Blood glucose control
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Blood Glucose Control: Insights from Recent Research
Model Predictive Control Algorithm in Cardiac Surgery Patients
Keywords: Model Predictive Control, Cardiac Surgery, Blood Glucose Management
A study compared the effectiveness of a model predictive control algorithm (eMPC) with a routine glucose management protocol (RMP) in cardiac surgery patients. The eMPC algorithm demonstrated superior performance in maintaining blood glucose levels within the target range of 4.4-6.1 mmol/liter. Patients managed with eMPC had a mean blood glucose level of 6.2 mmol/liter compared to 7.2 mmol/liter in the RMP group. Additionally, the eMPC group spent 60.4% of the time within the target range, significantly higher than the 27.5% achieved by the RMP group. Importantly, no severe hypoglycemia events were reported in either group, indicating that eMPC is both effective and safe for blood glucose control in this patient population1.
Real-Time Continuous Glucose Monitoring in Type 1 Diabetes
Keywords: Continuous Glucose Monitoring, Type 1 Diabetes, Glycemic Control
Real-time continuous glucose monitoring (CGM) has shown promise in improving glycemic control in patients with poorly controlled type 1 diabetes. A study involving 162 participants demonstrated that those using the Guardian RT CGM device had better glycemic control compared to those relying solely on self-monitoring of blood glucose (SMBG). The CGM group could see real-time glucose readings and set alarms for hypo- and hyperglycemia, which facilitated timely therapeutic interventions and improved overall glucose management2.
Intensive vs. Conventional Glucose Control in Critically Ill Patients
Keywords: Intensive Glucose Control, Critically Ill Patients, Mortality
A large randomized trial investigated the effects of intensive glucose control (target range: 4.5-6.0 mmol/liter) versus conventional glucose control (target: ≤10.0 mmol/liter) in critically ill patients. The study found that intensive glucose control increased mortality rates compared to conventional control, with 27.5% mortality in the intensive group versus 24.9% in the conventional group. Additionally, severe hypoglycemia was significantly more common in the intensive-control group. These findings suggest that less stringent glucose targets may be safer for critically ill patients3.
Methodological Aspects of Blood Glucose Control in ICU
Keywords: Blood Glucose Measurement, ICU, Insulin Titration
The accuracy of blood glucose measurement and the methodology of insulin titration are crucial for effective glucose control in the ICU. Blood gas analyzers are considered the gold standard for glucose measurement, and new-generation point-of-care meters may also be viable when used with validated insulin dosing algorithms. The interaction between glycemic targets and measurement methodologies must be carefully considered to avoid the pitfalls observed in large multicenter trials4.
Home Monitoring and Self-Adjustment of Insulin in Diabetes
Keywords: Home Monitoring, Insulin Self-Adjustment, Type 2 Diabetes
Home monitoring of blood glucose and educational programs for insulin self-adjustment have been shown to significantly improve glycemic control in patients with type 2 diabetes. A study involving poorly controlled insulin-requiring patients demonstrated that those who received structured education on insulin self-titration achieved better glycemic control compared to those who did not. This approach can empower patients to manage their diabetes more effectively and achieve near-normoglycemia8.
Continuous Subcutaneous Glucose Monitoring in Pediatric Type 1 Diabetes
Keywords: Pediatric Diabetes, Continuous Glucose Monitoring, Metabolic Control
In pediatric patients with type 1 diabetes, continuous subcutaneous glucose monitoring (CGM) has been found to improve metabolic control. A controlled crossover study showed that CGM use led to a significant reduction in hemoglobin A1C levels and provided valuable insights into glucose trends, which helped in adjusting insulin therapy more effectively. This technology also increased patient motivation and education, contributing to better overall diabetes management9.
Intensive Glucose Control and Vascular Outcomes in Type 2 Diabetes
Keywords: Intensive Glucose Control, Vascular Outcomes, Type 2 Diabetes
Intensive glucose control in patients with type 2 diabetes has been associated with a reduction in major microvascular events, particularly nephropathy. A study involving over 11,000 patients found that intensive glucose control, aiming for a glycated hemoglobin value of 6.5% or less, resulted in a 10% relative reduction in combined macrovascular and microvascular events. However, this approach also increased the risk of severe hypoglycemia, highlighting the need for a balanced strategy in glucose management10.
Conclusion
Effective blood glucose control is critical for managing diabetes and improving patient outcomes. Advances in technology, such as model predictive control algorithms and continuous glucose monitoring, offer promising tools for achieving better glycemic control. However, the choice of glucose targets and measurement methodologies must be carefully tailored to individual patient needs to ensure safety and efficacy.
Sources and full results
Most relevant research papers on this topic
Blood glucose control by a model predictive control algorithm with variable sampling rate versus a routine glucose management protocol in cardiac surgery patients: a randomized controlled trial.
The eMPC algorithm is more effective and safer than the routine glucose management protocol in maintaining euglycemia in cardiac surgery patients.
RCT
Highly CitedImproved glycemic control in poorly controlled patients with type 1 diabetes using real-time continuous glucose monitoring.
The Guardian RT real-time glucose monitor improves glycemic control in poorly controlled type 1 diabetes patients compared to conventional self-monitoring.
RCT
Rigorous JournalHighly CitedIntensive versus conventional glucose control in critically ill patients.
Intensive glucose control increased mortality in critically ill patients, while a blood glucose target of 180 mg or less per deciliter resulted in lower mortality.
RCT
Large Human TrialHighly CitedAccuracy of Blood Glucose Measurement and Blood Glucose Targets
Blood glucose measurement accuracy and insulin titration protocol play a crucial role in achieving optimal blood glucose control in ICU patients.
Systematic ReviewMeasurements of Glucose Control
Measurements of glucose control are crucial for evaluating new treatments and understanding the role of glycemia on diabetes degenerative complications.
Highly CitedHOME MONITORING OF BLOOD-GLUCOSE Method for Improving Diabetic Control
Self-monitoring blood-glucose levels by diabetics can significantly improve control and reduce long-term complications.
Observational StudyHighly CitedBlood glucose control algorithms for type 1 diabetic patients: A methodological review
A satisfactory blood glucose control strategy for type 1 diabetic patients has not yet been proposed, mainly due to the lack of continuous blood glucose measurement and the effects of physical activity on the metabolic system.
Literature ReviewHighly CitedAn educational program for insulin self-adjustment associated with structured self-monitoring of blood glucose significantly improves glycemic control in patients with type 2 diabetes mellitus after 12 weeks: a randomized, controlled pilot study
An educational program for insulin self-adjustment combined with structured self-monitoring of blood glucose can safely improve glycemic control in poorly controlled type 2 diabetes patients after 12 weeks.
RCTRigorous JournalContinuous subcutaneous glucose monitoring improved metabolic control in pediatric patients with type 1 diabetes: a controlled crossover study.
Continuous glucose monitoring in pediatric patients with type 1 diabetes improves metabolic control and provides new insight and increased motivation.
RCTHighly CitedIntensive blood glucose control and vascular outcomes in patients with type 2 diabetes.
Intensive glucose control with gliclazide and other drugs to lower glycated hemoglobin to 6.5% reduces the risk of major macrovascular and microvascular events in type 2 diabetes patients.
RCTLarge Human TrialHighly Cited