arterial values measured by glucometer was less in the study group (r = 0.936, P < 0.001 and r = 0.973, P < 0.001). Correlation between capillary values measured by glucometer and arterial values measured by blood gas analyzer was also less in the study group (r = 0.897, P = 0.001 and r = 0.964, P < 0.001). Capillary blood glucose monitoring is reliable only in a selected group of c Continue reading >>
- Diagnostic accuracy of resting systolic toe pressure for diagnosis of peripheral arterial disease in people with and without diabetes: a cross-sectional retrospective case-control study
- Consumer Driven Innovation for Continuous Glucose Monitoring in Diabetes Patients
- Abbott's Revolutionary Continuous Glucose Monitoring System, FreeStyle Libre, Now Available To Medicare Patients - Jan 4, 2018
Sensors | Free Full-text | The Clinical Benefits And Accuracy Of Continuous Glucose Monitoring Systems In Critically Ill Patientsa Systematic Scoping Review
Sensors 2017, 17(1), 146; doi: 10.3390/s17010146 The Clinical Benefits and Accuracy of Continuous Glucose Monitoring Systems in Critically Ill PatientsA Systematic Scoping Review Clinical Diabetology, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM Amsterdam, The Netherlands Medical Library, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands Department of Anesthesiology, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands Author to whom correspondence should be addressed. Received: 28 September 2016 / Revised: 15 December 2016 / Accepted: 8 January 2017 / Published: 14 January 2017 Continuous Glucose Monitoring (CGM) systems could improve glycemic control in critically ill patients. We aimed to identify the evidence on the clinical benefits and accuracy of CGM systems in these patients. For this, we performed a systematic search in Ovid MEDLINE, from inception to 26 July 2016. Outcomes were efficacy, accuracy, safety, workload and costs. Our search retrieved 356 articles, of which 37 were included. Randomized controlled trials on efficacy were scarce (n = 5) and show methodological limitations. CGM with automated insulin infusion improved time in target and mean glucose in one trial and two trials showed a decrease in hypoglycemic episodes and time in hypoglycemia. Thirty-two articles assessed accuracy, which was overall moderate to good, the latter mainly with intravascular devices. Accuracy in critically ill children seemed lower than in adults. Adverse events were rare. One study investigated the effect on workload and cost, and showed a significant reduction in both. In conclusion, studies on the eff Continue reading >>
Bedside Blood Glucose Testing In Critically Ill Patients
Bedside blood glucose testing in critically ill patients To earn CEUs, visit www.mlo-online.com under the CE Tests tab. 1. Define what constitutes a critically ill patient population and discuss the use of handheld blood glucose monitors in critically ill populations. 2. Discuss agencies that regulate off-label device use and identify the guidelines that laboratories must adhere to, in order to be compliant with off-label device use. 3. Recognize the characteristics of diabetes statistics as the relate to healthcare and morbidity. 4. List testing methods for diagnosing and monitoring diabetes and define the limitations with each method. Studies have demonstrated that the practice of hospital bedside blood glucose testing is a necessary and effective means of managing and monitoring glycemic control. Protocols vary by institution, but there is general consensus among providers that this process is an essential component of patient care. However, the use of handheld blood glucose meters within some critically ill patient populations has resulted in varying degrees of confusion about off-label use and potential discrepancies in results. As the most widely used option for measuring blood glucose at the point-of-care (POC), handheld meters offer the benefits of portability, ease of use, and procurement of quick results (less than 10 seconds) using small samples of capillary blood that can be obtained for frequent measurements. Testing can be performed by nurses, medical assistants, and technicians, and entails low risks of blood loss and arterial line infection. In comparison, core lab testing using arterial or venous blood involves a higher degree of complexity, along with the requirement that testing be performed by appropriately trained, qualified personnel. Under most c Continue reading >>
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Accuracy And Reliability Of A Subcutaneous Continuous Glucose Monitoring Device In Critically Ill Patients
