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Zhao H, Ying HL, Zhang C, Zhang S. Relative Hypoglycemia is Associated with Delirium in Critically Ill Patients with Diabetes: A Cohort Study. Diabetes Metab Syndr Obes 2022; 15:3339-3346. [PMID: 36341226 PMCID: PMC9628698 DOI: 10.2147/dmso.s369457] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Critically ill patients with premorbid diabetes can suffer from relative hypoglycemia (RHG), falling below the normal blood glucose (BG) target. However, these events have not been well defined or studied. In the present study, we aimed to explore the incidence and clinical significance of RHG events in critically ill patients with diabetes. PATIENTS AND METHODS Patients with a history of diabetes who stayed in the intensive care unit (ICU) for more than three days with at least 12 BG recordings were retrospectively included in the study. A BG level > 30% below the estimated average according to patient hemoglobin A1c measured at admission was defined as a single RHG event. Outcomes were compared between patients with and those without RHG events. RESULTS In total, 113 patients were included in the final analysis. RHG was detected in 73 patients (64.6%). Those who experienced RHG events had a significantly higher incidence of ICU delirium. They also had a higher risk of 28-day mortality, but this was not statistically significant. However, patients with a higher frequency of RHG events did have a significantly higher risk of overall mortality (57.1% for more than four events vs 15.4% for three to four events, P=0.006 and 15.1% for one to two events, P=0.003). CONCLUSION In conclusion, RHG is a common finding in critically ill patients with diabetes and is associated with mortality and the occurrence of delirium.
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Affiliation(s)
- Hui Zhao
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, People’s Republic of China
| | - Hua-Liang Ying
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, People’s Republic of China
| | - Chao Zhang
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, People’s Republic of China
- Correspondence: Chao Zhang; Shaohua Zhang, Intensive Care Unit (ICU), Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, No. 1 Tong-yang Road, Taizhou, People’s Republic of China, Tel +8613757602063; +8615268325868, Email ;
| | - Shaohua Zhang
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, People’s Republic of China
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Hsu WT, Yang DH, Liao CC, Chen JW, Hsu WH, Kuo CW, Hsu HC, Chang SH, Chen LM. Blood Glucose and Renal Function Evaluation in Patients with Viral Hepatitis. Diabetes Metab Syndr Obes 2021; 14:3337-3344. [PMID: 34321900 PMCID: PMC8312512 DOI: 10.2147/dmso.s303252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the blood glucose and renal function, determine the prevalence of hyperglycemia/diabetes mellitus (DM) and renal disease (nephropathy), and investigate the association between hyperglycemia/DM and renal disease in patients with viral hepatitis (VH). PATIENTS AND METHODS A total of 491 subjects were included in the study. Patients with VH were further divided into the hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection, and HBV-HCV co-infection subgroups. Fasting blood glucose, glycated hemoglobin (HbA1c), glycated albumin (GA), glutamic oxaloacetic transaminase (GOT), creatinine (Cr), and cystatin C (Cys C) levels were measured. Urine microalbumin levels were also assessed. Formulas for estimated average glucose calculated using glycated albumin(eAG(GA)), estimated average glucose calculated using HbA1c (eAG(HbA1c)), and estimated glomerular filtration rate calculated using cystatin C (eGFRcys) were used to evaluate the average glucose and renal function. RESULTS The prevalence of hyperglycemia/DM and renal disease was significantly higher in the VH group, especially in the HCV subgroup. The prevalence of renal disease was significantly higher in patients with VH with eAG(GA) ≥200 mg/dL. CONCLUSION Our study used multiple parameters to evaluate blood glucose and renal function in patients with VH and found that hyperglycemia/DM and renal disease are closely associated with VH, especially in subjects with HCV infection. Patients with VH, especially those with HCV infection and hyperglycemia/DM, were particularly vulnerable to renal disease.
