1
|
Hart K, Thames MA, Massey AC, Capasso T, Lee YL, Mbaka M, Kinnard CM, Bright AC, Williams AY, Polite NM, Simmons JD, Butts CC. Diabetes in Trauma Patients: A Potential Gateway to a Medical Home. Am Surg 2024; 90:1849-1852. [PMID: 38516800 DOI: 10.1177/00031348241241615] [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] [Indexed: 03/23/2024]
Abstract
BACKGROUND Diabetes is a major determinant of health outcomes. Trauma patients are disproportionately from lower socioeconomic status, where lack of access to health care prevents timely treatment. Trauma centers could play a role in identifying patients in need of improved glucose management, but the current burden of disease is not known. We assessed the incidence of patients in need of intervention that presented to a level 1 trauma center over a 6-month period. METHODS A retrospective chart review over 6 months of all trauma patients admitted to a level 1 trauma center was performed. Patients' past medical history (PMH), medication reconciliation, and hemoglobin A1c (HbA1c) were recorded on initial assessment; patients <18 years old, lacking an HbA1c, or missing PMH were excluded. Patients with PMH of diabetes or antihyperglycemic use were classified by HbA1c: well-controlled ≤8.0% or poorly controlled >8.0%. Patients with no history of diabetes or antihyperglycemic use were classified based on their HbA1c: non-diabetic <5.7%, pre-diabetic 5.7-6.4%, and undiagnosed diabetic ≥6.5%. RESULTS Overall, 1377 patients were identified. After exclusion criteria, 903 patients were classified as follows: 593 (66%) non-diabetics, 160 (18%) pre-diabetics, and 150 (17%) diabetics. Fifteen diabetics were undiagnosed; 39 of the diagnosed diabetics were poorly controlled. Including pre-diabetics, a total of 214 (24%) trauma patients were in need of improved glycemic control. DISCUSSION One in four trauma patients would benefit from improved outpatient glycemic management, representing a missed opportunity for preventative health care. Trauma centers should develop strategies to meet this need as part of their post-discharge care.
Collapse
Affiliation(s)
- Kaylee Hart
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Margaret A Thames
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Ashley Caroline Massey
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Thomas Capasso
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Yannlei L Lee
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Maryann Mbaka
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Christopher M Kinnard
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Andrew C Bright
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Ashley Y Williams
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Nathan M Polite
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Jon D Simmons
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - C Caleb Butts
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| |
Collapse
|
2
|
Massey AC, Dunbar EG, Lee YLL, Mbaka M, Kinnard CM, Bright AC, Williams AY, Polite NM, Capasso TJ, Simmons JD, Butts CC. Incidence and Outcomes of Undiagnosed and Untreated Diabetes Mellitus in Trauma Patients. Am Surg 2023:31348231157888. [PMID: 36800323 DOI: 10.1177/00031348231157888] [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: 02/18/2023]
Abstract
Diabetes is a major determinate for mortality in trauma patients. Many diabetics are undiagnosed or poorly controlled. Trauma patients disproportionately come from lower socioeconomic status, making missed diagnoses more likely. We aimed to quantify the incidence of undiagnosed or poorly controlled diabetics assessed at a Level 1 Trauma Center. We did a retrospective chart review of admitted trauma patients over a one-month period. Past Medical History, home medication lists, and Hemoglobin A1c on admission were recorded for each patient. We determined that 30 of 173 trauma patients qualifying for the study were diabetic. Furthermore, 30% of these diabetics were undiagnosed or had poorly controlled diabetes. Undiagnosed pre-diabetics made up 20% of the entire study group. Our data show that 26% of trauma patients would benefit from an intervention for improved glucose control. Trauma centers should consider creating routine clinical practice guidelines to identify at-risk patients and provide intervention for long-term management.
