Objective We investigated the effect of supplementation with alanyl-glutamine dipeptide on insulin resistance and outcome in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Methods A prospective, randomized, open and controlled trial was conducted. Patients with COPD and respiratory failure were recruited between Jan 2005 to Feb 2006 and randomly assigned to a trial group (n=14) with glutamine dipeptide supplmented parenteral nutrition and a control group (n=16) with isocaloric, isonitrogenic parenteral nutrition. On the third day and fifth day of nutrition treatment, blood glucose was clamped at level of 4.4 to 6.1 mmol/L by intravenously bumped insulin. Blood gas, blood glucose level, insulin dosage were recorded everyday. The outcomes were mortality, length of stay (LOS) in hospital and in ICU, mechanical ventilation times and the costs of ICU and hospital.Results Thirty patients successfully completed the trial. There was no difference in blood gas between two groups, but PaO2 increased gradually. Compared with control group, blood glucose level had trend to decrease in trial group. The average insul in consumption decreased significantly in trial group on the fifth day. There was no statistical difference between two groups in mortality, length of stay in hospital and the costs of hospital. But compared with control group, length of stay in ICU and mechanical ventilation days had trend to decrease in trial group. Conclusion Alanyl-glutamine dipeptide do not improve pulmonary function of patients with COPD and respiratory failure. However, alanyl-glutamine dipeptide attenuated insul in resistance and stabilized blood glucose. This trial does not confirm alanyl-glutamine di peptide can improve outcome in critically ill patients with COPD and respiratory failure between two groups in mortality at the end of 30 days, length of stay in hospital and the costs of hospital. But the length of stay in ICU and the duration of mechanical ventilation does decrease, but not significantly, in the trial group.
ObjectiveTo observe the effects of bulbar subconjunctival and periocular injection of dexamethasonone on blood glucose levels of type 1 diabetic mellitus (T1DM)rats. Methods80 healthy adult male Sprague-Dawley rats were randomly divided into GroupⅠ(n=40) and GroupⅡ(n=40). GroupⅠrats received intraperitoneal (IP) injection of streptozotocin to induce T1DM model, while GroupⅡrats received IP injection of citrate buffer solution and was the control group.GroupⅠrats and GroupⅡrats were further divided into four subgroups:A (n=10), a (n=10), B (n=10), and b (n=10). Subgroup-A rats received bulbar subconjunctival injection of dexamethasone, subgroup-a rats received bulbar subconjunctival injection of saline, subgroup-B rats received periocular injection of dexamethasone, subgroup-b rats received periocular injection of saline. After the injection, rats were fasted but could drink water. Tail vein blood samples were collected and the blood glucose level was measured by glucose monitor. ResultsAfter modeling, the blood glucose level of GroupⅠand GroupⅡrats was(9.31±1.79) mmol/L and (5.72±0.80) mmol/L respectively, the difference was statistically significant (P < 0.05). The blood glucose level of GroupⅠrats reached the peak in 3h after injection. In 6-24 h after injection, the blood glucose level of GroupⅠA rats was obviously increased than that of the blood glucose level of Group Ia rats and the difference was statistically significant (P < 0.05). In 3-24 hours after injection, the blood glucose level of GroupⅠB rats was obviously increased than that of the blood glucose level of GroupⅠb rats and the difference was statistically significant (P < 0.05). Comparing the blood glucose level during different injection time between GroupⅠA rats and GroupⅠB rats, between GroupⅠa rats and GroupⅠb rats, the difference was not statistically significant (P > 0.05). In 3-24 hours after injection, the blood glucose level of GroupⅡA rats was obviously increased than that of the blood glucose level of GroupⅡa rats and the difference was statistically significant (P < 0.05); the blood glucose level of GroupⅡB rats was obviously increased than that of the blood glucose level of GroupⅡb rats and the difference was statistically significant (P < 0.05). Comparing the blood glucose level during different injection time between GroupⅡA rats and GroupⅡB rats, between GroupⅡa rats and GroupⅡb rats, the difference was not statistically significant (P > 0.05). ConclusionBulbar subconjunctival injection and periocular injection of dexamethasone could both increase the blood glucose of TIDM rats, but these two injection methods had no differences on the blood glucose level.
