Diabetes care is a major challenge of patients treated in hospitals. A continuous glucose monitoring system (CGM) provides a more comprehensive assessment of glucose control than capillary blood glucose measurements. Especially in emergencies, data on CGM use in inpatients are limited. To evaluate real-world usability, accuracy of an intermittent scanning and a real-time CGM in patients admitted due to diabetes emergencies was assessed.

In 151 patients admitted due to diabetes emergencies, this single-center prospective study investigated the mean absolute relative difference (MARD) in broad glycemic ranges. The CGM accuracy was evaluated by applying a modified version of the Food and Drug Administration (FDA) criteria for CGM use, Clark Error Grid (CEG), and Bland Altman analysis (BAA).

Analysis of 1,498 CGM-/POC-glucose (CGM-/POC-G) pairs revealed a MARD of 10.8% with stepwise improvement from the hypoglycemic to the hyperglycemic range. The CEG analysis showed that 99.1% of all glucose values fell within the optimal or acceptable zones. BAA indicated that 96.0% of CGM-G values fell within the limits of the POC-G values. Day-by-day analysis of overall MARD revealed the highest MARD on the first day of CGM use, followed by consistent and stable MARD levels from day 2 onward until the end of wear time. Applying a modified version of the %20/20 agreement rate of the FDA criteria, 90.7% of CGM-G laid within ±20 mg/dl/±20% agreement rule.

This study indicates the usability of CGM for inpatient diabetes care by demonstrating a high accuracy and reliability of CGM measurement.

No widely adopted continuous glucose monitoring (CGM)-based insulin titration protocol exists, which may limit the effects of inpatient CGM on glycemic and clinical outcomes. We evaluate the acceptability and operability of the protocol proposed by Olsen et al for inpatients with type 2 diabetes in non-intensive care unit (non-ICU) settings.

7 inpatient diabetes team members, responsible for daily insulin titration, decided on insulin adjustments for 353 days. The members had the option to follow the CGM-based insulin protocol or override it for basal, prandial, and correctional insulin, separately, in 84 inpatients monitored by CGM. Questionnaires were used to evaluate the protocol's operability by the teams.

Of 456 basal insulin titration decisions, 439 (96.3%) adhered to the protocol. For prandial insulin, adherence rates were 83.9% (125/149) for breakfast, 87.2% (130/149) for lunch, and 92.6% (138/149) for dinner (p=0.163). All correctional insulin titrations adhered to the protocol. All team members expressed a preference for having a protocol for CGM-based insulin titration and rated the protocol's usability on a 1 to 10 scale, with mean scores (SD) of 8.7 (0.9) for basal insulin, 8.3 (1.4) for prandial insulin, and 7.4 (1.9) for correctional insulin.

The CGM-based insulin titration protocol by Olsen et al has been successfully implemented for titrating basal, prandial, and correctional insulin in inpatients with type 2 diabetes in non-ICU settings. It was highly accepted by inpatient diabetes teams and provides a framework for effective CGM implementation in these settings.

Diabetes mellitus is a chronic medical condition which affects millions of adults worldwide. It can result in various complications and is associated with a higher rate of hospitalizations. Blood glucose management in hospitalized patients is a critical aspect of care, which is important for preventing complications, improving patient outcomes, and reducing the length of hospital stay. Blood glucose control is difficult to achieve secondary to multiple factors involved in its regulation (e.g. type of medical illness, corticosteroid use, and enteral feeding) as well as varying evidence to determine different aspects of it. Our goal is to summarize the existing evidence from observational studies, clinical trials, and various society guidelines on blood glucose management in the hospitalized setting.

The Diabetes Team and CGM in Managing Hospitalized Patients With Diabetes (DIATEC) trial investigates the glycemic and clinical effects of inpatient continuous glucose monitoring (CGM)-guided insulin titration by diabetes teams.

This two-center trial randomized 166 non-intensive care unit patients with type 2 diabetes. Diabetes management was performed by regular staff, guided by diabetes teams using insulin titration algorithms based on either point-of-care glucose testing or CGM. The primary outcome was the difference in time in range (TIR) (3.9-10.0 mmol/L) between the two arms. Outcomes were assessed during hospitalization.

The CGM arm achieved a higher median (interquartile range [IQR]) TIR of 77.6% (24.4%) vs. 62.7% (31.5%) in the POC arm (P < 0.001). Median (IQR) time above range (TAR) >10.0 mmol/L was lower in the CGM arm at 21.1% (24.8%) vs. 36.5% (30.3%) in the POC arm (P = 0.001), and time below range (TBR) <3.9 mmol/L was reduced by CGM, with a relative difference to POC of 0.57 (95% CI 0.34-0.97; P = 0.042). Prolonged hypoglycemic events decreased (incidence rate ratio [IRR] 0.13; 95% CI 0.04-0.46; P = 0.001), and the mean (SD) coefficient of variation was lower in the CGM arm at 25.4% (6.3%) vs. 28.0% (8.2%) in the POC arm (P = 0.024). Mean (SD) total insulin doses were reduced in the CGM arm at 24.1 (13.9) vs. 29.3 (13.9) IU/day in the POC arm (P = 0.049). A composite of complications was lower in the CGM arm (IRR 0.76; 95% CI 0.59-0.98; P = 0.032).

In-hospital CGM increased TIR by 15 percentage points, mainly by reducing TAR. CGM also lowered TBR, glycemic variability, prolonged hypoglycemic events, insulin usage, and in-hospital complications.

To evaluate previous diabetes and hyperglycemia in post-COVID-19 mortality.

We evaluated patients with diabetes (previous diabetes and use of medication and random glucose ≥ 200 mg/dl and HbA1C ≥ 6.5 % or 48 mmol/mol) and patients without diabetes with hyperglycemia 1 year before COVID-19. Hazard ratios (HR) and 95 % confidence intervals, 95 %CI were calculated for all-cause mortality (1-week to 1-year) among those with diabetes (only), diabetes with comorbidities (hypertension, chronic kidney disease-CKD), and patients without diabetes but with hyperglycemia (≥ 100 ≥ 110 and ≥ 126 mg/dl).

Of 455 patients, 30.1 % had diabetes. Diabetes only had a high mortality risk in 7 days (HR: 6.24; 95 %CI: 1.03-37.77). Diabetes with hypertension and CKD were associated with increased mortality risks from 1-week (HR: 7.98; 95 %CI, 1.03-61.70) to 1-year (HR: 2.27; 95 %CI: 1.03-4.99) after COVID-19. Among those without diabetes, FBG ≥ 110 and ≥ 126 mg/dl were associated with more than double the risk of dying in 1-year after COVID-19 infection [1-year HR: 2.80 (95 %CI: 1.10 - 7.22) and 1-year HR: 2.54 (95 %CI:1.10-5.88), respectively].

Diabetes associated with other comorbidities had the highest risks of all-cause mortality in the short and long-term, hyperglycemia was a long-term marker of poor prognostic after COVID-19 infection.

