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[Malnutrition management of hospitalized patients with diabetes/hyperglycemia and cancer cachexia]. NUTR HOSP 2022; 39:40-46. [PMID: 36546331 DOI: 10.20960/nh.04510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction Diabetes is a frequent comorbidity in cancer patients, since they share common risk factors. In cancer, the concurrence of cachexia represents a poor prognostic factor, which is aggravated by poor nutritional status. Clinically, cancer cachexia manifests as a significant reduction in body weight, accompanied by changes in body composition and alterations in the balance of the biological system, and causes progressive dysfunction. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with cancer cachexia.
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Seisa MO, Saadi S, Nayfeh T, Muthusamy K, Shah SH, Firwana M, Hasan B, Jawaid T, Abd-Rabu R, Korytkowski MT, Muniyappa R, Antinori-Lent K, Donihi AC, Drincic AT, Luger A, Torres Roldan VD, Urtecho M, Wang Z, Murad MH. A Systematic Review Supporting the Endocrine Society Clinical Practice Guideline for the Management of Hyperglycemia in Adults Hospitalized for Noncritical Illness or Undergoing Elective Surgical Procedures. J Clin Endocrinol Metab 2022; 107:2139-2147. [PMID: 35690929 PMCID: PMC9653020 DOI: 10.1210/clinem/dgac277] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Indexed: 12/21/2022]
Abstract
CONTEXT Individuals with diabetes or newly recognized hyperglycemia account for over 30% of noncritically ill hospitalized patients. Management of hyperglycemia in these patients is challenging. OBJECTIVE To support development of the Endocrine Society Clinical Practice Guideline for management of hyperglycemia in adults hospitalized for noncritical illness or undergoing elective surgical procedures. METHODS We searched several databases for studies addressing 10 questions provided by a guideline panel from the Endocrine Society. Meta-analysis was conducted when feasible. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess certainty of evidence. RESULTS We included 94 studies reporting on 135 553 patients. Compared with capillary blood glucose, continuous glucose monitoring increased the number of patients identified with hypoglycemia and decreased mean daily blood glucose (BG) (very low certainty). Data on continuation of insulin pump therapy in hospitalized adults were sparse. In hospitalized patients receiving glucocorticoids, combination neutral protamine hagedorn (NPH) and basal-bolus insulin was associated with lower mean BG compared to basal-bolus insulin alone (very low certainty). Data on NPH insulin vs basal-bolus insulin in hospitalized adults receiving enteral nutrition were inconclusive. Inpatient diabetes education was associated with lower HbA1c at 3 and 6 months after discharge (moderate certainty) and reduced hospital readmissions (very low certainty). Preoperative HbA1c level < 7% was associated with shorter length of stay, lower postoperative BG and a lower number of neurological complications and infections, but a higher number of reoperations (very low certainty). Treatment with glucagon-like peptide-1 agonists or dipeptidyl peptidase-4 inhibitors in hospitalized patients with type 2 diabetes and mild hyperglycemia was associated with lower frequency of hypoglycemic events than insulin therapy (low certainty). Caloric oral fluids before surgery in adults with diabetes undergoing surgical procedures did not affect outcomes (very low certainty). Counting carbohydrates for prandial insulin dosing did not affect outcomes (very low certainty). Compared with scheduled insulin (basal-bolus or basal insulin + correctional insulin), correctional insulin was associated with higher mean daily BG and fewer hypoglycemic events (low certainty). CONCLUSION The certainty of evidence supporting many hyperglycemia management decisions is low, emphasizing importance of shared decision-making and consideration of other decisional factors.
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Affiliation(s)
- Mohamed O Seisa
- Correspondence: Mohamed Seisa, M.D., Mayo Clinic Rochester, Rochester, MN 55902, USA.
