IMPACT OF GLUCOSE MANAGEMENT TEAM ON OUTCOMES OF HOSPITALIZARON IN PATIENTS WITH TYPE 2 DIABETES ADMITTED TO THE MEDICAL SERVICE.

OBJECTIVE: To improve glycemic control of hospitalized patients with diabetes and hyperglycemia, many medical centers have established dedicated glucose management teams (GMTs). However, the impact of these specialized teams on clinical outcomes has not been evaluated. METHODS: We conducted a retrospective study of 440 patients with type 2 diabetes admitted to the medical service for cardiac or infection-related diagnosis. The primary endpoint was a composite outcome of several well-recognized markers of morbidity, consisting of: death during hospitalization, transfer to intensive care unit, initiation of enteral or parenteral nutrition, line infection, new in-hospital infection or infection lasting more than 20 days of hospitalization, deep venous thrombosis or pulmonary embolism, rise in plasma creatinine, and hospital re-admissions. RESULTS: Medical housestaff managed the glycemia in 79% of patients (usual care group), while the GMT managed the glycemia in 21% of patients (GMT group). The primary outcome was similar between cohorts (0.95 events per patient versus 0.99 events per patient in the GMT and usual care cohorts, respectively). For subanalysis, the subjects in both groups were stratified into those with average glycemia of <180 mg/dL versus those with glycemia >180 mg/dL. We found a significant beneficial impact of glycemic management by the GMT on the composite outcome in patients with average glycemia >180 mg/dL during their hospital stay. The number of patients who met primary outcome was significantly higher in the usual care group (40 of 83 patients, 48%) than in the GMT-treated cohort (8 of 33 patients, 25.7%) (P<.02). CONCLUSION: Our data suggest that GMTs may have an important role in managing difficult-to-control hyperglycemia in the inpatient setting. ABBREVIATIONS: BG = blood glucose GMT = glucose management team HbA1c = hemoglobin A1c ICU = intensive care unit POC = point of care T2D = type 2 diabetes.

Large-scale identification of microRNAs from a basal eudicot (Eschscholzia californica) and conservation in flowering plants.

MicroRNAs (miRNAs) negatively control gene expression by cleaving or inhibiting the translation of mRNA of target genes, and as such, they play an important role in plant development. Of the 79 plant miRNA families discovered to date, most are from the fully sequenced plant genomes of Arabidopsis, Populus and rice. Here, we identified miRNAs from leaves, roots, stems and flowers at different developmental stages of the basal eudicot species Eschscholzia californica (California poppy) using cloning and capillary sequencing, as well as ultrahigh-throughput pyrosequencing using the recently introduced 454 sequencing method. In total, we identified a minimum of 173 unique miRNA sequences belonging to 28 miRNA families and seven trans-acting small interfering RNAs (ta-siRNAs) conserved in eudicot and monocot species. miR529 and miR537, which have not yet been reported in eudicot species, were detected in California poppy; loci encoding these miRNAs were also found in Arabidopsis and Populus. miR535, which occurs in the moss Physcomitrella patens, was also detected in California poppy, but not in other angiosperms. Several potential miRNA targets were found in cDNA sequences of California poppy. Predicted target genes include transcription factors but also genes implicated in various metabolic processes and in stress defense. Comparative analysis of miRNAs from plants of phylogenetically-critical basal lineages aid the study of the evolutionary gains and losses of miRNAs in plants as well as their conservation, and lead to discoveries about the miRNAs of even well-studied model organisms.