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Reddy KSS, Varadaraj P, Nallusamy G, SenthilNathan S. Correlation Between Hemoglobin A1c (HbA1c) and High-Sensitivity C-Reactive Protein (hs-CRP) in Myocardial Infarction Patients and Their Six-Month Mortality Follow-Up. Cureus 2024; 16:e67070. [PMID: 39286672 PMCID: PMC11404393 DOI: 10.7759/cureus.67070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2024] [Indexed: 09/19/2024] Open
Abstract
Background Acute coronary syndrome (ACS), encompassing unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI), poses significant global health challenges because of its associated high mortality and morbidity rates. Vascular inflammation plays a crucial role in the pathogenesis of atherosclerosis, and it is often assessed using biomarkers such as high-sensitivity C-reactive protein (hs-CRP). Hyperglycemia, common in myocardial infarction patients, is linked to increased complications and mortality, with glycosylated hemoglobin A1c (HbA1c) serving as a key indicator of long-term glycemic control. Objective This study investigates the correlation between hs-CRP and HbA1c levels in patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus (T2DM) and evaluates their impact on six-month mortality outcomes. Methods A prospective observational study was conducted with 80 patients diagnosed with AMI. Data collection included demographic information, medical history, clinical assessments, laboratory investigations (including hs-CRP and HbA1c levels), and imaging studies. Patients received standard treatment and were followed up for six months. Statistical analyses were performed to examine the relationships between hs-CRP, HbA1c, and clinical outcomes. Results Higher HbA1c levels at admission were significantly correlated with elevated hs-CRP levels (p < 0.05). Both biomarkers showed a reduction at six months, correlating with improved glycemic control and reduced inflammation. Each unit increase in HbA1c was associated with a 21% increase in the hazard of mortality, and, similarly, each unit increase in hs-CRP was associated with a 17% increase in the hazard of mortality. The positive correlation between HbA1c and hs-CRP suggests that HbA1c can serve as an independent marker for predicting mortality in this patient population. Conclusion The study demonstrates a significant correlation between hs-CRP and HbA1c levels in patients with AMI and T2DM, with both biomarkers serving as strong predictors of six-month mortality. HbA1c, because of its positive correlation with hs-CRP, could be used as an independent marker for assessing the risk of adverse outcomes in these patients. These findings highlight the importance of managing both glycemic control and inflammation in diabetic patients with ACSs.
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Affiliation(s)
- Keesari Sai Sandeep Reddy
- Internal Medicine, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
| | - Priyadarshini Varadaraj
- Internal Medicine, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
| | - Gunasekaran Nallusamy
- Internal Medicine, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
| | - Subbiah SenthilNathan
- Internal Medicine, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
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Deng J, Zuo QK, Venugopal K, Hung J, Zubair A, Blais S, Porter V, Moskalyk M, Heybati K. Efficacy and Safety of Hydrocortisone, Ascorbic Acid, and Thiamine Combination Therapy for the Management of Sepsis and Septic Shock: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Int Arch Allergy Immunol 2024; 185:997-1018. [PMID: 38870923 PMCID: PMC11446305 DOI: 10.1159/000538959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/14/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION This systematic review aimed to assess the efficacy and safety of hydrocortisone, ascorbic acid, and thiamine (HAT) combination therapy in patients with sepsis and septic shock. METHODS We conducted a database search in MEDLINE, Embase, CENTRAL, Web of Science, and CNKI for randomised controlled trials (RCTs) comparing HAT against placebo/standard of care or against hydrocortisone in sepsis/septic shock patients. Outcomes included mortality, ICU/hospital length of stay (LOS), vasopressor durations, mechanical ventilation durations, change in SOFA at 72 h, and adverse events. RCT results were pooled in random-effects meta-analyses. Quality of evidence was assessed using GRADE. RESULTS Fifteen RCTs (N = 2,594) were included. At 72 h, HAT reduced SOFA scores from baseline (mean difference [MD] -1.16, 95% confidence interval [CI]: -1.58 to -0.74, I2 = 0%) compared to placebo/SoC, based on moderate quality of evidence. HAT also reduced the duration of vasopressor use (MD -18.80 h, 95% CI: -23.67 to -13.93, I2 = 64%) compared to placebo/SoC, based on moderate quality of evidence. HAT increased hospital LOS (MD 2.05 days, 95% CI: 0.15-3.95, I2 = 57%) compared to placebo/SoC, based on very low quality of evidence. HAT did not increase incidence of adverse events compared to placebo/SoC. CONCLUSIONS HAT appears beneficial in reducing vasopressor use and improving organ function in sepsis/septic shock patients. However, its advantages over hydrocortisone alone remain unclear. Future research should use hydrocortisone comparators and distinguish between sepsis-specific and comorbidity- or care-withdrawal-related mortality.
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Affiliation(s)
- Jiawen Deng
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Qi Kang Zuo
- UBC Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kaden Venugopal
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Jay Hung
- Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Areeba Zubair
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sara Blais
- UBC Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Victoria Porter
- UBC Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Myron Moskalyk
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kiyan Heybati
- Mayo Clinic Alix School of Medicine (Jacksonville), Mayo Clinic, Jacksonville, Florida, USA
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Yang CJ, Bourgeois C, Delgado E, Graham W, Burmeister MA. Real-world community hospital hyperglycemia management in noncritically ill, type 2 diabetic patients: a comparison between basal-bolus insulin and correctional insulin. JOURNAL OF PHARMACY & PHARMACEUTICAL SCIENCES : A PUBLICATION OF THE CANADIAN SOCIETY FOR PHARMACEUTICAL SCIENCES, SOCIETE CANADIENNE DES SCIENCES PHARMACEUTIQUES 2024; 27:13074. [PMID: 38919469 PMCID: PMC11196384 DOI: 10.3389/jpps.2024.13074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024]
Abstract
Purpose This study evaluated the safety and efficacy of two insulin regimens for inpatient hyperglycemia management: combination short-plus long-acting insulin (basal-bolus insulin regimen, BBIR) vs. short-acting insulin only (correctional insulin only regimen, CIOR). Methods Chart reviews identified noncritically ill patients with pre-existing type 2 diabetes mellitus receiving insulin injections. Study participants (N = 138) were divided into BBIR (N = 104) and CIOR (N = 34) groups. Data for the entire duration of each patient's stay were analyzed. Results The primary outcome of percent hyperglycemic days was higher in BBIR vs. CIOR (3.97 ± 0.33% vs. 1.22 ± 0.38%). The safety outcome of percent hypoglycemic events was not different between BBIR and CIOR (0.78 ± 0.22% vs. 0.53 ± 0.37%). Regarding secondary outcomes, the percentage of euglycemic days was lower in BBIR vs. CIOR (26.74 ± 2.97% vs. 40.98 ± 5.91%). Overall blood glucose (BG) and daily insulin dose were higher in BBIR vs. CIOR (231.43 ± 5.37 vs. 195.55 ± 6.25 mg/dL and 41.36 ± 3.07 vs. 5.02 ± 0.68 units, respectively). Insulin regimen-associated differences in hyperglycemia and daily insulin dose persisted after adjusting for covariates. Conclusion Our observations linking BBIR to worse glycemic outcomes differ from those reported in the randomized controlled Rabbit 2 and Rabbit 2 Surgery trials. This discrepancy can be partly explained by the fact that BBIR patients displayed worse glycemic baselines. Also, there was no diabetes stewardship team to monitor BG and modify insulin therapy, which is relevant since achieving euglycemia in BBIR patients requires more dose adjustments. This study highlights challenges with standard inpatient glycemic management and calls for further research assessing the benefits of pharmacist-led diabetes stewardship.