Collapse
Affiliation(s)
- Ashley C Massey
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Elizabeth G Dunbar
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Yann-Leei L Lee
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Maryann Mbaka
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Christopher M Kinnard
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Andrew C Bright
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Ashley Y Williams
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Nathan M Polite
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Thomas J Capasso
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Jon D Simmons
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Charles C Butts
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| |
Collapse
|
3
|
Alawneh KZ, Raffee LA, Alshehabat MA, Alkhatib AJ. Expressions of heat shock protein 90, inducible nitric oxide synthase, and vascular endothelial growth factor in the skin of diabetic rats. Vet World 2021; 14:1804-1807. [PMID: 34475701 PMCID: PMC8404126 DOI: 10.14202/vetworld.2021.1804-1807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Aim: Chronic skin ulceration is a common and painful condition that affects about 15% of patients with diabetes worldwide. The aim of this study was to evaluate the expressions of heat shock protein 90 (HSP 90), inducible nitric oxide synthase (iNOS), and vascular endothelial growth factor (VEGF) in the skin of diabetic rats. Materials and Methods: A total of 20 rats were divided randomly into two equal groups. Diabetes mellitus (DM) was induced in the rats of Group 2, whereas the rats in Group 1 were kept healthy and served as control. DM was induced by a single intraperitoneal injection of alloxan monohydrate at 120 mg/kg. Rats were considered diabetic if the blood glucose level was above 200 mg/dL. After induction of DM, the rats were monitored daily for 28 days. On day 28, the rats were humanely euthanized, and full-thickness skin punch biopsy was obtained from the dorsal side of the thoracolumbar region. Indirect immunoperoxidase staining was used to evaluate the expressions of HSP 90, iNOS, and VEGF in the skin tissue specimens. Results: The expressions of HSP 90, iNOS, and VEGF in the skin were significantly higher in diabetic rats than in the control rats. On day 28 in diabetic rats, a positive correlation (r=0.65, p=0.01) was detected between mean blood glucose level and the expression levels of HSP 90, iNOS, and VEGF. Conclusion: The results of this study indicated that DM upregulated the expressions of HSP 90, iNOS, and VEGF in the skin tissues of diabetic rats and may impact the healing of skin wounds. However, this study was preliminary and further studies to investigate this relationship are warranted.
Collapse
Affiliation(s)
- Khaled Z Alawneh
- Department of Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Liqaa A Raffee
- Department of Accident and Emergency, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Musa A Alshehabat
- Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Ahed Jumah Alkhatib
- Department of Legal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| |
Collapse
|
4
|
Guidry BS, Kelly KA, Yengo-Kahn AM, Lan M, Tang AR, Chotai S, Morone P, Kelly PD. Statins as a Medical Adjunct in the Surgical Management of Chronic Subdural Hematomas. World Neurosurg 2021; 149:e281-e291. [PMID: 33610873 DOI: 10.1016/j.wneu.2021.02.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND By stabilizing immature leaky vessel formation in neomembranes, statin drugs have been suggested as a nonsurgical treatment option for chronic subdural hematomas (cSDH). Statin therapy seems to reduce conservatively managed cSDH volume. However, the usefulness of these medications in supplementing surgical treatment is unknown. OBJECTIVE To investigate the effect of concurrent statin therapy on outcomes after surgical treatment of cSDH. METHODS A retrospective single-institution cohort study of surgically managed patients with convexity cSDH between 2009 and 2019 was conducted. Patients receiving this diagnosis who underwent surgical decompression were included, and those without follow-up scans were excluded. Demographic, clinical, and radiographic variables were collected. cSDH size was defined as maximum radial thickness in millimeters on axial computed tomography of the head. Multivariable linear regression was performed to identify factors (including statin use) that were associated with preoperative to follow-up cSDH size change. RESULTS Overall, 111 patients, including 36 patients taking statins on admission, were evaluated. Median time to follow-up postoperative imaging was 30 days (interquartile range, 17-42 days). Patients on statins were older (median, 75 years, range, 68-78.25 years vs. 69 years, range, 59-7 years; P = 0.006) and reported more antiplatelet use (67% vs. 28%; P < 0.001). Median change in follow-up size was 13 mm in both statin and nonstatin groups. Adjusting for other clinical covariates, statin use was associated with greater reduction in cSDH size (CE = -6.72 mm, 95% confidence interval, -13.18 to -0.26 mm; P = 0.042). CONCLUSIONS Statin use is associated with improved cSDH size postoperatively. Statin drugs might represent a low-cost and low-risk supplement to the surgical management for patients with cSDH.
