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Ong-Artborirak P, Seangpraw K, Boonyathee S, Auttama N, Winaiprasert P. Health literacy, self-efficacy, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus: a cross-sectional study in Thai communities. BMC Geriatr 2023; 23:297. [PMID: 37193967 DOI: 10.1186/s12877-023-04010-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 04/28/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Properly understanding the health information of people with type 2 diabetes mellitus (T2DM) is the basis for better risk factor management, which also positively affects their quality of life. The aim of this study was to investigate diabetes health literacy (HL), self-efficacy, and self-care behaviors associated with glycemic control among older adults with T2DM in northern Thai communities. METHODS A cross-sectional study was conducted among 414 older adults over the age of 60 diagnosed with T2DM. The study was conducted in Phayao Province from January to May 2022. Simple random sampling of the patient list for the Java Health Center Information System program was used. Questionnaires were used to collect data on diabetes HL, self-efficacy, and self-care behaviors. Blood samples were tested for estimated glomerular filtration rate (eGFR) and glycemic controls, such as fasting blood sugar (FBS) and glycated hemoglobin (HbA1c). RESULTS The mean age of participants was 67.1 years. FBS (mean ± SD = 108.5 ± 29.5 mg/dL) and HbA1c (mean ± SD = 6.6 ± 1.2%) levels were found to be abnormal in 50.5% (≥ 126 mg/dL) and 17.4% (≥ 6.5%) of the subjects, respectively. There was a strong correlation between HL and self-efficacy (r = 0.78), HL and self-care behaviors (r = 0.76), and self-efficacy and self-care behaviors (r = 0.84). The eGFR was significantly correlated with diabetes HL (r = 0.23), self-efficacy (r = 0.14), self-care behaviors (r = 0.16), and HbA1c (r = -0.16) scores. Linear regression after adjusting for sex, age, education, DM duration, smoking, and drinking alcohol showed that FBS level was inversely associated with diabetes HL (Beta = -0.21, R2 = 11.0%), self-efficacy (Beta = -0.43, R2 = 22.2%), and self-care behavior (Beta = -0.35, R2 = 17.8%), whereas HbA1C level was negatively associated with diabetes HL (Beta = -0.52, R2 = 23.8%), self-efficacy (Beta = -0.39, R2 = 19.1%), and self-care behavior (Beta = -0.42, R2 = 20.7%). CONCLUSION Diabetes HL was related to self-efficacy and self-care behaviors in elderly T2DM patients and was shown to influence their health, including glycemic control. These findings suggest that implementing HL programs to build competence in self-efficacy expectations is important for contributing to improvements in diabetes preventive care behaviors and HbA1c control.
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Affiliation(s)
| | | | | | - Nisarat Auttama
- School of Public Health, University of Phayao, Phayao, Thailand
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2
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Wang Y, Zhu J, Shan L, Wu L, Wang C, Yang W. Potentially inappropriate medication among older patients with diabetic kidney disease. Front Pharmacol 2023; 14:1098465. [PMID: 36843920 PMCID: PMC9946453 DOI: 10.3389/fphar.2023.1098465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023] Open
Abstract
Objective: Potentially inappropriate medications (PIM) contribute to poor outcomes in older patients, making it a widespread health problem. The study explored the occurrence and risk factors of PIM in older diabetic kidney disease (DKD) patients during hospitalization and investigated whether polypharmacy was associated with it. Methods: Retrospective analysis of the patients ≥ 65 years old diagnosed with DKD from July to December 2020; the PIM was evaluated according to the American Beers Criteria (2019). Factors with statistical significance in univariate analysis were included in Logistic multivariate analysis to explore the potential risk factors related to PIM. Results: Included 186 patients, 65.6% of patients had PIM, and 300 items were confirmed. The highest incidence of PIM was 41.7% for drugs that should be carefully used by the older, followed by 35.3% that should be avoided during hospitalization. The incidence of PIM related to diseases or symptoms, drug interactions to avoid, and drugs to avoid or reduce dose for renal insufficiency patients were 6.3%, 4.0% and 12.7%, respectively. The medications with a high incidence of PIM were diuretics (35.0%), benzodiazepines (10.7%) and peripheral ɑ1 blockers (8.7%). Compared with hospitalization, there were 26% of patients had increased PIM at discharge. Multivariate Logistic regression analysis showed that polypharmacy during hospitalization was an independent risk factor for PIM, OR = 4.471 (95% CI: 2.378, 8.406). Conclusion: The incidence of PIM in hospitalized older DKD patients is high; we should pay more attention to the problem of polypharmacy in these patients. Pharmacists identifying the subtypes and risk factors for PIM may facilitate risk reduction for older DKD patients.