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Affiliation(s)
- Caiyun J. Yang
- Slidell Memorial Hospital, Slidell, LA, United States
- William Carey University School of Pharmacy Department of Pharmacy Practice, Biloxi, MS, United States
| | | | - Elina Delgado
- Slidell Memorial Hospital, Slidell, LA, United States
- William Carey University School of Pharmacy Department of Pharmacy Practice, Biloxi, MS, United States
| | - William Graham
- William Carey University School of Pharmacy Department of Pharmacy Practice, Biloxi, MS, United States
| | - Melissa A. Burmeister
- William Carey University School of Pharmacy Department of Pharmaceutical Sciences, Biloxi, MS, United States
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Alkatiri AH, Qalby N, Mappangara I, Zainal ATF, Cramer MJ, Doevendans PA, Qanitha A. Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1303685. [PMID: 38529334 PMCID: PMC10961461 DOI: 10.3389/fcvm.2024.1303685] [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: 09/28/2023] [Accepted: 02/15/2024] [Indexed: 03/27/2024] Open
Abstract
Background Hyperglycemia, characterized by elevated blood glucose levels, is frequently observed in patients with acute coronary syndrome, including ST-elevation myocardial infarction (STEMI). There are conflicting sources regarding the relationship between hyperglycemia and outcomes in STEMI patients. We aimed to compile evidence to assess the association between hyperglycemia and adverse outcomes. Methods We conducted a comprehensive search for articles on PubMed and Embase using search strategies which yielded 4,061 articles. After full-text screening, 66 articles were included for systematic review, and 62 articles were further selected for meta-analysis. Results The 66 included articles spanned the years 2005-2023. Of these, 45 articles reported admission blood glucose, 13 articles used HbA1c, and 7 articles studied fasting blood glucose. Most studies defined STEMI with primary PCI as their inclusion criteria. Mortality was the most often outcome reported related to hyperglycemia. Overall, 55 (83.3%) studies were at low risk of bias. Both admission and fasting blood glucose were significantly related to short- and long-term mortality after STEMI, with a pooled risk ratio (RR) of 3.02 (95%CI: 2.65-3.45) and 4.47 (95% CI: 2.54-7.87), respectively. HbA1c showed substantial association with long-term mortality (HR 1.69, 95% CI: 1.31-2.18)) with a pooled RR of 1.58 (95% CI 1.26-1.97). In subsequent analyses, admission hyperglycemia was associated with an increased risk of reinfarction (pooled RR 1.69, 95% CI 1.31-2.17), heart failure (pooled RR 1.56, 95% CI: 1.37-1.77), cardiogenic shock (pooled RR 3.68, 95% CI 2.65-5.11), repeat PCI or stent thrombosis (pooled RR 1.99, 95% CI 1.21-3.28), and composite major adverse cardiac and cerebrovascular events (MACCE) (pooled RR 1.99, 95% CI: 1.54-2.58). Conclusions Our study demonstrated that hyperglycemia has a strong association with poor outcomes after STEMI. Admission and fasting blood glucose are predictors for short-term outcomes, while HbA1c is more appropriate for predicting longer-term outcomes in STEMI patients. Systematic Review Registration PROSPERO 2021 (CRD42021292985).
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Affiliation(s)
- Abdul Hakim Alkatiri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Makassar Cardiac Center, Dr. Wahidin Sudirohusodo General Teaching Hospital, Makassar, Indonesia
| | - Nurul Qalby
- Department of Public Health and Community Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Heart and Lung Division, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Idar Mappangara
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Makassar Cardiac Center, Dr. Wahidin Sudirohusodo General Teaching Hospital, Makassar, Indonesia
| | | | - Maarten J. Cramer
- Heart and Lung Division, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Pieter A. Doevendans
- Heart and Lung Division, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
- Netherlands Heart Institute, Utrecht, Netherlands
| | - Andriany Qanitha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Department of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Doctoral Study Program, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Chang C, Fleires A, Alshaikhli A, Arredondo H, Gavilanes D, Cabral-Amador FJ, Cantu J, Bazan D, Oliveira KO, Verduzco R, Pedraza L. Improving inpatient hyperglycaemia in non-critically ill adults in resident wards through audit and feedback. BMJ Open Qual 2024; 13:e002480. [PMID: 38429063 PMCID: PMC10910419 DOI: 10.1136/bmjoq-2023-002480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/11/2024] [Indexed: 03/03/2024] Open
Abstract
Inpatient hyperglycaemia is associated with an increase in morbidity and mortality, number of rehospitalisations and length of hospitalisation. Although the advantages of proper glycaemic control in hospitalised patients with diabetes are well established, a variety of barriers limit accomplishment of blood glucose targets. Our primary aim was to decrease the number of glucose values above 180 mg/dL in non-critical care hospitalised patients using an audit and feedback intervention with pharmacy and internal medicine residents. A resident-led multidisciplinary team implemented the quality improvement (QI) project including conception, literature review, educating residents, iterative development of audit and feedback tools and data analysis. The multidisciplinary team met every 5 weeks and undertook three 'plan-do-study-act' cycles over an 8-month intervention period (August 2022 to March 2023) to educate residents on inpatient hyperglycaemia management, develop and implement an audit and feedback process and assess areas for improvement. We performed 1045 audits analysing 16 095 accu-checks on 395 non-duplicated patients. Most audits showed compliance with guidelines. The monthly run-on chart shows per cent of glucose values above 180 mg/dL in our non-ICU hospitalised patients and an overall pre-to-post comparison of 25.1%-23.0% (p value<0.05). The intervention was well accepted by residents evidenced by survey results. We did not meet our primary aim to reduce hyperglycaemia by 30% and this combined with the audits showing mostly compliance with guidelines suggests that prescribing behaviour was not a key driver of inpatient hyperglycaemia in our population. This internal medicine resident and pharmacy interprofessional collaboration with audit and feedback for inpatient hyperglycaemia was feasible, well accepted and had a statistically significant yet small improvement in inpatient hyperglycaemia. The project may be helpful to others wishing to explore inpatient hyperglycaemia, interprofessional QI with pharmacists, resident-led QI and audit and feedback.
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Affiliation(s)
- Chelsea Chang
- Internal Medicine, The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA
| | - Alcibiades Fleires
- Internal Medicine, The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA
| | - Alfarooq Alshaikhli
- Internal Medicine, The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA
| | - Hector Arredondo
- Internal Medicine, The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA
| | - Diana Gavilanes
- Internal Medicine, The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA
| | - Francisco J Cabral-Amador
- Internal Medicine, The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA
| | | | - Daniela Bazan
- DHR Health, Edinburg, Texas, USA
- Irma Lerma Rangel School of Pharmacy, Texas A&M Health Science Center, College Station, Texas, USA
| | | | - Rene Verduzco
- DHR Health, Edinburg, Texas, USA
- Irma Lerma Rangel School of Pharmacy, Texas A&M Health Science Center, College Station, Texas, USA
| | - Lina Pedraza
- Internal Medicine, The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA
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Hyperglycemia and Glycemic Variability Associated with Glucocorticoids in Women without Pre-Existing Diabetes Undergoing Neoadjuvant or Adjuvant Taxane Chemotherapy for Early-Stage Breast Cancer. J Clin Med 2023; 12:jcm12051906. [PMID: 36902693 PMCID: PMC10004215 DOI: 10.3390/jcm12051906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
Glucocorticoids, which are administered with chemotherapy, cause hyperglycemia. Glycemic variability among breast cancer patients without diabetes is not well known. A retrospective cohort study was conducted involving early-stage breast cancer patients without diabetes who received dexamethasone prior to neoadjuvant or adjuvant taxane chemotherapy between August 2017-December 2019. Random blood glucose levels were analyzed, and steroid-induced hyperglycemia (SIH) was defined as a random glucose level of >140 mg/dL. A multivariate proportional hazards model was used to identify the risk factors of SIH. Out of 100 patients, the median age was 53 years (IQR: 45-63.5). A total of 45% of patients were non-Hispanic White, 28% Hispanic, 19% Asian, and 5% African American. The incidence of SIH was 67%, and glycemic fluctuations were highest in those with glucose levels of >200 mg/dL. Non-Hispanic White patients represented a significant predictor for time to SIH, with a hazard ratio of 2.5 (95% CI: 1.04, 5.95, p = 0.039). SIH was transient in over 90% of the patients, and only seven patients remained hyperglycemic after glucocorticoid and chemotherapy completion. Pretaxane dexamethasone-induced hyperglycemia was observed in 67% of the patients, with the greatest glycemic lability in those patients with blood glucose levels of >200 mg/dL. The non-Hispanic White patients had a higher risk of developing SIH.