ObjectiveTo summarize the monitoring experiences of blood glucose for patients with rheumatic heart disease combined with diabetes, in order to prevent postoperative complications caused by abnormal blood sugar, relieve pain and promote rehabilitation. MethodsWe reviewed the medical records of the patients with diabetes after heart valve replacement who were admitted to our department from April 2011 to March 2012. Eighty patients were randomly divided into observation group and control group with 40 in each group. Patients in the control group received conventional treatment with subcutaneous insulin injection, while the observation group patients were treated with intravenous insulin pump, and the dose of insulin was adjusted depending on blood glucose levels. Then we compared the postoperative changes in blood glucose level and complications between the two groups. ResultsThe insulin dose, the time of reaching target blood glucose levels, hospital stays and postoperative complication rates were significantly lower in the observation group than the control group (P<0.05). During the one-year follow-up after operations, 2 and 4 patients died respectively in the observation group and the control group, and the difference was not significant (χ2=0.180, P=0.670). ConclusionFor patients with diabetes after heart valve replacements, intravenous insulin pump is better than subcutaneous insulin injection. It can prevent complications, shorten hospital stays, reduce financial burden, and promote prognosis and harmonious doctor-patient relationship.
Objective To evaluate clinical effects of strict control vs. conventional control of blood glucose in perioperative cardiac surgery. Methods Databases including PubMed, EMbase, HighWire, The Cochrane Library, CBM and VIP were searched to collect the randomized controlled trials (RCTs) on strict control vs. conventional control of blood glucose in perioperative cardiac surgery, published from 2000 to 2011. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted data, and assessed quality of the included studies. Then meta-analysis was performed using RevMan 5.1. Results A total of 8 RCTs involving 2 250 patients were included. The results of meta-analysis showed that compared with the conventional group, the strict control of blood glucose could reduce postoperative short-term mortality (OR=0.52, 95% CI 0.30 to 0.91, P=0.02) and postoperative incidence rate of both atrial fibrillation (OR=0.64, 95%CI 0.43 to 0.96, P=0.03) and incision infection (OR=0.30, 95%CI 0.15 to 0.57, P=0.000 2), and shorten hospital stay (MD=1.75, 95%CI –3.18 to –0.32, Plt;0.02) and time of mechanical ventilation (MD=–0.9, 95%CI –1.43 to –0.38, Plt;0.000 8). Conclusion Current evidence shows that the strict control of blood glucose in perioperative cardiac surgery can reduce postoperative short-term mortality and postoperative incidence rate of both atrial fibrillation and incision infection, shorten hospital stay and time of mechanical ventilation, and have important clinical values and social and economic significance. However, this conclusion has to be proved by more high-quality and large-scale RCTs for the limitation of quantity and quality of the included studies.
Blood glucose monitoring has become the weakest point in the overall management of diabetes in China. Long-term monitoring of blood glucose levels in diabetic patients has become an important means of controlling the development of diabetes and its complications, so that technological innovations in blood glucose testing methods have far-reaching implications for accurate blood glucose testing. This article discusses the basic principles of minimally invasive and non-invasive blood glucose testing assays, including urine glucose assays, tear assays, methods of extravasation of tissue fluid, and optical detection methods, etc., focuses on the advantages of minimally invasive and non-invasive blood glucose testing methods and the latest relevant results, and summarizes the current problems of various testing methods and prospects for future development trends.
