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Chen Y, Tu C, Liu G, Bei M, Zhang J, Tan Z, Ge Y, Peng W, Gao F, Tian M, Yang M, Wu X. Preoperative Thyroid-Stimulating Hormone Levels and Three-Year Mortality in Elderly Hip Fracture Patients: Insights from a Prospective Cohort Study. Med Sci Monit 2024; 30:e944465. [PMID: 39099160 PMCID: PMC11312405 DOI: 10.12659/msm.944465] [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: 03/12/2024] [Accepted: 07/01/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND It is unclear whether preoperative thyroid-stimulating hormone (TSH) level is correlated with long-term mortality in the elderly after hip fracture surgery. We aimed to assess the association between TSH levels and 3-year mortality in these patients. MATERIAL AND METHODS We enrolled patients aged 65 and above who had hip fracture surgery and thyroid function tests upon admission from 2018 to 2019. Patients were categorized based on TSH median value, quartiles, or thyroid function status. The median follow-up time was 3.1 years. Cox proportional hazards models were used to examine the correlation between TSH levels and mortality, adjusting for covariates. RESULTS Out of 799 eligible patients, 92.7% (741/799) completed the follow-up, with 20.6% (153/741) of those having died by the end of the follow-up. No statistically significant differences in mortality risks were found when stratified by TSH median value (HR 0.88, 95% CI 0.64-1.22, P=0.448) or quartiles (HR ranging from 0.90 to 1.13, P>0.05). Similarly, when categorized based on admission thyroid function status, patients who presented with hypothyroidism, subclinical hypothyroidism, hyperthyroidism, and subclinical hyperthyroidism upon admission did not demonstrate a statistically significant difference in mortality risk compared to those who were considered euthyroid (HR 1.34, 95% CI 0.72-2.49, P=0.359; HR 0.77, 95% CI 0.38-1.60, P=0.489; HR 1.15, 95% CI 0.16-8.30, P=0.890; HR 1.07, 95% CI 0.34-3.38, P=0.913, respectively). CONCLUSIONS Admission TSH is not significantly associated with 3-year mortality in geriatric patients after hip fracture surgery.
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Affiliation(s)
- Yimin Chen
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing, PR China
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, PR China
- Department of Orthopaedics and Traumatology, National Center for Orthopaedics, Beijing, PR China
| | - Chao Tu
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing, PR China
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, PR China
- Department of Orthopaedics and Traumatology, National Center for Orthopaedics, Beijing, PR China
| | - Gang Liu
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing, PR China
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, PR China
- Department of Orthopaedics and Traumatology, National Center for Orthopaedics, Beijing, PR China
| | - Mingjian Bei
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing, PR China
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, PR China
- Department of Orthopaedics and Traumatology, National Center for Orthopaedics, Beijing, PR China
| | - Jing Zhang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, PR China
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Zhelun Tan
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing, PR China
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, PR China
- Department of Orthopaedics and Traumatology, National Center for Orthopaedics, Beijing, PR China
| | - Yufeng Ge
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing, PR China
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, PR China
- Department of Orthopaedics and Traumatology, National Center for Orthopaedics, Beijing, PR China
| | - Weidong Peng
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing, PR China
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, PR China
- Department of Orthopaedics and Traumatology, National Center for Orthopaedics, Beijing, PR China
| | - Feng Gao
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing, PR China
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, PR China
- Department of Orthopaedics and Traumatology, National Center for Orthopaedics, Beijing, PR China
| | - Maoyi Tian
- School of Public Health, Harbin Medical University, Harbin, Heilongjiang, PR China
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Minghui Yang
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing, PR China
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, PR China
- Department of Orthopaedics and Traumatology, National Center for Orthopaedics, Beijing, PR China
| | - Xinbao Wu
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing, PR China
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, PR China
- Department of Orthopaedics and Traumatology, National Center for Orthopaedics, Beijing, PR China
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Xie T, Meng J, Feng Z, Gao Y, Chen T, Chen Y, Geng J. Assessing patient information needs for new antidiabetic medications to inform shared decision-making: A best-worst scaling experiment in China. Health Expect 2024; 27:e14059. [PMID: 38689509 PMCID: PMC11061543 DOI: 10.1111/hex.14059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/20/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Shared decision-making (SDM) is a patient-centred approach to improve the quality of care. An essential requirement for the SDM process is to be fully aware of patient information needs. OBJECTIVES Our study aimed to assess patient information needs for new antidiabetic medications using the best-worst scaling (BWS) experiment. METHODS BWS tasks were developed according to a literature review and the focus group discussion. We used a balanced incomplete block design and blocking techniques to generate choice sets. The final BWS contains 11 attributes, with 6-choice scenarios in each block. The one-to-one, face-to-face BWS survey was conducted among type 2 diabetic patients in Jiangsu Province. Results were analyzed using count-based analysis and modelling approaches. We also conducted a subgroup analysis to observe preference heterogeneity. RESULTS Data from 539 patients were available for analysis. The most desired information domain was the comparative effectiveness of new antidiabetic medications. It consists of the incidence of macrovascular complications, the length of extended life years, changes in health-related quality of life, the incidence of microvascular complications, and the control of glycated haemoglobin. Of all the attributes, the incidence of macrovascular complications was the primary concern. Patients' glycemic control and whether they had diabetes complications exerted a significant influence on their information needs. CONCLUSIONS Information on health benefits is of critical significance for diabetic patients. Patients have different information needs as their disease progresses. Personalized patient decision aids that integrate patient information needs and provide evidence of new antidiabetic medications are worthy of being established. PATIENT OR PUBLIC CONTRIBUTION Before data collection, a pilot survey was carried out among diabetic patients to provide feedback on the acceptability and intelligibility of the attributes.