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Admission glucose as a prognostic marker for all-cause mortality and cardiovascular disease. Cardiovasc Diabetol 2022; 21:258. [PMID: 36435766 PMCID: PMC9701417 DOI: 10.1186/s12933-022-01699-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/16/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Diabetes and prediabetes are known risk factors for cardiovascular disease and associated with increased mortality risk. Whether patients with a random elevated blood glucose level but no history of diabetes are at a higher mortality and cardiovascular risk is not entirely known. METHODS A retrospective cohort study where patients (18-80 years) with no history of diabetes between 2006 and 2016 attending the emergency department (ED) in Sweden were included. Based on the first (index) blood glucose level patients were categorized into four groups: hypoglycemia (< 3.9 mmol/L), normal glucose tolerance (NGT) (3.9-7.8 mmol/L), dysglycemia (7.8-11.1 mmol/L), and hyperglycemia (> 11.1 mmol/L). Data was collected from four nationwide registers (National Patient Register, National Cause of Death Register, Prescribed Drug Register and Statistics Sweden). Cox regression was used to calculate adjusted hazard ratios (HR) with 95% confidence intervals (CI) for all-cause mortality and cardiovascular outcomes using NGT as reference. RESULTS 618,694 patients were included during a mean follow-up time of 3.9 years. According to the index blood glucose level: 1871 (0.3%) had hypoglycemia, 525,636 (85%) had NGT, 77,442 (13%) had dysglycemia, and 13,745 (2%) patients had hyperglycemia, respectively. During follow-up 44,532 (7.2%) deaths occurred. After multiple adjustments, mortality risk was highest in patients with hypoglycemia HR 2.58 (2.26-2.96) followed by patients with hyperglycemia HR 1.69 (1.63-1.76) and dysglycemia HR 1.16 (1.13-1.19). Risk for cardiovascular events: i.e., myocardial infarction, stroke and heart failure, were highest among patients with hyperglycemia HR 2.28 (2.13-2.44), HR 1.62 (1.51-1.74) and HR 1.60 (1.46-1.75), respectively. CONCLUSION Patients with disturbed blood glucose level at ED admission have a higher mortality risk than patients with NGT. Patients with hyperglycemia have almost a two folded increased long-term mortality risk and more than a doubled risk for cardiovascular events compared to patients with NGT.
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Farrugia Y, Mangion J, Fava MC, Vella C, Gruppetta M. Inpatient hyperglycaemia, and impact on morbidity, mortality and re-hospitalisation rates. Clin Med (Lond) 2022; 22:325-331. [PMID: 38589132 DOI: 10.7861/clinmed.2022-0112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Hyperglycaemia is related to poorer outcomes among hospital inpatients. We investigated the impact of hyperglycaemia at admission on length of hospital stay, readmission rate and mortality rate. METHOD We retrospectively analysed the records of 1,132 patients admitted to hospital in January 2019, April 2019, August 2019 and April 2020. RESULTS Hyperglycaemia was present in 14.1% of patients. New-onset hyperglycaemia on admission (in 3.9% of patients) was related to a higher mortality rate than in patients known to have diabetes admitted with hyperglycaemia (43.3% vs 17.9%; p=0.006). Mortality at 90 days and 1 year increased with higher admission glucose levels (p=0.03 and p=0.005, respectively), severe hyperglycaemia (>20 mmol/L) having a 1-year mortality of 34.3%. After accounting for confounding variables, admission glucose and length of stay remained significant predictors of 1-year mortality (p=0.034 and p=0.003, respectively). CONCLUSION Hyperglycaemia is an important prognostic marker and may indicate a more severe illness. These patients should be highlighted for a greater level of care.
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Toyoshima MTK, Brandes PHR, da Paz Lauterbach G, Moraes JRA, de Paiva EF, Umpierrez GE, Nery M, Kondo RH. InsulinAPP application protocol for the inpatient management of type 2 diabetes on a hospitalist-managed ward: a retrospective study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:498-505. [PMID: 35758838 PMCID: PMC10697650 DOI: 10.20945/2359-3997000000496] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/09/2022] [Indexed: 06/15/2023]
Abstract
Introduction We assessed metrics related to inpatient glycemic control using InsulinAPP, an application available for free in Brazil, on the hospitalist-managed ward of our hospital. Subjects and methods We performed a retrospective study of patients with type 2 diabetes (T2D) admitted from November 2018 to October 2019. InsulinAPP recommends NPH and regular insulins three times a day, in bolus-correction or basal-bolus schemes. Parameters that included BG within range of 70-180 mg/dL, insulin treatment regimen and frequency of hypoglycemia were evaluated. Results A total of 147 T2D individuals (23% medicine and 77% surgery) were included (mean age 62.3 ± 12.7 years, HbA1c: 8.3 ± 3.0%). The initial insulin regimen was 50% bolus-correction, 47% basal-bolus and 3% with sliding scale insulin. During hospitalization, 71% patients required a bolus-basal regimen. In the first 10 days of the protocol, 71% BG measurements were between 70-180 mg/dL and 26% patients experienced one or more episodes of hypoglycemia < 70 mg/dL, and 5% with BG < 54 mg/dL. Conclusion The results of this retrospective study indicate the InsulinAPP application using human insulin formulations was effective and safe for the management of hyperglycemia on a hospitalist-managed ward, with more than 70% BG measurements within the therapeutic range and a low rate of hypoglycemia.
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Affiliation(s)
- Marcos Tadashi Kakitani Toyoshima
- Serviço de Onco-endocrinologia, Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil,
- Serviço de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Serviço de Medicina Hospitalar, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Pedro Henrique Ribeiro Brandes
- Serviço de Medicina Hospitalar, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Gerhard da Paz Lauterbach
- Serviço de Medicina Hospitalar, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Jéssica Ribeiro Andrade Moraes
- Serviço de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Serviço de Medicina Hospitalar, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Edison Ferreira de Paiva
- Serviço de Medicina Hospitalar, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Guillermo E Umpierrez
- Department of Medicine, Division of Endocrinology at Emory University, Atlanta, GA, USA
| | - Marcia Nery
- Serviço de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Rodrigo Hidd Kondo
- Serviço de Medicina Hospitalar, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Lou R, Jiang L, Wang M, Zhu B, Jiang Q, Wang P. Association Between Glycemic Gap and Mortality in Critically Ill Patients with Diabetes. J Intensive Care Med 2022; 38:42-50. [PMID: 35611506 DOI: 10.1177/08850666221101856] [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: 11/17/2022]
Abstract
OBJECTIVES Dysglycemia is associated with poor outcomes in critically ill patients,which is uncertain in patients with diabetes regarding to the situation of glucose control before hospitalization. This study was aimed to investigate the effect of the difference between the level of blood glucose during ICU stay and before admission to ICU upon the outcomes of critically ill patients with diabetes. METHOD Patients with diabetes expected to stay for more than 24hs were enrolled, HbA1c was converted to A1C-derived average glucose (ADAG) by the equation: ADAG = [ (HbA1c * 28.7) - 46.7 ] * 18-1, blood glucose were measured four times a day during the first 7 days after admission, the mean glucose level(MGL) and SOFA (within 3, 5, and 7days) were calculated for each person, GAPadm and GAPmean was calculated as admission blood glucose and MGL minus ADAG, the incidence of moderate hypoglycemia(MH), severe hypoglycemia (SH), total dosage of glucocorticoids and average daily dosage of insulin, duration of renal replacement therapy(RRT), ventilator-free hours, and non-ICU days were also collected. Patients were divided into survival group and nonsurvival group according to survival or not at 28-day, the relationship between GAP and mortality were analyzed. RESULTS 431 patients were divided into survival group and nonsurvival group. The two groups had a comparable level of HbA1c, the nonsurvivors had greater APACHE II, SOFA, GAPadm, GAPmean-3, GAPmean-5, GAPmean-7 and higher MH and SH incidences. Less duration of ventilator-free, non-ICU stay and longer duration of RRT were recorded in the nonsurvival group. GAPmean-5 had the greatest predictive power with an AUC of 0.807(95%CI: 0.762-0.851), the cut-off value was 3.6 mmol/L (sensitivity 77.7% and specificity 76.6%). The AUC was increased to 0.852(95%CI: 0.814-0.889) incorporated with SOFA5 (NRI = 11.34%). CONCLUSION Glycemic GAP between the MGL within 5 days and ADAG was independently associated with 28-day mortality of critically ill patients with diabetes. The predictive power was optimized with addition of SOFA5.