Accuracy and reliability of a subcutaneous continuous glucose monitoring device in critically ill patients Subcutaneous continuous glucose monitoring (CGM) may have benefits in achieving glycemic control in critically ill patients. The aim of this study was to assess the accuracy and reliability of the FreeStyle Navigator I in critically ill patients and to assess patient related factors influencing the accuracy and reliability. This study is a retrospective analysis of data from a randomized controlled trial conducted in a 20-bed mixed intensive care unit. Analytical accuracy, clinical accuracy and reliability were assessed against arterial blood glucose samples as reference. Assessment was according to recent consensus recommendations with median absolute relative difference (median ARD), BlandAltman plots, the ISO system accuracy standards (ISO 15197:2013) and Clarke error grid analysis (CEG). We analyzed 2840 paired measurements from 155 critically ill patients. The median ARD of all paired values was 13.3 [6.922.1]%. The median ARD was significantly higher in both the hypoglycemic and the hyperglycemic range (32.4 [12.153.4]% and 18.7 [10.728.3]% respectively, p < 0.001). The BlandAltman analysis showed a mean bias of 0.82mmol/L with a lower limit of agreement (LOA) of 3.88mmol/L and an upper LOA of 2.24mmol/L. A total of 1626 (57.3%) values met the ISO-2013, standards and 1,334 (47%) CGM values were within 12.5% from the reference value. CEG: 71.0% zone A, 25.8% zone B, 0.5% zone C, 2.5% zone D, 0.3% zone E. The median overall real-time data display time was 94.0 14.9% and in 23% of the patients, the sensor measured < 95% of the time. Additionally, data gaps longer than 30min were found in 48% of the patients. The analytical accuracy of the FreeStyle Navigator I Continue reading >>
- Consumer Driven Innovation for Continuous Glucose Monitoring in Diabetes Patients
- Abbott's Revolutionary Continuous Glucose Monitoring System, FreeStyle Libre, Now Available To Medicare Patients - Jan 4, 2018
- Exercise and Glucose Metabolism in Persons with Diabetes Mellitus: Perspectives on the Role for Continuous Glucose Monitoring
Comparison Of Laboratory-based And Near-patient Glucose Monitoring In Critically Ill Patients
Endocrine Abstracts (2017) 50 P219 | DOI: 10.1530/endoabs.50.P219 Comparison of laboratory-based and near-patient glucose monitoring in critically ill patients Wende Wells1, Russell Fetzer1 & Ibrahim Hashim1,2 1University of Texas Southwestern Medical Center, Dallas, USA; 2Parkland Memorial Hospital, Dallas, USA. Frequent measurement of blood glucose among hospitalized patients including those in critically ill areas is routinely practiced. Evidence suggests that tight glycaemic control among hospitalized patients reduced complications such as sepsis and has been shown to reduce length of stay. Most commercially available devices have not been assessed in critically ill patients, furthermore point of care (POC) glucose testing among paediatric population has exhibited a discrepancy greater than 20 mg/dL (1 mmol/L). Recent regulatory agencies voiced concern on the validly of POC deceives use in critically ill patients and the lack of adequate data on its accuracy. This study examined the use of POC glucose measurement using Precision PXP (Abbott Diagnostics) in the monitoring of glucose in critically ill patients. Patients in intensive care units (adult and paediatric), in cardiac care units and those presenting to the emergency department were included in the study. Concurrent POC glucose measurements from 182 patients from those units were compared with laboratory-based glucose values measured using the Hexokinase methods (Cobas, Roche Diagnostics). Sixty three Patients were considered critically ill with a total of 438 samples analysed from all study patients. Glucose values ranged from 25 mg/dL (1.4 mmol/L) to 594 mg/dL (33.0 mmol/L). Bias ranged from 95 to 36 mg/dL (5.3 to 2.0 mmol/L). Among critically ill patients glucose levels ranged from 50 mg/dL (2.8 mmol/L) t Continue reading >>
- Consumer Driven Innovation for Continuous Glucose Monitoring in Diabetes Patients
- Abbott's Revolutionary Continuous Glucose Monitoring System, FreeStyle Libre, Now Available To Medicare Patients - Jan 4, 2018
- Exercise and Glucose Metabolism in Persons with Diabetes Mellitus: Perspectives on the Role for Continuous Glucose Monitoring
Continuous Glucose Monitoring In Diabetic & Critically Ill Patients - Acvim 2008 - Vin
