DRM is an etiology-based type of malnutrition caused by a concomitant disease and can occur with or without inflammation 2. In European hospitals, continuous effort towards the identification and the treatment of disease-related malnutrition (DRM) is going on to improve health care efficiency by securing patients’ nutritional status 1. More studies should investigate the importance of inflammation and reduced muscle mass, which is the main difference between nutritional risk screening and GLIM diagnostic assessment. However, a number of patients were malnourished who were not identified by the screening procedure. Malnutrition was evident in fewer patients than at risk of malnutrition, as expected. Of these 114 patients, 77 were also identified as at risk of malnutrition by NRS2002, while 37 patients were not identified by NRS2002. Nutritional risk screening identified 143 patients as at risk of malnutrition, while GLIM criteria led to a diagnosis of malnutrition in 114 patients. In total, 328 patients (median age 71 years, 47% women, median length of stay 7 days) were included. Malnutrition was diagnosed according to the GLIM-criteria. Nutritional risk screening was followed by anthropometric measurements including measurement of muscle mass, assessment of dietary intake and measurement of serum C-reactive protein (CRP) for inflammation in all patients. Hospitalized patients (excluding cancer, intensive care, and transmissible infections) who underwent nutritional risk screening (by NRS2002) were included. This study investigates the diagnosis of malnutrition in hospitalized patients using nutritional risk screening and the diagnostic assessment suggested by GLIM. In 2019, a consensus on criteria has been suggested for the diagnosis of malnutrition by the Global Leadership Initiative for Malnutrition (GLIM). It may be necessary to interrupt treatment to avoid additive effects which would increase the risk of hypoglycaemia.Nutritional risk screening, to identify patients at risk of malnutrition, is the first step in the prevention and treatment of malnutrition in hospitalized patients, and should be followed by a thorough nutritional assessment resulting in a diagnosis of malnutrition and subsequent treatment. Consideration must be given to the potency and duration of action of the previous blood sugar lowering agent. Any dose increase should be in accordance with guideline given above in ‘initial dose and dose titration’. When substituting Glimepiride for other such agents, the initial daily dose is 1 mg this applies even in changeover from maximum dose of other oral blood sugar lowering agents. A dose adjustment must also be considered whenever the patient’s weight or life-styie changes, or other factors arise which cause an increased susceptibility to hypo or hyperglycaemia.Ĭhangeover from other oral antidiabetics to Glimepiride: There is no exact dosage relationship between Glimepiride and other oral blood sugar lowering agents. To avoid hypoglycaemia, timely dose reduction or cessation of Glimepiride therapy must be considered. Secondary dosage adjustment: As control of diabetes improves, sensitivity to insuiin increases therefore, Glimepiride requirement may fall as treatment proceeds. It is very important not to skip meals after taking the drug. This should be taken immediately before a substantial breakfast or if none is taken immediately before the first main meal. Normally, a single daily dose is sufficient. Any increase can be based on regular blood sugar monitoring, and should be gradual, i.e., at intervals of 1 to 2 weeks, and carried out stepwise, as follows: 1 mg -> 2 mg -> 3 mg -> 4 mg -> 6 mg.ĭose in patients with well controlled diabetes: the usual dose range in patients with well controlled diabetes is 1 to 4 mg daily.ĭistribution of doses: Timing and distribution of doses are decided by the physician, in consideration of the patient’s current life-style. Initial dose and dose titration: the usual initial dose is 1 mg once daily, if necessary, the daily dose can be increased. Monitoring of glucose levels in blood and urine also serves to detect either primary or secondary failure of therapy. The initial and the maintenance doses are set based on the results of regular check of glucose in blood and urine. The dosage of Glimepiride must be the lowest which is sufficient to achieve the desired metabolic control. In principle, the dosage of Glimepiride is governed by the desired blood sugar level.
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