Glucose levels obtained on the day of surgery may be predictive of complications following total knee arthroplasty (TKA). Established glucose thresholds for TKA are either nonspecific or have low predictive power. Therefore, the purpose of this study was to create data-driven hemoglobin A1c (HbA1c) and same-day glucose thresholds associated with varying risks of 90-day major and surgical site infection (SSI) complications following TKA.

Stratum-specific likelihood ratio analysis was conducted to determine data-driven HbA1c and glucose strata associated with varying risks of 90-day major and SSI complications. Each strata was then propensity score matched to the lowest strata based on age, sex, hypertension, heart failure, chronic obstructive pulmonary disorder, and obesity. The risk ratio (RR) for complications in each stratum with respect to the lowest matched stratum was analyzed.

Four data-driven HbA1c (%) strata (4.5 to 5.9, 6.0 to 6.4, 6.5 to 7.9, and 8.0+) and two same-day glucose (mg/dL) strata (60 to 189 and 190+) were identified that predicted 90-day major complications. When compared to the propensity-matched lowest strata (4.5 to 5.9%), the risk of 90-day major complications sequentially increased as the HbA1c (%) strata increased: 6.0 to 6.4 (RR: 1.23; P = 0.024), 6.5 to 7.9 (RR: 1.38; P < 0.001), and 8.0+ (RR: 2.0; P < 0.001). When compared to the propensity-matched lowest strata (60 to 189 mg/dL), the 190+ mg/dL strata had a higher risk of 90-day major complications (RR: 1.18; P = 0.016). No HbA1c or same-day glucose strata had significantly different risks of 90-day SSI.

The multiple strata identified for HbA1c demonstrate that a single HbA1c cutoff as identified in prior literature may be missing a larger picture for risk stratification. The threshold identified for same-day glucose can be utilized in day-of-surgery glycemic control guidelines to further reduce the risk of 90-day major complications.

Acute pancreatitis (AP) is an inflammatory reaction of the pancreas. When the disease is severe, it is often accompanied by destruction of the pancreatic islets, resulting in dysfunction of the endocrine system of the pancreas. Stress hyperglycemia is a transient increase in glucose during a critical illness, and its possible mechanism is related to abnormal glucose metabolism and insulin resistance due to the increased release of counterregulatory hormones and cytokines, such as glucagon, cortisol, and catecholamines. Numerous studies have shown that stress hyperglycemia is strongly associated with morbidity, mortality, and increased risk of post-acute pancreatitis diabetes in AP patients. Therefore, stress hyperglycemia may be a significant independent risk factor for poor clinical outcomes and prognosis in patients with AP. This article reviews the clinical features, risk factors, and mechanisms of action of stress hyperglycemia in AP and its influence on adverse clinical outcomes and the prognosis of inpatients with AP. For AP patients with stress hyperglycemia, it is necessary to comprehensively consider their blood glucose levels, daily habits, and complications to develop an appropriate treatment plan for hyperglycemia. Limited evidence indicates that in the case of acute hyperglycemia in critically ill patients, especially during the first 3 days of hospitalization, insulin therapy should not be undertaken if the blood glucose level does not exceed 10 mmol/L. However, some important questions related to clinical practice remain to be answered. More clinical trials and studies are needed in the future to provide a sufficient basis for clinical practice.

In people living with chronic obstructive pulmonary disease (COPD), we aimed to estimate: (1) the prevalence of glucocorticoid-induced hyperglycaemia (GIH); (2) whether the prevalence of GIH varies by age, baseline diabetes status, treatment duration, ascertainment of glycaemia, definition of hyperglycaemia, study design and year of publication; and (3) the relative risk (RR) of new-onset hyperglycaemia in exposed vs non-exposed to systemic glucocorticoids.

We searched electronic databases until 9 November 2023 for randomised controlled trials and observational studies including adults diagnosed with COPD, with or without diabetes at baseline, using systemic glucocorticoids equivalent to prednisolone ≥5 mg/day for ≥3 days if exposed. Hyperglycaemia was defined as a blood glucose above a study-specific cut-off. We extracted data on study and participant characteristics, exposure and outcome. We performed random-effects meta-analysis to calculate pooled prevalence estimate of GIH. Prevalence was expressed as the proportion of people who developed hyperglycaemia among all exposed to systemic glucocorticoids during follow-up. We calculated RR of new-onset hyperglycaemia in exposed vs non-exposed to systemic glucocorticoids from eight studies.

Of 25,806 citations, we included 18 studies comprising 3642 people of whom 3125 received systemic glucocorticoids and 1189 developed hyperglycaemia. Pooled prevalence of GIH was 38.6% (95%CI 29.9%-47.9%) with significant heterogeneity, I2 = 96% (p < 0.010), which was partially explained by differences in study design. Pooled RR = 2.39 (95%CI 1.51-3.78). Publication bias was present.

The prevalence of GIH was 38.6%. Being treated with systemic glucocorticoids for COPD was associated with 2.4 times higher risk of new-onset hyperglycaemia versus no glucocorticoid treatment.

Hyperglycemia and diabetes place hospitalized patients at a greater risk for serious complications such as infections, diabetic ketoacidosis, hyperosmolar hyperglycemic state, dehydration, electrolyte imbalances, polypharmacy, and lengthened hospitalization. Identification and proper treatment of hyperglycemia and diabetes are essential to reduce morbidity and mortality, as well as to conserve limited health care resources. This article will summarize the current American Diabetes Association and Endocrine Society recommendations for the management of hospitalized patients with hyperglycemia and diabetes. It will discuss the diagnostic criteria for the identification of diabetes and hyperglycemia, glycemic targets, pharmacologic management of hyperglycemia, and the transition to outpatient care.

To evaluate the impact of a proactive action of a specialized diabetes team (SDT) on different health outcomes in patients hospitalized in high complexity surgery units, including solid organ transplant surgical units, of a tertiary hospital.

Nested case control study matched (1:1) by age and gender. The control group consisted of patients (n = 120) who were under the standard of care diabetes management admitted three months' prior the cases. The cases were admitted in the same surgical units (n = 120) and were treated in the setting of the so called "Smart Diabetes Hospital" (SDH) consisting in a SDT that prioritized their actions through a digital map showing blood glucose levels obtained during the previous 24 h.

SDH implementation resulted in a significant reduction in both blood glucose levels (mean 162.1 ± SD 44.4 vs. mean 145.5 ± SD 48.0; p = 0.008) and hypoglycaemic episodes (19.7% vs. 8.4%: p = 0.002). Furthermore, a reduction of 3 days in the length of stay (LOS) was observed (15.6 ± 10.3 vs. 12.4 ± 6.0), which represents a significant cost-saving. Moreover, more new cases of diabetes were detected during the SDT period (2.5% vs. 6.7%, p = 0.04).

