Lesiones cutáneas asociadas al uso de bombas de insulina y sistemas de monitoreo: un problema desafiante / Insulin pumps and glucose monitors related cutaneous lesions: a challenging problem

Los cuidados actuales de la diabetes incluyen altos niveles de tecnología y los pacientes utilizan diferentes dispositivos que pueden ayudar en su control metabólico, pero pueden impactar negativamente en su piel. Sensores de glucosa como el Freestyle, Dexcom, el Enlite de Medtronic y los sistemas de infusión continua de insulina contienen diferentes productos químicos que están en contacto directo con la piel del paciente y pueden causar una dermatitis irritativa o de contacto alérgica. Las lesiones incluyen eczema, prurito, heridas, cicatrices y cambios en la pigmentación de la piel. Los productos químicos involucrados que pueden ocasionarlas son el isobornil acrilato, N, N- dimetilacrilamida, etil cianoacrilato y colophonium, forzando a los pacientes a cambiar los sitios de infusión, el set de infusión o el sensor mismo más pronto de lo esperado, para reducir el nivel de daño en la piel. Existe gran número de productos que permiten proteger la piel y reducir el contacto de la piel con la cánula de la bomba o el sensor. Para reducir o prevenir el daño existen productos como cremas o spray y parches de hidrocoloide que actúan como barrera y existen técnicas para aplicar y retirar cuidadosamente los parches y adhesivos de los dispositivos. Una vez que las lesiones se han producido, el tratamiento incluye pomadas y a veces corticoides tópicos y/o antibióticos. Para prevenir o reducir el daño de la piel asociado al sensor y uso de la bomba de insulina, la industria que los produce debería incluir la información en relación a los productos químicos incluidos en cada dispositivo.

Diabetes care nowadays includes a high level of technology and patients use different devices which can help them in their glycemic control, but can have a negative impact on their skin. Glucose sensors such as Freestyle, Dexcom, Medtronic Enlite and also continuous subcutaneous insulin infusion systems contain different chemical products which are in direct contact with the patient's skin and can cause irritative or allergic contact dermatitis. Lesions include eczema, pruritus, wounds, scars and changes in skin pigmentation. The chemical products which can induce them are isobornyl acrylate, N, N- dimethylacrylamide, ethyl cyanoacrylate and colophonium, forcing patients to change the infusion site, set or the sensor itself, earlier than expected, in order to reduce the level of skin damage. There are a number of products which can protect the skin and reduce it's contact with the pump cannula or the sensor. To reduce or prevent damage, we have products such as barrier cream or spray films and hydrocolloid blister plasters and actions such as careful application and removal of device's patches and adhesives. Once lesions are established, treatment includes ointments and sometimes topical steroids and/ or antibiotics. In order to prevent or reduce skin damage related to sensor and insulin pump use, the manufacturers should include the information related to the chemicals included in each device.

Efficacy of a glucose meter connected to a mobile app on glycemic control and adherence to self-care tasks in patients with T1DM and LADA: a parallel-group, open-label, clinical treatment trial

ABSTRACT Objective: The main aim of the study was to evaluate the patients' glycemic control and adherence to self-care tasks. Materials and methods: Patients with type 1 diabetes mellitus (T1DM) or latent autoimmune diabetes of the adult (LADA) using a multiple daily injection (MDI) regimen with carbohydrate counting (n = 25, Subgroup B) or fixed insulin dose (n = 25, Subgroup C) were allocated to use the application (app) for 12 weeks. Both subgroups were compared with each other and against a control group (n = 25, Group A) comprising patients with T1DM or LADA treated with continuous subcutaneous insulin infusion (CSII) in a parallel-group, open-label, clinical treatment trial. All patients had glycated hemoglobin (A1C) levels measured and were asked to fill out the Diabetes Self-Management Profile (DSMP) questionnaire at study start and end. The patients were instructed to measure capillary glucose six times daily in study weeks 4, 8, and 12. Results: Mean A1C levels decreased 0.725% in Subgroup C in intragroup analysis (p = 0.0063), and had a mean variation of 0.834% compared with Group A (p = 0.003). Mean DSMP scores increased 5.77 points in Subgroup B in intragroup analysis (p = 0.0004) and increased by a mean of 6.815 points in relation to Group A (p = 0.002). Conclusion: OneTouch Reveal improved both A1C levels and DSMP scores in patients with T1DM or LADA compared with standard treatment (CSII).

Sistema de Infusión continua de insulina con sensor de glucemia en pacientes con diabetes mellitus tipo 1 / Continuous insulin infusion system with blood glucose sensor in patients with type 1 diabetes mellitus

El presente informe es producto del trabajo colaborativo de la Comisión Nacional de Evaluación de Tecnologías de Salud (CONETEC), dependiente del Ministerio de Salud de la Nación y creada por RM N° 623/2018. La CONETEC realiza evaluaciones y emite recomendaciones a la autoridad sanitaria sobre la incorporación, forma de uso, financiamiento y políticas de cobertura de las tecnologías sanitarias desde una perspectiva global del sistema de salud argentino. En sus evaluaciones y recomendaciones, la CONETEC tiene en cuenta criterios de calidad, seguridad, efectividad, eficiencia y equidad, evaluados bajo dimensiones éticas, médicas, económicas y sociales. Sus resultados son consensuados mediante discusiones públicas y ponderados a través de un marco de valor explícito, con la participación de todos los actores involucrados en el proceso de toma de decisiones en salud. Los informes y recomendaciones de esta comisión surgen de este proceso público, transparente y colaborativo, siendo de libre consulta y acceso para toda la sociedad.

Development and validation of an instrument (CSII - Brazil) to assess users' conceptual and procedural knowledge of continuous subcutaneous infusion systems

ABSTRACT Objective: To develop, adapt and validate an instrument named "CSII - Brazil" to assess users' conceptual and procedural knowledge of continuous subcutaneous insulin infusion systems. Materials and methods: Methodological and exploratory study developed in three stages: a) instrument development; b) content validation and cultural adaptation (evaluation by a committee of experts and pre-test with CSII users); c) psychometric validation through instrument application in a sample of 60 patients by means of the web tool e-Surv. Internal consistency and reproducibility analyses were performed within IBM SPSS Statistics 20 programming environment. Results: The 16 multiple-choice question instrument successfully attained a content validity index of 0.97, showing satisfactory internal consistency, with 0.61 Cronbach's alpha [95% CI 0.462-0.746] and an intraclass correlation coefficient of 0.869 [95% CI: 0.789-0.919] between the test and retest scores. Conclusion: The CSII - Brazil instrument is considered adequate and validated to assess continuous subcutaneous infusion system users' conceptual and procedural knowledge.