| | - Samer Saadi
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
| | - Tarek Nayfeh
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
| | | | - Sahrish H Shah
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
| | | | - Bashar Hasan
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
| | - Tabinda Jawaid
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
| | - Rami Abd-Rabu
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
| | | | - Ranganath Muniyappa
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA
| | | | - Amy C Donihi
- University of Pittsburgh School of Pharmacy,Pittsburgh, PA 15261, USA
| | | | - Anton Luger
- Medical University and General Hospital of Vienna, Austria
| | | | | | - Zhen Wang
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
| | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
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Ashley L, Kassim S, Kellar I, Kidd L, Mair F, Matthews M, Price M, Swinson D, Taylor J, Velikova G, Wadsley J. Identifying ways to improve diabetes management during cancer treatments (INDICATE): protocol for a qualitative interview study with patients and clinicians. BMJ Open 2022; 12:e060402. [PMID: 35193924 PMCID: PMC8867345 DOI: 10.1136/bmjopen-2021-060402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION A large and growing number of patients with cancer have comorbid diabetes. Cancer and its treatment can adversely impact glycaemic management and control, and there is accumulating evidence that suboptimal glycaemic control during cancer treatment is a contributory driver of worse cancer-related outcomes in patients with comorbid diabetes. Little research has sought to understand, from the perspective of patients and clinicians, how and why different aspects of cancer care and diabetes care can complicate or facilitate each other, which is key to informing interventions to improve diabetes management during cancer treatments. This study aims to identify and elucidate barriers and enablers to effective diabetes management and control during cancer treatments, and potential intervention targets and strategies to address and harness these, respectively. METHODS AND ANALYSIS Qualitative interviews will be conducted with people with diabetes and comorbid cancer (n=30-40) and a range of clinicians (n=30-40) involved in caring for this patient group (eg, oncologists, diabetologists, specialist nurses, general practitioners). Semistructured interviews will examine participants' experiences of and perspectives on diabetes management and control during cancer treatments. Data will be analysed using framework analysis. Data collection and analysis will be informed by the Theoretical Domains Framework, and related Theory and Techniques Tool and Behaviour Change Wheel, to facilitate examination of a comprehensive range of barriers and enablers and support identification of pertinent and feasible intervention approaches. Study dates: January 2021-January 2023. ETHICS AND DISSEMINATION The study has approval from National Health Service (NHS) West Midlands-Edgbaston Research Ethics Committee. Findings will be presented to lay, clinical, academic and NHS and charity service-provider audiences via dissemination of written summaries and presentations, and published in peer-reviewed journals. Findings will be used to inform development and implementation of clinical, health services and patient-management intervention strategies to optimise diabetes management and control during cancer treatments.
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Affiliation(s)
- Laura Ashley
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Saifuddin Kassim
- Leeds Centre for Diabetes and Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, UK
| | - Lisa Kidd
- Nursing & Healthcare, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Frances Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mike Matthews
- Patient and Public Involvement representative, Harrogate, UK
| | - Mollie Price
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Daniel Swinson
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Johanna Taylor
- Department of Health Sciences, University of York, York, UK
| | - Galina Velikova
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Jonathan Wadsley
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Yue C, Zhang C, Ying C, Jiang H. Diabetes associated with cervical carcinoma among high-risk HPV-infected patients with cytologically diagnosed high grade squamous intraepithelial lesion. Front Endocrinol (Lausanne) 2022; 13:993785. [PMID: 36387876 PMCID: PMC9646939 DOI: 10.3389/fendo.2022.993785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diabetes causes metabolic disorders and immune changes that may be potential triggers of cervical cancer. Therefore, diabetes is not a "bystander" to cervical cancer. However, the conclusion that diabetes promotes cervical cancer lacks clinical epidemiological evidence, and the reported potential association between diabetes and cervical cancer is controversial. METHODS We conducted an explorative cross-sectional study of 791 women with cytological HGSIL and HR-HPV, who attended the cervical clinic of the largest academic women's hospital in China from May 2019 to March 2022. After cervical screening, patients who were requiring colposcopy were tested for HbA1c. HbA1c level of 6.5% or higher defines diabetes and HbA1c level of 5.7%-6.4% was defined as prediabetes. The relationship between diabetes and cervical cancer was observed by a dose-response graph. Subgroup analysis and multivariate logistic regression analysis were conducted to estimate the associations between diabetes and cervical cancer. RESULTS Among HGSIL patients with high-risk HPV infection, compared with women with HbA1c <5.7%, the odds ratio for women with prediabetes was 1.72 (95% CI: 0.87-3.41) and the odds ratio for women with diabetes was 3.29 (95% CI: 1.10-9.80) for cervical cancer. Sensitivity analysis showed that diabetes was significantly associated with cervical cancer in different age groups and different HPV variant. E-value analysis showed robustness to unmeasured confounding. CONCLUSIONS In patients with HR-HPV combined with HGSIL, diabetes and prediabetes are associated with cervical cancer.