Collapse
Affiliation(s)
- Bradley S Guidry
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Aaron M Yengo-Kahn
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthews Lan
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Alan R Tang
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Silky Chotai
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter Morone
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Patrick D Kelly
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| |
Collapse
|
5
|
Strollo F, Furia A, Verde P, Bellia A, Grussu M, Mambro A, Petrelli MD, Gentile S. Technological innovation of Continuous Glucose Monitoring (CGM) as a tool for commercial aviation pilots with insulin-treated diabetes and stakeholders/regulators: A new chance to improve the directives? Diabetes Res Clin Pract 2021; 172:108638. [PMID: 33358969 DOI: 10.1016/j.diabres.2020.108638] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022]
Abstract
Civil aviation pilots who develop insulin-treated diabetes and want to renew a Commercial Pilot License (CPL) represent a medical, social and regulatory problem. This depends on justified concerns about hypoglycemia, the most threatening event for people who carry out jobs requiring a high level of concentration and reliability. This negatively affects social and working aspects of pilots' lives, who have a high profile and a high-cost professional qualification. It could be possible now to revise this attitude thanks to the availability of Continuous Glucose Monitoring (CGM) devices. CGM clearly showed to prevent hypoglycemic events in insulin-treated diabetic patients by allowing strict monitoring and trend prediction of glucose levels. By systematizing available data on such devices and present regulations in CPL issuance worldwide, our review can be used as handy tool for a fruitful discussion among the scientific community, national and international civil aviation regulators, stakeholders and pilots, aimed at evaluating the evidence-based opportunity to revise CPL issuance criteria for insulin-treated diabetic pilots. For the above-mentioned reasons, there are, among the regulatory administrations of Civil Aviation around the globe, several different approaches and limitations set for the subjects with insulin-treated diabetes who want to obtain, or renew, a CPL.
Collapse
Affiliation(s)
- F Strollo
- AMD (Associazione Medici Diabetologi), ESAM (European Society of Aerospace Medicine) and IRCCS San Raffaele Pisana, Rome, Italy.
| | - A Furia
- ENAC (Italian National Civil Aviation Authority), Aeromedical Section, Rome, Italy
| | - P Verde
- AIMAS (Italian Association of AeroSpace Medicine) and IAF (Italian Air Force), Experimental Flight Center, Aerospace Medicine Department, Pratica di Mare, Rome, Italy
| | - A Bellia
- SID (Società Italiana di Diabetologia), Department of Systems Medicine, Rome University, "Tor Vergata", Italy
| | - M Grussu
- ANIAD (Italian National Association of Athletes with Diabetes), Oristano, Italy
| | - A Mambro
- AIMAS (Italian Association of AeroSpace Medicine), Anesthesiology and Resuscitation Unit, Alesini CTO Hospital, Rome, Italy
| | - M D Petrelli
- SID (Società Italiana di Diabetologia), Clinic of Endocrinology and Metabolic Diseases, Polytechnic University of Marche, Ancona, Italy
| | - S Gentile
- Associazione Medici Diabetologi), Campania University "Luigi Vanvitelli", Naples, Italy, and Nefrocenter Research & Nyx Start-UP, Naples, Italy
| |
Collapse
|
6
|
Davie GS, Pal K, Orton E, Tyrrell EG, Petersen I. Incident Type 2 Diabetes and Risk of Fracture: A Comparative Cohort Analysis Using U.K. Primary Care Records. Diabetes Care 2021; 44:58-66. [PMID: 33148635 DOI: 10.2337/dc20-1220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/30/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate risk of fracture in men and women with recent diagnosis of type 2 diabetes compared with individuals without diabetes. RESEARCH DESIGN AND METHODS In this cohort study, we used routinely collected U.K. primary care data from The Health Improvement Network. In adults (>35 years) diagnosed with type 2 diabetes between 2004 and 2013, fractures sustained until 2019 were