SDH is effective in diabetes management and reduce LOS in complex surgical units.

Carbohydrate metabolism can change in hospitalized patients due to stress, or the use of enteral nutrition (EN). The aim of this study was to determine the risk factors triggering these changes.

We conducted a retrospective observational study in non-diabetic patients with low levels of stress on EN. Five groups were categorized based on changes to the metabolism of hydrocarbons produced before or after EN: plasma glycemia prior to EN >126mg/dL (stress hyperglycemia - SH) (35.1%); plasma glycaemia prior to EN <126mg/dL (non-HE) (64.89%). Hyperglycemia with EN (HyperEN): at least, two capillary blood glucose readings >140mg/dL or 1 >180mg/dL during EN (71%); non-HyperEN: capillary blood glucose readings with EN <140mg/dL (29%).

A total of 131 patients were included (45.8% men) with a median age of 81 (71-87) years. A total of 52 patients exceeded 180mg/dL at one measurement, and 24 patients required insulin detemir with a median of 16 (12-27) IU per day. Risk factors for HyperEN were identified as patient age (OR, 1.186; 95% CI, 1.051-1.341; p<0.01) and duration of nutritional treatment (OR, 1.320; 95% CI, 1.086-1.605; p<0.01).

Our study shows a high prevalence of carbohydrate metabolism disorders in hospitalized patients on total EN, with age and duration of nutritional treatment being the main risk factors.

To determine the effect and safety of Continuous Glucose Monitoring (CGM) use in glycemic control compared to standard approach in hospitalized patients with Type 2 Diabetes (T2D).

This was a pilot randomized controlled clinical trial enrolled 37 hospitalized patients with T2D admitted in medical and surgical wards. All patients used CGM (Abbott FreeStyle2 or FreeStyle3) and concomitantly 6-point point of care glucose (POCG). In group A (n=19), daily CGM profiles, alarms, and trend arrows were considered for glycemic therapeutic decisions and in group B (n=18) were based on POCG. Primary outcomes included the difference in time in range (TIR) 70-180 mg/dL, hospital glycemia risk index (GRI), time below range (TBR) measured as the percentage below 70 mg/dL and below 54 mg/dL, and time above range (TAR) measured as the percentage above 180 mg/dL and above 250 mg/dL.

TIR was higher in group A: 78.26±10.83% vs. 67.39±19.13% p=0.04. TAR level 1 in group A: 14.37±8.33% vs. group B: 23.28±16.62% p=0.04. Asymptomatic hypoglycemic events were more detected by CGM-group (1.65±2.03 vs. 0.31±0.60 p=0.01). Overall MARD: 14.7%. DTS Error Grid: 69.5% zone A and 29.3% zone B.

The implementation of CGM in hospitals could represent a significant advancement in diabetes management, offering a more comprehensive and dynamic approach to monitoring glucose levels. Further research is needed to explore the long-term impacts of CGM on clinical outcomes and to optimize its integration into hospital protocols.

Most current guideline statements support some level of unrestricted glycemic management in critically ill adult patients. Nevertheless, the effectiveness of liberal glucose control is currently not well-supported by evidence. Therefore, our objective is to investigate the influence of liberal glucose control (> 180 mg/dl) on critically ill patients in the intensive care unit (ICU).

Until November 23, 2023, English language literature was thoroughly and systematically searched through multiple databases, including PubMed, Embase, Cochrane Library, and Web of Science. Our primary endpoints of interest were the occurrence of hypoglycemia, mortality in the ICU, and mortality during hospitalization. In addition, our secondary outcomes comprised of 90-day mortality, bloodstream infections, the proportion of patients necessitating renal replacement therapy (RRT), the length of time under mechanical ventilation, duration of stay in the ICU, and length of the overall hospitalization. Weighted mean difference (WMD) and relative risk (RR) were respectively computed as overall effect size for continuous and dichotomous data and reported with their 95% confidence intervals (95% CI).

A total of 9 studies were incorporated, which included 14,878 patients in the ICU. Compared with other blood glucose target control groups, liberal glucose control significantly reduced the incidence of hypoglycemia (RR = 0.41; 95% CI:0.25 to 0.69; P = 0.001), but increased ICU mortality (RR = 1.23; 95% CI:1.03 to 1.48; P = 0.023), in-hospital mortality risk (RR = 1.18; 95% CI:1.03 to 1.35; P = 0.020), and the risk of requiring RRT (RR = 1.26; 95% CI:1.11 to1.42; P < 0.001).

Liberal glucose control can reduce the risk of hypoglycemia but increases the risks of ICU mortality, in-hospital mortality, and the requirement for RRT. To confirm the outcomes further, large-scale, high-quality clinical trials are necessary.

Hospital Hyperglycemia (HH) is linked to poorer outcomes, including higher mortality rates, increased ICU admissions, and extended hospital stays, and occurs in both people living with diabetes or not. The prevalence of HH in non-critical patients ranges from 22 to 46%. This panel reviewed the evidence and made recommendations for the best care for hospitalized hyperglycemic patients, with or without diabetes mellitus.

The methodology was published previously and was defined by the internal institutional steering committee. The SBD Acute and Hospital Complications Department drafted the manuscript, selecting key clinical questions for a narrative review using MEDLINE via PubMed. The best available evidence was reviewed, including randomized clinical trials (RCTs), meta-analyses, and high-quality observational studies related to Hospital Hyperglycemia.

The department members and external experts developed 23 recommendations for the management of patients with HH, including screening, initial interventions, treatment adjustments, and care for potential complications. Based on the best available evidence, our article provides safe and effective management strategies for both public and private healthcare settings.

Abnormal admission blood glucose levels were proved to have a mortality predictive value in polytraumatized patients, as reported by studies in developed countries. Reports from developing countries are scarce.

To evaluate the reliability of on-admission blood glucose levels in predicting mortality in polytraumatized patients presented to a North African (developing country) trauma center. The secondary objectives were to investigate other possible mortality predictors and if a cutoff value for each could be obtained.

In this prospective longitudinal study, over one year, we included adult (≥18 years) patients who were polytraumatized (ISS ≥17) and presented to our trauma center within six hours of the trauma incident. Various clinical, laboratory, and trauma scores were collected. Blood glucose levels were assessed from blood samples obtained directly after admission. Patients were divided into five groups based on the admission blood glucose levels.

We included 202 patients, having a mean age of 44±13.9 (20 to 70) years, and 52% were females. The mortality rate was 10.9% (including all patients presented with blood glucose levels≥15 mmol/L). The following were significant mortality predictors, admission blood glucose (OR=3.31, 95% CI=1.902-5.763, p<0.001), serum lactate levels (OR=4.017, 95% CI=1.627-9.917, p=0.003), length of hospital stay (OR=1.18, 95% CI= 1.058-1.305, p=0.003), RTS score (OR=1.43, 95% CI=1.023-2.005, p=0.037), and TRISS score (OR=1.099, 95% CI=1.052-1.148, p<0.001). Admission blood glucose levels cutoff value of 15 mmol/L can significantly differentiate between survivors and non-survivors with sensitivity, specificity, PPV, and NPV of 86.4%, 100%, 100%, and 88%, respectively.