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Affiliation(s)
- Yuping Wang
- Department of Pharmacy, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jie Zhu
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China,Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, Guangzhou, China,Department of Gastrointestinal Surgery, The Second People’s Hospital of Yibin, Yibin, Sichuan, China
| | - Luchen Shan
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Ling Wu
- Department of Pharmacy, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China,Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, Guangzhou, China,*Correspondence: Cunchuan Wang, ; Wah Yang,
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China,Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, Guangzhou, China,*Correspondence: Cunchuan Wang, ; Wah Yang,
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Moody L, Wood E, Needham A, Booth A, Jimenez-Aranda A, Tindale W. Identifying individual enablers and barriers to the use of digital technology for the self-management of long-term conditions by older adults. J Med Eng Technol 2022; 46:448-461. [PMID: 35748238 DOI: 10.1080/03091902.2022.2089249] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Evidence suggests that much of the digital technology available and provided to older adults to enable self-management of long-term conditions is under-utilised. This research focuses on three conditions prevalent amongst older adults: diabetes, dementia and chronic kidney disease and explores the individual enablers and barriers to the use of digital self-management technology. The paper reports findings from a series of three systematic reviews of qualitative research (qualitative evidence syntheses). These reviews informed the design of a Delphi study. The first round of the Delphi involving 15 expert interviews is reported. The findings highlight common themes across the three conditions: how technology is used; barriers to use; assessing individual needs when selecting technology; support requirements; multi-functional self-management technologies; trust, privacy and data sharing; achieving accessible and aspirational design. Some emerging recommendations have been suggested to guide the design, and provision of technology to older adults. These will extended and refined through subsequent rounds of the Delphi method.
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Affiliation(s)
- Louise Moody
- Centre for Arts, Memory and Communities, Coventry University, Coventry, UK.,NIHR Devices for Dignity MedTech Co-operative, UK, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Esmé Wood
- Centre for Arts, Memory and Communities, Coventry University, Coventry, UK
| | - Abigail Needham
- NIHR Devices for Dignity MedTech Co-operative, UK, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Angel Jimenez-Aranda
- NIHR Devices for Dignity MedTech Co-operative, UK, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Wendy Tindale
- NIHR Devices for Dignity MedTech Co-operative, UK, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Clemens KK, Ouédraogo AM, Lam M, Muanda FT, Loeschnik E, Wilk P, Shariff SZ. Trends in basal insulin prescribing in older adults with chronic kidney disease in Ontario, Canada: A population-based analysis from 2010 to 2020. Diabetes Obes Metab 2022; 24:641-651. [PMID: 34910362 DOI: 10.1111/dom.14622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/29/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022]
Abstract
AIM To examine trends in basal insulin prescribing in older adults with chronic kidney disease (CKD). MATERIALS AND METHODS We conducted a population-based study of adults aged 66 years or older with treated diabetes from 1 January 2010 to 30 September 2020 in Ontario, Canada. We examined prevalent and incident prescriptions for human NPH, Levemir, glargine-100, Basaglar, glargine-300, and degludec insulin over 43 study intervals. We present trends in those with CKD, and in a subgroup, by estimated glomerular filtration rate (eGFR). To provide context for prescribing, we provide demographics, co-morbidities, and the healthcare utilization of included patients. RESULTS In CKD, use of basal insulin was about 2-fold higher than in the general treated diabetes cohort. Prescriptions for NPH declined over time, while prescriptions for Levemir and glargine-100 increased until 2018 then decreased. Following drug formulary approval (September 2018), prescriptions for glargine-300 and degludec increased substantially. Incident prescriptions for basal insulin in CKD declined over time; however, in those with an eGFR of less than 30 ml/min/1.73m2 , rates remained stable. In recent years, rates of degludec and glargine-300 have rivalled glargine-100. CONCLUSIONS In an era of new oral and injectable diabetes medications, the use of basal insulin has declined in older adults with CKD. However, in those with more advanced CKD, basal insulin, particularly newer analogues, remain a mainstay treatment.
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Affiliation(s)
- Kristin K Clemens
- Department of Medicine, Division of Endocrinology and Metabolism, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- ICES, London, Ontario, Canada
- St. Joseph's Healthcare London, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | | | | | | | - Emma Loeschnik
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Piotr Wilk
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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5
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Wang CS, Pai YW, Lin CH, Lee IT, Chang MH. Renal impairment is one of appropriate predictors of future diabetic peripheral neuropathy: a hospital-based 6-year follow-up study. Sci Rep 2022; 12:5240. [PMID: 35347201 PMCID: PMC8960825 DOI: 10.1038/s41598-022-09333-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/21/2022] [Indexed: 11/09/2022] Open
Abstract
The relationship between renal impairment and diabetic peripheral neuropathy (DPN) remains inconclusive. We aim to investigate the risk factors for the occurrence of DPN in Taiwanese adults with type 2 diabetes mellitus (T2DM) and focus on renal impairment. A hospital-based study was conducted from 2013 to 2019 and 552 Taiwanese people who had T2DM without DPN at baseline were enrolled. DPN was diagnosed using the Michigan Neuropathy Screening Instrument. Potential risk factors were recorded, including patient’s sociodemographic factors, current medication usage and biochemical markers. As of 2019, 73 developed DPN and 479 had no DPN. The cumulative incidence during the 6-year period was 13.22%. Multivariable logistic regression analysis revealed that lower estimated glomerular filtration rate (eGFR) (odds ratio [OR] 0.98, p = 0.005), advanced age (OR 1.06, p = 0.001), increased body weight (OR 1.04, p = 0.018), duration of DM (OR 1.05, p = 0.036) and male gender (OR 3.69, p = 0.011) were significantly associated with future DPN. In addition, patients with T2DM under the age of 65 with higher serum creatinine concentration (OR 8.91, p = 0.005) and higher baseline HbA1C (OR 1.71, p < 0.001) revealed significantly associated with future DPN. In conclusion, this is the first large scaled hospital-based study with long term follow-up to investigate risk factors for DPN in Taiwanese. Lower eGFR and higher serum creatinine concentration, particularly in people under the age of 65, are predictors of future DPN in Taiwanese people with T2DM. Other predictors included advanced age, increased body weight, duration of DM, male gender for all ages and HbA1c in enrolled patients under the age of 65. Our study not only confirms the association between renal impairment and future DPN but also provides a commonly available assessment to predict the future DPN.
