OBJECTIVES The goals of this study were to develop (1) a safe and effective protocol for the clinical control of type 1 diabetes using conventional self-monitoring blood glucose (SMBG) measurements and multiple daily injections with insulin analogues, and (2) an in silico simulation tool of type 1 diabetes to predict long-term glycemic control outcomes of clinical interventions. METHODS The v...

It seems intuitive that in a disease marked by hyperglycemia, normalization of glycemia should prevent the end-organ damage associatedwith it. Indeed, lowering blood glucose has been the focus of diabetes management for decades on the presumption that it would improve risk of renal failure, cardiovascular events, and death in patients with elevated levels of glycated hemoglobin, even though the...

BACKGROUND This proof of concept study was designed to evaluate the safety and effectiveness of an intravenous insulin dosing calculator, the Clarian GlucoStabilizer program, and to determine the feasibility of its use as part of a glycemic control program. This paper discusses the impact of the GlucoStabilizer program on the glycemic control of intensive care patients with hyperglycemia. MET...

BACKGROUND Tight glycemic control (TGC) is rapidly becoming a standard of care for all hospitalized patients. However, fear of hypoglycemia has proven a potent barrier to adoption of such initiatives by physicians and medical staff. Henry Ford Hospital has pursued aggressive glycemic control for all hospital patients. Because the initial standard TGC protocol (TGCP) was insufficient to improve ...

BACKGROUND Gain in VO2 peak after cardiac rehabilitation (CR) following an acute coronary syndrome (ACS), is associated with reduced mortality and morbidity. We have previously shown in CR, that gain in VO2 peak is reduced in Type 2 diabetic patients and that response to CR is impaired by hyperglycemia. METHODS We set up a prospective multicenter study (DARE) whose primary objective was to de...

The management of inpatient hyperglycemia is a focus of quality improvement projects across many hospital systems while remaining a point of controversy among clinicians. The association of inpatient hyperglycemia with suboptimal hospital outcomes is accepted by clinical care teams; however, the clear benefits of targeting hyperglycemia as a mechanism to improve hospital outcomes remain content...

We report the case of a 67-year-old Japanese woman with type 1 diabetes mellitus. At 47 years of age, her hemoglobin A1c (HbA1c) was 10.0%, and she had overt nephropathy. The first renal biopsy yielded a diagnosis of diabetic nephropathy. Intensive glycemic control was initiated and her HbA1c improved to 6.0%. Renal dysfunction showed no progression for 15 years. At 62 years of age, a second re...

There is an independent progressive epidemiologic relation between glycemia and cardiovascular disease (CVD) events; however, whether lowering glucose levels with currently available therapies can reduce CVD events remains unknown. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial is designed to answer this question in high-risk patients with type 2 diabetes mellitus. In ACCO...

BACKGROUND Diabetes is a common disease with self-management a key aspect of care. Large prospective trials have shown that maintaining glycated hemoglobin less than 7% greatly reduces complications but translating this level of control into everyday clinical practice can be difficult. Intensive improvement programs are successful in attaining control in patients with type 2 diabetes, however, ...

A survey among pediatric intensive care physicians showed that a great disparity exists between physicians' beliefs regarding hyperglycemia in critically ill patients and their daily practices to screen and treat hyperglycemia. One of the most prominent reasons for hesitating to implement tight glycemic control is the fear of evoking iatrogenic hypoglycemia. Results from ongoing and future stud...