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Affiliation(s)
- Ran Lou
- Department of Crtical Care Medicine, 71044Xuanwu Hospital Capital Medical University, 45Changchun Street, Xicheng District, Beijing 100053, China
| | - Li Jiang
- Department of Crtical Care Medicine, 71044Xuanwu Hospital Capital Medical University, 45Changchun Street, Xicheng District, Beijing 100053, China
| | - Meiping Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China
| | - Bo Zhu
- Department of Critical Care Medicine, 71043Fu Xing Hospital, Capital Medical University, 20A Fuxingmenwai Street, Xicheng District, Beijing 100038, China
| | - Qi Jiang
- Department of Critical Care Medicine, 71043Fu Xing Hospital, Capital Medical University, 20A Fuxingmenwai Street, Xicheng District, Beijing 100038, China
| | - Peng Wang
- Department of Critical Care Medicine, 71043Fu Xing Hospital, Capital Medical University, 20A Fuxingmenwai Street, Xicheng District, Beijing 100038, China
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Olsen MT, Dungu AM, Klarskov CK, Jensen AK, Lindegaard B, Kristensen PL. Glycemic variability assessed by continuous glucose monitoring in hospitalized patients with community-acquired pneumonia. BMC Pulm Med 2022; 22:83. [PMID: 35264139 PMCID: PMC8905566 DOI: 10.1186/s12890-022-01874-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/25/2022] [Indexed: 01/17/2023] Open
Abstract
Background Glycemic variability (GV) has only been sparsely studied in patients with community-acquired pneumonia (CAP). This study aimed to quantify in-hospital GV in CAP patients, including determining the impact of type 2 diabetes mellitus (T2DM) and glucocorticoid (GC) treatment on GV. Methods This is a prospective cohort study of CAP patients (N = 40) with or without T2DM and treated or not with GCs. The primary endpoint was GV measured as glucose standard deviation (SD), coefficient of variation (CV), and postprandial glucose excursions (PPGE) based on continuous glucose monitoring (CGM). Analysis of glucose data was split into daytime and nighttime when possible. Results Patients included had a mean age of 74 (range 55 to 91) years. SD (95%CI) increased by a factor of 1.93 (1.40 to 2.66) and 2.29 (1.38 to 3.81) in patients with T2DM and not treated with GCs during the daytime and the nighttime, respectively (both P < 0.01), and by a factor of 1.42 (1.04 to 1.97) in patients treated with GCs but without T2DM during the daytime (P = 0.031) compared to patients without T2DM and not treated with GCs. CV (95%CI) increased by 5.1 (0.0 to 10.1) and 8.1 (1.0 to 15.2) percentage points during the daytime and the nighttime, respectively, in patients with T2DM and not treated with GCs compared to patients without T2DM and not treated with GCs (P = 0.046 and P = 0.026, respectively). PPGE (95% CI) increased during lunch by 2.5 (0.7 to 4.3) mmol/L (45 (13 to 77) mg/dL) in patients with T2DM and treated with GCs compared to patients without T2DM and not treated with GCs (P = 0.018). Conclusions CAP patients receiving GCs, especially those with T2DM, are at great risk of developing high GV and therefore require clinical attention to mitigate GV. This applies particularly during the daytime. Results support the 1 to 2-h post-lunch screening procedure for glucocorticoid-induced hyperglycemia in patients without diabetes. SD was positively correlated with hospital length of stay. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01874-7.
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Affiliation(s)
- Mikkel Thor Olsen
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.
| | - Arnold Matovu Dungu
- Department of Pulmonary- and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Carina Kirstine Klarskov
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Andreas Kryger Jensen
- Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.,Department of Clinical Research, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Birgitte Lindegaard
- Department of Pulmonary- and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Peter Lommer Kristensen
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
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12
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Klarskov CK, Windum NA, Olsen MT, Dungu AM, Jensen AK, Lindegaard B, Pedersen-Bjergaard U, Kristensen PL. Telemetric Continuous Glucose Monitoring During the COVID-19 Pandemic in Isolated Hospitalized Patients in Denmark: A Randomized Controlled Exploratory Trial. Diabetes Technol Ther 2022; 24:102-112. [PMID: 34524009 DOI: 10.1089/dia.2021.0291] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To investigate whether telemetric continuous glucose monitoring (CGM) in hospitalized and isolated patients with diabetes mellitus and coronavirus disease 2019 (COVID-19) is associated with better glycemic outcomes and fewer patient health care worker contacts compared to blood glucose monitoring by traditional point-of-care (POC) glucose testing and to investigate the user aspect of implementing a CGM-system in-hospital. Materials and Methods: A randomized controlled exploratory trial was performed on hospitalized and isolated patients with diabetes and COVID-19 from May 2020 until February 2021 at Nordsjællands Hospital, Denmark. Participants were randomized to nonblinded telemetric CGM (as the only glucose monitoring method) or traditional POC glucose testing + blinded CGM. The primary endpoint was time in range (TIR) based on CGM data in both groups. A questionnaire about the user aspect of the CGM system was answered by health care personnel (HCP). Results: We included 64 participants in the analysis, 31 in the CGM group and 33 in the POC glucose group. TIR median was 46% for the CGM group and 68% for the POC glucose group (P = 0.368). The mean glucose value for the CGM group was 11.1 and 10.8 mmol/L in the POC glucose group (P = 0.372). CGM was associated with fewer POC glucose measurements (P < 0.001). Out of 30 HCPs, 28 preferred telemetric CGM over POC glucose testing. Conclusion: Remote glucose monitoring by CGM did not improve glycemic outcomes compared to traditional POC glucose testing, but was associated with fewer patient-personnel contacts, saving time for HCPs performing diabetes-related tasks. Most HCPs preferred CGM. The study is registered at http://www.clinicaltrials.gov (#NCT04430608).
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Affiliation(s)
- Carina Kirstine Klarskov
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Nicole Avlund Windum
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Mikkel Thor Olsen
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Arnold Matovu Dungu
- Department of Pulmonary and Infectious Diseases, and Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Andreas Kryger Jensen
- Department of Clinical Research, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Lindegaard
- Department of Pulmonary and Infectious Diseases, and Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Lommer Kristensen
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Sheen Y, Huang C, Huang S, Lin C, Lee I, H‐H Sheu W. Electronic dashboard-based remote glycemic management program reduces length of stay and readmission rate among hospitalized adults. J Diabetes Investig 2021; 12:1697-1707. [PMID: 33421275 PMCID: PMC8409866 DOI: 10.1111/jdi.13500] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 01/22/2023] Open
Abstract
AIMS/INTRODUCTION Currently, the impact of hospital-wide glycemic control interventions on length of hospital stay (LOS) and readmission rates are largely unknown. We investigated the impact of a 4-year hospital-wide remote glycemic management program on LOS and 30-day readmission rates among hospitalized adults who received glucose monitoring. MATERIALS AND METHODS In this retrospective study, hospitalized patients who received glucose monitoring were classified into groups 1 (high glucose variability), 2 (hypoglycemia), 3 (hyperglycemia) and 4 (relatively stable). The monthly percentage changes, and average monthly percentage changes of hyperglycemia, hypoglycemia and treat to target were determined using joinpoint regression analysis. RESULTS A total of 106,528 hospitalized patients (mean age 60.9 ± 18.5 years, 57% men) were enrolled. We observed a significant reduction in the percentage of inpatients in poor glycemic control groups (groups 1, 2 and 3, all P < 0.001), and a reciprocal increase in the relatively stable group (group 4) from 2016 to 2019. We found a significant reduction in LOS by 11.4% (10.5-9.3 days, P = 0.002, after adjustment for age, sex, and admission department). The 30-day readmission rate decreased from 29.9% to 29.3%, mainly among those in group 4 in 2019 (P < 0.001 after adjustment of sex, age, admission department and LOS). CONCLUSIONS Improved glycemic control through a hospital-wide electronic remote glycemic management system reduced LOS and 30-day readmission rates. Findings observed in this study might be associated with the reduction in cost of avoidable hospitalizations.