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Affiliation(s)
- Chi-Sheng Wang
- Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC
| | - Yen-Wei Pai
- Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC.,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, No 145, XingDa Road, South Dist., Taichung, Taiwan, ROC
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC.,Department of Medicine, School of Medicine, Chung Shan Medical University, No.110, Sec. 1, Jianguo N. Road, Taichung City, 40201, Taiwan, ROC
| | - Ming-Hong Chang
- Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC. .,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, No 145, XingDa Road, South Dist., Taichung, Taiwan, ROC.
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Mohottige D, Manley HJ, Hall RK. Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review. KIDNEY360 2021; 2:1510-1522. [PMID: 35373095 PMCID: PMC8786141 DOI: 10.34067/kid.0001942021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/08/2021] [Indexed: 02/04/2023]
Abstract
Due to age and impaired kidney function, older adults with kidney disease are at increased risk of medication-related problems and related hospitalizations. One proa ctive approach to minimize this risk is deprescribing. Deprescribing refers to the systematic process of reducing or stopping a medication. Aside from preventing harm, deprescribing can potentially optimize patients' quality of life by aligning medications with their goals of care. For some patients, deprescribing could involve less aggressive management of their diabetes and/or hypertension. In other instances, deprescribing targets may include potentially inappropriate medications that carry greater risk of harm than benefit in older adults, medications that have questionable efficacy, including medications that have varying efficacy by degree of kidney function, and that increase medication regimen complexity. We include a guide for clinicians to utilize in deprescribing, the List, Evaluate, Shared Decision-Making, Support (LESS) framework. The LESS framework provides key considerations at each step of the deprescribing process that can be tailored for the medications and context of individu al patients. Patient characteristics or clinical events that warrant consideration of deprescribing include limited life expectancy, cognitive impairment, and health status changes, such as dialysis initiation or recent hospitalization. We acknowledge patient-, clinician-, and system-level challenges to the depre scribing process. These include patient hesitancy and challenges to discussing goals of care, clinician time constraints and a lack of evidence-based guidelines, and system-level challenges of interoperable electronic health records and limited incentives for deprescribing. However, novel evidence-based tools designed to facilitate deprescribing and future evidence on effectiveness of deprescribing could help mitigate these barriers. This review provides foundational knowledge on deprescribing as an emerging component of clinical practice and research within nephrology.
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Affiliation(s)
- Dinushika Mohottige
- Renal Section, Durham Veterans Affairs Healthcare System, Durham, North Carolina,Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Rasheeda K. Hall
- Renal Section, Durham Veterans Affairs Healthcare System, Durham, North Carolina,Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Flythe JE, Karlsson N, Sundgren A, Cordero P, Grandinetti A, Cremisi H, Rydén A. Development of a preliminary conceptual model of the patient experience of chronic kidney disease: a targeted literature review and analysis. BMC Nephrol 2021; 22:233. [PMID: 34162354 PMCID: PMC8220773 DOI: 10.1186/s12882-021-02440-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/04/2021] [Indexed: 11/18/2022] Open
Abstract
Background Patient-reported outcome (PRO) instruments should capture the experiences of disease and treatment that patients consider most important in order to inform patient-centred care and product development. The aim of this study was to develop a preliminary conceptual model of patient experience in chronic kidney disease (CKD) based on a targeted literature review and to characterize existing PRO instruments used in CKD. Methods PubMed, EMBASE and Cochrane databases and recent society meetings were searched for publications reporting signs/symptoms and life impacts of CKD. Concepts identified in the literature review were used to develop a preliminary conceptual model of patient experience of CKD, overall, and within patient subpopulations of differing CKD causes, severities and complications. PRO instruments, identified from PRO databases, CKD literature and CKD clinical trials, were assessed for content validity, psychometric strength and coverage of concepts in the literature review. Results In total, 100 publications met criteria for analysis; 56 signs/symptoms and 37 life impacts of CKD were identified from these sources. The most frequently mentioned signs/symptoms were pain/discomfort (57% of publications) and tiredness/low energy/lethargy/fatigue (42%); the most commonly reported life impacts were anxiety/depression (49%) and decrements in physical functioning (43%). Signs/symptoms and life impacts varied across the subpopulations and were more frequent at advanced CKD stages. The preliminary conceptual model grouped signs/symptoms into seven domains (pain/discomfort; energy/fatigue; sleep-related; gastrointestinal-related; urinary-related; skin−/hair−/nails-related; and other) and life impacts into six domains (psychological/emotional strain; cognitive impairment; dietary habit disruption; physical function decrements; interference with social relationships; and other). Eleven PRO instruments were considered to be promising for use in CKD; all had limitations. Conclusions Although preliminary, the proposed conceptual model highlights key PROs for people with CKD and is intended to spur development of more tailored PRO instruments to assess these concepts. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02440-9.