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Affiliation(s)
- Tongling Xie
- Center for Evidence‐Based MedicineNantong University Medical SchoolNantongChina
- Information CenterThe People's Hospital of RugaoNantongChina
| | - Jingyi Meng
- Center for Evidence‐Based MedicineNantong University Medical SchoolNantongChina
| | - Zhe Feng
- Center for Evidence‐Based MedicineNantong University Medical SchoolNantongChina
| | - Yue Gao
- Hepatobiliary CenterThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Tian Chen
- Department of Rehabilitation Medicine and Clinical MedicineMedical Institute of Taizhou Polytechnic CollegeTaizhouChina
| | - Yalan Chen
- Center for Evidence‐Based MedicineNantong University Medical SchoolNantongChina
| | - Jinsong Geng
- Center for Evidence‐Based MedicineNantong University Medical SchoolNantongChina
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O'Neil H, Todd A, Pearce M, Husband A. What are the consequences of over and undertreatment of type 2 diabetes mellitus in a frail population? A systematic review. Endocrinol Diabetes Metab 2024; 7:e00470. [PMID: 38411378 PMCID: PMC10897870 DOI: 10.1002/edm2.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/28/2024] Open
Abstract
AIMS This review aims to identify the evidence base for the consequences of over and undertreatment of type 2 diabetes mellitus in a frail population. METHOD In this systematic review, we searched MEDLINE, Embase, PubMed, CINAHL and the Cochrane Library for studies from January 2001 to 15th August 2022. We included a variety of study types that assessed and reported frailty including patients ≥18 years old. Studies included those that reported the prevalence of over or undertreatment of diabetes mellitus in a frail population and those examining outcomes related to glucose control in frail older people living with diabetes. Data were extracted using a bespoke extraction table using a narrative synthesis approach. RESULTS A total of 4114 articles were identified with 112 meeting inclusion criteria. These included 15,130 participants across the 11 studies with sample sizes ranging from 101 to 11,140. Several areas were identified in the included studies where under or overtreatment of diabetes impacted outcomes for patients. These included hospital admissions, readmissions, length of stay, falls, mortality, cognitive impairment and cardiovascular disease outcomes. CONCLUSION The results showed that there was a high heterogeneity of outcomes between the studies and that many examined small numbers of participants. In this review, both over and undertreatment were shown to increase adverse outcomes in frail older people. Further research around optimal glycaemic control for frail older people living with diabetes is required with the aim to identify ideal target ranges and produce practical clinical guidelines to promote attainment of these.
