Hypoglycemia in the hospital

Hypoglycemia is a common adverse event affecting hospitalized patients with diabetes. This paper reviews the data regarding optimization of glucose in hospitalized patients, discusses the scope and significance of hypoglycemia in the hospital, and makes recommendations on how to reduce the risk of this serious adverse event

Incidence of extreme hyperglycemia and hypoglycemia in hospitalized patients during the month of July in teaching hospitals

Introduction: Blood glucose control has been found to be an important component in the care of hospitalized patients. Maintaining blood glucose within a target range using insulin intensively is a challenging task for physicians and requires skill and experience. We hypothesized that there may be more hyper- and hypoglycemia in July in teaching hospitals when new resident physicians begin their training. Methods: We reviewed point-of-care blood glucose data from hospitalized patients at four community teaching hospitals for 2010. We defined severe hypoglycemia as blood glucose < 41 mg/dL and severe hyperglycemia as blood glucose > 399 mg/dL. Occurrence of hyper- and hypoglycemic events was assessed overall at the particular hospital globally and based on individual nursing units. Monthly occurrence rates were compared against the annual mean for that unit. Results: The occurrence of hyper- and hypoglycemic events in July 2010 did not differ from the mean annual percentage of events at the applicable hospital. However, when the data were analyzed by the nursing unit, these extreme glucose events were significantly more common in 4 of the 11 units studied. Three of those four units were resident teaching units. Conclusions: These data suggest that there is some potential for increased risk of extreme hyper- and hypoglycemia at teaching hospitals in July, when new residents begin training

Diabetes treatment in 2025: can scientific advances keep pace with prevalence?

Despite the known benefits of a healthy lifestyle, many individuals find it hard to maintain such a lifestyle in our modern world, which facilitates sedentary behavior and overeating. As a consequence, the prevalence of type 2 diabetes mellitus is predicted to increase dramatically over the coming years. Will developments in treatments be able to counteract the resulting impact on morbidity and mortality? The various lines of research can be grouped into three main categories: technological, biological, and pharmacological. Technological solutions are focused on the delivery of insulin and glucagon via an artificial pancreas, and components of the system are already in use, suggesting this option may well be available within the next 10 years. Of the biological solutions, pancreas transplants seem unlikely to be used widely, and islet cell transplants have also been hampered by a lack of appropriate donor tissue and graft survival after transplant. However, significant progress has been made in these areas, and additional research suggests manipulating other cell types to replace beta cells may be a viable option in the longer term. The last category, pharmacological research, appears the most promising for significantly reducing the burden of type 2 diabetes mellitus. In recent years, research has concentrated on reducing blood glucose, and the increasing pace of research has been reflected in a growing number of antidiabetic agents. In the past few years, studies of the complementary approach of protecting cells from the damaging effects of high blood glucose have also been reported, as has research into the control of energy intake and energy expenditure. Evidence from studies of dietary restriction and bariatric surgery suggests it may be possible to reset metabolism to effectively cure diabetes, and research into pharmacological agents that could selectively restore energy balance is currently the most exciting prospect for future treatments for people with type 2 diabetes mellitus

Impact of a Combined Continuous Glucose Monitoring–Digital Health Solution on Glucose Metrics and Self-Management Behavior for Adults With Type 2 Diabetes: Real-World, Observational Study

BackgroundThe BlueStar (Welldoc) digital health solution for people with diabetes incorporates data from multiple devices and generates coaching messages using artificial intelligence. The BlueStar app syncs glucose data from the G6 (Dexcom) real-time continuous glucose monitoring (RT-CGM) system, which provides a glucose measurement every 5 minutes. ObjectiveThe objective of this real-world study of people with type 2 diabetes (T2D) using the digital health solution and RT-CGM was to evaluate change in glycemic control and engagement with the program over 3 months. MethodsParticipants were current or former enrollees in an employer-sponsored health plan, were aged 18 years or older, had a T2D diagnosis, and were not using prandial insulin. Outcomes included CGM-based glycemic metrics and engagement with the BlueStar app, including logging medications taken, exercise, food details, blood pressure, weight, and hours of sleep. ResultsParticipants in the program that met our analysis criteria (n=52) were aged a mean of 53 (SD 9) years; 37% (19/52) were female and approximately 50% (25/52) were taking diabetes medications. The RT-CGM system was worn 90% (SD 8%) of the time over 3 months. Among individuals with suboptimal glycemic control at baseline, defined as mean glucose >180 mg/dL, clinically meaningful improvements in glycemic control were observed, including reductions in a glucose management indicator (–0.8 percentage points), time above range 181-250 mg/dL (–4.4 percentage points) and time above range >250 mg/dL (–14 percentage points; all P<.05). Time in range 70-180 mg/dL also increased by 15 percentage points (P=.016) in this population, which corresponds to an increase of approximately 3.5 hours per day in the target range. Over the 3-month study, 29% (15/52) of participants completed at least one engagement activity per week. Medication logging was completed most often by participants (23/52, 44%) at a rate of 12.1 (SD 0.8) events/week, and this was closely followed by exercise and food logging. ConclusionsThe combination of an artificial intelligence–powered digital health solution and RT-CGM helped people with T2D improve their glycemic outcomes and diabetes self-management behaviors