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Affiliation(s)
- Jennifer E Flythe
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, 7024 Burnett-Womack CB #7155, Chapel Hill, NC, USA.
| | | | - Anna Sundgren
- Cardiovascular Renal & Metabolic late stage development, AstraZeneca, Gaithersburg, MD, USA
| | | | | | - Henry Cremisi
- US Medical Affairs, Renal, AstraZeneca, Wilmington, DE, USA
| | - Anna Rydén
- R&D Digital Health, AstraZeneca, Gothenburg, Sweden
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8
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Almomani HY, Pascual CR, Al-Azzam SI, Ahmadi K. Randomised controlled trial of pharmacist-led patient counselling in controlling hypoglycaemic attacks in older adults with type 2 diabetes mellitus (ROSE-ADAM): A study protocol of the SUGAR intervention. Res Social Adm Pharm 2021; 17:885-893. [PMID: 32763086 PMCID: PMC7387288 DOI: 10.1016/j.sapharm.2020.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Hypoglycaemia is one of the most serious adverse effects of diabetes treatment. Older adults are at the highest risk to develop hypoglycaemia. Several studies have established the important positive role of educational interventions on achieving glycaemic control and other clinical outcomes, however, there is still a lack in studies that evaluate the impact of such type of interventions on hypoglycaemia risk in elderly patients with type 2 diabetes. The purpose of this research is to evaluate the effectiveness of pharmacist-led patient counselling on reducing hypoglycaemic attacks in older adults with type 2 diabetes mellitus. METHODS and analysis: This study is an open-label, parallel controlled randomised trial, which will be conducted in the outpatient clinics at the largest referral hospital in the north of Jordan. Participants who are elderly (age ≥ 65 years), diagnosed with type 2 diabetes mellitus, and taking insulin, sulfonylurea, or any three anti-diabetic medications will be randomly assigned to intervention (SUGAR Handshake) and control (usual care) groups. The SUGAR Handshake participants will have an interactive, individualised, medications-focused counselling session reinforced with a pictogram and a phone call at week six of enrolment. The primary outcome measure is the frequency of total hypoglycaemic events within 12 weeks of follow up. Secondary outcomes include the frequency of asymptomatic, symptomatic, and severe hypoglycaemic events, hypoglycaemia incidence, and time to the first hypoglycaemic attack. We will also conduct a nested qualitative study for process evaluation. ETHICS AND DISSEMINATION The Human Research Ethics Committee of the University of Lincoln and the Institutional Review Board of King Abdullah University Hospital approved this protocol. The findings of this study will be presented in international conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER The study protocol has been registered with ClinicalTrials.gov, NCT04081766.
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Affiliation(s)
- Huda Y Almomani
- School of Pharmacy, University of Lincoln, LN6 7DL, Lincoln, UK.
| | | | - Sayer I Al-Azzam
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Keivan Ahmadi
- Lincoln Medical School, Universities of Nottingham and Lincoln, University of Lincoln, LN6 7TS, Lincoln, UK
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Ricós C, Fernández-Calle P, Gonzalez-Lao E, Simón M, Díaz-Garzón J, Boned B, Marqués-García F, Minchinela J, Perich MC, Tejedor-Ganduxé X, Corte Z, Aarsand AK, Aslan B, Carobene A, Coskun A, Sandberg S. Evaluación crítica y meta-análisis de estudios de variación biológica para albúmina glicosilada, glucosa y HbA 1c. ADVANCES IN LABORATORY MEDICINE 2020; 1:20200040. [PMCID: PMC10197261 DOI: 10.1515/almed-2020-0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/15/2020] [Indexed: 06/28/2023]
Abstract
Objetivos A lo largo de los años se han publicado numerosos artículos sobre variación biológica (VB) de diferente calidad. Los objetivos de este trabajo fueron realizar una revisión sistemática y una evaluación crítica de los estudios de VB para albúmina glicosilada y proporcionar datos actualizados de VB para glucosa y HbA1c, incluyendo prestigiosos estudios recientemente publicados como el Estudio de Variación Biológica Europea (EuBIVAS). Métodos Se hizo una búsqueda bibliográfica sistemática para identificar estudios sobre VB, encontrándose 9 estudios no incluidos en la primera revisión: 4 para albúmina glicosilada, 3 para glucosa y 3 para HbA1c. Se realizó una evaluación crítica de los estudios relevantes, utilizando la herramienta Biological Variation Data Critical Appraisal Checklist (BIVAC). Se obtuvieron los estimados globales de VB mediante meta-análisis de los estudios que cumplían los requisitos BIVAC, realizados en individuos sanos con estudios de diseño similar. Resultados Un estudio recibió el grado A, dos el B y 6 el C. en la mayoría de los casos el grado C se asoció a deficiencias en el análisis estadístico de los datos. Los estimados de VB para albúmina glicosilada fueron: CVI = 1,4%(1,2–2,1) y CVG = 5,7%(4,7–10,6); para HbA1c, CVI = 1,2%(0,3–2,5), CVG = 5,4%(3,3–7,3) y para glucosa, CVI = 5,0%(4,1–12,0), CVG = 8,1%(2,7–10,8) no difirieron de los estimados globales previamente descritos. Conclusiones La evaluación crítica y clasificación de los estudios de VB a tenor de su calidad metodológica, seguido de un meta-análisis, genera estimados de VB robustos y fiables. Este estudio proporciona datos de VB para albúmina glicolisada, glucosa y HbA1c actualizados y basados en la evidencia científica.