Uso do sistema de infusão contínua de insulina em crianças e adolescentes com diabetes mellitus tipo 1: revisão de mapeamento sistemático / Use of continuous insulin infusion systems in children and adolescents with type 1 diabetes mellitus

Um dos avanços tecnológicos no tratamento do diabetes mellitus tipo 1 (DM1) é o uso do sistema de Infusão Contínua de Insulina (SICI). Essa revisão sistemática de mapeamento teve como objetivo agrupar e descrever as evidências dos estudos relacionados ao uso do SICI em crianças e adolescentes com DM1. A estratégia de busca foi estruturada a partir da ferramenta PCO, utilizando-se uma combinação de descritores e palavras-chaves. Buscas bibliográficas foram conduzidas nas seguintes bases de dados: PubMed, Embase, CINAHL, Lilacs e PsycINFO, aplicando-se um único filtro, que foi o temporal, delimitando-se a publicação dos estudos até dezembro de 2020. Os critérios de inclusão foram: estudos primários e secundários, quantitativos e qualitativos, que tivessem como objetivo abordar o uso do SICI em crianças e adolescentes (0-18 anos) com DM1; e estudos que abordassem as perspectivas das próprias crianças e adolescentes, dos profissionais de saúde e dos familiares. Constituíram critérios de exclusão: estudos que comparassem a terapia de múltiplas injeções de insulina com a terapia por meio do SICI ou que incluíssem adultos jovens e adultos conjuntamente às crianças e adolescentes, participantes com diabetes mellitus tipo 2 (DM2) ou usuários do SICI com foco no sistema de monitorização contínua de glicose (CGM) ou pâncreas artificial. Utilizou-se o software Rayyan para exclusão das referências duplicadas e para a triagem dos títulos e resumos das referências capturadas, a qual foi conduzida por dois revisores independentes. Os dados dos estudos incluídos foram analisados com auxílio de uma ferramenta de extração adaptada e validada por pesquisadores especialistas em diabetes e com experiência no desenvolvimento de métodos de síntese de conhecimento. Os resultados foram analisados segundo a técnica de análise de conteúdo. Incluiu-se um total de 113 estudos na revisão, dentre eles, estudos originais, revisões de literatura e publicações de literatura cinzenta. Mapas de geocodificação dos estudos foram produzidos com auxílio do software ArcGis 10.5 para ilustrar o local de desenvolvimento dos estudos. A análise geográfica dos estudos possibilitou identificar maior concentração de publicações conduzidas em países desenvolvidos. Esta revisão reuniu as evidências para o uso do SICI em crianças e adolescentes com DM1, as quais foram apresentadas por meio das seguintes categorias: indicações e contraindicações para o uso do SICI; controle metabólico; redes de apoio; e benefícios e desafios do uso do SICI. As indicações para o uso do SICI superam as contraindicações. Apesar de grande parte dos estudos evidenciar melhora do controle metabólico de crianças e adolescentes em uso do SICI, a piora desse controle foi descrita em algumas pesquisas, o que sugere que esse parâmetro não deve ser analisado de forma isolada. As redes de apoio foram citadas como um dos fatores que influenciam os parâmetros de controle metabólico, conformando as subcategorias: apoio familiar e apoio da equipe de saúde e escola. Foram elencados desafios para o uso do SICI na população pediátrica, porém, vale ressaltar que parte destes desafios tem sido superada com o avanço da ciência e da tecnologia moderna. Múltiplos benefícios também foram descritos na literatura, os quais podem auxiliar profissionais de saúde na tomada de decisão para a melhor escolha e acompanhamento do tratamento do DM1 em crianças e adolescentes. Esta revisão reúne evidências sobre o uso do SICI em crianças e adolescentes com DM1 e contribui com o corpo de conhecimento relacionado à temática

One of the technological advances in type 1 diabetes mellitus (T1DM) treatment is the use of Continuous Subcutaneous Insulin Infusion (CSII). The aim of this systematic mapping review was to group and describe the evidence from research on the use of CSII in children and adolescents with T1DM. The search strategy was structured based on the PCO tool, using a combination of descriptors and keywords. Bibliographic searches were undertaken in the following databases: PubMed, Embase, CINAHL, Lilacs and PsycINFO, applying a single time-based filter to delimit the publication of studies until December 2020. The inclusion criteria were: primary and secondary studies, quantitative and qualitative, aimed at discussing the use of CSII in children and adolescents (0-18 years) with T1DM; and studies addressing the perspectives of the actual children and adolescents, the health professionals and Family members. Exclusion criteria were: studies that compared multiple insulin injection therapy with therapy using CSII or that included young adults and adults together with the children and adolescents, participants with type 2 diabetes mellitus (T2DM), or with CSII users focusing on the continuous glucose monitoring (CGM) system or artificial pancreas. The software Rayyan was used to exclude duplicated references and to screen the titles and abstracts of the collected references, which was conducted by two independent reviewers. The data from the included studies were analyzed with the help of an extraction tool, adapted and validated by researchers with diabetes expertise and knowledgeable on the development of knowledge synthesis methods. The content analysis technique was used to analyze the results. In total, 113 studies were included in the review, covering original studies, literature reviews and grey literature publications. Geocoding maps of the studies were produced in ArcGis 10.5 to illustrate where the studies had been developed. Through the geographic analysis of the studies a greater concentration of publications in developed countries was identified. This review gathered evidence on the use of CSII in children and adolescents with T1DM, presented in the following categories: indications and contraindications for the use of CSII; metabolic control; support networks; and benefits and challenges of CSII use. The indications in favor of using CSII outweigh the contraindications. Although most of the studies evidence improved metabolic control in children and adolescents who use CSII, some studies described worse control, suggesting that this parameter should not be analyzed in isolation. The support networks were mentioned as one of the factors that influence the metabolic control parameters. This category includes the following subcategories: family support and support from the health team and school. Challenges were listed for the use of CSII in the pediatric population, although it should be highlighted that advanced science and modern technology have overcome some of these. Multiple benefits have also been described in the literature, which can help health professionals to make decisions in order to better choose and monitor T1DM treatment in children and adolescents. This review gathers evidence on the use of CSII in children and adolescents with T1DM and contributes to the body of knowledge on the theme

Uso do sistema de infusão contínua de insulina em crianças e adolescentes com diabetes mellitus tipo 1: revisão de mapeamento sistemático / Use of continuous insulin infusion systems in children and adolescents with type 1 diabetes mellitus