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Affiliation(s)
- Wen-Tung Hsu
- Division of Laboratory, Taichung Armed Force General Hospital, Taichung, Taiwan, Republic of China
| | - Deng-Ho Yang
- Division of Laboratory, Taichung Armed Force General Hospital, Taichung, Taiwan, Republic of China
- Department of Internal Medicine, Taichung Armed Force General Hospital, Taichung, Taiwan, Republic of China
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, Taiwan, Republic of China
| | - Chun-Cheng Liao
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of Family Medicine, Taichung Armed Force General Hospital, Taichung, Taiwan, Republic of China
| | - Jia -Wen Chen
- Medicine Laboratory, Ministry of Health and Welfare Feng Yuan Hospital, Taichung, Taiwan, Republic of China
| | - Wen-Hsiu Hsu
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Gastroenterology, Taichung Armed Force General Hospital, Taichung, Taiwan, Republic of China
| | - Chia-Wen Kuo
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Nephrology, Taichung Armed Force General Hospital, Taichung, Taiwan, Republic of China
| | - Hung-Chang Hsu
- Division of Laboratory, Ching Chyuan Hospital, Taichung, Taiwan, Republic of China
| | - Sheng-Huang Chang
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan, Republic of China
| | - Li-Mien Chen
- Department of Internal Medicine, Taichung Armed Force General Hospital, Taichung, Taiwan, Republic of China
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Correspondence: Li-Mien Chen Department of Internal Medicine, Taichung Armed Force General Hospital, No. 348, Sec. 2, Chung-Shan Road, Taiping, Taichung, Taiwan, Republic of China Email
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Giordanengo A, Årsand E, Woldaregay AZ, Bradway M, Grottland A, Hartvigsen G, Granja C, Torsvik T, Hansen AH. Design and Prestudy Assessment of a Dashboard for Presenting Self-Collected Health Data of Patients With Diabetes to Clinicians: Iterative Approach and Qualitative Case Study. JMIR Diabetes 2019; 4:e14002. [PMID: 31290396 PMCID: PMC6647758 DOI: 10.2196/14002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/27/2019] [Accepted: 06/13/2019] [Indexed: 01/16/2023] Open
Abstract
Background Introducing self-collected health data from patients with diabetes into consultation can be beneficial for both patients and clinicians. Such an initiative can allow patients to be more proactive in their disease management and clinicians to provide more tailored medical services. Optimally, electronic health record systems (EHRs) should be able to receive self-collected health data in a standard representation of medical data such as Fast Healthcare Interoperability Resources (FHIR), from patients systems like mobile health apps and display the data directly to their users—the clinicians. However, although Norwegian EHRs are working on implementing FHIR, no solution or graphical interface is available today to display self-collected health data. Objective The objective of this study was to design and assess a dashboard for displaying relevant self-collected health data from patients with diabetes to clinicians. Methods The design relied on an iterative participatory process involving workshops with patients, clinicians, and researchers to define which information should be available and how it should be displayed. The assessment is based on a case study, presenting an instance of the dashboard populated with data collected from one patient with diabetes type 1 (in-house researcher) face-to-face by 14 clinicians. We performed a qualitative analysis based on usability, functionality, and expectation by using responses to questionnaires that were distributed to the 14 clinicians at the end of the workshops and collected before the participants left. The qualitative assessment was guided by the Standards for Reporting Qualitative Research. Results We created a dashboard permitting clinicians to assess the reliability of self-collected health data, list all collected data including medical calculations, and highlight medical situations that need to be investigated to improve the situation of the patients. The dashboard uses a combination of tables, graphs, and other visual representations to display the relevant information. Clinicians think that this type of solution will be useful during consultations every day, especially for patients living in remote areas or those who are technologically interested. Conclusions Displaying self-collected health data during consultations is not enough for clinicians; the data reliability has to be assured and the relevant information needs to be extracted and displayed along with the data to ease the introduction during a medical encounter. The prestudy assessment showed that the system provides relevant information to meet clinicians’ need and that clinicians were eager to start using it during consultations. The system has been under testing in a medical trial since November 2018, and the first results of its assessment in a real-life situation are expected in the beginning of next year (2020).