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Affiliation(s)
- Carmen Ricós
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Padilla, 323, Barcelona, España
| | - Pilar Fernández-Calle
- SEQCML, Analytical Quality Commission, Barcelona, España
- EFLM, Task Group on Biological Variation Database, Madrid, España
- EFLM, Working Group on Biological Variation, Madrid, España
- Hospital Universitario La Paz, Madrid, España
| | - Elisabet Gonzalez-Lao
- SEQCML, Analytical Quality Commission, Barcelona, España
- EFLM, Task Group on Biological Variation Database, Madrid, España
- Quality Healthcare, Grupo ACMS, Madrid, España
| | - Margarida Simón
- SEQCML, Analytical Quality Commission, Barcelona, España
- EFLM, Task Group on Biological Variation Database, Vilafranca del Penedes, España
- Consortium of Laboratory Intercomarcal Alt Penedès and Garraf l’Anoia, Vilafranca del Penedes, España
| | - Jorge Díaz-Garzón
- SEQCML, Analytical Quality Commission, Barcelona, España
- EFLM, Task Group on Biological Variation Database, Madrid, España
- EFLM, Working Group on Biological Variation, Madrid, España
- Hospital Universitario La Paz, Madrid, España
| | - Beatriz Boned
- SEQCML, Analytical Quality Commission, Barcelona, España
- EFLM, Task Group on Biological Variation Database, Madrid, España
- Hospital Royo Villanova, Zaragoza, España
| | - Fernando Marqués-García
- SEQCML, Analytical Quality Commission, Barcelona, España
- EFLM, Task Group on Biological Variation Database, Salamanca, España
- Hospital Universitario de Salamanca, Salamanca, España
| | - Joana Minchinela
- SEQCML, Analytical Quality Commission, Barcelona, España
- EFLM, TaskGroup on Biological Variation Database, Badalona, España
- Hospital Germans Trias i Pujol, Badalona, España
| | - Maria Carmen Perich
- SEQCML, Analytical Quality Commission, Barcelona, España
- EFLM, Task Group on Biological Variation Database, Barcelona, España
- Hospital Vall d’Hebron, Barcelona, España
| | - Xavier Tejedor-Ganduxé
- SEQCML, Analytical Quality Commission, Barcelona, España
- EFLM, TaskGroup on Biological Variation Database, Badalona, España
- Hospital Germans Trias i Pujol, Badalona, España
| | - Zoraida Corte
- SEQCML, Analytical Quality Commission, Barcelona, España
- Hospital Universitario San Agustin, Aviles, España
| | - Aasne K. Aarsand
- EFLM, Task Group on Biological Variation Database, Bergen, Norway
- EFLM, Working Group on Biological Variation, Bergen, Norway
- Haukeland University Hospital, Bergen, Norway
- Norwegian Quality Improvement of Laboratory Examinations, Haraldplass Deaconess Hospital, Bergen, Norway
| | - Berna Aslan
- EFLM, Task Group on Biological Variation Database, Toronto, Canada
- Institute for Quality Management in Healthcare of Canada, Toronto, Canada
| | - Anna Carobene
- EFLM, Task Group on Biological Variation Database, Milan, Italy
- EFLM, Working Group on Biological Variation, Milan, Italy
- Laboratory Medicine, Ospedale San Raffaele, Milan, Italy
| | - Abdurrahman Coskun
- EFLM, Task Group on Biological Variation Database, Istanbul, Turkey
- EFLM, Working Group on Biological Variation, Istanbul, Turkey
- Acibadem Universitesi, Istanbul, Turkey
| | - Sverre Sandberg
- EFLM, Task Group on Biological Variation Database, Bergen, Norway
- EFLM, Working Group on Biological Variation, Bergen, Norway
- Department of Global Public Health, Bergen, Norway
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Ricós C, Fernández-Calle P, Gonzalez-Lao E, Simón M, Díaz-Garzón J, Boned B, Marqués-García F, Minchinela J, Perich MC, Tejedor-Ganduxé X, Corte Z, Aarsand AK, Aslan B, Carobene A, Coskun A, Sandberg S. Critical appraisal and meta-analysis of biological variation studies on glycosylated albumin, glucose and HbA 1c. ADVANCES IN LABORATORY MEDICINE 2020; 1:20200029. [PMID: 37361503 PMCID: PMC10197502 DOI: 10.1515/almed-2020-0029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/15/2020] [Indexed: 06/28/2023]
Abstract
OBJECTIVES Numerous biological variation (BV) studies have been performed over the years, but the quality of these studies vary. The objectives of this study were to perform a systematic review and critical appraisal of BV studies on glycosylated albumin and to deliver updated BV estimates for glucose and HbA1c, including recently published high-quality studies such as the European Biological Variation study (EuBIVAS). METHODS Systematic literature searches were performed to identify BV studies. Nine publications not included in a previous review were identified; four for glycosylated albumin, three for glucose, and three for HbA1c. Relevant studies were appraised by the Biological Variation Data Critical Appraisal Checklist (BIVAC). Global BV estimates were derived by meta-analysis of BIVAC-compliant studies in healthy subjects with similar study design. RESULTS One study received BIVAC grade A, 2B, and 6C. In most cases, the C-grade was associated with deficiencies in statistical analysis. BV estimates for glycosylated albumin were: CVI=1.4% (1.2-2.1) and CVG=5.7% (4.7-10.6), whereas estimates for HbA1c, CVI=1.2% (0.3-2.5), CVG=5.4% (3.3-7.3), and glucose, CVI=5.0% (4.1-12.0), CVG=8.1% (2.7-10.8) did not differ from previously published global estimates. CONCLUSIONS The critical appraisal and rating of BV studies according to their methodological quality, followed by a meta-analysis, generate robust, and reliable BV estimates. This study delivers updated and evidence-based BV estimates for glycosylated albumin, glucose and HbA1c.