Um dos avanços tecnológicos no tratamento do diabetes mellitus tipo 1 (DM1) é o uso do sistema de Infusão Contínua de Insulina (SICI). Essa revisão sistemática de mapeamento teve como objetivo agrupar e descrever as evidências dos estudos relacionados ao uso do SICI em crianças e adolescentes com DM1. A estratégia de busca foi estruturada a partir da ferramenta PCO, utilizando-se uma combinação de descritores e palavras-chaves. Buscas bibliográficas foram conduzidas nas seguintes bases de dados: PubMed, Embase, CINAHL, Lilacs e PsycINFO, aplicando-se um único filtro, que foi o temporal, delimitando-se a publicação dos estudos até dezembro de 2020. Os critérios de inclusão foram: estudos primários e secundários, quantitativos e qualitativos, que tivessem como objetivo abordar o uso do SICI em crianças e adolescentes (0-18 anos) com DM1; e estudos que abordassem as perspectivas das próprias crianças e adolescentes, dos profissionais de saúde e dos familiares. Constituíram critérios de exclusão: estudos que comparassem a terapia de múltiplas injeções de insulina com a terapia por meio do SICI ou que incluíssem adultos jovens e adultos conjuntamente às crianças e adolescentes, participantes com diabetes mellitus tipo 2 (DM2) ou usuários do SICI com foco no sistema de monitorização contínua de glicose (CGM) ou pâncreas artificial. Utilizou-se o software Rayyan para exclusão das referências duplicadas e para a triagem dos títulos e resumos das referências capturadas, a qual foi conduzida por dois revisores independentes. Os dados dos estudos incluídos foram analisados com auxílio de uma ferramenta de extração adaptada e validada por pesquisadores especialistas em diabetes e com experiência no desenvolvimento de métodos de síntese de conhecimento. Os resultados foram analisados segundo a técnica de análise de conteúdo. Incluiu-se um total de 113 estudos na revisão, dentre eles, estudos originais, revisões de literatura e publicações de literatura cinzenta. Mapas de geocodificação dos estudos foram produzidos com auxílio do software ArcGis 10.5 para ilustrar o local de desenvolvimento dos estudos. A análise geográfica dos estudos possibilitou identificar maior concentração de publicações conduzidas em países desenvolvidos. Esta revisão reuniu as evidências para o uso do SICI em crianças e adolescentes com DM1, as quais foram apresentadas por meio das seguintes categorias: indicações e contraindicações para o uso do SICI; controle metabólico; redes de apoio; e benefícios e desafios do uso do SICI. As indicações para o uso do SICI superam as contraindicações. Apesar de grande parte dos estudos evidenciar melhora do controle metabólico de crianças e adolescentes em uso do SICI, a piora desse controle foi descrita em algumas pesquisas, o que sugere que esse parâmetro não deve ser analisado de forma isolada. As redes de apoio foram citadas como um dos fatores que influenciam os parâmetros de controle metabólico, conformando as subcategorias: apoio familiar e apoio da equipe de saúde e escola. Foram elencados desafios para o uso do SICI na população pediátrica, porém, vale ressaltar que parte destes desafios tem sido superada com o avanço da ciência e da tecnologia moderna. Múltiplos benefícios também foram descritos na literatura, os quais podem auxiliar profissionais de saúde na tomada de decisão para a melhor escolha e acompanhamento do tratamento do DM1 em crianças e adolescentes. Esta revisão reúne evidências sobre o uso do SICI em crianças e adolescentes com DM1 e contribui com o corpo de conhecimento relacionado à temática

One of the technological advances in type 1 diabetes mellitus (T1DM) treatment is the use of Continuous Subcutaneous Insulin Infusion (CSII). The aim of this systematic mapping review was to group and describe the evidence from research on the use of CSII in children and adolescents with T1DM. The search strategy was structured based on the PCO tool, using a combination of descriptors and keywords. Bibliographic searches were undertaken in the following databases: PubMed, Embase, CINAHL, Lilacs and PsycINFO, applying a single time-based filter to delimit the publication of studies until December 2020. The inclusion criteria were: primary and secondary studies, quantitative and qualitative, aimed at discussing the use of CSII in children and adolescents (0-18 years) with T1DM; and studies addressing the perspectives of the actual children and adolescents, the health professionals and Family members. Exclusion criteria were: studies that compared multiple insulin injection therapy with therapy using CSII or that included young adults and adults together with the children and adolescents, participants with type 2 diabetes mellitus (T2DM), or with CSII users focusing on the continuous glucose monitoring (CGM) system or artificial pancreas. The software Rayyan was used to exclude duplicated references and to screen the titles and abstracts of the collected references, which was conducted by two independent reviewers. The data from the included studies were analyzed with the help of an extraction tool, adapted and validated by researchers with diabetes expertise and knowledgeable on the development of knowledge synthesis methods. The content analysis technique was used to analyze the results. In total, 113 studies were included in the review, covering original studies, literature reviews and grey literature publications. Geocoding maps of the studies were produced in ArcGis 10.5 to illustrate where the studies had been developed. Through the geographic analysis of the studies a greater concentration of publications in developed countries was identified. This review gathered evidence on the use of CSII in children and adolescents with T1DM, presented in the following categories: indications and contraindications for the use of CSII; metabolic control; support networks; and benefits and challenges of CSII use. The indications in favor of using CSII outweigh the contraindications. Although most of the studies evidence improved metabolic control in children and adolescents who use CSII, some studies described worse control, suggesting that this parameter should not be analyzed in isolation. The support networks were mentioned as one of the factors that influence the metabolic control parameters. This category includes the following subcategories: family support and support from the health team and school. Challenges were listed for the use of CSII in the pediatric population, although it should be highlighted that advanced science and modern technology have overcome some of these. Multiple benefits have also been described in the literature, which can help health professionals to make decisions in order to better choose and monitor T1DM treatment in children and adolescents. This review gathers evidence on the use of CSII in children and adolescents with T1DM and contributes to the body of knowledge on the theme

Custo direto da judicialização dos sistemas de infusão contínua de insulina (Sici) no município do Rio de Janeiro / Direct cost of the judicialization of continuous insulin infusion systems (Sici) in the city of Rio de Janeiro