Abnormal admission blood glucose with a cutoff value of 15mmol/L is a significant mortality predictor in polytraumatized patients from developing country trauma center, among other clinical, laboratory, and trauma scores parameters.

Severe sepsis is cognate with life threatening multi-organ dysfunction. There is a disturbance in endocrine functions with alterations in several hormonal pathways. It has frequently been linked with dysfunction in the hypothalamic pituitary-adrenal axis (HPA). Increased cortisol or cortisolemia is evident throughout the acute phase, along with changes in the hypothalamic pituitary thyroid (HPT) axis, growth hormone-IGF-1 axis, insulin-glucose axis, leptin, catecholamines, renin angiotensin aldosterone axis, ghrelin, glucagon, hypothalamic pituitary gonadal (HGA) axis, and fibroblast growth factor-21. These changes and metabolic alterations constitute the overall response to infection in sepsis. Further research is essential to look into the hormonal changes that occur during sepsis, not only to understand their potential relevance in therapy but also because they may serve as prognostic indicators.

The objective of this study was to reduce by 50% the occurrence of average daily blood glucose (ADBG) > 180 mg/dL among noncritical patients admitted to a surgical ward at a public tertiary care hospital.

This project ran from April 2022 to June 2023 and used the Model for Improvement (MFI) method. Health care Failure Modes and Effects Analysis was used to identify and analyze failure modes in hyperglycemia management, and a driver diagram (DD) was used to prioritize and structure changes. The Plan-Do-Study-Act (PDSA) tool facilitated the change process. Data were collected using standardized forms and monitored with run charts, considering process, outcome, and balance indicators. The DD included 12 changes focusing on protocol implementation, adequate medical prescription, correct insulin administration, proper blood glucose monitoring, appropriate diet prescription, safe care transitions between units, routine of publication and discussion of indicators, leadership engagement with frontline workers on hyperglycemia management, educational actions, and defining roles and responsibilities.

A 69.0% reduction in ADBG > 180 mg/dL and a 100% reduction in ADBG > 300 mg/dL were achieved, though hypoglycemic events increased from 8 to 11 per 100 patient-days using insulin or oral antidiabetic medications. Reductions in nonconformities in medical prescription and insulin administration (50.0% and 71.4%, respectively) were also achieved.

In this pilot project, use of the MFI led to improved prescription practices, insulin administration, and blood glucose control, reducing the rate of hyperglycemia in hospitalized patients.

To identify the key populations for Hospital Hyperglycemia (HH) management and to assess recent trends in the management of HH.

This retrospective study analyzed 1,136,092 point-of-care blood glucose (POC-BG) measurements from 40,758 patients with HH in non-intensive care unit (non-ICU) wards at Ningbo No.2 hospital from January 2020 to December 2022. We compared glucose monitoring and management across varying years, age groups, and hospital departments.

The overall incidence of HH was 16.87%. From 2020 to 2022, the number of patients with HH increased from 9,893 to 15,639, accompanied by a marginal improvement in average BG levels (slope difference, -8.137E-09 [CI, -8.742E-09 to -7.531E-09]; p <0.001). In the ≥80 years group, the median BG was 9.4 mmol/L, significantly higher than in other age groups (p<0.001). Hypoglycemia in this group was most frequently detected during nighttime and bedtime, with an incidence of 2.67%, significantly higher than at other times of the day (p<0.001). The daily POC-BG testing rate was significantly higher in the medical ward group than it in the surgical ward group (57.9% vs 51.7%, p<0.05). Proportions of glycemic targets days were 35.66% and 39.90% in the medical wards on day 1 and day 7, respectively (Day 7 39.90% vs Day 1 35.66%, p>0.05), and 46.16% and 45.07% in the surgical wards (Day 7 45.07% vs Day 1 46.16%, p>0.05), showing no significant improvements in glycemic control. Endocrinology consultations occurred at rates of 14.2% in the medical wards and 14.9% in the surgical wards (p>0.05).

Although the prevalence of HH is consistently high and the number of affected patients continues to rise, modest improvements in glycemic management have been observed. However, control among the elderly remains poor, with a notably high risk of hypoglycemia during nighttime and bedtime periods.

Sodium-glucose cotransporter 2 inhibitors (SGLT2is), originally approved by the US Food and Drug Administration for glycemic control in type 2 diabetes mellitus (DM2), have shown substantial cardiovascular and renal benefits, leading to their expanded use in managing heart failure (HF) and chronic kidney disease in the outpatient setting. Despite these benefits, their use for inpatient hyperglycemia management is not universally endorsed due to safety concerns and inadequate data. However, emerging evidence suggests potential advantages of initiating SGLT2i treatment for patients during hospitalization in the setting of HF. While SGLT2is are not recommended for managing inpatient hyperglycemia, initiation during hospitalization for HF provides significant benefits. We review the current literature on the pros and cons of using SGLT2is in hospitalized DM2 and HF patients and provide guidance on careful patient selection and risk mitigation for inpatient use.

Our study examined the association between the Cambridge Risk Score (CRS), new hyperglycemia (NH), and complications in patients undergoing elective surgery.

In this retrospective cross-sectional study, adult surgical patients, without diabetes, with NH (blood glucose ≥140 mg/dL) were identified, and the CRS was calculated. We used univariate regression models to evaluate the relationship between CRS and NH with 30-day readmission, length of stay (LOS), and complications. Models were stratified by surgical specialty (cardiac/vascular, general, orthopedic, neurologic).

Of 10,531 patients in the study, 24 % had NH. After adjusting for covariates, the CRS was associated with increased odds of complications [OR 2.09; 95%CI:1.69, 2.59] and NH [OR 1.95; 95%CI:1.66, 2.29]. NH was associated with increased odds of 30-day readmission [β 1.60; 95%CI:1.31, 1.96], and increased LOS [β 0.64; 95%CI:0.59, 0.68]. When stratified by surgery type, the CRS was associated with increased LOS in neurosurgery, decreased LOS in orthopedics, and increased odds of complications and NH in neurosurgery and orthopedics.

The CRS is associated with NH, complications, and LOS in patients undergoing elective neurosurgery, orthopedic surgery, and general surgery. This suggests that CRS may have potential to help identify surgical patients at high risk for NH and complications.

Stress hyperglycaemia ratio (SHR) has been reported to be independently and significantly associated with various adverse cardiovascular events as well as mortality. Moreover, in-hospital heart failure following acute myocardial infarction has been demonstrated to account for majority of all heart failure (HF) cases with anterior myocardial infarction showing higher rates of HF. However, the association between SHR and in-hospital HF following an anterior ST-elevation myocardial infarction (STEMI) has not been reported earlier. Therefore, the present study aimed at identifying the relationship between SHR and in-hospital HF post STEMI.