ObjectiveTo explore the clinical effect of comprehensive nursing on cerebral infarction patients with high blood glucose. MethodsEighty cerebral infarction patients with high blood glucose treated between March 2012 and February 2013 were divided into observation group and control group with 40 patients in each. Patients in the control group received routine nursing care, while those in the observation group were given comprehensive nursing care. Then, we compared the two groups of patients in terms of their blood glucose control level, the recovery of neurological function and life quality. ResultsThe fasting glucose, 2-hour postprandial blood glucose, National Institude of Health stroke scale (NIHSS), and modified Edinburgh Scandinavican scoring scale (MESSS) scores of the two groups were not statistically different at the time of hospital admission (P>0.05). However, fasting blood sugar, 2-hour postprandial blood glucose, NIHSS, and MESSS scores in the observation group were significantly lower than those in the control group before discharge (P<0.05). Life quality score of self-care, mental health, and social function before discharge in the observation group were significantly higher than those in the control group (P<0.05). ConclusionComprehensive nursing is helpful to control blood glucose in an ideal level range for cerebral infarction patients with hyperglycemia, which can also promote the recovery of neurological function and improve the life quality of patients.
Objective To assess the differences between a glucose meter and autoanalyzer at home and broad.Method MEDLINE, CNKI, FMJS, and CBM were searched electronically (1995 to May, 2008). The statistical analysisof included studies was performed according to the Cochrane systematic reviews method. Result Twenty four studies, including 11 English records and 19 Chinese records involving 4 963 specimens, were included in this study. Meta-analysis showed us the blood glucose values of Abbott, Roche, and Johnson abroad subgroups are higher than the laboratory method, and their WMD (95%CI) are 0.57 (0.34,0.80), 0.43 (0.04,0.81), 0.41 (0.11,0.71). The blood glucose values of the Abbot and Roche domestic subgroups are comparable to the laboratory method [WMD= 0.60, 95%CI (– 0.79, 1.99); WMD= – 0.13, 95%CI (– 0.56, 0.29)]. The blood glucose value of the Johnson domestic subgroup is lower than laboratory method [WMD= – 0.95, 95%CI (– 1.42, – 0.48)]. Conclusion The results of the abroad studies are relatively consistent, and the blood glucose values of all abroad subgroups are higher than laboratory method. The domestic studies are different because of other factors.
ObjectiveTo explore the application effect of the new in-hospital blood glucose management model for patients with stroke and diabetes mellitus during the epidemic of coronavirus disease 2019.MethodsA total of 120 patients with stroke and diabetes mellitus who were admitted to Mianyang Central Hospital and were consulted by the Department of Endocrinology between October 1st 2019 and April 12th 2020 were recruited. Patients who used the traditional consultation model for blood glucose management between October 1st 2019 and January 19th 2020 were classified as the control group (60 cases). Patients who were managed by the virtual ward of remote blood glucose management combined with the video consultation mode between January 20th 2020 and April 12th 2020 were classified as the observation group (60 cases). The basic conditions, the time to reach target blood glucose, the completion time of the consultation, the accuracy of blood glucose related data, the satisfaction rate of the consultation, the rate of reaching target blood glucose, the incidence of hypoglycemia, the blood glucose fluctuation (standard deviation of blood glucose level, maximum blood glucose fluctuation range), the incidence of nosocomial infections, diabetes mellitus diagnosis and treatment related expenses, and average hospitalization expenses of the two groups were compared.ResultsThere was no significant difference in the basic conditions between the two groups of patients (P>0.05). The time to reach target blood glucose [(5.38±2.16) vs. (8.18±2.63) d], completion time ofthe consultation [(4.33±1.51) vs. (17.97±3.23) h], incidence of hypoglycemia (6.67% vs. 21.67%), standard deviation of blood glucose level [(2.16±0.34) vs. (2.52±0.34) mmol/L] and maximum blood glucose fluctuation range [(5.72±1.36) vs. (6.34±1.51) mmol/L] of the observation group were lower than those of the control group, the accuracy rate of blood glucose related data (100.00% vs. 83.33%), satisfaction rate of the consultation (93.33% vs. 73.33%) and rate of reaching target blood glucose (88.33% vs. 70.00%) of the observation group were higher than those of the control group, and the differences were statistically significant (P<0.05). There was no significant difference in the incidence of nosocomial infections, diabetes mellitus diagnosis and treatment related expenses, or average hospitalization expenses between the two groups of patients (P>0.05).ConclusionDuring the epidemic of coronavirus disease 2019, the combined video consultation model of remote blood glucose virtual ward for patients with stroke and diabetes mellitus has a good application effect, which has certain feasibility and clinical promotion value.