identified and compared with fractures sustained in individuals without diabetes. Multivariable models estimated time to first fracture following diagnosis of diabetes. Annual prevalence rates included at least one fracture in a given year. RESULTS Among 174,244 individuals with incident type 2 diabetes and 747,290 without diabetes, there was no increased risk of fracture among males with diabetes (adjusted hazard ratio [aHR] 0.97 [95% CI 0.94, 1.00]) and a small reduced risk among females (aHR 0.94 [95% CI 0.92, 0.96]). In those aged ≥85 years, those in the diabetes cohort were at significantly lower risk of incident fracture (males: aHR 0.85 [95% CI 0.71, 1.00]; females: aHR 0.85 [95% CI 0.78, 0.94]). For those in the most deprived areas, aHRs were 0.90 (95% CI 0.83, 0.98) for males and 0.91 (95% CI 0.85, 0.97) for females. Annual fracture prevalence rates, by sex, were similar for those with and without type 2 diabetes. CONCLUSIONS We found no evidence to suggest a higher risk of fracture following diagnosis of type 2 diabetes. After a diagnosis of type 2 diabetes, individuals should be encouraged to make positive lifestyle changes, including undertaking weight-bearing physical activities that improve bone health.
Collapse
Affiliation(s)
- Gabrielle S Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Kingshuk Pal
- Department of Primary Care and Population Health, University College London, London, U.K
| | - Elizabeth Orton
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, U.K
| | - Edward G Tyrrell
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, U.K
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, U.K
| |
Collapse
|
7
|
Barnard-Kelly KD, Naranjo D, Majidi S, Akturk HK, Breton M, Courtet P, Olié E, Lal RA, Johnson N, Renard E. Suicide and Self-inflicted Injury in Diabetes: A Balancing Act. J Diabetes Sci Technol 2020; 14:1010-1016. [PMID: 31801353 PMCID: PMC7645123 DOI: 10.1177/1932296819891136] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Glycemic control in type 1 diabetes mellitus (T1DM) remains a challenge for many, despite the availability of modern diabetes technology. While technologies have proven glycemic benefits and may reduce excess mortality in some populations, both mortality and complication rates remain significantly higher in T1DM than the general population. Diabetes technology can reduce some burdens of diabetes self-management, however, it may also increase anxiety, stress, and diabetes-related distress. Additional workload associated with diabetes technologies and the dominant focus on metabolic control may be at the expense of quality-of-life. Diabetes is associated with significantly increased risk of suicidal ideation, self-harm, and suicide. The risk increases for those with diabetes and comorbid mood disorder. For example, the prevalence of depression is significantly higher in people with diabetes than the general population, and thus, people with diabetes are at even higher risk of suicide. The Center for Disease Control and Prevention reported a 24% rise in US national suicide rates between 1999 and 2014, the highest in 30 years. In the United Kingdom, 6000 suicides occur annually. Rates of preventable self-injury mortality stand at 29.1 per 100 000 population. Individuals with diabetes have an increased risk of suicide, being three to four times more likely to attempt suicide than the general population. Furthermore, adolescents aged 15 to 19 are most likely to present at emergency departments for self-inflicted injuries (9.6 per 1000 visits), with accidents, alcohol-related injuries, and self-harm being the strongest risk factors for suicide, the second leading cause of death among 10 to 24 year olds. While we have developed tools to improve glycemic control, we must be cognizant that the psychological burden of chronic disease is a significant problem for this vulnerable population. It is crucial to determine the psychosocial and behavioral predictors to uptake and continued use of technology in order to aid the identification of those individuals most likely to realize benefits of any intervention as well as those individuals who may require more support to succeed with technology.