In this retrospective study electronic health records of 512 patients who presented with anterior STEMI from 01 January 2022 to 31 January 2024 were analysed. Based on the development of in-hospital HF, the enrolled patients were stratified into two groups: Group I, comprising of 290 patients who developed in-hospital HF and Group II comprising of 222 patients who did not develop in-hospital HF. ROC and Multivariable logistic regression analyses were performed to assess the relationship between SHR and in-hospital HF.

The results revealed that SHR is a significant independent predictor of in-hospital HF (OR: 3.53; 95%CI: 2.02-6.15; p < 0.001). Apart from SHR, the results also identified age, nosocomial pneumonia, ventricular fibrillation, LVEF, and NT-pro-BNP levels as other independent predictors. ROC analysis showed that SHR independently had a moderate discriminative power with AUC: 0.683, 95% CI 0.605-0.762; p = 0.04, which was almost comparable to the combined predictive value of other independent risk factors (AUC: 0.726, 95% CI 0.677-0.784). Noticeably, combining SHR and other identified independent predictors demonstrated a significant predictive power (AUC: 0.813, 95% CI 0.757-0.881; p = 0.01).

SHR is an independent predictor for in-hospital HF in anterior wall STEMI patients.

The benefits of continuous glucose monitoring (CGM) in managing hyperglycemia in hospitalized patients with type 2 diabetes (T2D) have been documented in observation and intervention clinical studies. However, the benefits of CGMs after hospital discharge in improving the care of patients with T2D remain unknown.

This pilot randomized clinical trial aimed to compare the effectiveness and safety of using the FreeStyle Libre 2 CGM vs capillary point-of-care (POC) glucose testing (standard of care) in insulin-treated patients with T2D for up to 12 weeks after hospital discharge. We assessed safety (hypoglycemia), efficacy (mean daily glucose), and healthcare utilization (emergency room visits and hospital admissions) associated with the use of FreeStyle Libre 2 CGM compared to capillary POC testing following hospital discharge.

Among 100 participants (mean age 54.3 ± 10.7 years, HbA1c 10.46 ± 2.24%, median diabetes duration of 9.0 years, IQR 1.0, 42), there were no significant differences in baseline clinical characteristics between the groups at discharge. We observed a trend toward improved glycemic control in the CGM group, including increased time in range 70-180 mg/dl, reduced time above range > 180 and 250 mg/dl, and decreased hypoglycemia and insulin requirements after discharge compared to the POC group. There were no differences in emergency room visits or hospitalization between the study groups.

The results of this pilot study indicate that the use of CGM leads to improved glycemic control, reduced hypoglycemia, and decreased glucose variability compared to POC glucose testing after hospital discharge.

During intensive hematologic care, patients are exposed to high-dose chemotherapy, corticosteroids, immunosuppressants, and total parenteral nutrition. Combined with physiologic stress and increased release of cytokines and hormones, this can lead to dysglycemia, which is associated with adverse clinical outcomes. This prospective study aimed to investigate continuous glucose monitoring (CGM) to identify dysglycemia during intensive hematologic care.

Patients receiving chimeric antigen receptor T-cell therapy or allogeneic or autologous stem cell transplantation were eligible. Throughout the study, glucose levels were concurrently monitored using CGM and point-of-care (POC) glucose measurements in 60 patients (71% male, median age of 64 [interquartile range, 58-68] years, and 10% with diabetes).

Hyperglycemia (glucose level, >10 mmol/L) was prevalent in 93% of patients, of whom 90% had no history of diabetes. Severe hyperglycemia (glucose level, >13.1 mmol/L) was present in 38%. Additionally, hyperglycemia was associated with prolonged hospitalization in patients undergoing chimeric antigen receptor T-cell treatment (β, 0.19; 95% CI, 0.04-0.35) and autologous stem cell transplantation (β, 0.16; 95% CI, 0.01-0.32). CGM outperformed POC in detecting hyperglycemia (>10 mmol/L: 1060 vs 124, detected 2.8 [interquartile range, 0.7-4.0]) hours earlier. The mean absolute relative difference between CGM and POC was 21.5%, with 99.8% of measurements in the clinical acceptable zone A + B of the Clarke error grid.

These findings emphasize the potential and importance of glucose monitoring with CGM for improved and earlier detection of hyperglycemia, in this patient population, which seems feasible. Our results suggest a need for further studies into CGM as method to optimize glucose levels, which could improve outcomes in patients receiving intensive hematologic care.

Dysglycaemia in hospitalised patients is associated with poorer clinical outcomes, including cardiovascular events, longer hospital stays, and increased risk of mortality. Therefore, glucose monitoring is necessary to achieve best outcomes.

This audit assesses use of point-of-care (POC) blood glucose (BG) testing in Tallaght University Hospital (TUH) over an 8-day period. It evaluates compliance with international and TUH glucose monitoring protocols and determines frequency of diabetes team consultations for inpatient adults.

Data from an 8-day period (12/03/2023-19/03/2023) were extracted from the TUH COBAS-IT system and analysed. Invalid tests were excluded. Hyperglycaemia was defined as ≥ 10 mmol/L and hypoglycaemia as ≤ 3.9 mmol/L. Persistent hyperglycaemia was defined as two BG results of ≥ 10 mmol/L. A chart review was conducted on adult patients with persistent hyperglycaemia to assess for HbA1C results, diabetes diagnosis, and diabetes consult.

3,530 valid tests were included and analysed. 674 individual patients had tests done. 1,165 tests (33.00%) were hyperglycaemic and 75 (2.12%) were hypoglycaemic. 68.25% of adults with persistent hyperglycaemia had an HbA1C test performed or documented within three months. 42.71% of inpatient adults with persistent hyperglycaemia and a known diabetes diagnosis received a consult from the diabetes team.

Increased adherence to hospital protocols for testing HbA1C in adults with persistent hyperglycaemia could improve treatment and clinical outcomes. Increased diabetes team consultation could facilitate appropriate treatment and improve patient outcomes in persistently hyperglycaemic adult patient populations.

Continuous glucose monitoring (CGM) improves glycaemic outcomes in the outpatient setting; however, there are limited data regarding CGM accuracy in hospital.

We conducted a prospective, observational study comparing CGM data from blinded Dexcom G6 Pro sensors with reference point of care and laboratory glucose measurements during participants' hospitalisations. Key accuracy metrics included the proportion of CGM values within ±20% of reference glucose values >5.6 mmol/l or within ±1.1 mmol/l of reference glucose values ≤5.6 mmol/l (%20/20), the mean and median absolute relative difference between CGM and reference value (MARD and median ARD, respectively) and Clarke error grid analysis (CEGA). A retrospective calibration scheme was used to determine whether calibration improved sensor accuracy. Multivariable regression models and subgroup analyses were used to determine the impact of clinical characteristics on accuracy assessments.

