@article{bcf25add20e14f488480f45e2d28ce49,
title = "Continuous glucose monitoring identifies relationship between optimized glycemic control and post-discharge acute care facility needs",
abstract = "Objective: Hyperglycemia is an independent risk factor in hospitalized patients for adverse outcomes, even if patients are not diabetic. We used continuous glucose monitoring to evaluate whether glycemic control (hyperglycemia) in the first 72 h after an intensive care admission was associated with the need for admission to a post discharge long-term medical facility. Results: We enrolled 59 coronary artery bypass grafting patients. Poor glycemic control was defined as greater than 33\% of continuous glucose monitoring values < 70 and > 180 mg/dL (group 1); and then these patients were reevaluated with a less strict definition of poor glycemic control with greater than 25\% of continuous glucose values < 70 and > 180 mg/dL (group 2). In group 1 4/10 (40.0\%) whose glucose was not well controlled went to an extended care post discharge facility as opposed to 6/49 (12.2\%) that were well controlled. In reevaluation as group 2, 5/14 (35.7\%) whose glucose was not well controlled went to an extended care post discharge facility as opposed to 5/45 (11.1\%) who were well controlled. Admission to a post discharge facility was increased in patients with poor glycemic control p = 0.045 and p = 0.042 for group 1 and group 2, and with odds ratios of 4.8 (95\% CI 1.0-22.5) and 4.4 (95\% CI 1.0-19.4), respectively.",
keywords = "Algorithms, Clinical decision support systems, Extended care facilities, Glucose, Monitoring, Thoracic surgery",
author = "Pappada, \{Scott M.\} and Karina Woodling and Owais, \{Mohammad Hamza\} and Zink, \{Evan M.\} and Layth Dahbour and Tripathi, \{Ravi S.\} and Khuder, \{Sadik A.\} and Papadimos, \{Thomas J.\}",
note = "Funding Information: Work was funded by an intramural Ohio State University Grant for the development of a comprehensive clinical decision support system and educational tool to support optimization of glycemic control in the hospital and critical care setting, \$25,000 USD. Funding Information: Also, the fact that surgical site infections in the older patients are more frequent, deadlier, have higher costs, and are related to a decreased host response, make the optimization of perioperative glycemic control very important [7]. When studying the biological considerations of enhanced recovery after surgery programs (ERAS), it is evident the inflammatory stress response of surgery with the accompanying release of counter regulatory hormones, leads to insulin resistance, which if not addressed is a source of adverse outcomes in patients [8]. Recent direct evidence has identified a genetic pathway in which acute hyperglycemia can obliterate the cardiopro-tective effect of remote ischemic preconditioning through nitrative stresses and activation of the phosphorylation of the rapamycin pathway [9]. Additionally, inflammation of the central nervous system secondary to anesthesia, the surgical insult, and cardiopulmonary bypass may initiate rapid neurological and cognitive decline in patients [10], and this effect can be compounded by a lack of periop-erative glycemic control [11–14]. In this study we used CGM in caring for our patients; its use in the critically ill is safe, economical, and can decrease nursing workload [6]. The use of CGM is supported by the 2016 Consensus Statement of the American Association of Clinical Endocrinologists and the American College of Endocrinology [15]. The Association and the College state that CGM improves the control of glucose, reduces costs in the care of diabetics, and will likely improve the outcomes of diabetics. Publisher Copyright: {\textcopyright} 2018 The Author(s).",
year = "2018",
month = jul,
day = "31",
doi = "10.1186/s13104-018-3656-3",
language = "English",
volume = "11",
journal = "BMC research notes",
issn = "1756-0500",
number = "1",
}