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Affiliation(s)
- Helen O'Neil
- School of PharmacyNewcastle UniversityNewcastleUK
- South Tyneside and Sunderland NHS Foundation TrustSinderlandUK
- NIHR North East and North Cumbria Applied Research Collaboration (NIHR NENC ARC)NewcastleUK
| | - Adam Todd
- School of PharmacyNewcastle UniversityNewcastleUK
| | - Mark Pearce
- Population Health Sciences Institute, Newcastle UniversityNewcastle upon TyneUK
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Ge Y, Chen Y, Liu G, Zhu S, Li B, Tian M, Zhang J, Wu X, Yang M. Association Between Hip Bone Mineral Density and Mortality Risk After Hip Fracture: A Prospective Cohort Study. Calcif Tissue Int 2023; 113:295-303. [PMID: 37347299 PMCID: PMC10449952 DOI: 10.1007/s00223-023-01109-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023]
Abstract
Factors related to mortality after osteoporotic hip fracture (HF) have been investigated intensively, except for proximal femoral bone mineral density (BMD), which is also the primary cause of osteoporosis. In this study, we aimed to investigate the association of hip BMD with mortality risk after HF. Four hundred and eleven elderly patients with HF in Beijing, China, were included and prospectively followed up with a median time of 3 years. At baseline, quantitative CT technique (QCT) was used to measure areal BMD (aBMD) of the unaffected hip. Areal BMDs of the total hip (TH), femoral neck (FN), trochanter (TR), and intertrochanter were analyzed with postoperative mortality as the primary outcome. A total of 394 patients (78.59 ± 7.59 years, 75.4% female) were included in our final analysis, with 86 (82.23 ± 7.00 years, 81.4% female) dead. All hip bone densities demonstrated a significant association with mortality risks in the unadjusted model, but only TR aBMD remained significantly correlated after adjusting for all covariates. Compared to the lower TR aBMD group, the higher TR aBMD group yielded significantly lower death risks (HR 0.21 95% CI 0.05-0.9, P = 0.036). Higher survival probabilities were observed for higher TH and TR aBMD in survival analysis (P < 0.001). Hip BMD, especially TR BMD assessed by QCT, is an independent risk factor for postoperative mortality following HF. QCT may present a promising avenue for opportunistic analysis in immobilized patients, providing valuable information for early detection and personalized interventions to enhance patient outcomes.
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Affiliation(s)
- Yufeng Ge
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Yimin Chen
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Gang Liu
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Shiwen Zhu
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Bo Li
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Maoyi Tian
- The George Institute for Global Health at Peking University Health Science Centre, Beijing, China
| | - Jing Zhang
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Xinbao Wu
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Minghui Yang
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China.
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Keegan GL, Bhardwaj N, Abdelhafiz AH. The outcome of frailty in older people with diabetes as a function of glycaemic control and hypoglycaemic therapy: a review. Expert Rev Endocrinol Metab 2023; 18:361-375. [PMID: 37489773 DOI: 10.1080/17446651.2023.2239907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/08/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Frailty is an emerging and newly recognized complication of diabetes in older people. However, frailty is not thoroughly investigated in diabetes outcome studies. AREAS COVERED This manuscript reviews the effect of glycemic control and hypoglycemic therapy on the incidence of frailty in older people with diabetes. EXPERT OPINION Current studies show that both low glycemia and high glycemia are associated with frailty. However, most of the studies, especially low glycemia studies, are cross-sectional or retrospective, suggesting association, rather than causation, of frailty. In addition, frail patients in the low glycemia studies are characterized by lower body weight or lower body mass index (BMI), contrary to those in the high glycemia studies, who are either overweight or obese. This may suggest that frailty has a heterogeneous metabolic spectrum, starting with an anorexic malnourished (AM) phenotype at one end, which is associated with low glycemia and a sarcopenic obese (SO) phenotype on the other end, which is associated with high glycemia. The current little evidence suggests that poor glycemic control increases the risk of frailty, but there is a paucity of evidence to suggest that tight glycemic control would reduce the risk of incident frailty. Metformin is the only well-studied hypoglycemic agent, so far, to have a protective effect against frailty independent of glycemic control in the non-frail older people with diabetes. However, once frailty is developed, the choice of the best hypoglycemic agent for these patients will be affected by the metabolic phenotype of frailty. For example, sodium glucose transporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RA) are appropriate in the SO phenotype due to their weight losing properties, while insulin therapy may be considered early in the AM phenotype due to its anabolic and weight gaining benefits. Future studies are still required to further investigate the metabolic effects of frailty on older people with diabetes, determine the most appropriate HbA1c target, and explore the most suitable hypoglycemic agent in each metabolic phenotype of frailty.