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Affiliation(s)
- Carmen Ricós
- Spanish Society of Laboratory Medicine (SEQC), Analytical Quality Commission, Barcelona, Spain
- Padilla, 323, Barcelona 08035, Spain
| | - Pilar Fernández-Calle
- SEQC, Analytical Quality Commission, Barcelona, Spain
- EFLM, Task Group on Biological Variation Database; EFLM, Working Group on Biological Variation; and Hospital Universitario La Paz, Madrid, Spain
| | - Elisabet Gonzalez-Lao
- SEQC, Analytical Quality Commission, Barcelona, Spain
- EFLM, Task Group on Biological Variation Database; and Quality Healthcare, Grupo ACMS, Madrid, Spain
| | - Margarida Simón
- SEQC, Analytical Quality Commission, Barcelona, Spain
- EFLM, Task Group on Biological Variation Database; and Consortiumof Laboratory Intercomarcal Alt Penedès and Garraf l’Anoia, Vilafranca del Penedes, Spain
| | - Jorge Díaz-Garzón
- SEQC, Analytical Quality Commission, Barcelona, Spain
- EFLM, Task Group on Biological Variation Database; EFLM, Working Group on Biological Variation; and Hospital Universitario La Paz, Madrid, Spain
| | - Beatriz Boned
- SEQC, Analytical Quality Commission, Barcelona, Spain
- EFLM, TaskGroup on Biological Variation Database; and Hospital Royo Villanova, Zaragoza, Spain
| | - Fernando Marqués-García
- SEQC, Analytical Quality Commission, Barcelona, Spain
- EFLM, Task Group on Biological Variation Database; and Hospital Universitario de Salamanca, Salamanca, Spain
| | - Joana Minchinela
- SEQC, Analytical Quality Commission, Barcelona, Spain
- EFLM, TaskGroup on Biological VariationDatabase; and Hospital Germans Trias i Pujol, Badalona, Spain
| | - Maria Carmen Perich
- SEQC, Analytical Quality Commission, Barcelona, Spain
- EFLM, Task Group on Biological Variation Database; and Hospital Vall d’Hebron, Barcelona, Spain
| | - Xavier Tejedor-Ganduxé
- SEQC, Analytical Quality Commission, Barcelona, Spain
- EFLM, Task Group on Biological Variation Database; and Hospital Germans Trias i Pujol, Badalona, Spain
| | - Zoraida Corte
- SEQC, Analytical Quality Commission, Barcelona, Spain
- Hospital Universitario San Agustin, Aviles, Spain
| | - Aasne K. Aarsand
- EFLM, Task Group on Biological Variation Database; EFLM, Working Group on Biological Variation; Haukeland University Hospital, Bergen, Norway
- Norwegian Quality Improvement of Laboratory Examinations, Haraldplass Deaconess Hospital, Bergen, Norway
| | - Berna Aslan
- EFLM, Task Group on Biological Variation Database; Institute for Quality Management in Healthcare of Canada, Toronto, Canada
| | - Anna Carobene
- EFLM, Task Group on Biological Variation Database; EFLM,Working Group on Biological Variation; and LaboratoryMedicine, Ospedale San Raffaele, Milan, Italy
| | - Abdurrahman Coskun
- EFLM, Task Group on Biological Variation Database; EFLM, Working Group on Biological Variation; and Acibadem Universitesi, Istanbul, Turkey
| | - Sverre Sandberg
- EFLM, Task Group on Biological Variation Database; EFLM,Working Group on Biological Variation; and Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Di Rosa M, D’Alia S, Guarasci F, Soraci L, Pierpaoli E, Lenci F, Ricci M, Onder G, Volpato S, Ruggiero C, Cherubini A, Corsonello A, Lattanzio F. Cognitive Impairment, Chronic Kidney Disease, and 1-Year Mortality in Older Patients Discharged from Acute Care Hospital. J Clin Med 2020; 9:E2202. [PMID: 32664677 PMCID: PMC7408778 DOI: 10.3390/jcm9072202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 02/01/2023] Open
Abstract
The prognostic interaction between chronic kidney disease (CKD) and cognitive impairment is still to be elucidated. We investigated the potential interaction of overall cognitive impairment or defective constructional praxis and CKD in predicting 1-year mortality among 646 older patients discharged from hospital. The estimated glomerular filtration rate (eGFR) was calculated using the Berlin Initiative Study (BIS) equation. Cognitive impairment was assessed by the Mini Mental State Exam (MMSE) and defective constructional praxis was ascertained by the inherent MMSE item. The study outcome was 1-year mortality. Statistical analysis was carried out using Cox regression. After adjusting for potential confounders, the co-occurrence of eGFR <30 and overall cognitive impairment (Hazard Ratio (HR) = 3.12, 95% Confidence Interval (CI) = 1.26-7.77) and defective constructional praxis (HR = 2.50, 95% CI = 1.08-5.77) were associated with the outcome. No significant