Collapse
Affiliation(s)
- Katharine D. Barnard-Kelly
- Faculty of Health and Social Science, Bournemouth University, UK
- BHR Limited, Fareham, Hampshire, UK
- Katharine D. Barnard-Kelly, PhD, Faculty of Health and Social Science, Bournemouth University, Bournemouth, UK.
| | | | - Shideh Majidi
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO, USA
| | - Halis K. Akturk
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO, USA
| | - Marc Breton
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA
| | - Philippe Courtet
- Psychiatric Emergency and Acute Care, Lapeyronie Hospital, University of Montpellier, France
| | - Emilie Olié
- Psychiatric Emergency and Acute Care, Lapeyronie Hospital, University of Montpellier, France
| | | | | | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, France
| |
Collapse
|
8
|
Leonard CE, Brensinger CM, Pham Nguyen TP, Horn JR, Chung S, Bilker WB, Dublin S, Soprano SE, Dawwas GK, Oslin DW, Wiebe DJ, Hennessy S. Screening to identify signals of opioid drug interactions leading to unintentional traumatic injury. Biomed Pharmacother 2020; 130:110531. [PMID: 32739738 DOI: 10.1016/j.biopha.2020.110531] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/07/2020] [Accepted: 07/11/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Efforts to minimize harms from opioid drug interactions may be hampered by limited evidence on which drugs, when taken concomitantly with opioids, result in adverse clinical outcomes. OBJECTIVE To identify signals of opioid drug interactions by identifying concomitant medications (precipitant drugs) taken with individual opioids (object drugs) that are associated with unintentional traumatic injury DESIGN: We conducted pharmacoepidemiologic screening of Optum Clinformatics Data Mart, identifying drug interaction signals by performing confounder-adjusted self-controlled case series studies for opioid + precipitant pairs and injury. SETTING Beneficiaries of a major United States-based commercial health insurer during 2000-2015 PATIENTS: Persons aged 16-90 years co-dispensed an opioid and ≥1 precipitant drug(s), with an unintentional traumatic injury event during opioid therapy, as dictated by the case-only design EXPOSURE: Precipitant-exposed (vs. precipitant-unexposed) person-days during opioid therapy. OUTCOME Emergency department or inpatient International Classification of Diseases discharge diagnosis for unintentional traumatic injury. We used conditional Poisson regression to generate confounder adjusted rate ratios. We accounted for multiple estimation via semi-Bayes shrinkage. RESULTS We identified 25,019, 12,650, and 10,826 new users of hydrocodone, tramadol, and oxycodone who experienced an unintentional traumatic injury. Among 464, 376, and 389 hydrocodone-, tramadol-, and oxycodone-precipitant pairs examined, 20, 17, and 16 (i.e., 53 pairs, 34 unique precipitants) were positively associated with unintentional traumatic injury and deemed potential drug interaction signals. Adjusted rate ratios ranged from 1.23 (95 % confidence interval: 1.05-1.44) for hydrocodone + amoxicillin-clavulanate to 4.21 (1.88-9.42) for oxycodone + telmisartan. Twenty (37.7 %) of 53 signals are currently reported in a major drug interaction knowledgebase. LIMITATIONS Potential for reverse causation, confounding by indication, and chance CONCLUSIONS: We identified previously undescribed and/or unappreciated signals of opioid drug interactions associated with unintentional traumatic injury. Subsequent etiologic studies should confirm (or refute) and elucidate these potential drug interactions.