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Affiliation(s)
- Alain Giordanengo
- Department of Computer Science, UiT The Arctic University of Norway, Tromsø, Norway.,Norwegian Centre for E-health Research, Tromsø, Norway
| | - Eirik Årsand
- Norwegian Centre for E-health Research, Tromsø, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Meghan Bradway
- Norwegian Centre for E-health Research, Tromsø, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Gunnar Hartvigsen
- Department of Computer Science, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Torbjørn Torsvik
- Norwegian Centre for E-health Research, Tromsø, Norway.,Department of Neuroscience, Norwegian Electronic Health Record Research Centre, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Helen Hansen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Centre for Quality Improvement and Development, University Hospital of North Norway, Tromsø, Norway
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Hempe JM, Soros AA, Chalew SA. Estimated average glucose and self-monitored mean blood glucose are discordant estimates of glycemic control. Diabetes Care 2010; 33:1449-51. [PMID: 20357368 PMCID: PMC2890337 DOI: 10.2337/dc09-1498] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 03/27/2010] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The A1C-Derived Average Glucose study recommended reporting A1C in estimated average glucose (eAG) equivalents. We compared eAG with self-monitored mean blood glucose (MBG) to determine whether eAG is systematically biased due to biological variation in the relationship between MBG and A1C. RESEARCH DESIGN AND METHODS MBG and A1C were recorded from charts of 202 pediatric type 1 diabetic patients at 1,612 clinic visits. Patients were divided into groups with low, moderate, or high A1C bias based on a hemoglobin glycation index (HGI). RESULTS The mean +/- SD values for MBG versus eAG were as follows: total population, 194 +/- 34 vs. 196 +/- 36 mg/dl; low-HGI group, 186 +/- 31 vs. 163 +/- 20 mg/dl; moderate-HGI group, 195 +/- 28 vs. 193 +/- 19 mg/dl; and high-HGI group, 199 +/- 42 vs. 230 +/- 31 mg/dl. CONCLUSIONS eAG underestimated MBG in low HGI patients and overestimated MBG in high HGI patients. Disagreement between eAG and MBG downloaded from patient glucose meters will cause confusion if eAG is implemented for clinical use.
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Affiliation(s)
- James M Hempe
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.
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Bozkaya G, Ozgu E, Karaca B. The association between estimated average glucose levels and fasting plasma glucose levels. Clinics (Sao Paulo) 2010; 65:1077-80. [PMID: 21243275 PMCID: PMC2999698 DOI: 10.1590/s1807-59322010001100003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 08/02/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The level of hemoglobin A1c (HbA1c), also known as glycated hemoglobin, determines how well a patient's blood glucose level has been controlled over the previous 8-12 weeks. HbA1c levels help patients and doctors understand whether a particular diabetes treatment is working and whether adjustments need to be made to the treatment. Because the HbA1c level is a marker of blood glucose for the previous 120 days, average blood glucose levels can be estimated using HbA1c levels. Our aim in the present study was to investigate the relationship between estimated average glucose levels, as calculated by HbA1c levels, and fasting plasma glucose levels. METHODS The fasting plasma glucose levels of 3891 diabetic patient samples (1497 male, 2394 female) were obtained from the laboratory information system used for HbA1c testing by the Department of Internal Medicine at the Izmir Bozyaka Training and Research Hospital in Turkey. These samples were selected from patient samples that had hemoglobin levels between 12 and 16 g/dL. The estimated glucose levels were calculated using the following formula: 28.7 x HbA1c - 46.7. Glucose and HbA1c levels were determined using hexokinase and high performance liquid chromatography (HPLC) methods, respectively. RESULTS A strong positive correlation between fasting plasma glucose levels and estimated average blood glucose levels (r=0.757, p<0.05) was observed. The difference was statistically significant. CONCLUSION Reporting the estimated average glucose level together with the HbA1c level is believed to assist patients and doctors determine the effectiveness of blood glucose control measures.
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Affiliation(s)
- Giray Bozkaya
- Izmir Bozyaka Training and Research Hospital, Turkey.
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