prognostic interaction of eGFR < 30 with either overall cognitive impairment (HR = 1.99, 95% CI = 0.38-10.3) or constructional apraxia (HR = 1.68, 95% CI = 0.33-8.50) was detectable, while only cognitive deficits were found significantly associated with the outcome in the interaction models (HR = 3.12, 95% CI = 1.45-6.71 for overall cognitive impairment and HR = 2.16, 95% CI = 1.05-4.45 for constructional apraxia). Overall cognitive impairment and defective constructional praxis may be associated with increased risk of 1-year mortality among older hospitalized patients with severe CKD. However, no significant prognostic interaction between CKD and cognitive impairment could be observed.
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Affiliation(s)
- Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, Italy; (M.D.R.); (S.D.A.); (F.G.); (A.C.)
| | - Sonia D’Alia
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, Italy; (M.D.R.); (S.D.A.); (F.G.); (A.C.)
| | - Francesco Guarasci
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, Italy; (M.D.R.); (S.D.A.); (F.G.); (A.C.)
| | - Luca Soraci
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, Italy; (M.D.R.); (S.D.A.); (F.G.); (A.C.)
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - Elisa Pierpaoli
- Advanced Technology Center for Aging Research, Scientific Technological Area, IRCCS INRCA, 60124 Ancona, Italy;
| | - Federica Lenci
- Unit of Nephrology and Dialysis, IRCCS INRCA, 60124 Ancona, Italy; (F.L.); (M.R.)
| | - Maddalena Ricci
- Unit of Nephrology and Dialysis, IRCCS INRCA, 60124 Ancona, Italy; (F.L.); (M.R.)
| | - Graziano Onder
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Carmelinda Ruggiero
- Section of Gerontology and Geriatrics, Department of Medicine, University of Perugia, 06132 Perugia, Italy;
| | - Antonio Cherubini
- Geriatria Accettazione Geriatrica e Centro di Ricerca per l’Invecchiamento, IRCCS INRCA, 60124 Ancona, Italy;
| | - Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, Italy; (M.D.R.); (S.D.A.); (F.G.); (A.C.)
- Unit of Geriatric Medicine, IRCSS INRCA, 60124 Ancona, Italy
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12
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Raval N, Kumawat A, Kalyane D, Kalia K, Tekade RK. Understanding molecular upsets in diabetic nephropathy to identify novel targets and treatment opportunities. Drug Discov Today 2020; 25:862-878. [PMID: 31981791 DOI: 10.1016/j.drudis.2020.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/26/2019] [Accepted: 01/15/2020] [Indexed: 12/11/2022]
Abstract
Diabetes and related complications are becoming a global encumbrance. Diabetic nephropathy (DN) is a major cause of end-stage renal disease (ESRD). The available therapeutic modalities related to DN do not treat DN at the molecular level, proposing further amendments in the management of DN based on the pathogenesis of DN. This manuscript discusses the concept and applications of nanomedicine for the treatment of DN that can improve renal targeting, retention and localization. This review also highlights the current issues related to targeting DN, challenges and allied opportunities toward the development of next-generation drugs and treatments for the management of DN.
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Affiliation(s)
- Nidhi Raval
- National Institute of Pharmaceutical Education and Research (NIPER) Ahmedabad, An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Opp. Air Force Station, Gandhinagar 382355, Gujarat, India
| | - Akshant Kumawat
- National Institute of Pharmaceutical Education and Research (NIPER) Ahmedabad, An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Opp. Air Force Station, Gandhinagar 382355, Gujarat, India
| | - Dnyaneshwar Kalyane
- National Institute of Pharmaceutical Education and Research (NIPER) Ahmedabad, An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Opp. Air Force Station, Gandhinagar 382355, Gujarat, India
| | - Kiran Kalia
- National Institute of Pharmaceutical Education and Research (NIPER) Ahmedabad, An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Opp. Air Force Station, Gandhinagar 382355, Gujarat, India
| | - Rakesh K Tekade
- National Institute of Pharmaceutical Education and Research (NIPER) Ahmedabad, An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Opp. Air Force Station, Gandhinagar 382355, Gujarat, India; Indian Institute of Technology-Jammu, Jagti, PO Nagrota, Jammu 181 221, J&K, India.