Collapse
Affiliation(s)
- Charles E Leonard
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Center for Therapeutic Effectiveness Research, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
| | - Colleen M Brensinger
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Thanh Phuong Pham Nguyen
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - John R Horn
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA, United States
| | - Sophie Chung
- AthenaHealth, Inc., Watertown, MA, United States
| | - Warren B Bilker
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Sascha Dublin
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States
| | - Samantha E Soprano
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Ghadeer K Dawwas
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David W Oslin
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA, United States
| | - Douglas J Wiebe
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Injury Science Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Sean Hennessy
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Center for Therapeutic Effectiveness Research, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
9
|
Li TT, Yang WC, Wang YZ, Sun T, Cao HL, Chen JF, Li WZ. Effects of a high concentration of hydrogen on neurological function after traumatic brain injury in diabetic rats. Brain Res 2020; 1730:146651. [PMID: 31926128 DOI: 10.1016/j.brainres.2020.146651] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 12/14/2019] [Accepted: 01/06/2020] [Indexed: 12/15/2022]
Abstract
Reactive oxygen species, inflammation, and apoptosis are major contributors to secondary injuries that follow traumatic brain injury (TBI) in diabetic patients. Hydrogen (H2) can selectively neutralize reactive oxygen species and downregulate inflammatory and apoptotic factors. Therefore, we investigated the effects of inhaled high and low concentrations of hydrogen on neurological function after TBI in diabetic rats and the potential mechanism. We found that the inhalation of high concentrations of H2 significantly improved outcomes following TBI in diabetic rats. The inhalation of 42% H2 for one hour per day for 48 h significantly reduced brain edema, decreased the extravasation of sodium fluorescein, and reduced oxidative stress markers (p < 0.05). In addition, the inhalation of a high concentration of H2 (42% for one hour per day for 7 days) improved neurological deficits (p < 0.05) and reduced the expression of apoptotic protein markers (p < 0.05). However, the inhalation of 3% H2 did not yield significant effects. These results showed that the inhalation of 42% H2 can alleviate nerve damage and improve neurological function after TBI in diabetic rats. Therefore, the inhalation of a high concentration of H2 may be associated with the treatment of traumatic brain injuries.
Collapse
Affiliation(s)
- Ting-Ting Li
- Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, 246 XueFu Road, NanGang District, Harbin 150086, People's Republic of China
| | - Wan-Chao Yang
- Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, 246 XueFu Road, NanGang District, Harbin 150086, People's Republic of China.
| | - Yue-Zhen Wang
- Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, 246 XueFu Road, NanGang District, Harbin 150086, People's Republic of China
| | - Tian Sun
- Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, 246 XueFu Road, NanGang District, Harbin 150086, People's Republic of China
| | - Hong-Ling Cao
- Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, 246 XueFu Road, NanGang District, Harbin 150086, People's Republic of China
| | - Jian-Feng Chen
- Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, 246 XueFu Road, NanGang District, Harbin 150086, People's Republic of China
| | - Wen-Zhi Li
- Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, 246 XueFu Road, NanGang District, Harbin 150086, People's Republic of China.