A total of 326 adults hospitalised on 19 medical or surgical non-intensive care hospital floors were enrolled, providing 6648 matched glucose pairs. The %20/20 was 59.5%, the MARD was 19.2% and the median ARD was 16.8%. CEGA showed that 98.2% of values were in zone A (clinically accurate) and zone B (benign). Subgroups with lower accuracy metrics included those with severe anaemia, renal dysfunction and oedema. Application of a once-daily morning calibration schedule improved accuracy (MARD 11.4%).

The CGM accuracy when used in hospital may be lower than that reported in the outpatient setting, but this may be improved with appropriate patient selection and daily calibration. Further research is needed to understand the role of CGM in inpatient settings.

Background The stress hyperglycemia ratio (SHR) indicates relative hyperglycemia levels. Research on the impact of SHR on mortality in coronary heart disease (CHD) patients in intensive care is limited. This study explores the predictive accuracy of SHR for the prognosis of CHD patients in the ICU. Methods This study included 2,059 CHD patients from the American Medical Information Mart for Intensive Care (MIMIC-IV) database. SHR was determined using the formula: SHR = (admission glucose) (mmol/L) / (1.59 * HbA1c [%] - 2.59). Subjects were stratified into quartiles based on SHR levels to examine the correlation between SHR and in-hospital mortality. The restricted cubic splines and Cox proportional hazards models were employed to assess this association, while Kaplan-Meier survival analysis was executed to ascertain the mortality rates across the SHR quartiles. Results Among the 2059 participants (1358 men), the rates of in-hospital and ICU mortality were 8.5% and 5.25%, respectively. Analysis showed SHR as a significant predictor of increased risk for both in-hospital (HR,1.16, 95% CI: 1.02-1.32, P = 0.022) and ICU mortality (HR, 1.16, 95% CI: 1.01-1.35, P = 0.040) after adjustments. A J-shaped relationship was noted between SHR and mortality risks (p for non-linearity = 0.002, respectively). Kaplan-Meier analysis confirmed substantial differences in in-hospital and ICU mortality across SHR quartiles. Conclusions SHR significantly predicts in-hospital and ICU mortality in critically ill CHD patients, indicating that higher SHR levels correlate with longer ICU stays and increased mortality. This underscores the potential of SHR as a prognostic marker for ICU CHD patients.

There has been a concerning rise in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) following noncardiac surgeries (NCS), significantly impacting surgical outcomes and patient prognosis. Glucose metabolism abnormalities induced by stress response under acute medical conditions may be a risk factor for postoperative MACCE. This study aims to explore the association between stress hyperglycemia ratio (SHR) and postoperative MACCE in patients undergoing general anesthesia for NCS.

There were 12,899 patients in this perioperative cohort study. The primary outcome was MACCE within 30 days postoperatively, defined as angina, acute myocardial infarction, cardiac arrest, arrhythmia, heart failure, stroke, or in-hospital all-cause mortality. Kaplan-Meier curves visualized the cumulative incidence of MACCE. Cox proportional hazard models were utilized to assess the association between the risk of MACCE and different SHR groups. Restricted cubic spline analyses were conducted to explore potential nonlinear relationships. Additionally, exploratory subgroup analyses and sensitivity analyses were performed.

A total of 592 (4.59%) participants experienced MACCE within 30 days after surgery, and 1,045 (8.10%) within 90 days. After adjusting for confounding factors, compared to the SHR T2 group, the risk of MACCE within 30 days after surgery increased by 1.34 times (95% CI 1.08-1.66) in the T3 group and by 1.35 times (95% CI 1.08-1.68) in the T1 group respectively. In the non-diabetes group, the risk of MACCE within 30 days after surgery increased by 1.60 times (95% CI 1.21-2.12) in the T3 group and by 1.61 times (95% CI 1.21-2.14) in the T1 group respectively, while no statistically significant increase in risk was observed in the diabetes group. Similar results were observed within 90 days after surgery in the non-diabetes group. Additionally, a statistically significant U-shaped nonlinear relationship was observed in the non-diabetes group (30 days: P for nonlinear = 0.010; 90 days: P for nonlinear = 0.008).

In this large perioperative cohort study, we observed that both higher and lower SHR were associated with an increased risk of MACCE within 30 and 90 days after NCS, especially in patients without diabetes. These findings suggest that SHR potentially plays a key role in stratifying cardiovascular and cerebrovascular risk after NCS.

Corticosteroids raise blood glucose concentrations; however, it remains unknown which form of administration, oral or intravenous, is associated with the greatest degree of blood glucose rise in hospitalised patients. Furthermore, it is not known whether the pattern of the associated hyperglycaemia throughout the day differs depending on the route of administration.

This was a single centre retrospective study of 384 adult inpatients receiving oral or intravenous hydrocortisone and dexamethasone. Data on capillary glucose concentrations and time taken over 7 days were collected. A mixed model for repeated measures was applied to compare changes in glucose concentration over time for oral and intravenous corticosteroids. An auto-regressive covariance structure was employed to model correlations between repeated measurements. This was adjusted for age, sex, pre-admission diabetes, and/or pre-admission corticosteroid status.

No significant difference was found between oral and intravenous hydrocortisone on day 1 or across all 7 days (mean difference 0.17 mmol/L (-1.39, 1.75), p = 0.827, and mean difference 0.20 mmol/L (-0.61, 1.01), p = 0.639 respectively). There were no differences in mean glucose concentrations between those on oral or intravenous dexamethasone on day 1 or across all 7 days (mean difference 0.41 mmol/L (-0.55, 1.38), p = 0.404 and mean difference -0.09 mmol/L (-1.05,0.87), p = 0.855, respectively).

This study found that oral and intravenous administration of hydrocortisone and dexamethasone do not have a significantly differing impact on blood glucose levels. Capillary glucose monitoring is strongly recommended in all individuals who are on either oral or intravenous corticosteroids.

We aimed to determine if hospital admission hyperglycaemia and hypoglycaemia are associated with increased long-term mortality.

A post-hoc analysis of data from a trial of glucose screening in the emergency department was conducted. Data were linked with a death registry up to 5 years after admission. The relationship between admission glucose and mortality was examined by cox regression. Further analyses of people who survived the admission and subsequent 28 days was performed.

There were 131,322 patients, of whom 38,712 (29.5 %) died. Mean follow-up was 3·3 ± 1·5 years. Compared to the reference glucose band of 6·1-8·0 mmol/L, there was increased mortality in higher bands, reaching a hazard ratio (HR) of 1·44 (95 %CI 1·34-1·55, p < 0·001) for people with glucose > 20·0 mmol/L. The HR was 1·56 (95 %CI 1·46-1·68, p < 0·001) for people with glucose ≤ 4·0 mmol/L. Similar relationships were observed among 28-day survivors. The relationships were attenuated among people with known diabetes. Among 4867 subjects with glucose ≥ 14·0 mmol/L, those diagnosed with diabetes during the admission had lower mortality compared to subjects where the diagnosis was not made (HR 0·53, 95 %CI 0·40-0·72, p < 0·001). This was attenuated among 28-day survivors.