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Rhee JJ, Han J, Montez-Rath ME, Kim SH, Cullen MR, Stafford RS, Winkelmayer WC, Chertow GM. Antidiabetic medication use in patients with type 2 diabetes and chronic kidney disease. J Diabetes Complications 2019; 33:107423. [PMID: 31537413 PMCID: PMC6823164 DOI: 10.1016/j.jdiacomp.2019.107423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
AIMS To quantify patterns of conventional and newer antidiabetic medication use in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). METHODS We used data from a large claims and integrated dataset that includes employed and commercially insured patients in the US to select patients who had T2DM and CKD with information on laboratory values and prescriptions for antidiabetic medications from January 1, 2014 to January 1, 2015. We stratified the analyses by sociodemographic variables. RESULTS In a cohort of 38,577 patients with T2DM and CKD, we found wide variation in the treatment of T2DM by CKD stage as well as by several sociodemographic factors. Although metformin was the most commonly prescribed medication, only about half of patients in the cohort and fewer than two-thirds of patients with early stage CKD were prescribed metformin. Approximately 10.6% of patients with CKD stage 4 and 2.1% of the patients with CKD stage 5 were prescribed metformin. Sulfonylureas with active metabolites that accumulate with impaired kidney function were prescribed in more than one-third of patients with CKD stages 3b, 4, and 5. Only 3.4% and 12.3% of patients were prescribed GLP-1 and DPP-4 respectively. CONCLUSIONS Prescriptions for metformin were lower than expected among patients with mild to moderate CKD. Prescriptions for newer antidiabetic medications with known safety and efficacy across the spectrum of CKD remained low. Prescriptions for agents contraindicated in advanced CKD continued to be written in a sizeable fraction of patients.
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Affiliation(s)
- Jinnie J Rhee
- Division of Nephrology, Stanford University School of Medicine, Stanford, CA, United States; Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, United States.
| | - Jialin Han
- Division of Nephrology, Stanford University School of Medicine, Stanford, CA, United States
| | - Maria E Montez-Rath
- Division of Nephrology, Stanford University School of Medicine, Stanford, CA, United States
| | - Sun H Kim
- Division of Endocrinology, Gerontology, and Metabolism, Stanford University School of Medicine, Stanford, CA, United States; Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Mark R Cullen
- Division of Primary Care and Population health, Stanford University School of Medicine, Stanford, CA, United States
| | - Randall S Stafford
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Wolfgang C Winkelmayer
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Glenn M Chertow
- Division of Nephrology, Stanford University School of Medicine, Stanford, CA, United States; Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, United States
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14
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Kaewput W, Thongprayoon C, Varothai N, Sirirungreung A, Rangsin R, Bathini T, Mao MA, Cheungpasitporn W. Prevalence and associated factors of hospitalization for dysglycemia among elderly type 2 diabetes patients: A nationwide study. World J Diabetes 2019; 10:212-223. [PMID: 30891156 PMCID: PMC6422861 DOI: 10.4239/wjd.v10.i3.212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The prevalence of older individuals with type 2 diabetes mellitus (T2DM) is increasing due to the aging population and improved medical care. These patients are very susceptible to disease and treatment-related hospitalizations, resulting in higher health care costs, morbidity, and decreased quality of life. However, data of treatment-related complications, especially dysglycemia-related hospitalizations, are lacking.
AIM To assess the prevalence and associated factors for dysglycemia-related hospitalizations among elderly diabetic patients in Thailand using nationwide patient sample.
METHODS T2DM patients aged ≥ 65 years who received medical care at public hospitals in Thailand in the year 2014 were included. The prevalence of hospitalization due to dysglycemia within one year was examined. Multivariable logistic regression was performed to assess the independent factors associated with hospitalization due to hypoglycemia and hyperglycemia
RESULTS A total of 11404 elderly T2DM patients were enrolled in this study. The mean age was 72.9 ± 5.5 years. The prevalence of hospital admissions due to diabetic ketoacidosis, hyperosmolar hyperglycemic state, hyperglycemic dehydration syndrome, and hypoglycemia among elderly T2DM patients in the year 2014 was 0.1%, 0.1%, 1.7% and 3.1%, respectively. Increased hospitalization due to hypoglycemia was associated with older age, female sex, had hypertension, dementia, lower body mass index, elevated hemoglobin A1C (HbA1C), decreased kidney function, insulin use. Increased hospitalization due to hyperglycemia was associated with dementia, depression, lower body mass index, elevated HbA1C, and insulin use.
CONCLUSION The prevalence of dysglycemia-related hospitalization in elderly T2DM patients in Thailand was 4.9%. Close monitoring of blood glucose should be provided in high-risk patients for prevention and early detection for these complications.
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Affiliation(s)
- Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Narittaya Varothai
- Division of Geriatrics, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok 10400, Thailand
| | - Anupong Sirirungreung
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA 90095, United States
| | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, United States
| | - Michael A Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, United States
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