| |
Collapse
|
10
|
Li Y, Glotfelty EJ, Namdar I, Tweedie D, Olson L, Hoffer BJ, DiMarchi RD, Pick CG, Greig NH. Neurotrophic and neuroprotective effects of a monomeric GLP-1/GIP/Gcg receptor triagonist in cellular and rodent models of mild traumatic brain injury. Exp Neurol 2019; 324:113113. [PMID: 31730763 DOI: 10.1016/j.expneurol.2019.113113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 02/08/2023]
Abstract
A synthetic monomeric peptide triple receptor agonist, termed "Triagonist" that incorporates glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP) and glucagon (Gcg) actions, was previously developed to improve upon metabolic and glucose regulatory benefits of single and dual receptor agonists in rodent models of diet-induced obesity and type 2 diabetes. In the current study, the neurotrophic and neuroprotective actions of this Triagonist were probed in cellular and mouse models of mild traumatic brain injury (mTBI), a prevalent cause of neurodegeneration in both the young and elderly. Triagonist dose- and time-dependently elevated cyclic AMP levels in cultured human SH-SY5Y neuronal cells, and induced neurotrophic and neuroprotective actions, mitigating oxidative stress and glutamate excitotoxicity. These actions were inhibited only by the co-administration of antagonists for all three receptor types, indicating the balanced co-involvement of GLP-1, GIP and Gcg receptors. To evaluate physiological relevance, a clinically translatable dose of Triagonist was administered subcutaneously, once daily for 7 days, to mice following a 30 g weight drop close head injury. Triagonist fully mitigated mTBI-induced visual and spatial memory deficits, evaluated at 7 and 30 days post injury. These results establish Triagonist as a novel neurotrophic/protective agent worthy of further evaluation as a TBI treatment strategy.
Collapse
Affiliation(s)
- Yazhou Li
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA.
| | - Elliot J Glotfelty
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA; Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Inbar Namdar
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - David Tweedie
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Lars Olson
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Barry J Hoffer
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | | | - Chagi G Pick
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Nigel H Greig
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA.
| |
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW The effects of hypoglycemia can result in injury, including at work. Our goal was to review the recent medical literature regarding hypoglycemia and occupational injuries and provide guidance to clinicians asked to render opinions regarding fitness for work duties in individuals with diabetes. RECENT FINDINGS Recent studies contain conflicting conclusions regarding the occupational risks posed by workers with diabetes. However, the US Federal Motor Carrier Safety Administration concluded there was sufficient evidence to change the rule that previously disqualified commercial drivers with insulin-treated diabetes. Blanket employment policies that disqualify workers with diabetes are unnecessary in many occupational fields. In assessing occupational risks and fitness for duty in workers with diabetes, it is important to perform an individualized assessment of the worker and consider the risk factors for hypoglycemia, information from the treating clinician, essential functions of the job, and, if needed, availability of reasonable accommodations.
Collapse
Affiliation(s)
- Robert M Gerbo
- Department of Occupational and Environmental Sciences, Section of Occupational Medicine, West Virginia University School of Public Health, 3860 Health Sciences Center, Morgantown, WV, 26506-9145, USA.
| | - Chuan Fang Jin
- Department of Occupational and Environmental Sciences, Section of Occupational Medicine, West Virginia University School of Public Health, 3860 Health Sciences Center, Morgantown, WV, 26506-9145, USA
| | - Karen Clark
- Department of Medicine, Section of General Internal Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| |
Collapse
|
12
|
Pal R, Ghosh A, Kumar R, Galwankar S, Paul SK, Pal S, Sinha D, Jaiswal AK, Moscote-Salazar LR, Agrawal A. Public health crisis of road traffic accidents in India: Risk factor assessment and recommendations on prevention on the behalf of the Academy of Family Physicians of India. J Family Med Prim Care 2019; 8:775-783. [PMID: 31041200 PMCID: PMC6482791 DOI: 10.4103/jfmpc.jfmpc_214_18] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Roads are considered a sign of development bringing colossal benefits to community as socioeconomic and logistic facilitator. Yet, growth of road network has brought road crashes leading to civic pain from premature deaths of productive age group. In 2017, 16 citizens were killed and 53 injured every hour on Indian roads as per officially reported data, while a fair number go unreported. This is unacceptably high when compared with international standards. Risk correlates of road traffic injuries (RTIs) need to be redefined so as to form a continuum with other confounding factors that impact to take lives on road. Risk factors impacting RTIs vary from human components to the roles and responsibilities of healthcare stakeholders. We should have made roads safer for all citizens because a large percentage of population – children, pedestrians, cyclists, motorcyclists, and the elderly – are most vulnerable. A taskforce was set up by the Academy of Family Physicians of India to scientifically analyze the literature available to assess risks and put forward appropriate recommendations.