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Affiliation(s)
| | | | | | - Hua Jiang
- *Correspondence: Hua Jiang, ; Chunmei Ying,
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He T, Zhu W, Wang C, Lu H, Wu T, Pan K, Chen S, Xu B, Mao W, Li W, Chen M. Relationship Between Pre-operative Blood Glucose Level and Length of Hospital Stay in Patients With Renal Cell Carcinoma Undergoing Laparoscopic Nephrectomy. Front Surg 2021; 8:659365. [PMID: 34109208 PMCID: PMC8180589 DOI: 10.3389/fsurg.2021.659365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/26/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose: The aim of this study was to assess the effect of pre-operative blood glucose (POBG) levels on the length of stay (LOS) in patients with renal cell carcinoma (RCC) undergoing laparoscopic nephrectomy. Methods: We collected clinical data on 338 patients with RCC who underwent laparoscopic nephrectomy between 2014 and 2019. Univariate and multivariate logistic regression and dose-response analysis curves of restricted cubic spline function were used to investigate the relationship between POBG and LOS. Results: According to the level of POBG, we divided the patients into three groups: <4.94 mmol/L group, 4.94 to <7.11 mmol/L group, and ≥7.11 mmol/L group. According to the dose-response analysis curves, we found that the adjusted risk of LOS > 2 weeks and LOS > 3 weeks gradually increased with increasing POBG. In addition, we found that among all patients, patients with POBG levels ≥ 7.11 mmol/L had a 115% higher risk of LOS > 2 weeks than patients with POBG levels <4.94 mmol/L [adjusted odds risk (aOR) 2.15; 95% CI 1.11-4.20; p = 0.024] and patients with POBG levels ≥ 7.11 mmol/L had a 129% higher risk of LOS > 3 weeks than patients with POBG levels <4.94 mmol/L (aOR 2.29; 95% CI 1.16-4.52; p = 0.017). Moreover, similar results were observed in the most subgroups analysis. Conclusion: We found that in patients with RCC undergoing laparoscopic nephrectomy, higher POBG levels were significantly associated with prolonged LOS.
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Affiliation(s)
- Ting He
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Weidong Zhu
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China.,Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China.,Department of Urology, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Chunying Wang
- Department of Nursing, Zhongda Hospital, Southeast University, Nanjing, China
| | - Haowen Lu
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Tiange Wu
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Kehao Pan
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Shuqiu Chen
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Bin Xu
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China.,Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China.,Department of Urology, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Weipu Mao
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China.,Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China.,Department of Urology, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Wei Li
- Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ming Chen
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China.,Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China.,Department of Urology, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
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Chiang HY, Lin KTR, Hsiao YL, Huang HC, Chang SN, Hung CH, Chang Y, Wang YC, Kuo CC. Association Between Preoperative Blood Glucose Level and Hospital Length of Stay for Patients Undergoing Appendectomy or Laparoscopic Cholecystectomy. Diabetes Care 2021; 44:107-115. [PMID: 33177174 PMCID: PMC7783940 DOI: 10.2337/dc19-0963] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/17/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the effect of preoperative blood glucose (POBG) level on hospital length of stay (LOS) in patients undergoing appendectomy or laparoscopic cholecystectomy. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of patients aged ≥18 years who had undergone appendectomy or laparoscopic cholecystectomy procedures between 2005 and 2016 at a tertiary medical center in Taiwan. The association between POBG level and LOS was evaluated using a multivariable quasi-Poisson regression with robust variance. Multiple imputations were performed to replace missing values. RESULTS We included 8,291 patients; 4,025 patients underwent appendectomy (appendectomy group) and 4,266 underwent laparoscopic cholecystectomy (laparoscopic cholecystectomy group). In the appendectomy group, patients with POBG levels of ≥123 mg/dL (adjusted relative risk [aRR] 1.19; 95% CI 1.06-1.33) had a 19% higher risk of having a LOS of >3 days than did those with POBG levels of <106 mg/dL. In the laparoscopic cholecystectomy group, patients with POBG levels of ≥128 mg/dL also had a significantly higher risk of having a LOS of >3 days (aRR 1.17; 95% CI 1.07-1.29) than did those with POBG levels of <102 mg/dL. A positive dose-response curve between POBG and an adjusted risk of a LOS of >3 days was observed, although the curve starts to flatten at a POBG level of ∼130 mg/dL. CONCLUSIONS We demonstrated that a higher POBG level was significantly associated with a prolonged LOS for patients undergoing appendectomy or laparoscopic cholecystectomy. The optimal POBG level may be lower than that commonly perceived.
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Affiliation(s)
- Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Ting Robin Lin
- College of Medicine, China Medical University, Taichung, Taiwan.,Department of Neurosurgery, Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Ya-Luan Hsiao
- Big Data Center, China Medical University Hospital, Taichung, Taiwan.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Han-Chun Huang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan.,PhD Program for Cancer Biology and Drug Discovery, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chien-Hui Hung
- Department of Medical Quality, China Medical University Hospital, Taichung, Taiwan
| | - Ying Chang
- Department of Nursing, China Medical University Hospital and College of Nursing, Taichung, Taiwan
| | - Yu-Chun Wang
- Department of Medical Quality, China Medical University Hospital, Taichung, Taiwan .,Department of Acute Care Surgery, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung, Taiwan .,College of Medicine, China Medical University, Taichung, Taiwan.,Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
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