Objetivo: Estimar o custo direto anual da judicialização dos sistemas de infusão contínua de insulina (Sici), no município do Rio de Janeiro, entre 2015 e 2017, e analisar as características dos processos relacionados à referida tecnologia. Métodos: Estudo transversal descritivo que analisou os pareceres técnicos emitidos pelo Núcleo de Assessoria Técnica em Ações de Saúde e os respectivos processos judiciais. As informações relacionadas aos custos foram provenientes do relatório de solicitação de empenho da Central de Atendimento às Demandas Judiciais do Estado do Rio de Janeiro e de orçamentos fornecidos pelos fabricantes/distribuidores. Resultados: Foram avaliados 189 processos emitidos. A média de idade dos autores dos processos foi de 25,1 anos e 57,1% eram do sexo feminino. Em 98 casos (51,9%), o documento utilizado no processo foi proveniente de médicos da rede pública de saúde. O juiz deferiu o pleito em 153 processos (80,9%). De um total de 75 médicos prescritores, nove foram responsáveis por 43,9% das prescrições, demonstrando uma concentração das prescrições em determinados profissionais. O valor estimado de custo direto acumulado (2015- 2017) decorrente da judicialização dos Sici, no município do Rio de Janeiro, corresponde a R$ 6,9 milhões, o que representa 6,7% dos gastos de judicialização da saúde no mesmo período. Conclusão: Considerando que a tecnologia analisada é recorrentemente judicializada, os dados coletados podem gerar informações úteis para os gestores governamentais da área da saúde, na avaliação da eficiência na alocação dos recursos públicos, para os profissionais que trabalham na assistência judiciária e para os juízes.

Objective: To estimate the annual direct cost of the Judicialization of Continuous Insulin Infusion Systems (Sici), in the city of Rio de Janeiro, between 2015 and 2017. Methods: It is a cross sectional study that analyzed the technical opinions on the Sici issued by the Core of Technical Advice on Health Actions and the respective judicial processes. The information related to the costs was obtained from the Report of Request for Compromise provided by the Center of Attendance to the Lawsuits of the state of Rio de Janeiro and budgets of the manufacturer /distributors. Results: There were 189 processes and the average age of the authors was 25.1 years and that the majority was female (57.1%). In 98 cases (51.9%) the document used in the process came from doctors of the public health network. The judge granted the suit in 153 cases (80.9%). Nine physicians were responsible for 43.9% of the prescriptions, out of a total of 75 prescribing physicians, demonstrating a concentration of prescribing physicians. The estimated value of accumulated direct cost (2015-2017), due to the Sici's judicialization in the city of Rio de Janeiro, corresponds to R$ 6.9 million, which represents 6.7% of health care expenditures in the same period. Conclusion: Considering that the technology under review is repeatedly judicialized, the data collected can generate useful information to public healthcare decision makers, the evaluation of efficiency in the allocation of public resources, and professionals working in legal aid or for the judges themselves.

Use of flash glucose-sensing technology in patients with type 2 diabetes treated with liraglutide combined with CSII: a pilot study

Glycemic variability (GV) may be linked to the development of diabetic complications by inducing inflammation, oxidative stress, and endothelial dysfunction. Flash glucose monitoring (FGM) provides a novel method of continuously monitoring interstitial glucose levels for up to 14 days. This study randomly assigned poorly controlled type 2 diabetes mellitus patients treated with metformin and multiple daily injections of insulin (n=60) to either continuous subcutaneous insulin infusion (CSII) treatment or CSII in combination with liraglutide (CSII+Lira) treatment for 14 days during hospitalization. GV was assessed using a FGM system; weight and cardiometabolic biomarkers were also evaluated. The coefficient of variation was significantly reduced in the CSII+Lira group (P<0.001), while no significant change was observed in the CSII group. The changes differed significantly between the two groups in mean amplitude of glycemic excursions (P=0.004), standard deviation (P=0.006), and the percentage of time in the target range (4-10 mmol/L, P=0.005 and >10 mmol/L, P=0.028). The changes in mean of daily differences, interquartile range, and percentage of time in hypoglycemia (<3.3 mmol/L) and hyperglycemia (>13.9 mmol/L) identified by FGM showed no difference. Treatment with liraglutide increased serum adiponectin [33.5 (3.5, 47.7) pg/mL, P=0.003] and heme oxygenase-1 levels [0.4 (-0.0, 1.8) ng/mL, P=0.001] and reduced serum leptin levels [-2.8 (3.9) pg/mL, P<0.001]. Adding the glucagon-like peptide-1 analog liraglutide improved GV, weight, and some cardiometabolic risk markers. The FGM system is, therefore, shown to be a novel and useful method for glucose monitoring.

Características clínicas, esquemas de tratamiento, grado de control y variables asociadas a este en una cohorte de adultos con diabetes mellitus tipo 1 en un centro terciario / Clinical features and management of 205 adults with type 1 diabetes mellitus

Background: Few studies have evaluated the details of insulin therapy for type 1 diabetes mellitus (T1D) in Chile. Aim: To describe clinical features and treatment details of adults with T1D and its association with metabolic control. Material and Methods: Review of medical records of patients with T1D treated in a clinical network. Demographic and clinical features, types and doses of insulin and glycated hemoglobin levels were registered. The use flash glucose monitors (FGM) and insulin pumps (CSII) were also recorded. Results: 205 records were reviewed, with T1d lasting 12 ± 10 years. Twenty six percent had hypothyroidism, 1% had celiac disease, 12% had hypertension, 20% had dyslipidemia; 13% had diabetic retinopathy, 2% had diabetic nephropathy, 8% had neuropathy and 2% cardiovascular diseases. Mean body mass index was 25 kg/ m2 and mean glycated hemoglobin was 8%. Eighty-two percent used multiple daily injections, 18% used CSII and 24% used FGM. As basal insulin, 35% used slow acting analogs and 65% used ultra-slow analogs. As rapid acting insulin, 69 patients used Lispro, 79 Aspart and 50 Glulisin. Bolus doses were calculated using only capillary glucose in 22%, while 78% also considered carbohydrate consumption. Variables significantly associated to better control were the use of carbohydrates for dosing rapid insulin (A1c 7,85% vs 8,59%, p = 0,008), use of CSII (A1c 7,36% vs 8,16%, p = 0,008), and basal dose < 0,4 U/kg (A1c 7,81% vs 8,58%, p = 0,003). There were no differences regarding insulin type or use of FGM. Conclusions: The use of formulas considering carbohydrates for dosing rapid insulin, use of infusion pumps and physiological doses of basal insulin are significantly associated with a better metabolic control in adults with T1d.