Collapse
Affiliation(s)
- Ranabir Pal
- Department of Community Medicine, Venereology and Leprosy, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India
| | - Amrita Ghosh
- Department of Biochemistry, Medical College, Kolkata, West Bengal, India
| | - Raman Kumar
- Academy of Family Physicians of India, All India Institute of Medical Sciences, New Delhi, India
| | - Sagar Galwankar
- Department of Emergency Medicine, University of Florida, Jacksonville, FL, USA
| | - Swapan Kumar Paul
- Department of Community Medicine, Venereology and Leprosy, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India
| | - Shrayan Pal
- Department of Dermatology, Venereology and Leprosy, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India
| | - Debashis Sinha
- High Court at Calcutta and The Supreme Court of India, All India Institute of Medical Sciences, New Delhi, India
| | - A K Jaiswal
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India
| | - Luis Rafael Moscote-Salazar
- Neurosurgery-Critical Care, RED LATINO, Organización Latinoamericana de Trauma y cuidado, Neurointensivo, Bogota, Colombia
| | - Amit Agrawal
- Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
| |
Collapse
|
13
|
Kouvonen A, Kivimäki M, Pentti J, Aalto V, Oksanen T, Virtanen M, Vahtera J. Diabetes and risk of occupational injury: a cohort study. Diabet Med 2017; 34:1629-1636. [PMID: 28703867 DOI: 10.1111/dme.13423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 12/18/2022]
Abstract
AIMS To investigate if diabetes is associated with a higher risk of occupational (workplace or commuting) injury. METHODS Medication data from the Finnish Prescription Register were used to identify diabetes cases in 2004 in a large employee cohort (the Finnish Public Sector study). These data were linked to injury records obtained from the Federation of Accident Insurance Institutions. A total of 1020 diabetes cases (median age 52 years, range 20 to 65 years; 66% women) and their 5234 age- and sex-matched controls were followed up until 2011. Sex-stratified Cox proportional hazards models, adjusting for age, occupational status, obesity and health behaviours, were applied. Because of the small number of men in the cohort, injury types and locations were only examined among women. RESULTS During the median follow-up of 6.7 years, 25% of the participants with diabetes (n=252) and 20% of those without (n=1051) experienced an occupational injury. The association between diabetes and injury was stronger in women than men (P=0.048). Diabetes was associated with a higher risk of workplace (hazard ratio 1.37, 95% CI 1.11 to 1.69) and commuting (hazard ratio 1.36, 95% CI 1.03 to 1.79) injury in women. With regard to different injury types and locations, diabetes was associated with bone fractures, dislocations, sprains and strains, and injuries to upper and lower extremities. In men, there was an association between insulin-treated diabetes and commuting injury (hazard ratio 3.14, 95% CI 1.52 to 6.49). CONCLUSIONS Diabetes was associated with workplace and commuting injuries in women. Men with insulin-treated diabetes had a higher risk of commuting injuries.
Collapse
Affiliation(s)
- A Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Administrative Data Research Centre - Northern Ireland, Centre for Public Health, Queen's University Belfast, Belfast, UK
- SWPS University of Social Sciences and Humanities in Wroclaw, Wroclaw, Poland
| | - M Kivimäki
- Finnish Institute of Occupational Health, Turku and Helsinki, Finland
- Department of Epidemiology and Public Health, University College London, London, UK
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - J Pentti
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - V Aalto
- Finnish Institute of Occupational Health, Turku and Helsinki, Finland
| | - T Oksanen
- Finnish Institute of Occupational Health, Turku and Helsinki, Finland
| | - M Virtanen
- Finnish Institute of Occupational Health, Turku and Helsinki, Finland
| | - J Vahtera
- Department of Public Health, University of Turku, Turku University Hospital, Turku, Finland
| |
Collapse
|