What makes tight glycemic control tight? The impact of variability and nutrition in two clinical studies.

in Journal of Diabetes Science and Technology (2010), 4(2), 284-98

INTRODUCTION: Tight glycemic control (TGC) remains controversial while successful, consistent, and effective protocols remain elusive. This research analyzes data from two TGC trials for root causes of ... [more ▼]

INTRODUCTION: Tight glycemic control (TGC) remains controversial while successful, consistent, and effective protocols remain elusive. This research analyzes data from two TGC trials for root causes of the differences achieved in control and thus potentially in glycemic and other outcomes. The goal is to uncover aspects of successful TGC and delineate the impact of differences in cohorts. METHODS: A retrospective analysis was conducted using records from a 211-patient subset of the GluControl trial taken in Liege, Belgium, and 393 patients from Specialized Relative Insulin Nutrition Titration (SPRINT) in New Zealand. Specialized Relative Insulin Nutrition Titration targeted 4.0-6.0 mmol/liter, similar to the GluControl A (N = 142) target of 4.4-6.1 mmol/liter. The GluControl B (N = 69) target was 7.8-10.0 mmol/liter. Cohorts were matched by Acute Physiology and Chronic Health Evaluation II score and percentage males (p > .35); however, the GluControl cohort was slightly older (p = .011). Overall cohort and per-patient comparisons (median, interquartile range) are shown for (a) glycemic levels achieved, (b) nutrition from carbohydrate (all sources), and (c) insulin dosing for this analysis. Intra- and interpatient variability were examined using clinically validated model-based insulin sensitivity metric and its hour-to-hour variation. RESULTS: Cohort blood glucose were as follows: SPRINT, 5.7 (5.0-6.6) mmol/liter; GluControl A, 6.3 (5.3-7.6) mmol/liter; and GluControl B, 8.2 (6.9-9.4) mmol/liter. Insulin dosing was 3.0 (1.0-3.0), 1.5 (0.5-3), and 0.7 (0.0-1.7) U/h, respectively. Nutrition from carbohydrate (all sources) was 435.5 (259.2-539.1), 311.0 (0.0-933.1), and 622.1 (103.7-1036.8) kcal/day, respectively. Median per-patient results for blood glucose were 5.8 (5.3-6.4), 6.4 (5.9-6.9), and 8.3 (7.6-8.8) mmol/liter. Insulin doses were 3.0 (2.0-3.0), 1.5 (0.8-2.0), and 0.5 (0.0-1.0) U/h. Carbohydrate administration was 383.6 (207.4-497.7), 103.7 (0.0-829.4), and 207.4 (0.0-725.8) kcal/day. Overall, SPRINT gave approximately 2x more insulin with a 3-4x narrower, but generally non-zero, range of nutritional input to achieve equally TGC with less hypoglycemia. Specialized Relative Insulin Nutrition Titration had much less hypoglycemia (<2.2 mmol/liter), with 2% of patients, compared to GluControl A (7.7%) and GluControl B (2.9%), indicating much lower variability, with similar results for glucose levels <3.0 mmol/liter. Specialized Relative Insulin Nutrition Titration also had less hyperglycemia (>8.0 mmol/liter) than groups A and B. GluControl patients (A+B) had a approximately 2x wider range of insulin sensitivity than SPRINT. Hour-to-hour variation was similar. Hence GluControl had greater interpatient variability but similar intrapatient variability. CONCLUSION: Protocols that dose insulin blind to carbohydrate administration can suffer greater outcome glycemic variability, even if average cohort glycemic targets are met. While the cohorts varied significantly in model-assessed insulin resistance, their variability was similar. Such significant intra- and interpatient variability is a further significant cause and marker of glycemic variability in TGC. The results strongly recommended that TGC protocols be explicitly designed to account for significant intra- and interpatient variability in insulin resistance, as well as specifying or having knowledge of carbohydrate administration to minimize variability in glycemic outcomes across diverse cohorts and/or centers. [less ▲]

Le paradoxe de la limite

in Steinmetz, Rudy; Lenain, Thierry (Eds.) Cadre, seuil, limite. La question de la frontière dans la théorie des arts (2010)

De l’écran global à l’écran total : une expérience de cinéma mis à la rue

in Dubois, Philippe; Monvoisin, Frédéric; Biserna, Elena (Eds.) Extended Cinema. Le cinéma gagne du terrain (2010)

Droit international privé - supports didactiques

Learning material (2010)

Ce document reprend l'ensemble des supports de présentation utilisés pour appuyer l'enseignement d'un cours d'introduction au droit international privé qui figure au programme du master en droit offert ... [more ▼]

Ce document reprend l'ensemble des supports de présentation utilisés pour appuyer l'enseignement d'un cours d'introduction au droit international privé qui figure au programme du master en droit offert par la Faculté de droit de l'ULg. Ce document n'a pas de valeur scientifique propre. L'ambition est uniquement pédagogique. [less ▲]

Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC).

in Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology (2010), 12(10), 1360-420

Human Papillomavirus Virus-Like particles and NK cell interactions:role of CD16

in International Immunology (2010), 22(suppl Pt 5), 17

Comment j'explore une masse cervicale chez l'enfant

in Revue Médicale de Liège (2010), 65

The discovery of a cervical mass in a child suggests several possible diagnoses ranging from benign conditions to more severe pathologies, even cancer. Parents often worry and consult a physician when ... [more ▼]

The discovery of a cervical mass in a child suggests several possible diagnoses ranging from benign conditions to more severe pathologies, even cancer. Parents often worry and consult a physician when such a mass fails to regress after a few weeks. Palpation of small and solid lymph nodes is commonplace and generally trivial in children. A detailed clinical history and a careful examination often allow a distinction to be made between a benign and a serious condition. Additional tests are needed in case of doubt or in the prospect of reaching an precise aetiological diagnosis. These exams should be selected according to a decision algorithm. The investigation remains delicate. When the physician is convinced of the benign nature of the lymphadenopathy, there is no real need to identify the aetiology with the greatest precision, especially in acute cases with bilateral nodes that are commonly benign and spontaneously resolve. [less ▲]

Examen de jurisprudence récente en matière de règlement collectif de dettes

in J. CLESSE et M. DUMONT (Ed.) Actualités de droit social - CUP (2010)

Rez. zu: Spiekermann, Helmut: Sprache in Baden-Württemberg. Merkmale des regionalen Standards.

in Rheinische Vierteljahrsblätter (2010), 74(2010), 262-266

Bubble splitting in oscillatory flows on ground and in reduced gravity

in European Physical Journal E -- Soft Matter (2010), 31

The stability of centimeter scale air bubbles is studied in quiescent suspending liquid under an imposed oscillatory acceleration field. Experiments were performed in reduced- and normal-gravity ... [more ▼]

The stability of centimeter scale air bubbles is studied in quiescent suspending liquid under an imposed oscillatory acceleration field. Experiments were performed in reduced- and normal-gravity environments. A strong acceleration resulted in an instability leading to the breakups of the bubbles in both gravity environments. The breakup onset was investigated and found to be characterized by a critical acceleration acr . The influence of the liquid viscosity and the gravitational environment was studied. Empirical correlations for the onset are presented and discussed with the intention to reveal splitting mechanism. The inertial mechanism often deemed to cause the breakup of drops sub jected to a rapid gas stream is shown to give explanations consistent with the experiments. A breakup criterion for both gravitational environments is proposed through discussions from an energetic point of view. [less ▲]