Continuous Glucose Monitoring in Diabetic & Critically Ill Patients Glucose Homeostasis in Health and Illness In health, plasma glucose concentrations are maintained within a narrow range by homeostatic mechanisms involving several anabolic hormones, including insulin and insulin-like growth factors as well as catabolic, counter-regulatory hormones such as glucagon, cortisol, catecholamines, and growth hormone. The balance between intake (gastrointestinal carbohydrate absorption), tissue utilization (glycolysis, glycogen synthesis, the citric acid cycle, etc.) and endogenous production (glycogenolysis and gluconeogenesis) determines the plasma glucose concentration at any given time. Patients with derangements in these homeostatic mechanisms may experience significant excursions in blood glucose concentrations. Diseases such as diabetes mellitus and insulinoma are associated with severe glucose excursions due to direct effects on insulin secretion. However, significant derangements in glucose homeostasis due to peripheral insulin resistance have also been documented in other critically ill patients suffering from a multitude of primary diseases, even those without diabetes. High serum levels of insulin-like growth factor-binding protein 1, related to an impaired response of hepatocytes to insulin, have been reported in non-diabetic critically ill patients, and have been associated with an increased risk of death. Several recent controlled clinical trials have demonstrated significant improvement in outcome in heterogeneous populations of critically ill people treated with intensive insulin therapy to maintain normal blood glucose concentrations.1-3 Patients at risk of derangements in blood glucose concentrations have traditionally been monitored using intermittent bloo Continue reading >>
- Consumer Driven Innovation for Continuous Glucose Monitoring in Diabetes Patients
- Abbott's Revolutionary Continuous Glucose Monitoring System, FreeStyle Libre, Now Available To Medicare Patients - Jan 4, 2018
- Exercise and Glucose Metabolism in Persons with Diabetes Mellitus: Perspectives on the Role for Continuous Glucose Monitoring
Bedside Glucose Monitoringis It Safe? A New, Regulatory-compliant Risk Assessment Evaluation Protocol In Critically Ill Patient Care Settings*
Inpatient glycemic management (IPGM) has become widely accepted as a standard of care ( 1 ). Proper glucose measurement is key to safe and effective IPGM ( 2 , 3 ). Bedside glucose monitoring with blood glucose meters is an essential component of IPGM, but has been shown to create confounding analytical and clinical factors ( 4 , 5 ). This occurred when self-monitoring blood glucose meters (SMBG) designed for diabetic patient self-use migrated into the hospital. Subsequently, numerous studies demonstrated confounding factors affecting clinical outcomes in acute care settings. This multicenter observational study is the first to present an algorithm combining four statistical tools to evaluate the analytical and clinical accuracy of a blood glucose monitoring system (BGMS) in critical care patient settings. In the 1990s through the first decade of the new millennium, glycemic management programs were developed, implemented, and studied to determine the clinical outcome of glycemic control through IV intensive insulin therapy (IIT) in critically ill patients ( 69 ). The initial outcomes of these glycemic management programs were profound; they significantly reduced postsurgical infections, blood transfusion, acute kidney injury, polyneuropathy, ICU length of stay, and in-hospital mortality ( 68 ). Unfortunately, follow-up studies reported increased risk for hypoglycemia with an associated enhanced mortality in critically ill patients who received IV IIT ( 1012 ). Central to these adverse events was the unreliability and lack of standardization of glucose measurement. Historically, the quality of glucose measurement for diabetic patients was assessed using measurement validation protocols established by regulatory and standards agencies in cooperation with manufacturers, Continue reading >>
Glucose Meters In Critically Ill Patients: What New Guidance Means For Labs
Home // ... // Clinical Laboratory News // CLN Articles // Glucose Meters in Critically Ill Patients: What New Guidance Means for Labs Glucose Meters in Critically Ill Patients: What New Guidance Means for Labs Author: James Nichols, PhD // Date: MAY.1.2015 // Source: Clinical Laboratory News What is all the buzz about use of glucose meters in critically ill patients? Glucose meters have been used for more than 30 years to provide rapid measurement of glucose on whole blood fingersticks from patients with diabetes. Originally developed for patient self-testing, glucose meter use has expanded throughout the healthcare industry. Meters currently are being used in physician offices, schools, nursing homes, ambulances, helicopters, airplanes, and cruise ships. Glucose meters have even traveled on the Space Shuttle! They are common throughout hospitals and are used for a variety