Hyperglycaemia and hypoglycaemia on hospital admission are associated with increased long-term mortality.

Patients with hyperglycemia, thyroid dysfunction, and adrenal insufficiency face increased perioperative risk, which may be mitigated by appropriate management. This review addresses preoperative glycemic control, makes evidence-based recommendations for the increasingly complex perioperative management of noninsulin diabetes medications, and provides guideline-supported strategies for the perioperative management of insulin, including suggested indications for continuous intravenous insulin. The authors propose a strategy for determining when surgery should be delayed in patients with thyroid dysfunction and present a matrix for managing perioperative stress dose corticosteroids based on the limited evidence available.

Hyperglycemia in hospital inpatients without pre-existing diabetes is associated with increased mortality. However, the independent contribution of hyperglycemia to health care-associated infection (HAI), acute kidney injury (AKI), and stroke is unclear.

To investigate the relationship between hyperglycemia and adverse clinical outcomes in hospital for patients with and without diabetes.

Diabetes IN-hospital: Glucose and Outcomes (DINGO) was a 26-week (October 2019-March 2020) prospective cohort study. Clinical and glucose data were collected up to the 14th day of admission. Primary stratification was by hyperglycemia, defined as ≥2 random capillary blood glucose (BG) measurements ≥11.1 mmol/L (≥200 mg/dL). Propensity weighting for 9 clinical characteristics was performed to allow interrogation of causality. To maintain the positivity assumption, patients with HbA1c >12.0% were excluded and prehospital treatment not adjusted for. The setting was the Royal Melbourne Hospital, a quaternary referral hospital in Melbourne, Australia. Admissions with at least 2 capillary glucose values and length of stay >24 hours were eligible, with half randomly sampled. Outcome measures were HAI, AKI, stroke, and mortality.

Of 2558 included admissions, 1147 (45%) experienced hyperglycemia in hospital. Following propensity-weighting and adjustment, hyperglycemia in hospital was found to, independently of 9 covariables, contribute an increased risk of in-hospital HAI (130 [11.3%] vs 100 [7.1%], adjusted odds ratio [aOR] 1.03, 95% CI 1.01-1.05, P = .003), AKI (120 [10.5%] vs 59 [4.2%], aOR 1.07, 95% CI 1.05-1.09, P < .001), and stroke (10 [0.9%] vs 1 [0.1%], aOR 1.05, 95% CI 1.04-1.06, P < .001).

In hospital inpatients (HbA1c ≤12.0%), irrespective of diabetes status and prehospital glycemia, hyperglycemia increases the risk of in-hospital HAI, AKI, and stroke compared with those not experiencing hyperglycemia.

While preliminary evidence for use of real-time continuous glucose monitoring (rtCGM) in the hospital setting is encouraging, challenges with currently available devices and technology will need to be overcome as part of real-world integration. This paper reviews the current evidence and guidelines regarding use of rtCGM in the hospital and suggests a practical approach to implementation.

There is now a considerable body of real-world evidence on the benefits of reducing dysglycemia in the hospital using both traditional point-of-care (POC) glucose testing and rtCGM. Benefits of rtCGM include decreased frequency of hypo- and hyperglycemia with reduced need of frequent POC checks and it is both feasible and well-accepted by nursing staff and providers. If expansion to additional sites is to be considered, practical solutions will need to be offered. Recommendations for an operational workflow and tools are described to guide implementation in the non-ICU setting. Further testing in randomized controlled trials and real-world dissemination and implementation designs is needed, together with industry and technology collaborations, to further streamline the integration into health systems.

Fish protein hydrolysates (FPHs) were obtained from different fish sources using a combination of microbial enzymes. The industrially produced FPHs from blue whiting (Micromesistius poutassou) and sprat (Sprattus sprattus) were compared to freeze-dried FPHs generated in-house from hake (Merluccius merluccius) and mackerel (Scomber scombrus) in terms of their physicochemical composition and functionality. Significant differences (p < 0.05) were observed in the protein, moisture, and ash contents of the FPHs, with the majority having high levels of protein (73.24-89.31%). Fractions that were more extensively hydrolysed exhibited a high solubility index (74.05-98.99%) at different pHs. Blue whiting protein hydrolysate-B (BWPH-B) had the highest foaming capacity at pH 4 (146.98 ± 4.28%) and foam stability over 5 min (90-100%) at pH 4, 6, and 8. The emulsifying capacity ranged from 61.11-108.90 m2/g, while emulsion stability was 37.82-76.99% at 0.5% (w/v) concentration. In terms of peptide bioactivity, sprat protein hydrolysate (SPH) had the strongest overall reducing power. The highest Cu2+ chelating activity was exhibited by hake protein hydrolysate (HPH) and mackerel protein hydrolysate (MPH), with IC50 values of 0.66 and 0.78 mg protein/mL, respectively, while blue whiting protein hydrolysate-A (BWPH-A) had the highest activity against Fe2+ (IC50 = 1.89 mg protein/mL). SPH scavenged DPPH and ABTS radicals best with IC50 values of 0.73 and 2.76 mg protein/mL, respectively. All FPHs displayed noteworthy scavenging activity against hydroxyl radicals, with IC50 values ranging from 0.48-3.46 mg protein/mL. SPH and MPH showed the highest scavenging potential against superoxide radicals with IC50 values of 1.75 and 2.53 mg protein/mL and against hydrogen peroxide with 2.22 and 3.66 mg protein/mL, respectively. While inhibition of α-glucosidase was not observed, the IC50 values against α-amylase ranged from 8.81-18.42 mg protein/mL, with SPH displaying the highest activity. The stability of FPHs following simulated gastrointestinal digestion (SGID) showed an irregular trend. Overall, the findings suggest that marine-derived protein hydrolysates may serve as good sources of natural nutraceuticals with antioxidant and antidiabetic properties.

Regarding a potential relationship between diabetes and the prognostic significance of hyperglycemia in patients presenting with acute myocardial infarction (AMI), there is still debate. Therefore, we aimed in this study to demonstrate the effect of hyperglycemia on different outcomes in AMI patients, whether they are diabetic or not.

We searched PubMed, Web of Science, and Scopus using the following search strategy: "Diabetes" or "Diabetic" AND "Acute myocardial infarction" OR "AMI" AND "hyperglycemia" OR "glucose level" to find eligible articles that needed to go through the screening process for inclusion in our study. We conducted a meta-analysis of 19 included studies from Japan, Germany, China, the United Kingdom, and others using Review Manager version 5.4 software, pooling the mean difference in continuous variables, the number and total of dichotomous variables to measure the odds ratio (OR), and the generic inverse variance of OR or hazard ratio (HR) as reported in the included studies.