Continuous Glucose Monitoring Sensors for Diabetes Management: A Review of Technologies and Applications

By providing blood glucose (BG) concentration measurements in an almost continuous-time fashion for several consecutive days, wearable minimally-invasive continuous glucose monitoring (CGM) sensors are revolutionizing diabetes management, and are becoming an increasingly adopted technology especially for diabetic individuals requiring insulin administrations. Indeed, by providing glucose real-time insights of BG dynamics and trend, and being equipped with visual and acoustic alarms for hypo- and hyperglycemia, CGM devices have been proved to improve safety and effectiveness of diabetes therapy, reduce hypoglycemia incidence and duration, and decrease glycemic variability. Furthermore, the real-time availability of BG values has been stimulating the realization of new tools to provide patients with decision support to improve insulin dosage tuning and infusion. The aim of this paper is to offer an overview of current literature and future possible developments regarding CGM technologies and applications. In particular, first, we outline the technological evolution of CGM devices through the last 20 years. Then, we discuss about the current use of CGM sensors from patients affected by diabetes, and, we report some works proving the beneficial impact provided by the adoption of CGM. Finally, we review some recent advanced applications for diabetes treatment based on CGM sensors.

De la bomba de insulina y el monitoreo continuo de glucosa al páncreas artificial / From insulin pump and continuous glucose monitoring to the artificial pancreas

Technology for diabetes care has undergone major development during recent decades. These technological advances include continuous subcutaneous insulin infusion (CSII), also known as insulin pumps, and real-time continuous glucose monitoring system (RT-CGMS). The integration of CSII and RT-CGMS into a single device has led to sensor-augmented pump therapy and more recently, a technology that has automated delivery of basal insulin therapy, known as hybrid system. These new technologies have led to benefits in attaining better metabolic control and decreasing the incidence of severe hypoglycemia, especially in patients with type 1 diabetes. This review describes the types of technologies currently available or under investigation for these purposes, their benefits and disadvantages, recommendations and the appropriate patient selection for their use. The clinical use of the hybrid system and artificial pancreas seem to be possible in the near future.

effect of retraining on treatment success, quality of life, and metabolic parameters in patients with type 1 diabetes using an insulin pump

Objective:To investigate the effect of insulin pump user retraining on treatment success, quality of life, and metabolic parameters of patients with type 1 diabetes using continuous subcutaneous insulin infusion

Subjects and Methods: A total of 35 subjects participated in this prospective study. All patients were given insulin pump user retraining. Their knowledge level and application skills, metabolic parameters, quality of life, and satisfaction from treatment were evaluated at baseline and after 6 months

Results: There was significant improvement in patients' knowledge and application skills after insulin pump user retraining [self-assess-ment of user skills: 69.7 +/-11.5 vs. 76.3 +/- 11.3, p < 0.001; knowledge level on technical issues: 3.3 +/- 1.1 vs. 4.1 +/- 1.8, p = 0.003; glucose monitoring: 27.1 +/- 5.8 vs. 29.2 +/- 5.6, p = 0.006; management of hyperglycemia: 13.1 +/- 3.2 vs. 15.7 +/- 3.4, p < 0.001; management of pump and infusion site problems: 8.8 +/- 2.6 vs. 10.6 +/- 2.6, p = 0.001]. Hemoglobin [Hb]A[ic] levels of patients with poor glycemic control improved after retraining [8.61 % +/- 0.78 vs. 8.23% +/- 0.79, p = 0.02]. However, no significant improvement in quality of life and treatment satisfaction parameters were found

Conclusion: Management of type 1 diabetes in insulin pump users can be significantly improved by retraining. Even a basic short-term retraining program helps patients to increase their knowledge level and ability to more effectively use the insulin pump. The fact that retraining significantly improves glycemic parameters in patients with poor metabolic control indicates that priority should be given to this group of patients. Further studies with individualized training programs i larger sample sizes with long-term follow-up are needed 1 establish the importance of retraining and create re-educ. tion plans for patients with type 1 diabetes using an insuli pump

Effectiveness of glargine insulin on recovery of patients with diabetic ketoacidosis

Background: Diabetic Ketoacidosis [DKA] is one of emergency conditions caused by acute hyperglycemia in diabetic patients. The main treatment is injection of rapid-acting Regular insulin. This study was aimed to investigate the effect of Glargine insulin on recovery of patients with DKA

Methods: A randomized clinical trial [RCT] conducted on 40 patients [twenty patients in each group] with DKA. Both groups received standard treatment regimen for DKA. In addition, the experimental group was given 0.4 U/kg of insulin glargine

Results: The mean duration of acidosis correction time and recovery from DKA was 13.77+/-6.10 hours in the case group and 16.91+/-6.49 hours in control group [p=0.123]. The mean dosage of regular insulin until recovery from DKA was 84.8+/-45.6 units in the case group and 116.5+/-91.6 units in control group [p=0.17]. Hypokalemia [p=l] and hypoglycemia [p=l] were not different between two groups. In 35% of samples in case group and 51% in controls, the blood sugar [BS] was more than 180 mg/dl for 24 hours after discontinuation of the insulin infusion [pFO.046]. The mean duration of hospitalization was 5.1+/-1.88 days in case and 5.9+/-2.19 days in control group [p=0.225]

Conclusion: Adding insulin Glargine to the standard treatment regimen of DKA significantly reduced rebound hyperglycemia without incurring episodes of hypoglycemia and hypokalemia

It also reduced the average time of recovery from DKA, regular insulin consumption and hospital length, although these changes were not statistically significant. It seems that the non-significant difference be related to the paucity of sample size and close monitoring of patients

Impact of targeted education on managing warning and error signals by children and adolescents with type 1 diabetes using the Accu-Chek Combo Insulin Pump System

PURPOSE: Insulin pumps are widely used in diabetes. They are equipped with safety alarms to alert users. Pump manuals contain alarm codes and how to troubleshoot them. However, these manuals are lengthy and difficult to use, particularly in emergencies. We aim to assess the impact of targeted education on warnings and errors in improving competency to troubleshoot the alarms. METHODS: Twenty-one patients, with a median age of 13, were recruited over a 5-month period. Each patient had 2 study visits. The frequencies and types of alarms were recorded, and patients were given a summary sheet that outlined common alarms encountered and troubleshooting tips. In visit 2, the frequencies and types of alarms were compared to those of visit 1. The patients were asked to fill a questionnaire and to rate the education session given in visit 1, their level of competency in decrypting alarm codes, and their promptness in responding to alarms. RESULTS: Low cartridge (W1), low battery (W2), and bolus cancelled (W8) were the commonest warnings. The most noted errors were occlusion (E4), power interruption (E8), empty battery (E2), set not primed (E11), and cartridge empty (E1). The numbers of warning and error signals markedly decreased after targeted education (P < 0.05). The ability in decrypting warning signals significantly improved (P=0.02), and the frequency of response to pump alarms significantly increased (P=0.001). CONCLUSION: Certain warnings and errors are more common than others in insulin pumps. Targeted education is useful in improving competency and response of patients in managing pump alarms.