of reasons, from quick checks of glucose levels to hourly glucose level monitoring as part of intensive insulin protocols. So, why is there now a concern over the use of glucose meters? Problems with glucose meters have been known from the start. Glucose meters designed for patient self-monitoring are validated primarily on ambulant, well patients who happen to have diabetes. These meters are calibrated for normal hematocrits and physiology. Study data from patient self-management is how many of the current meters gained market approval through the Food and Drug Administration (FDA). Unfortunately, when the same meters and test strip methodologies are applied to sick inpatients, comparable performance to outpatient use is not always achieved. Hospitalized patients pre-sent with extremes of hematocrit, pH, and perfusion that challenge glucose meter performance. They also often are on intravenous drug Continue reading >>
Fda Clears Glucose Monitoring System For Use In Critical Care Units
FDA Clears Glucose Monitoring System for Use in Critical Care Units First blood glucose meter approved for this setting The FDA has approved a new indication for the Nova StatStrip Glucose Hospital Meter System (Nova Biomedical), extending its use to hospitalized critically ill patients. This is the first blood glucose monitoring system (BGMS) approved for use in these patients. BGMSs, also called blood glucose meters, are handheld devices that measure the amount of sugar (glucose) in blood by analyzing a small drop of blood that is placed on a test strip. After inserting the test strip into the device, the system displays a glucose level reading. Blood glucose measurements are used in the management of many patients in the hospital, including patients requiring insulin to manage blood sugar, and in the assessment of blood glucose levels in newborn babies. The Nova StatStrip Glucose Hospital Meter System is the first FDA-cleared device specifically indicated for use in all types of hospital patients, including critically ill patients. Users of BGMSs with manufacturer instructions that do not allow use with critically ill hospital patients would be subject to high-complexity testing requirements under the Clinical Laboratory Improvement Amendments (CLIA) if such systems were to be used in the critically ill hospital population. Those requirements include the validation of how well the BGMSs worked in that patient population. The FDA determined that the Nova StatStrip Glucose Hospital Meter System is simple to use and has a low risk of false results, and granted the device with a "clearance waived test system status under the CLIA. This waived status allows a variety of health care professionals, such as nurses and technicians, to perform the test at the point-of-care, s Continue reading >>
Blood Glucose At The Point Of Care: The Current Controversies Surrounding Inpatient Blood Glucose Monitoring
Blood Glucose at the Point of Care: The Current Controversies Surrounding Inpatient Blood Glucose Monitoring Blood Glucose at the Point of Care: The Current Controversies Surrounding Inpatient Blood Glucose Monitoring News Site: Advance Healthcare Network - Medical Laboratory Professionals The timely and accurate determination of blood glucose in the hospital setting is critical to effective nursing workflow and improved patient care. The results have a direct impact on the delivery of insulin and, ultimately, glycemic control. With roughly 25% of people admitted to the hospital experiencing hyperglycemia and the improved outcomes proven to occur with appropriate glycemic management, more and more hospitals, providers and patients are struggling with the recent controversies surrounding inpatient blood glucose monitoring. Advances in blood glucose monitoring technology have been astounding, but despite this fact, several barriers exist regarding the accuracy and dependability of blood glucose measurements in hospitalized patients. One of the many difficult aspects of glycemic management in the hospital is the timing of point-of-care (POC) blood glucose (BG) testing, insulin administration and meals. The workflow surrounding this aspect of care is essential to optimizing blood glucose control and overall patient care. Either nurses or nursing assistants, depending upon the facility, perform POC testing, and this can further complicate the process. When each of the three responsibilities: meal delivery, POC testing and insulin administration are done by different individuals, the coordination of the three can be difficult and opportunities for failure abound. There are multiple indications for the use of IV insulin, but its use is often limited to intensive care units (I Continue reading >>