The mean age of the participants ranged from 56.3 to 72.3 years old. The difference in blood glucose levels between diabetes and non-diabetes patients was found to be statistically significant, with an SMD of 1.39 (95%CI: 1.12, 1.66, p < 0.00001). In diabetic patients, hyperglycemia was statistically significantly associated with mortality, with a HR of 1.92 (95% CI: 1.45, 2.55, p < 0.00001) and an OR of 1.76 (95% CI: 1.15, 2.7, p = 0.01). In non-diabetic patients admitted with AMI, hyperglycemia was statistically significantly associated with mortality, with a HR of 1.56 (95% CI: 1.31, 1.86, p < 0.00001) and an OR of 2.89 (95% CI: 2.47, 3.39, p < 0.00001). AMI patients who were diabetic were statistically more likely to have a major adverse cardiovascular event (MACE) (HR = 1.9; 95% CI: 1.19-3.03; p = 0.007). AMI patients who were not diabetic were also statistically more likely to have a MACE (HR = 1.6; 95% CI: 1.15-2.23, p = 0.006).

Hyperglycemia in AMI patients is a predictor of worse outcomes, including MACE and mortality, regardless of whether these patients are diabetic or not. In these patients, some factors act as predictors of mortality, including older age, higher glucose levels on admission, and a high Killip class.

To investigate the relationship between preoperative blood glucose levels and long-term all-cause mortality in patients with osteoporotic vertebral compression fractures (OVCF) who underwent percutaneous vertebroplasty (VP). This single-center retrospective study involved a chart review of patients admitted for VP to treat OVCF between 2013 and 2020. Patients with pathological or multiple fractures or those who did not undergo bone mineral density assessment were excluded. All relevant information was collected from electronic medical records. The survival status of all patients was confirmed at the end of March 2021. Cox proportional hazard models with multivariate adjustments were used to examine the effects of blood glucose levels on all-cause mortality. Overall, 131 patients were retrospectively analyzed (mean age: 75.8 ± 9.3 years, male patients: 26.7%) with a median follow-up period of 2.1 years. Preoperative hyperglycemia (hazard ratio: 2.668, 95% confidence interval [CI] 1.064, 6.689; p = 0.036) and glucose levels (hazard ratio: 1.007, 95% CI 1.002-1.012; p = 0.006) were found to be independently associated with a higher risk of all-cause mortality. This correlation remained significant even after adjusting for age and sex, and other factors and comorbidities that might affect outcomes (hazard ratio: 2.708, 95% CI 1.047, 7.003, p = 0.040 and 1.007; 95% CI 1.001, 1.013, p = 0.016, respectively). Furthermore, a history of diabetes mellitus was not a significant factor influencing long-term all-cause mortality. Preoperative glucose levels were found to be independently associated with survival outcomes in patients with OVCF who underwent VP. Conversely, diabetes mellitus was not associated with long-term all-cause mortality. Our findings highlight that preoperative hyperglycemia is a risk factor for long-term mortality in this aging surgical population.

Aim: This study is aimed at assessing the prevalence of poor glycemic control using different metrics and its association with in-hospital adverse outcomes. Methods: This cross-sectional study was conducted in diabetic patients admitted to a third-level hospital in Colombia between January and July 2022. Poor glycemic control was determined using capillary glucose metrics, including mean glucose values outside the target range, derived time in range (dTIR) (100-180 mg/dL) < 70%, coefficient of variation (CV > 36%), and hypoglycemia (<70 mg/dL). Multiple regression models were adjusted for hospital outcomes based on glycemic control, as well as other sociodemographic and clinical covariates. Results: A total of 330 Hispanic patients were included. A total of 27.6% had mean glucose measurements outside the target range, 33% had a high CV, 64.8% had low dTIR, and 28.8% experienced hypoglycemia. The in-hospital mortality rate was 8.8%. An admission HbA1c level greater than 7% was linked to an increased mortality risk (p = 0.016), as well as a higher average of glucometer readings (186 mg/dL vs. 143 mg/dL; p < 0.001). A lower average of dTIR (41.0% vs. 60.0%; p < 0.001) was also associated with a higher mortality risk. Glycemic variability was correlated with an increased risk of mortality, hypoglycemia, delirium, and length of hospital stay (LOS). Conclusion: A significant number of hospitalized diabetic patients exhibit poor glycemic control, which has been found to be associated with adverse outcomes, including increased mortality. Metrics like dTIR and glycemic variability should be considered as targets for glycemic control, highlighting the need for enhanced management strategies.

Inpatient use of insulin pump therapy has been increasing due to greater availability of this technology, however there is a paucity of research that investigates glycemic control of inpatient insulin pump users.

To compare the glycemic control of hospitalized patients with type 1 diabetes (T1D) who used insulin pump vs. multiple daily injections (MDI).

Retrospective chart review.

Patients with T1D who were hospitalized between January 1, 2017, and December 31, 2019, in an academic medical center in the New York metropolitan area.

Patients were categorized into three groups based on their method of insulin administration: "pump only" group used insulin pump exclusively, "MDI only" group used MDI only, and "intermittent pump" group used a combination of both methods. The primary endpoints are mean blood glucose, rates of hypoglycemic events (blood glucose < 70 mg/dL), and rates of hyperglycemic events (blood glucose > 250 mg/dL). Separate multivariable Poisson regressions were performed to determine the association between the type of insulin administration and rate outcomes (i.e., rate of hypoglycemic events and rate of hyperglycemic events).

The study included 78 patients with a mean age of 51, who were mostly male (54%), and white (72%). The average proportion of glucose measurements that were hyperglycemic for the "pump only", "MDI only", and "intermittent pump" groups were 0.11 (SD = 0.11), 0.25 (SD = 0.19), and 0.24 (SD = 0.25), respectively. The "pump only" group has a significantly lower proportion of hyperglycemic events as compared to the "MDI only" group (p = 0.0227).

In this sample, patients who exclusively used their insulin pump while inpatient had a lower rate of hyperglycemic events than patients who used MDI only; suggesting that select patients can safely continue their insulin pump therapy in the inpatient setting.

Enteral nutrition (EN) support therapy increases the risk of abnormal blood glucose (BG). The aim of this study is to evaluate the clinical value of a real-time continuous glucose monitoring (rt-CGM) system in BG monitoring during postoperative EN support therapy in patients with esophageal cancer.

Patients without diabetes mellitus (DM) with esophageal cancer who planned to receive postoperative EN were enrolled. With the self-monitoring of BG value as the reference BG, the accuracy of rt-CGM was evaluated by the mean absolute relative difference (MARD) value, correlation efficient, agreement analysis, and Parkes and Clarke error grid plot. Finally, paired t tests were used to compare the differences in glucose fluctuations between EN and non-EN days and slow and fast days.