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Affiliation(s)
- Yi‐Jing Sheen
- Division of Endocrinology and MetabolismDepartment of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
- Department of MedicineSchool of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
| | - Chien‐Chung Huang
- Department of Computer & Communications CenterTaichung Veterans General HospitalTaichungTaiwan
| | - Shih‐Che Huang
- Division of Clinical InformationCenter of Quality ManagementTaichung Veterans General HospitalTaichungTaiwan
| | - Ching‐Heng Lin
- Department of Medical ResearchTaichung Veterans General HospitalTaichungTaiwan
| | - I‐Te Lee
- Division of Endocrinology and MetabolismDepartment of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
- Department of MedicineSchool of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
- School of MedicineChung Shan Medical UniversityTaichung CityTaiwan
- College of ScienceTunghai UniversityTaichung CityTaiwan
| | - Wayne H‐H Sheu
- Division of Endocrinology and MetabolismDepartment of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
- Department of MedicineSchool of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
- Institute of Medical TechnologyCollege of Life ScienceNational Chung‐Hsing UniversityTaichungTaiwan
- School of MedicineNational Defense Medical CenterTaipeiTaiwan
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Watanabe T, Sugawara H, Saito K, Ishii A, Fukuchi T, Omoto K. Predicting 72-h mortality in patients with extremely high random plasma glucose levels: A case-controlled cross-sectional study. Medicine (Baltimore) 2021; 100:e24510. [PMID: 33530277 PMCID: PMC7850777 DOI: 10.1097/md.0000000000024510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 01/06/2021] [Indexed: 01/05/2023] Open
Abstract
The risk factors associated with 72-hours mortality in patients with extremely high levels of random plasma glucose (RPG) remain unclear.To explore the risk factors predictive of 72-hours mortality in patients with extremely high RPG under heterogenos pathophysiological conditions.Retrospective, single-center, case-controlled cross-sectional study.University teaching hospital.Adults over age 18 were selected from the medical records of patients at the Saitama Medical Center, Japan, from 2004 to 2013.Extremely high RPG (≥500 mg/dl).Mortality at 72 hours following the RPG test, regardless of hospitalization or in an outpatient setting. Multivariate logistic regression analysis was performed with adjustment for age, sex, body mass index (BMI), and RPG level. The final prediction model was built using the logistic regression model with a higher C-statistic, specificity, and sensitivity.A total of 351 patients with RPG ≥500 mg/dl were identified within the 10-year period. The 72-hours mortality rate was 16/351 (4.6%). The C-statistics of the 72-hours mortality prediction model with serum albumin (ALB) and creatine kinase (CK) was 0.856. The probability of 72-hours mortality was calculated as follows: 1/[1 + exp (-5.142 + 0.901log (CK) -1.087 (ALB) + 0.293 (presence (1) or absence (0) of metastatic solid tumor)]. The sensitivity and specificity of this model was 75.5%.The independent risk factors associated with 72-hours mortality in patients with RPG ≥500 mg/dl are hypoalbuminemia, elevated CK, and presence of a metastatic solid tumour. Further research is needed to understand the mechanisms and possible interventions to prevent mortality associated with extremely high RPG.
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Affiliation(s)
- Tamami Watanabe
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Saitama
| | - Hitoshi Sugawara
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Saitama
| | - Kai Saito
- Medical Student, Nara Medical University, Nara
| | - Akira Ishii
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Saitama
| | - Takahiko Fukuchi
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Saitama
| | - Kiyoka Omoto
- Department of Laboratory Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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15
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Lago AS, Lima FR, Carvalho AM, Sampaio C, Lago N, Guimarães LH, Lago J, Machado PRL, Carvalho LP, Arruda S, Carvalho EM. Diabetes Modifies the Clinic Presentation of Cutaneous Leishmaniasis. Open Forum Infect Dis 2020; 7:ofaa491. [PMID: 33324720 PMCID: PMC7724508 DOI: 10.1093/ofid/ofaa491] [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: 06/19/2020] [Accepted: 11/05/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) caused by L. braziliensis is characterized by 1 or multiple well-limited ulcerated lesions. Diabetes mellitus (DM) impairs neutrophil and monocyte function, and there is a report of vegetative lesions in a patient with both diseases in Morocco. Here we evaluate the influence of DM on clinical manifestations, immune response, and in the treatment of CL. METHODS The participants were 36 DM patients with CL and 36 patients with CL without DM, matched by age and gender. The diagnosis of CL was performed by documentation of DNA of L. braziliensis by polymerase chain reaction in the lesion biopsy and histopathologic findings. All patients were treated with Glucantime (Sanofi-Aventis) 20 mg/kg of weight per day for 20 days. RESULTS There was no difference in the majority of the clinical variables between the groups, and the cure rate in patients with CL and DM (67%) was similar to that observed in CL patients (56%; P ˃ .05). The most important finding was the documentation that 36% of the patients with DM and CL had atypical cutaneous lesions characterized by large superficial ulcers without defined borders. High levels of interferon-γ, tumor necrosis facor, and interleukin-1β were detected in the supernatants of mononuclear cells stimulated with Leishmania antigen in patients with DM and atypical CL. Moreover, while cure was observed in only 33% of the patients with DM and atypical CL lesions, it was observed in 85% of patients with typical lesions (P < .05). CONCLUSIONS DM modifies the clinical presentation of CL, enhances pro-inflammatory cytokine production, and impairs response to antimony therapy.
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Affiliation(s)
- Alexsandro S Lago
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Bahia, Brazil
- Post-Graduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Bahia, Brazil
| | - Filipe R Lima
- Gonçalo Moniz Institute (IGM), Fiocruz, Salvador, Bahia, Brazil
| | | | - Camilla Sampaio
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Bahia, Brazil
- Post-Graduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Bahia, Brazil
| | - Neuza Lago
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Luiz H Guimarães
- Federal University of Southern Bahia, Teixeira de Freitas, Bahia, Brazil
| | - Jamile Lago
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Bahia, Brazil
- Post-Graduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Bahia, Brazil
| | - Paulo R L Machado
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Bahia, Brazil
- Post-Graduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Bahia, Brazil
| | - Lucas P Carvalho
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Bahia, Brazil
- Post-Graduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Bahia, Brazil
- Gonçalo Moniz Institute (IGM), Fiocruz, Salvador, Bahia, Brazil
| | - Sérgio Arruda
- Gonçalo Moniz Institute (IGM), Fiocruz, Salvador, Bahia, Brazil
| | - Edgar M Carvalho
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Bahia, Brazil
- Post-Graduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Bahia, Brazil
- Gonçalo Moniz Institute (IGM), Fiocruz, Salvador, Bahia, Brazil
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Khan AA, Shahzad A, Rose S, Al Mohanadi DHSH, Zahid M. Quality improvement project for improving inpatient glycaemic control in non-critically ill patients admitted on medical floor with type 2 diabetes mellitus. BMJ Open Qual 2020; 9:bmjoq-2020-000982. [PMID: 32792342 PMCID: PMC7430318 DOI: 10.1136/bmjoq-2020-000982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/04/2020] [Accepted: 07/21/2020] [Indexed: 12/18/2022] Open
Abstract
A significant number of patients admitted to the medical floor have type 2 diabetes mellitus (DM). Lack of a standardised inpatient hyperglycaemia management protocol leads to improper glycaemic control adding to morbidity in such patients. American Diabetes Association, in its 2019 guidelines, recommends initiation of a regimen consisting of basal insulin (long-acting insulin) or basal plus correctional insulin for non-critically ill hospitalised patients with poor or no oral intake. A combination of basal insulin, bolus (short-acting premeal or prandial) insulin and correctional scale insulin is recommended for inpatient hyperglycaemia management in non-critical patients with type 2 DM who have proper oral intake. Baseline data of 100 patients with diabetes admitted to Hamad General Hospital Doha, Qatar, showed that although insulin was used in the majority of patients, there was lack of uniformity in the initiation of insulin regimen. Adequate glycaemic control (7.8–10 mmol/L) was achieved in 45% of patients. Using Plan–Do–Study–Act (PDSA) model of improvement, a quality improvement project was initiated with the introduction of a standardised inpatient hyperglycaemia management protocol aiming to achieve 50% compliance to protocol and improvement in inpatient glycaemic control from baseline of 45% to 70%. Interventions for change included development of a standardised inpatient hyperglycaemia management protocol and its provision to medical trainees, teaching sessions for trainees and nurses, active involvement of medical consultants for supervision of trainees to address the fear of hypoglycaemia, regular reminders/feedbacks to trainees and nurses about glycaemic control of their patients and education about goals of diabetes management during hospitalisation for patients with diabetes. Overall, glycaemic control improved significantly with target glycaemic control of 70% achieved in 4 of the 10 PDSA cycles without an increase in the number of hypoglycaemic episodes. We conclude that development of a standardised inpatient insulin prescribing protocol, educational sessions for medical trainees and nurses about goals of diabetes management during hospitalisation, regular reminders to healthcare professionals and patient education are some of the measures that can improve glycaemic control of patients with type 2 DM during inpatient stay.