Efetividade e segurança da insulina em bolus versus em infusão contínua, no controle glicêmico de pacientes no pós operatório de transplante hepático / Effectiveness and safety of bolus insulin versus continuous infusion in the glycemic control of patients in the postoperative period of liver transplantation

Na literatura, ainda, existe controvérsia quanto ao melhor e mais seguro método de controle glicêmico (intermitente ou contínuo) e faixa alvo da glicemia em pacientes críticos, no qual se insere o que se submete ao transplante de fígado. Na perspectiva do transplante, o assunto interessa devido aos efeitos deletérios da hiperglicemia e/ou hipoglicemia ao paciente e enxerto. Neste sentido, o objetivo foi analisar a efetividade e segurança da insulina em bolus versus em infusão contínua, no controle glicêmico de pacientes no pós-operatório imediato de transplante hepático. O estudo foi do tipo ensaio clínico pragmático, aberto, prospectivo, com 42 participantes, segregados em dois grupos (caso e controle), 21 cada, em pós-operatório imediato de transplante hepático. Os participantes do grupo BIC e BOLUS receberam como intervenção insulinoterapia em infusão contínua e em bolus, respectivamente, a partir de glicemia capilar de 150mg/dl. O estudo foi aprovado pelo Comitê de Ética em Pesquisa (CEP), da Universidade Federal do Ceará/PROPESQ, sob parecer nº 1.063.210. Ademais, foi cadastrado no Registro Brasileiro de Ensaios Clínicos (REBEC), conforme número de RBR- 9Y5tbp. Não identificamos estatística significante, entre as técnicas de insulinoterapia, quanto ao tempo de redução da glicemia (p=0,919), presença de hipoglicemia (p=0,500) e o valor inicial da glicemia (p= 0,345). Identificou-se valor final da glicemia na UTI pós-operatória menor e estatisticamente significante no grupo bomba de infusão contínua em relação ao bolus (p<0.001). Ademais, a variação de redução glicêmica foi maior e estatisticamente significante, no grupo BIC (p = 0,041). O método contínuo por bomba de infusão contínua obteve melhores resultados quanto à redução dos valores da glicemia. Em relação aos casos de hipoglicemia e desfechos clínicos, não houve diferenças entre os grupos. Com base na variação e no valor glicêmico final, conclui-se que o método da infusão contínua foi mais efetivo e seguro no controle glicêmico de pacientes no pós-operatório de transplante hepático.(AU)

Continuous insulin therapy versus multiple insulin injections in the management of type 1 diabetes: a longitutinal study / Insulinoterapia contínua versus múltiplas injeções de insulina no tratamento da diabetes tipo 1: um estudo longitudinal

To compare multiple doses of insulin and continuous insulin infusion therapy as treatment for type 1 diabetes mellitus. Methods: 40 patients with type 1 diabetes mellitus (21 female) with ages between 10 and 20 years (mean=14.2) and mean duration of diabetes of 7 years used multiple doses of insulin for at least 6 months and after that, continuous insulin infusion therapy for at least 6 months. Each one of the patients has used multiple doses of insulin and continuous insulin infusion therapy. For analysis of HbA1c, mean glycated hemoglobin levels (mHbA1c) were obtained during each treatment period (multiple doses of insulin and continuous insulin infusion therapy period). Results: Although mHbA1c levels were lower during continuous insulin infusion therapy the difference was not statistically significant. During multiple doses of insulin, 14.2% had mHbA1c values below 7.5% vs. 35.71% while on continuous insulin infusion therapy; demonstrating better glycemic control with the use of continuous insulin infusion therapy. During multiple doses of insulin, 15–40 patients have severe hypoglycemic events versus 5–40 continuous insulin infusion therapy. No episodes of ketoacidosis events were recorded. Conclusions: This is the first study with this design comparing multiple doses of insulin and continuous insulin infusion therapy in Brazil showing no significant difference in HbA1c; hypoglycemic events were less frequent during continuous insulin infusion therapy than during multiple doses of insulin and the percentage of patients who achieved a HbA1c less than 7.5% was greater during continuous insulin infusion therapy than multiple doses of insulin therapy.

Comparar terapia com múltiplas doses de insulina e o sistema de infusão continua de insulina no tratamento da diabetes melito tipo 1. Métodos: 40 pacientes com diabetes melito tipo 1 (21 mulheres) com idades entre 10 e 20 anos (média=14,2) e duração média do diabetes de sete anos utilizaram múltiplas doses de insulina durante pelo menos seis meses e, depois disso, sistema de infusão continua de insulina por pelo menos seis meses. Todos os pacientes usaram múltiplas doses de insulina e sistema de infusão continua de insulina. Para a análise de HbA1c, níveis médios de hemoglobina glicada (mHbA1c) foram obtidos em cada período de tratamento (múltiplas doses de insulina e sistema de infusão continua de insulina). Resultados: Embora os níveis de mHbA1c tenham sido menores com o uso de sistema de infusão continua de insulina a diferença não foi estatisticamente significante. Durante o uso de múltiplas doses de insulina, 14,2% tiveram valores de mHbA1c <7,5% vs. 35,71% quando usando sistema de infusão continua de insulina; demonstrando melhor controle glicêmico com o uso de sistema de infusão continua de insulina. Durante o uso de múltiplas doses de insulina, 15-40 pacientes tiveram eventos hipoglicêmicos graves contra 5–40 com sistema de infusão continua de insulina. Não foram registrados episódios de cetoacidose. Conclusões: Esse é o primeiro estudo cujo desenho comparou o uso de múltiplas doses de insulina e sistema de infusão continua de insulina no Brasil, não demonstrando nenhuma diferença significativa nos níveis de HbA1c. Eventos hipoglicêmicos foram menos frequentes com o uso de sistema de infusão continua de insulina do que com múltiplas doses de insulina e a porcentagem de pacientes que obteve um HbA1c <7,5% foi maior com sistema de infusão continua de insulina do que com múltiplas doses de insulina.