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Affiliation(s)
- Grace L Keegan
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, UK
| | - Namita Bhardwaj
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, UK
| | - Ahmed H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, UK
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Granata N, Vigoré M, Steccanella A, Ranucci L, Sarzi Braga S, Baiardi P, Pierobon A. The Clinical Frailty Scale (CFS) employment in the frailty assessment of patients suffering from Non-Communicable Diseases (NCDs): A systematic review. Front Med (Lausanne) 2022; 9:967952. [PMID: 36052327 PMCID: PMC9425100 DOI: 10.3389/fmed.2022.967952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background The Clinical Frailty Scale (CFS) is a well-established tool that has been widely employed to assess patients' frailty status and to predict clinical outcomes in the acute phase of a disease, but more information is needed to define the implications that this tool have when dealing with Non-Communicable Diseases (NCDs). Methods An electronic literature search was performed on PubMed, Scopus, EMBASE, Web of Science, and EBSCO databases to identify studies employing the CFS to assess frailty in patients with NCDs. Findings After database searching, article suitability evaluation, and studies' quality assessment, 43 studies were included in the systematic review. Researches were conducted mostly in Japan (37.5%), and half of the studies were focused on cardiovascular diseases (46.42%), followed by cancer (25.00%), and diabetes (10.71%). Simplicity (39.29%), efficacy (37.5%), and rapidity (16.07%) were the CFS characteristics mostly appreciated by the authors of the studies. The CFS-related results indicated that its scores were associated with patients' clinical outcomes (33.92%), with the presence of the disease (12.5%) and, with clinical decision making (10.71%). Furthermore, CFS resulted as a predictor of life expectancy in 23 studies (41.07%), clinical outcomes in 12 studies (21.43%), and hospital admissions/readmissions in 6 studies (10.71%). Discussion CFS was found to be a well-established and useful tool to assess frailty in NCDs, too. It resulted to be related to the most important disease-related clinical characteristics and, thus, it should be always considered as an important step in the multidisciplinary evaluation of frail and chronic patients. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.asp? PROSPERO 2021, ID: CRD42021224214.
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Affiliation(s)
- Nicolò Granata
- Department of Cardiac Respiratory Rehabilitation of Tradate Institute, Istituti Clinici Scientifici Maugeri IRCCS, Varese, Italy
| | - Martina Vigoré
- Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit of Montescano Institute, Montescano, Italy
- *Correspondence: Martina Vigoré
| | - Andrea Steccanella
- Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit of Montescano Institute, Montescano, Italy
| | - Luca Ranucci
- Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit of Montescano Institute, Montescano, Italy
| | - Simona Sarzi Braga
- Cardio-vascular Department, MultiMedica IRCCS, Sesto San Giovanni, Italy
| | - Paola Baiardi
- Central Scientific Direction, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Antonia Pierobon
- Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit of Montescano Institute, Montescano, Italy
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Tang Y, Kang L, Guo M, Fan L. Intertrochanteric Fracture Surgery Patients with Diabetes Mellitus are Prone to Suffer Perioperative Neurological and Endocrine/Metabolic Complications: A Propensity-Score Matched Analysis. Ther Clin Risk Manag 2022; 18:775-783. [PMID: 35967194 PMCID: PMC9365324 DOI: 10.2147/tcrm.s366846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background In older adults, the recovery after hip fracture surgery is not always to be well expected due to high risks of adverse outcomes including perioperative complications and mortality. We aimed to evaluate the intertrochanteric fracture (IF) patients with diabetes mellitus (DM) and receiving surgical fixation with intramedullary nail on the perioperative complications, total hospital costs (THC), length of hospital stay (LOS), and mortality. Methods In this retrospective cohort study, among 487 consecutive intertrochanteric fracture patients with age over 65 years and treated surgically by using intramedullary nail between Jan. 2015 and Mar. 2020, 353 patients were included, including 81 with DM and 272 without DM. After using propensity-score matched (PSM) analysis, 80 patients remained in each group. The perioperative complications, 30-day, 90-day, 1-year, and 2-year survival rates, THC, and LOS were observed and compared between two groups. Overall survival was compared by Kaplan–Meier method. Results No significant between-group differences were found in 30-day, 90-day, 1-year, and 2-year mortality rates, THC, LOS, and other perioperative complications after PSM and McNemar’s tests (all p>0.05), except for neurological complications (p<0.004) and endocrine/metabolic complications (p<0.001). At a mean follow-up time of 36.2 months, there were no statistically significant differences between the groups based on the Kaplan–Meier survival curve (p=0.171, log-rank). Conclusion IF surgery patients with DM are more prone to suffer perioperative neurological and endocrine/metabolic complications and they should be managed individually while being aware of these risks henceforth. Further high evidence clinical trials are needed to expand in DM patients with IF.
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Affiliation(s)
- You Tang
- Department of Joint Surgery, Binzhou People’s Hospital, Binzhou, People’s Republic of China
- Correspondence: You Tang, Department of Joint Surgery, Binzhou People’s Hospital, Binzhou, People’s Republic of China, Email
| | - Le Kang
- Department of Hand Surgery & Microsurgery and Foot & Ankle Surgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, People’s Republic of China
| | - Meng Guo
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, People’s Republic of China
| | - Linlin Fan
- Department of Child Healthcare, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, People’s Republic of China
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