ABSTRACT
Objective To investigate the clinical effects of a blood glycaemic control optimization programme in patients with stress hyperglycaemia after thoracic surgery.Methods One hundred and sixty patients with postoperative stress hyperglycaemia in the First Affiliated Hospital of Nanjing Medical University form July 2016 to July 2018 were randomly divided into control group and experimental group,with 80 patients in each group.Participants in the control group underwent conventional intensive insulin therapy,while participants in the experimental group underwent blood glycaemic control optimization programme.The blood glycaemic control validity index,glycemic variability index and prognostic index were compared between two groups.Results The total-dose insulin,time to reach the target range,high glycaemic index (HGI),72 h average blood glycaemic (GluAve),standard deviation of blood glycaemic (GluSD),mean amplitude of glycaemic excursions (MAGE),glycaemic instability index (GLI),variable coefficient of glycaemic (GluCv) were (69.34 ± 13.97) U,(4.14 ± 1.27) h,0.94 ± 0.30,(8.20 ± 1.06) mmol/L,(1.95 ± 0.35) mmol/L,(0.74 ± 0.27) mmol/L,35.10 ± 13.03,(22.49 ± 6.92) ％ in the experimental group.However,those index were (78.99 ± 11.46) U,(5.80 ± 2.05) h,2.27 ± 0.62,(8.30 ± 1.18) mmol/L,(2.32 ± 0.52) mmol/L,(1.15 ± 0.59) mmol/L,42.06 ± 17.09,(26.54 ± 5.14) ％ in the control group.The total-dose insulin,time to reach the target range,high glycaemic index,GluSD,MAGE,GLI,GluCv were significantly lower in the experimental group than those in control group (P ＜ 0.05).In addition,the incidence of hypoglycaemia,50％ glucose rescue and nosocomial infection were significantly decreased in the experimental group compared to the control group (P＜0.05).Conclusions Blood glycaemic control optimization programme can reduce the incidence of hypoglycemia and infection and achieve blood sugar control goal faster,safer and more effectively in patients with stress hyperglycaemia after thoracic surgery.
ABSTRACT
Objective@#To investigate the clinical effects of a blood glycaemic control optimization programme in patients with stress hyperglycaemia after thoracic surgery.@*Methods@#One hundred and sixty patients with postoperative stress hyperglycaemia in the First Affiliated Hospital of Nanjing Medical University form July 2016 to July 2018 were randomly divided into control group and experimental group, with 80 patients in each group. Participants in the control group underwent conventional intensive insulin therapy, while participants in the experimental group underwent blood glycaemic control optimization programme. The blood glycaemic control validity index, glycemic variability index and prognostic index were compared between two groups.@*Results@#The total-dose insulin, time to reach the target range, high glycaemic index (HGI), 72 h average blood glycaemic (GluAve), standard deviation of blood glycaemic (GluSD), mean amplitude of glycaemic excursions (MAGE), glycaemic instability index (GLI), variable coefficient of glycaemic (GluCV) were (69.34 ± 13.97) U, (4.14 ± 1.27) h, 0.94 ± 0.30, (8.20 ± 1.06) mmol/L, (1.95 ± 0.35) mmol/L, (0.74 ± 0.27) mmol/L, 35.10 ± 13.03, (22.49 ± 6.92)% in the experimental group. However, those index were (78.99 ± 11.46) U, (5.80 ± 2.05) h, 2.27 ± 0.62, (8.30 ± 1.18) mmol/L, (2.32 ± 0.52) mmol/L, (1.15 ± 0.59) mmol/L, 42.06 ± 17.09, (26.54 ± 5.14)% in the control group. The total-dose insulin, time to reach the target range, high glycaemic index, GluSD, MAGE, GLI, GluCV were significantly lower in the experimental group than those in control group (P<0.05). In addition, the incidence of hypoglycaemia, 50% glucose rescue and nosocomial infection were significantly decreased in the experimental group compared to the control group (P<0.05).@*Conclusions@#Blood glycaemic control optimization programme can reduce the incidence of hypoglycemia and infection and achieve blood sugar control goal faster, safer and more effectively in patients with stress hyperglycaemia after thoracic surgery.
ABSTRACT
Background: With about 425 million patients globally and 72.9 million patients in India, diabetes mellitus (DM) is one of the global health emergency of 21st century. Perioperative hyperglycaemia is reported in 20-40% of patients undergoing general surgery. A substantial body of literature demonstrates a clear association between perioperative hyperglycaemia and adverse clinical outcomes. This study aims to find out the frequency of preoperative hyperglycaemia and factors influencing it among patients undergoing surgery at a tertiary health care hospital of Eastern India.Methods: This Institution based, cross-sectional, observational study was conducted among study subjects who were operated at IQ City Medical College and Multispecialty Hospital, Durgapur, India during January-February 2019. Relevant medical records were reviewed to collect data regarding clinic-social data. Estimation of fasting plasma glucose (FPG) has been done as per World Health Organization (WHO) guidelines. Hyperglycaemia was defined and classified as per American Diabetes Association (ADA). Anthropometric measurements were taken as per standard WHO protocols.Results: A total 158 study subjects participated in study. The mean age and mean FPG of the study subjects was 42.63±12.95 years and 103.3±17.37 mg/dl respectively. As per the ADA criteria, 58.9% had normal FPG, 24.0% had impaired fasting glucose (IFG) and 17.1% had diabetes. Out of total 27 T2DM patients, 22 (13.9%) were known cases of T2DM and 5 (3.2%) were undiagnosed. The frequency of preoperative hyperglycaemia i.e. sums of IFG and diabetes was found to be 41.1%. Increasing age, male gender and overweight and obesity significantly influenced the occurrence of preoperative hyperglycaemia.Conclusions: The prevalence of preoperative hyperglycaemia among patients undergoing surgery is higher than the prevalence of hyperglycaemia among non surgical patients. Routine HbA1C should be done in all surgical patients to differentiate between chronic undiagnosed hyperglycaemia and stress hyperglycaemia.
ABSTRACT
Se presenta un niño de 2 años internado con diagnóstico de debut diabético, con glucemia de 500 mg% al ingreso, sin cetosis ni acidosis metabólica. Presenta también vómitos biliosos y amarronados, con deposiciones sanguinolentas. Se opera con diagnóstico presuntivo de obstrucción intestinal aguda, hallándose vólvulo intestinal secundario a malrotación intestinal congénita. Luego de la cirugía normaliza la glucemia. Se asume el cuadro como hiperglucemia sin cetosis, de característica graves, por estrés, secundaria a vólvulo por malrotación intestinal. Esta asociación, aún no ha sido descripta.
A 2-year-old boy was admitted with diagnosis of diabetes debut, with blood glucose of 500 mg% on admission, without ketosis or metabolic acidosis. He also presented bilious vomiting and brownish bloody stools. He was operated with a presumptive diagnosis of acute intestinal obstruction. The fnal diagnosis was volvulus, secondary to congenital malrotation. After surgery, he normalized blood sugar levels. The clinical setting was assumed as hyperglycemia without ketosis, with characteristic of severity caused by stress, secondary to volvulus in malrotation. This association has not yet been described.