Tratamiento basado en la administración de insulina, a través de infusores subcutáneos continuos de insulina (bombas de insulina) para personas con diagnóstico de diabetes tipo 1 inestable severa / Treatment based on insulin administration through continuous subcutaneous infusions of insulin (insulin pumps) for people diagnosed with severe unstable type 1 diabetes

Proporcionar un marco común para el manejo clínico de infusores subcutáneos continuos de \r\ninsulina en personas con diabetes tipo 1 inestable severa. Estandarizar el diagnóstico en personas con diabetes tipo 1 inestable severa, que requieran infusores subcutáneos continuos de insulina con sensor de glucosa. Estandarizar el tratamiento en personas con diabetes tipo 1 inestable severa, que requieran infusores subcutáneos continuos de insulina con sensor de glucosa. Los ámbitos de la aplicación son dirigidos a equipos multidisciplinarios de salud, que atienden personas con infusores subcutáneos continuos de insulina como tratamiento para la diabetes tipo 1 inestable severa. Población Objetivo para personas con diabetes tipo 1, que requieren el uso de infusores subcutáneos continuos de insulina de acuerdo a los siguientes subgrupos: Subgrupo 1: Personas con diagnóstico de diabetes tipo 1, con requerimientos de micro dosis de insulina, y que a pesar de llevar una correcta adherencia al tratamiento no pueden lograr un control glicémico apropiado, presentando niveles de hemoglobina glicosilada, mayor o igual a 8,0%; múltiples episodios de hiperglicemias sobre 300mg/dl o de cetoacidosis o cetosis recurrente, todas de causa no precisada. Subgrupo 2: Personas con diagnóstico de diabetes tipo 1, que a pesar de llevar una correcta adherencia al tratamiento, no pueden lograr un control glicémico apropiado, y que han presentado episodios de hipoglicemias severas o inadvertidas, de causa no precisada. El tratamiento consta de la administración de insulina a través de un infusor subcutáneo continuo. Este dispositivo de uso médico será entregado al beneficiario junto a todos los insumos necesarios para su funcionamiento y de acuerdo a las características de cada paciente.

Propostas de barreiras para o uso seguro da insulina intravenosa: contribuições da prática da enfermagem / Proposals for barriers for the safe use of intravenous solutions: contributions from the practice of nursing

O objeto deste estudo são as características clínicas para hipoglicemia grave em pacientes críticos no pós-operatório de cirurgia cardíaca submetidos a controle glicêmico intensivo. Tem como objetivo geral elaborar uma barreira para prevenir a hipoglicemia grave no paciente crítico que usa infusão contínua de insulina, centrada na identificação das características clínicas para este evento pelo enfermeiro. Esta pesquisa procura contribuir com a farmacovigilância da insulina e com a qualidade da assistência de enfermagem. Trata-se de um estudo de coorte retrospectivo, com análise em prontuário, desenvolvido em unidade cardiointensiva cirúrgica de um hospital público do Rio de Janeiro. Foram investigados 550 prontuários de 2012 a 2013, encontrando-se uma população de 168 pacientes que fizeram uso de insulina intravenosa em infusão contínua. As variáveis do estudo foram submetidas a tratamentos estatísticos não paramétricos e a medidas de associação. Os resultados mostram que a incidência de hipoglicemia geral foi de 8,97%, sendo a taxa de incidência de hipoglicemia grave de 2,85%. Dos 22 pacientes com hipoglicemia grave, observou-se que a maioria era homens (13,79%) com a mediana de idade de 57 anos, sobrepeso (10,34%), hipertensos (17,24%), diabéticos (10,34%) e isquêmicos (11,20%). Ao avaliar a média de escores de gravidade verificou-se o APACHE II de 16,36 (4,28), SOFA 6,18 (2,17) e a probabilidade média de óbito segundo o escore APACHE II de 10,90 (6,13). Apresentaram como fatores predisponentes para hipoglicemia grave estar em uso de aminas (p valor = 0.000000598), ter insuficiência renal (p valor = 0.005744), ter diabetes (p valor = 0,02588) e apresentar hematócrito inferior a 30% (p valor = 0.00009559). A média de utilização da insulina intravenosa foi de 13,03 (6,98) horas e tiveram uma mediana de 11 medidas glicêmicas. Três pacientes receberam insulina conforme o previsto pelo protocolo, 13 pacientes receberam insulina a mais e oito pacientes receberam insulina a menos. A média a de glicose ofertada foi de 1,16 (0,13) gramas/kg. A variação hipoglicêmica nos pacientes que fizeram insulina a mais foi de 13 mg/dl ­ 59 mg/dl. Entre os pacientes que utilizaram insulina a menos, verificamos uma variação de 34mg/dl ­ 58 mg/dl. Já os pacientes que se beneficiaram de insulina de acordo com o protocolo, apresentaram uma variação de 44 mg/dl ­ 56 mg/dl. Portanto, para garantir o uso seguro na infusão de insulina, descrevem-se alguns cuidados específicos de enfermagem baseados nos fatores predisponentes e na indicação clínica de cada paciente. Acredita-se que o problema principal envolvido seja a necessidade da enfermagem moderna evoluir na construção e/ou renovação das formas de executar suas técnicas de trabalho em consonância com o desenvolvimento dos novos tratamentos prestados. Com isso contribuir para a qualidade da assistência à saúde, obtendo melhores resultados e evitando desfechos desfavoráveis para os pacientes.

This study aims at the clinical characteristics for severe hypoglycemia in critical patients in the postoperative period of cardiac surgery submitted to intensive glucose control. It aims to set up a general barrier to prevent severe hypoglycemia in the critical patient using continuous insulin infusion, centered in identifying the clinical characteristics for this event by the nurse. This research seeks to contribute to insulin pharmacovigilance and to nursing care quality. It is a retrospective cohort study, with medical record analysis, developed in a surgical cardio intensive unit in a public hospital in Rio de Janeiro. 550 medical records were investigated from 2012 to 2013, finding a population of 168 patients who used intravenous continuous insulin infusion. Study variables were subjected to nonparametric statistical treatments and association measures. The results show that the hypoglycemia incidence rate was 8.97%, being the incidence rate of severe hypoglycemia 2.85%. Of 22 patients with severe hypoglycemia, it was noted that the majority were men (13.79%) with median age of 57 years, overweight (10.34%), hypertension (17.24%), diabetes (10.34%) and ischemic (11.20%). When evaluating the mean severity scores we found APACHE II 16.36 (4.28), SOFA 6.18 (2.17) and the mean probability of death according to the APACHE II score 10.90 (6.13). The following were found as predisposing factors for severe hypoglycemia, such as using amines (p value = 0.000000598), kidney failure (p value = 0.005744), diabetes mellitus (p value = 0.02588) and having hematocrit below 30% (p value = 0.00009559). The mean use of intravenous insulin was 13.03 (6.98) hours and had a median of 11 glucose measures. Three patients received insulin as provide by the protocol, 13 patients received more insulin, and eight patients received less insulin. The mean of offered glucose was 1.16 (0.13) g/kg. The hypoglycemic variation in patients who received more insulin was 13 mg/dl - 59 mg/dl. Among the patients who used less insulin, we see a variation of 34mg/dl - 58 mg/dl. However, the patients, who benefited from insulin according to the protocol, have a variation of 44 mg/dl ­ 56 mg/dl. Therefore, in order to ensure the safe use on insulin infusion, we describe some specific nursing cares based on predisposing factors and on the clinical indication of each patient. It is believed that the main problem involved is the need for modern nursing to evolve in the construction and/or renovation of ways to perform their work techniques in line with the development of the new treatments provided. With this in mind, contribute to the quality of health care, obtaining better results and avoiding adverse outcomes for the patients.