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Affiliation(s)
- Adeel Ahmad Khan
- Department of Internal Medicine, Hamad Medical Corporation, Doha 3050, Qatar
| | - Aamir Shahzad
- Department of Internal Medicine, Hamad Medical Corporation, Doha 3050, Qatar
| | - Samman Rose
- Department of Internal Medicine, Hamad Medical Corporation, Doha 3050, Qatar
| | | | - Muhammad Zahid
- Department of Internal Medicine, Hamad Medical Corporation, Doha 3050, Qatar
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Klarskov CK, Holm Schultz H, Wilbek Fabricius T, Persson F, Pedersen-Bjergaard U, Lommer Kristensen P. Oral treatment of glucocorticoid-induced diabetes mellitus: A systematic review. Int J Clin Pract 2020; 74:e13529. [PMID: 32392375 DOI: 10.1111/ijcp.13529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Carina K Klarskov
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Hilleroed, Denmark
| | | | | | - Frederik Persson
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Hilleroed, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Hilleroed, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Zhu Y, Yang Y, Yang M, Xia W, Zhou H, Zhu XJ, Tang N, Li PQ. Effect of informatization-based blood glucose team management on the control of hyperglycaemia in noncritical care units. PLoS One 2020; 15:e0230115. [PMID: 32160260 PMCID: PMC7065766 DOI: 10.1371/journal.pone.0230115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/23/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To provide a new system of in-hospital blood glucose team management combined with a network blood glucose monitoring system and analyse the effect on hyperglycaemic participants' blood glucose control in noncritical care units. METHODS Hyperglycaemic participants in noncritical care units were divided into two groups. They underwent active intervention by the hospital's blood glucose management team or the routine consultation group. The better method, based on a shorter length of stay (LOS) and lower hospital cost, could be selected by comparing the two blood glucose management strategies. RESULTS Compared with the routine consultation group, the team management group had a higher detection rate of hyperglycaemia (18.49% vs 16.17%, P<0.01) and glycosylated haemoglobin (51.53% vs 30.97%, P<0.01) and a lower incidence rate of hyperglycaemia (59.24% vs 61.59%, P<0.01), severe hyperglycaemia (3.56% vs 5.19%, P<0.01) and clinically significant hypoglycaemia (0.26% vs 0.35%, P<0.05). Simultaneously, blood glucose drift (mmol/L) (2.50 (1.83, 3.25) vs 2.76 (2.01, 3.57), P<0.01), blood glucose coefficient of variation (%) (28.86 (22.70, 34.83) vs 29.80 (23.47, 36.13), P<0.01), maximum blood glucose fluctuation (mmol/L) (9.30 (6.20, 13.10) vs 10.10 (7.00, 14.40), P<0.01) and nosocomial infection (5.42% vs 8.05%, P<0.05) were all lower among participants in the team management group. In addition, the LOS (P<0.001) and hospital costs (P<0.001) of participants were lower in the team management group. CONCLUSION In-hospital blood glucose team management combined with a network blood glucose monitoring system effectively improved the blood glucose control and fluctuation levels of participants who were admitted to noncritical care units, thereby reducing LOS and hospital cost.
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Affiliation(s)
- Ying Zhu
- Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Yan Yang
- Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Miao Yang
- Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Wei Xia
- Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Hui Zhou
- Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Xian-Jun Zhu
- Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Nie Tang
- Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Peng-Qiu Li
- Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
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Effects of Bamboo Stem Extracts on Adipogenic Differentiation and Lipid Metabolism Regulating Genes. BIOTECHNOL BIOPROC E 2019. [DOI: 10.1007/s12257-019-0029-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Olariu E, Pooley N, Danel A, Miret M, Preiser JC. A systematic scoping review on the consequences of stress-related hyperglycaemia. PLoS One 2018; 13:e0194952. [PMID: 29624594 PMCID: PMC5889160 DOI: 10.1371/journal.pone.0194952] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/13/2018] [Indexed: 01/04/2023] Open
Abstract
Background Stress-related hyperglycaemia (SHG) is commonly seen in acutely ill patients and has been associated with poor outcomes in many studies performed in different acute care settings. We aimed to review the available evidence describing the associations between SHG and different outcomes in acutely ill patients admitted to an ICU. Study designs, populations, and outcome measures used in observational studies were analysed. Methods We conducted a systematic scoping review of observational studies following the Joanna Briggs methodology. Medline, Embase, and the Cochrane Library were searched for publications between January 2000 and December 2015 that reported on SHG and mortality, infection rate, length of stay, time on ventilation, blood transfusions, renal replacement therapy, or acquired weakness. Results The search yielded 3,063 articles, of which 43 articles were included (totalling 536,476 patients). Overall, the identified studies were heterogeneous in study conduct, SHG definition, blood glucose measurements and monitoring, treatment protocol, and outcome reporting. The most frequently reported outcomes were mortality (38 studies), ICU and hospital length of stay (23 and 18 studies, respectively), and duration of mechanical ventilation (13 studies). The majority of these studies (40 studies) compared the reported outcomes in patients who experienced SHG with those who did not. Fourteen studies (35.9%) identified an association between hyperglycaemia and increased mortality (odds ratios ranging from 1.13 to 2.76). Five studies identified hyperglycaemia as an independent risk factor for increased infection rates, and one identified it as an independent predictor of increased ICU length of stay. Discussion SHG was consistently associated with poor outcomes. However, the wide divergences in the literature mandate standardisation of measuring and monitoring SHG and the creation of a consensus on SHG definition. A better comparability between practices will improve our knowledge on SHG consequences and management.
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Affiliation(s)
| | | | | | | | - Jean-Charles Preiser
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
- * E-mail:
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Thaiss CA, Levy M, Grosheva I, Zheng D, Soffer E, Blacher E, Braverman S, Tengeler AC, Barak O, Elazar M, Ben-Zeev R, Lehavi-Regev D, Katz MN, Pevsner-Fischer M, Gertler A, Halpern Z, Harmelin A, Aamar S, Serradas P, Grosfeld A, Shapiro H, Geiger B, Elinav E. Hyperglycemia drives intestinal barrier dysfunction and risk for enteric infection. Science 2018. [PMID: 29519916 DOI: 10.1126/science.aar3318] [Citation(s) in RCA: 550] [Impact Index Per Article: 91.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Obesity, diabetes, and related manifestations are associated with an enhanced, but poorly understood, risk for mucosal infection and systemic inflammation. Here, we show in mouse models of obesity and diabetes that hyperglycemia drives intestinal barrier permeability, through GLUT2-dependent transcriptional reprogramming of intestinal epithelial cells and alteration of tight and adherence junction integrity. Consequently, hyperglycemia-mediated barrier disruption leads to systemic influx of microbial products and enhanced dissemination of enteric infection. Treatment of hyperglycemia, intestinal epithelial-specific GLUT2 deletion, or inhibition of glucose metabolism restores barrier function and bacterial containment. In humans, systemic influx of intestinal microbiome products correlates with individualized glycemic control, indicated by glycated hemoglobin levels. Together, our results mechanistically link hyperglycemia and intestinal barrier function with systemic infectious and inflammatory consequences of obesity and diabetes.
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Affiliation(s)
- Christoph A Thaiss
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Maayan Levy
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Inna Grosheva
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Danping Zheng
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Eliran Soffer
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Eran Blacher
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Sofia Braverman
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Anouk C Tengeler
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Oren Barak
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel.,Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, affiliated with the Hebrew University and Hadassah School of Medicine, Jerusalem, Israel
| | - Maya Elazar
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Rotem Ben-Zeev
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Dana Lehavi-Regev
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Meirav N Katz
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | | | - Arieh Gertler
- The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University, Rehovot, Israel
| | - Zamir Halpern
- Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Research Center for Digestive Tract and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Digestive Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Alon Harmelin
- Department of Veterinary Resources, Weizmann Institute of Science, Rehovot, Israel
| | - Suhail Aamar
- Department of Medicine, Hadassah-Hebrew University Hospital, Jerusalem, Israel
| | - Patricia Serradas
- INSERM Centre de Recherche des Cordeliers, Sorbonne Université, Sorbonne Cités, UPD Univ. Paris 05, CNRS, IHU ICAN, Paris, France
| | - Alexandra Grosfeld
- INSERM Centre de Recherche des Cordeliers, Sorbonne Université, Sorbonne Cités, UPD Univ. Paris 05, CNRS, IHU ICAN, Paris, France
| | - Hagit Shapiro
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Benjamin Geiger
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Eran Elinav
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel.