Objective To investigate the effects of tight blood glucose control on the shortterm prognosis of the patients after heart valve replacement, in order to improve treatment effectiveness and lower postoperative complications. Methods A total of 240 patients including 150 males and 90 females underwent mitral valve replacement or mitral and aortic valve replacement were enrolled in this study from January 2007 to December 2008 at the cardiac surgery department of Renmin hospital of Wuhan university. The age of these patients ranged from 19 to 65 years old with an average age of 53.33 years. According to insulin administration time and blood glucose control level, they were randomly separated into two groups. In the experimental group, there were 121 patients who received continuous insulin infusion to maintain postoperative glucose level between 4.4 and 6.1 mmol/L, while 119 patients in the control group received insulin infusion when their glucose level went higher than 11.1 mmol/L to control the level between 6.1 and 11.1 mmol/L. Then the postoperative wound infection, malignant arrhythmia rate, the assisted ventilation time, intensive care unit(ICU) stay time and count of neutrophils were compared and analyzed. Results There was no hospitalized death in both groups. The rate of wound infection（3.31% vs.10.08%, χ2=4.430,P=0.035）, the assisted ventilation time（9.02±2.73 h vs. 10.01±3.58 h, t=2.280,P=0.024）, time for count of leukocytes to decrease to the normal level（11.04±3.16 d vs. 12.05±3.76 d, t=2.168,P=0.031）, average hospitalization time（13.49±3.81 d vs. 14.51±4.02 d,t=2.017,P=0.045）, and count of neutrophils on the third day（0.82±0.04 vs. 0.84±0.05, t=2.644,P=0.009） in the experimental group were significantly lower or shorter than those in the control group. But there was no significant difference between both groups in ICU stay time and the rate of malignant arrhythmia. Conclusion Tight blood glucose control can lower the rate of postoperative wound infection, shorten the assisted ventilation time and hospitalization time, and reduce the usage of antibiotics in patients after heart valve replacement. Accordingly, it can enhance the curative effect, reduce overall medical expenses, and improve prognosis.
ObjectiveTo investigate the epidemiological characteristics and predisposing causes of diabetic foot ulcer (DFU) in the hospitalized patients with diabetic foot disease (DFD).MethodsThe clinical data of patients with DFD admitted to West China Hospital of Sichuan University between January 1st, 2012 and December 31st, 2018 were collected through the electronic medical record system. The demographic characteristics, blood glucose control status, and the predisposing causes of DFU were analyzed.ResultsA total of 1 022 DFD inpatients with an average age of (65.5±11.9) years old were included in this study, including 679 males and 343 females; 59.4% (513/864) of the patients had a college degree or above, but the patients with more severe DFD had lower educational level (χ2trend=19.554, P<0.001). The average time from diagnosis of diabetes mellitus to occurrence of DFD was (10.6±7.1) years, and 42.4% (433/1 022) of the patients had diabetes for over 10 years. Among the patients, 82.3% (841/1 022) treated diabetes irregularly, 56.2% (555/987) never monitored blood glucose, 51.2% (523/1 022) had a history of foot ulcers, and 8.6% (88/1 022) had a history of lower extremity or toe amputation. The average fasting blood glucose and hemoglobin A1c were (8.6±3.8) mmol/L and (8.2±2.1)%, respectively. There were 52.2% (525/1 006) and 94.4% (958/1 015) of the DFD patients companied with peripheral arterial disease and neuropathy, respectively. DFUs were mainly single (52.7%, 447/849) and neuro-ischemic ulcers (53.0%, 389/734). The main predisposing causes were physical causes (21.6%, 180/834) and trauma (19.2%, 160/834).ConclusionsThe patients with DFD have the characteristics of old age, long course of diabetes, irregular treatment of diabetes and poor control of blood glucose, combined with neurovascular diseases, and high recurrence rate of foot ulcer. Therefore, diabetes education, early screening of foot risk factors, and early intervention should be strengthened to prevent the occurrence and recurrence of DFU.