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Diabetes Management
At present, CGGMS afford an improved approach to facilitate ‘tighter’ complicated by the critical and complex patient who often presents with
glucose goals with a reduced incidence of hypoglycemia, and in some numerous co-morbid conditions.
systems a reduced nurse and physician workload. Attainment of
improved glycemic control in critically ill patients has been reported to Although the entity of tight glucose control is difficult to attain and the
be cost-effective.
42
The cost-effectiveness of different CGGMS intuitively evidence-based data cannot be objectively compared, at present the use
would seem to be equal; however, it may vary significantly depending on of CGGMS has introduced a treatment modality that affords an
the system used, and this awaits further study. opportunity to accomplish appropriate blood glucose goals utilizing
complicated mathematics not amenable to bedside use with the potential
As treatment systems for hyperglycemia continue to evolve with of a very low incidence of hypoglycemia and improved patient safety. n
utilization of closed-loop glucose monitoring, hypoglycemia, decreased
blood glucose variability, and problems with POC blood glucose
Samuel E Crockett, MD, is an Associate Professor of
measurement should continue to improve. This will allow the attainment
Medicine in the Department of Medical Education at the
of improved glucose goals and even greater patient safety, with the
University of Central Florida College of Medicine. He is a
hopeful result of decreased morbidity and mortality.
consultant to the Adventist Health System on the Inpatient
Hyperglycemia Initiative. Dr Crockett is a board-certified
endocrinologist and served as Medical Director of the
Glycemic control using intravenous insulin has been shown to improve
Florida Hospital Diabetes Institute in Orlando for 15 years.
outcomes in critically ill as well as non-critically ill patients. The
appropriate control of blood glucose in the ICU is a demanding process
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with undiagnosed diabetes, J Clin Endocrinol Metab, 2002;53: Diabetes Association consensus statement on inpatient variability is associated with mortality in the surgical
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48 US ENDOCRINOLOGY
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