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22
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Valizadeh Hasanloei MA, Shariatpanahi ZV, Vahabzadeh D, Vahabzadeh Z, Nasiri L, Shargh A. Non-diabetic Hyperglycemia and Some of Its Correlates in ICU Hospitalized Patients Receiving Enteral Nutrition. MAEDICA 2017; 12:174-179. [PMID: 29218064 PMCID: PMC5706756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Hyperglycemia is a common occurrence in critically ill patients, and its prevalence in patients receiving nutritional support is much higher than in other patients. The non-diabetic form is associated with more undesirable outcomes. This study was performed to determine the prevalence of non-diabetic hyperglycemia and its correlates in patients receiving enteral nutrition. MATERIAL AND METHODS This cross-sectional study was performed between March and December 2015. Seven hundred forty eight (748) patients were reviewed to see if they met the inclusion criteria. After random sequence numbering, 414 patients who were eligible for further assessment and data gathering were selected. Hyperglycemia was defined as the blood glucose levels higher than either 126 mg/dL, in the fasting state, or 180 mg/dL, in a random state. Blood glucose was measured by an ACCU-CHECK glucometer (Roche diagnostics, Mannheim, Germany) three times, after ICU admission, in both fasting and random state. A pre-prepared form was used to extract data from hospital records. Data analysis was performed by SPSS 21 software. RESULTS In this group of hospitalized patients, the prevalence of non-diabetic hyperglycemia was 14/49 (60/414). In the hyperglycemic subgroup, mean FBS was 228.00±36.42, mean random BS was 183.19±43.94 and mean blood sugar on the first day of hospitalization was 203.60 ± 60.79. The mean age of patients was 56.64±19.79 years and the mean duration of hospitalization was 19.24±15.33 days. There was no significant relationship between enteral nutrition feeding volume and hyperglycemia. Majorly, patients aged above 60 years were hyperglycemic. The prevalence was higher in men than in women. Most patients were internal cases, but with the highest prevalence of hyperglycemia in surgical patients. CONCLUSIONS Since among different studied variables just diagnosed disease and the level of provided calorie showed significant differences between subgroup categories, so it can be suggested that designing on-time appropriate management programs based them can be effective on the administration of non-diabetic hyperglycemia and its undesirable consequences in such patients.
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Affiliation(s)
| | - Zahra Vahdat Shariatpanahi
- Associated professor of Nutrition, Dept of Clinical Nutrition, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Davoud Vahabzadeh
- PhD Student in Nutrition, International Branch of Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zakaria Vahabzadeh
- Liver & Digestive Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Leila Nasiri
- General practitioner in clinic, Emam Khomeini Hospital, Urmia University of Medical Sciences, Iran
| | - Ali Shargh
- Evaluation and accreditation manager for hospital settings, Urmia University of Medical Sciences, Urmia, Iran
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23
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Efecto de una intervención sobre indicadores de calidad para mejorar el tratamiento de la hiperglucemia en pacientes hospitalizados en áreas no críticas. Rev Clin Esp 2016; 216:352-360. [DOI: 10.1016/j.rce.2016.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/05/2016] [Accepted: 05/08/2016] [Indexed: 11/20/2022]
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24
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Ena J, Gómez-Huelgas R, Zapatero-Gaviria A, Vázquez-Rodriguez P, González-Becerra C, Romero-Sánchez M, Igúzquiza-Pellejero M, Artero-Mora A, Varela-Aguilar J. Effect of an intervention on quality indicators for improving the treatment of hyperglycemia in patients hospitalized in noncritical areas. Rev Clin Esp 2016. [DOI: 10.1016/j.rceng.2016.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Martin WG, Galligan J, Simpson S, Greenaway T, Burgess J. Admission blood glucose predicts mortality and length of stay in patients admitted through the emergency department. Intern Med J 2016; 45:916-24. [PMID: 26109328 DOI: 10.1111/imj.12841] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 06/03/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hyperglycaemia has been associated with adverse outcomes in several different hospital populations. AIM The aim of this study was to investigate the relationship between admission blood glucose level (BGL) and outcomes in all patients admitted through the emergency department. METHODS This study was a retrospective observational cohort study from an Australian tertiary referral hospital. Patients admitted in the first week of each month from April to October 2012 had demographic data, co-morbidities, BGL, intensive care unit admission, length of stay and dates of death recorded. Factors associated with outcomes were assessed by multi-level mixed-effects linear regression. RESULTS Admission BGL was recorded for 601 admissions with no diagnosis of diabetes and for 219 admissions diagnosed with type 2 diabetes (T2DM). In patients with no diagnosis of diabetes, admission BGL was associated with in-hospital and 90-day mortality (P < 0.001). After multivariate analysis, BGL greater than 11.5 mmol/L was significantly associated with increased mortality at 90 days (P < 0.05). In patients with T2DM increased BGL on admission was not associated with in-hospital or 90-day mortality but was associated with length of hospital stay (β: 0.22 days/mmol/L; 95% confidence interval 0.09-0.35; P < 0.001), although this association was lost on multivariable analysis. In patients with T2DM, increased coefficient of variation of BGL was also positively associated with length of hospital stay in an almost dose-dependent fashion (P < 0.001). CONCLUSION Admission BGL was independently associated with increased mortality in patients with no diagnosis of diabetes. Glycaemic variability was associated with increased length of hospital stay in patients with T2DM.
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Affiliation(s)
- W G Martin
- Department of Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - J Galligan
- Department of Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - S Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - T Greenaway
- Clinical Endocrinology, Royal Hobart Hospital, Hobart, Tasmania, Australia.,School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - J Burgess
- Endocrinology Laboratory, Royal Hobart Hospital, Hobart, Tasmania, Australia.,School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Chai TY, Tonks KT, Campbell LV. Long-term glycaemic control (HbA1c), not admission glucose, predicts hospital re-admission in diabetic patients. Australas Med J 2015. [PMID: 26213582 DOI: 10.4066/amj.2015.2351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Diabetic patients are commonly hyperglycaemic on presentation. Admission hyperglycaemia is associated with adverse outcomes, particularly prolonged hospitalisation. Improving inpatient glycaemia may reduce length of hospital stay (LOS) in diabetic patients. AIMS To determine whether in-hospital recognition and treatment of admission hyperglycaemia in diabetic patients is associated with reduced LOS. METHODS Medical records were reviewed from 1 November 2011 to 31 May 2012 for 162 diabetic patients admitted with a blood glucose level (BGL) ≥11.1mmol/L. In-hospital outcomes were compared. Stepwise multiple regression was used to evaluate factors contributing to LOS. RESULTS Compared to the untreated individuals (n=67), hyperglycaemia treatment (n=95) was associated with a longer LOS (median eight vs. four days, p<0.01), higher HbA1c (9.0 vs. 7.3 per cent, p<0.01), more infections (50 vs. 25 per cent, p<0.01), and more patients with follow-up plans (35 vs. 10 per cent, p<0.01). Higher HbA1c was significantly related to more follow-up (ρs=0.30, n=110, p<0.01) with a trend to lower re-admission in those with follow-up plans (ρs=-1.41, n=162, p=0.07). CONCLUSION Recognition and treatment of admission hyperglycaemia in diabetic patients was associated with longer LOS than if untreated. Contributory factors to LOS include: illness severity, infections, and higher HbA1c. Although follow-up plans were few (27 per cent) for diabetic patients with hyperglycaemia, it was significantly more likely in those with higher HbA1c. Diabetic patients' complexities require timely multidisciplinary team involvement. Improved follow-up care, particularly for hospitalised diabetic patients identified to have chronically poor glycaemic control, may help prevent future diabetic patient re-admissions.
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Affiliation(s)
- Thora Y Chai
- School of Medicine Sydney, University of Notre Dame Australia, Darlinghurst, NSW, Australia
| | - Katherine T Tonks
- Department of Endocrinology, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Lesley V Campbell
- Diabetes and Metabolism Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
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27
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Bueno E, Benitez A, Rufinelli JV, Figueredo R, Alsina S, Ojeda A, Samudio S, Cáceres M, Argüello R, Romero F, Echagüe G, Pasquel F, Umpierrez GE. BASAL-BOLUS REGIMEN WITH INSULIN ANALOGUES VERSUS HUMAN INSULIN IN MEDICAL PATIENTS WITH TYPE 2 DIABETES: A RANDOMIZED CONTROLLED TRIAL IN LATIN AMERICA. Endocr Pract 2015; 21:807-13. [PMID: 26121460 DOI: 10.4158/ep15675.or] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Few randomized studies have focused on the optimal management of non-intensive care unit patients with type 2 diabetes in Latin America. We compared the safety and efficacy of a basal-bolus regimen with analogues and human insulins in general medicine patients admitted to a University Hospital in Asunción, Paraguay. METHODS In a prospective, open-label trial, we randomized 134 nonsurgical patients with blood glucose (BG) between 140 and 400 mg/dL to a basal-bolus regimen with glargine once daily and glulisine before meals (n = 66) or Neutral Protamine Hagedorn (NPH) twice daily and regular insulin before meals (n = 68). Major outcomes included differences in daily BG levels and frequency of hypoglycemic events between treatment groups. RESULTS There were no differences in the mean daily BG (157 ± 37 mg/dL versus 158 ± 44 mg/dL; P = .90) or in the number of BG readings within target <140 mg/dL before meals (76% versus 74%) between the glargine/glulisine and NPH/regular regimens. The mean insulin dose in the glargine/glulisine group was 0.76 ± 0.3 units/kg/day (glargine, 22 ± 9 units/day; glulisine, 31 ± 12 units/day) and was not different compared with NPH/regular group (0.75 ± 0.3 units/kg/day [NPH, 28 ± 12 units/day; regular, 23 ± 9 units/day]). The overall prevalence of hypoglycemia (<70 mg/dL) was similar between patients treated with NPH/regular and glargine/glulisine (38% versus 35%; P = .68), but more patients treated with human insulin had severe (<40 mg/dL) hypoglycemia (7.6% versus 25%; P = .08). There were no differences in length of hospital stay or mortality between groups. CONCLUSION The basal-bolus regimen with insulin analogues resulted in equivalent glycemic control and frequency of hypoglycemia compared to treatment with human insulin in hospitalized patients with diabetes.