El objetivo de este estudio es indicar cuáles son las características clínicas para hipoglucemia grave en pacientes críticos, en el posoperatorio de cirugía cardíaca, sometidos a control glucémico intensivo. El estudio tiene como propósito general elaborar una barrera para prevenir la hipoglucemia grave en pacientes críticos que utilizan insulina intravenosa en infusión continua, y está enfocado para que el enfermero identifique las características clínicas en estos casos. Esta investigación busca contribuir con la farmacovigilancia de la insulina y con la calidad de la atención de la enfermería. Se trata de un estudio de cohorte retrospectivo, con análisis en la historia clínica, desarrollado en una unidad intensiva de cardiocirugía de un hospital público de Rio de Janeiro. Se investigaron 550 historias clínicas, de 2012 a 2013, donde se encontró 168 pacientes que utilizaron insulina intravenosa en infusión continua. Se sometieron las variables del estudio a tratamientos estadísticos no paramétricos y a medidas de asociación. Los resultados demuestran que la incidencia de hipoglucemia general fue de 8,97%, siendo la tasa de incidencia de hipoglucemia grave de 2,85%. De los 22 pacientes con hipoglucemia severa, se observó que la mayoría era hombres (13,79%) con un promedio de edad de 57 años, sobrepeso (10,34%), hipertensos (17,24%), diabéticos (10,34%) e isquémicos (11,20%). Al evaluar el promedio de los valores de gravedad, se comprobó APACHE II de 16,36 (4,28), SOFA de 6,18 (2,17) y la media de probabilidad de óbito, según el promedio APACHE II de 10,90 (6,13). Se presenta como factores predisponentes para la hipoglucemia severa el uso de aminas (valor p = 0.000000598), tener insuficiencia renal (valor p = 0.005744), tener diabetes (valor p = 0,02588) y presentar hematocrito inferior a 30% (valor p = 0.00009559). La media del uso de la insulina intravenosa fue de 13,03 (6,98) horas y realizaron cerca de 11 mediciones glucémicas. Tres pacientes recibieron insulina, según lo previsto por el protocolo; 13 pacientes recibieron más insulina y 8 pacientes recibieron menos insulina. La media de glucosa suministrada fue de 1,16 (0,13) gramos/kg. La variante hipoglucémica en pacientes que recibieron más insulina fue de 13 mg/dl ­ 59 mg/dl. Entre los pacientes que utilizaron menos insulina, se comprobó una variación de 34mg/dl ­ 58 mg/dl. En cambio, en pacientes que se beneficiaron de la insulina, según el protocolo, presentaron una variante de 44 mg/dl ­ 56 mg/dl. Por lo tanto, para garantizar el uso seguro de la infusión de insulina, se describen algunos cuidados específicos de enfermería, basados en factores predisponentes y en la indicación clínica para cada paciente. Se considera que la solución al problema principal implicado sea una enfermería moderna, que evolucione hacia la construcción y/o innovación de las formas de ejecutar técnicas de trabajo, en consonancia con el desarrollo de los nuevos tratamientos ofrecidos. Así, se podrá contribuir a la calidad de la asistencia a la salud, obteniendo mejores resultados y evitando resultados desfavorables a los pacientes.

Controle glicêmico em pacientes críticos que recebem insulina: revisão integrativa / Control de la glucemia en los pacientes que recibieron insulina críticos: revisión integrada / Glycemic control in patients receiving insulin critics: integrative review

Objective: To discuss the knowledge produced on glycemic control for critically ill patients receiving continuous insulin infusion. Method: Integrative review of publications in the literature bases Ovid, Scopus and Science that dealt with continuous insulin infusion in hospitalized patients from 2003 to 2013 and full text available online. Selected eleven publications. Results: Glycemic control with intravenous insulin showed higher rates of hypoglycemia despite allowing achieve faster target goal and computerized protocols are effective resources to prevent hypoglycemic events though expensive and still not available on the Brazilian reality. Conclusion: It is important for nurses to provide input on the implications of severe hypoglycemia during continuous infusion of insulin for the control of risks in nursing care processes.

Objetivo: Discutir o conhecimento produzido sobre o controle glicêmico de pacientes críticos que recebem infusão contínua de insulina. Método: Revisão integrativa de literatura de publicações nas bases Ovid, Science e Scopus que abordassem a infusão contínua de insulina em pacientes hospitalizados, entre 2003 a 2013 e texto completo disponível on line. Selecionados onze publicações. Resultados: O controle glicêmico com insulina intravenosa apresentou maiores taxas de hipoglicemia apesar de permitir alcançar a meta alvo mais rápido, e verificar que protocolos informatizados são recursos eficazes na prevenção de eventos hipoglicêmicos apesar de caros e ainda pouco disponíveis na realidade brasileira. Conclusão: É importante fornecer subsídios para o enfermeiro sobre as implicações da hipoglicemia grave durante a infusão contínua de insulina para o controle dos riscos nos processos assistenciais de enfermagem.

Objetivo: Discutir el conocimiento producido acerca del control glucémico en pacientes críticamente enfermos que recibieron infusión continua de insulina. Método: Revisión integradora de literatura en bases de datos de Ovid, Science y Scopus que hablasen de infusión contínua de insulina en pacientes hospitalizados, entre 2003 a 2013 y texto completo disponível on line. Selecionados onze publicaciones. Resultados: El control glicêmico con insulina intravenosa indicó tasas más grandes de hipoglicemia apesar de permitir alcançar la meta alvo mas rápido y protocolos informatizados son recursos eficazes en la prevención de eventos hipoglicêmicos apesar de caros y poco disponibles. Conclusión: És importante que se informe al enfermero acerca de la hipoglicemia grave que ocurre encuanto se administra insulina intravenosa.