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Helfand BKI, Maselli NJ, Lessard DM, Yarzebski J, Gore JM, McManus DD, Saczynski JS, Goldberg RJ. Elevated serum glucose levels and survival after acute heart failure: a population-based perspective. Diab Vasc Dis Res 2015; 12:119-25. [PMID: 25525077 DOI: 10.1177/1479164114559024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Limited data are available about the characteristics, treatment and survival in patients without diabetes mellitus (DM), previously diagnosed DM and patients with hyperglycaemia who present with acute decompensated heart failure (ADHF). Our objectives were to examine differences in these endpoints in patients hospitalized with ADHF. METHODS Patients hospitalized with ADHF during 1995, 2000, 2002 and 2004 comprised the study population. RESULTS A total of 5428 non-diabetic patients were hospitalized with ADHF, 3807 with diagnosed DM and 513 with admission hyperglycaemia. Patients with admission hyperglycaemia experienced the highest in-hospital death rates (9.9%) compared to those with diagnosed DM (6.5%) and non-diabetics (7.5%). Patients with diagnosed DM had the greatest risk of dying after hospital discharge. CONCLUSIONS Patients with elevated blood glucose levels at hospital admission are more likely to die acutely. After resolution of the acute illness, patients with previously diagnosed DM need careful monitoring and enhanced treatment.
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Affiliation(s)
- Benjamin K I Helfand
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nicholas J Maselli
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Darleen M Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Joel M Gore
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - David D McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jane S Saczynski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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29
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The 2012 SEMDSA Guideline for the Management of Type 2 Diabetes (Revised). JOURNAL OF ENDOCRINOLOGY, METABOLISM AND DIABETES OF SOUTH AFRICA 2014. [DOI: 10.1080/22201009.2012.10872287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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30
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The 2012 SEMDSA Guideline for the Management of type 2 Diabetes. JOURNAL OF ENDOCRINOLOGY METABOLISM AND DIABETES OF SOUTH AFRICA 2014. [DOI: 10.1080/22201009.2012.10872277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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31
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Evans NR, Dhatariya KK. Assessing the relationship between admission glucose levels, subsequent length of hospital stay, readmission and mortality. Clin Med (Lond) 2012; 12:137-9. [PMID: 22586788 PMCID: PMC4954098 DOI: 10.7861/clinmedicine.12-2-137] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study aimed to investigate relationships between dysglycaemia and length of hospital stay, short-term mortality and readmission in an unselected population in an acute medical unit (AMU). The rate of follow up in non-diabetic individuals with hyperglycaemia was also measured. We analysed data from all 1,502 patients admitted through our AMU in February 2010 to assess blood glucose levels on admission, length of stay, 28-day readmissions and mortality, and to determine whether blood glucose > or = 11.1 mmol/l on admission in non-diabetic individuals was followed up. In total, blood glucose was measured on admission for 893 patients. Mean length of stay was 8.8 (standard deviation 11.9) days, for patients with blood glucose < 6.5 mmol/l on admission; 11.3 (13.6) days, for 6.5-7 mmol/l; 10.2 (14.5) days, for 7.1-9 mmol/l; 10.6 (14.9) days, for 9.1-11 mmol/l; 12 (18.4) days, for 11.1-20 mmol/l and 9.1 (11.2) days, for > 20.1 mmol/l. Length of stay for patients with blood glucose > 6.5 mmol/l on admission was significantly longer (p = 0.002). The 28-day readmission rates were 6.4%, 6%, 9.7%, 12.5%, 10% and 15%, respectively, and 28-day death rates were 4.8%, 6%, 5.8%, 17.2%, 17.1% and 6.1%, respectively. Overall, 51.4% of non-diabetic individuals with blood glucose > 11.1 mmol/l on admission were followed up. The study showed that blood glucose > 6.5 mmol/l on admission is associated with significantly longer length of stay. Hyperglycaemia was associated with increased 28-day mortality and readmissions, and is frequently underinvestigated.
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Affiliation(s)
- NR Evans
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich
| | - KK Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich
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Peterson G. Transitioning from inpatient to outpatient therapy in patients with in-hospital hyperglycemia. Hosp Pract (1995) 2012; 39:87-95. [PMID: 22056828 DOI: 10.3810/hp.2011.10.927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Transition from inpatient to outpatient care for patients with type 2 diabetes mellitus is an important aspect of patient management for which there is no guidance. Intensive glucose lowering with insulin is generally favored for seriously ill hospitalized patients, but after discharge, patients often resume their prior regimens, which may include an array of oral or injected glucose-lowering agents. Factors that should be considered in this transition include goals of care/life expectancy, glycated hemoglobin at hospital admission, home medications for other illnesses and their potential for interactions with antidiabetes treatment, comorbidities, nutritional status, physical disabilities, ability to carry out self-monitoring of blood glucose, risk for hypoglycemia, contraindications to oral medications, health literacy, and financial and other resources. Traditional oral therapies that may be used after the patient leaves the hospital include sulfonylureas, α-glucosidase inhibitors, thiazolidinediones, and metformin. α-Glucosidase inhibitors are limited by gastrointestinal adverse events, and thiazolidinediones by fluid retention and increased risk for heart failure. Thiazolidinediones also require a long period of administration for onset glucose lowering and are not suitable for transitioning hospitalized patients who have been receiving insulin to outpatient care. Metformin is contraindicated in patients with renal, cardiac, or pulmonary insufficiency. Incretin-based therapies, glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors, have limited use in hospitals, but may be suitable for the transition to outpatient treatment. The most common adverse events with glucagon-like peptide-1 inhibitors involve the gastrointestinal system. More formal studies of treatment regimens for patients with hyperglycemia leaving the hospital are needed to guide care for this group.
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Scurlock C, Raikhelkar J, Mechanick JI. The economics of glycemic control in the ICU in the United States. Curr Opin Clin Nutr Metab Care 2011; 14:209-12. [PMID: 21192256 DOI: 10.1097/mco.0b013e3283437bc4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Currently the USA has an aging population, with increasing deficits and a healthcare system that most would agree is in need of repair. Finding ways to curtail costs is urgently needed. Attention to glycemic control and metabolic care offers a cost-effective method of treatment to reduce complications. RECENT FINDINGS Healthcare-related expenses occupy an expanding portion of gross domestic product in the US and are a driver of the deficit. Despite all of this spending, the US receives average marks on outcomes and is not obtaining value in its healthcare. Any movements toward healthcare reform must focus on improving outcomes per healthcare dollar spent, and increasing value. The Affordable Care Act will place greater emphasis on preventing complications and reducing hospital-acquired infections. The original Leuven trial demonstrated that proper implementation of glycemic control can reduce morbidity and mortality. More recent studies have shown that there is a cost-benefit to glycemic control as well, through reduction of hospital stay and prevention of complications. On the basis of these changes, physicians who practice metabolic care and provide glycemic control are well positioned to add value in this era of healthcare reform. SUMMARY Glycemic control is inherently valuable in the care of ICU patients as it decreases infectious complications, reduces lengths of stay, and has a positive effect on morbidity and mortality. Further studies should be completed to delineate the exact amount of cost-savings that can be obtained by proper implementation of glycemic control in the ICU.
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Affiliation(s)
- Corey Scurlock
- Department of Anesthesiology, Division of Critical Care, Cardiothoracic Intensive Care Unit, Mount Sinai School of Medicine, New York, New York, USA.
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