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Veríssimo D, Pereira BR, Vinhais J, Ivo C, Martins AC, Silva JN, Passos D, Lopes L, Jácome de Castro J, Marcelino M. Cost-Effectiveness of Inpatient Continuous Glucose Monitoring. Cureus 2024; 16:e55999. [PMID: 38476508 PMCID: PMC10928466 DOI: 10.7759/cureus.55999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction Our department conducted a retrospective cohort study to compare the efficacy of continuous glucose monitoring devices versus capillary blood glucose in the glycemic control of inpatient type 2 diabetes on intensive insulin therapy in a Portuguese hospital. The use of continuous glucose monitoring devices was associated with improved glycemic control, including an increased number of glucose readings within target range and reduced hyperglycemic events, being safe concerning hypoglycemias. This is the cost-effectiveness analysis associated with these results. Aim The primary objective was to compare the cost-effectiveness of achieving glycemic control, defined as the number of patients within glycemic goals, between groups. Secondary endpoints included cost-effectiveness analyses of each time in range goal, and each percentual increment in time in range. Methods We defined each glycemic goal as: "readings within range (70-180 mg/dL) >70%", "readings below range (below 70 mg/dL) <4%", "severe hypoglycemia (below 54 mg/dL) <1%", "readings above range (above 180 mg/dL) <25%", "very high glycemic readings (above 250 mg/dL) <5%". Results Continuous glucose monitoring showed lower median cost per effect for the primary outcome (€11.1 vs. €34.9/patient), with lower cost for readings in range (€7.8 vs. €11.6/patient) and for both readings above range goals ("above 180mg/dL": €7.4 vs. €9.9/patient, and "above 250mg/dL": €6.9 vs. €17.4/patient). Conclusions There are no published data regarding the cost-effectiveness of continuous glucose monitoring devices in inpatient settings. Our results show that continuous glucose monitoring devices were associated with an improved glycemic control, at a lower cost, and endorse the feasibility of incorporating these devices into hospital settings, presenting a favorable cost-effective option compared to capillary blood glucose.
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Affiliation(s)
- David Veríssimo
- Department of Endocrinology, Hospital das Forças Armadas, Lisbon, PRT
| | - Beatriz R Pereira
- Department of Endocrinology, Hospital das Forças Armadas, Lisbon, PRT
| | - Joana Vinhais
- Department of Endocrinology, Hospital das Forças Armadas, Lisbon, PRT
| | - Catarina Ivo
- Department of Endocrinology, Hospital das Forças Armadas, Lisbon, PRT
| | - Ana C Martins
- Department of Endocrinology, Hospital das Forças Armadas, Lisbon, PRT
| | - João N Silva
- Department of Endocrinology, Hospital das Forças Armadas, Lisbon, PRT
| | - Dolores Passos
- Department of Endocrinology, Hospital das Forças Armadas, Lisbon, PRT
| | - Luís Lopes
- Department of Endocrinology, Hospital das Forças Armadas, Lisbon, PRT
| | | | - Mafalda Marcelino
- Department of Endocrinology, Hospital das Forças Armadas, Lisbon, PRT
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Veríssimo D, Regala C, Damásio I, Santos S, Donato S, Leite V. Treatment of metastatic paraganglioma: experience of a single center. Endocrine 2024:10.1007/s12020-024-03700-y. [PMID: 38296912 DOI: 10.1007/s12020-024-03700-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/14/2024] [Indexed: 02/02/2024]
Abstract
PURPOSE Data regarding treatment options and their efficacy for metastatic paragangliomas (mPPGL) is limited. This study aims to report a single center experience in treating mPPGL, comparing the efficacy and safety of various treatment approaches. METHODS Retrospective analysis of patients with mPPGL treated at an Endocrinology Department of a cancer institute between January 2000 and October 2022. RESULTS We analyzed 25 patients with mPPGL, 8 pheochromocytomas and 20 paragangliomas (12% multifocal), followed for a median of 9 [4; 14] years. Surgical approach, aimed at the primary tumor or at debulking of metastases, was the only treatment achieving complete response: 87% in primary tumor and 87.5% with debulking of metastases. These were long-lasting results with a duration of 69 (23.8; 136.8) months in primary tumor removal and 35.1 (15.3; 41) months in metastases debulking. As for other therapeutic approaches, such as radioactive isotopes, tyrosine kinase inhibitors, chemotherapy and external beam radiotherapy, the main outcome was stable disease, with few partial responses. At the last follow-up, 66% of the patients were alive, 15.4% were in remission and 84.6% had stable disease. Median overall survival was 14 years. The 5-year and 10-year survival rates from primary tumor diagnosis were 77.9% and 66.9% respectively, and from metastasis diagnosis were 67.4% and 55.6%, respectively. CONCLUSION This is the only European single center analysis addressing outcomes of different therapies in mPGL. The results support surgery as a first-line treatment, being the only approach that may achieve complete response with satisfactory and long-lasting results.
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Affiliation(s)
- David Veríssimo
- Endocrinology Department, Hospital das Forças Armadas - Pólo de Lisboa, Lisbon, Portugal.
| | - Catarina Regala
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - Inês Damásio
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - Sofia Santos
- Radiology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - Sara Donato
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
- Nova Medical School, Faculdade de Ciências Médicas de Lisboa, Lisbon, Portugal
| | - Valeriano Leite
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
- Nova Medical School, Faculdade de Ciências Médicas de Lisboa, Lisbon, Portugal
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
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Veríssimo D, Vinhais J, Ivo C, Martins AC, Nunes E Silva J, Passos D, Lopes L, Jácome de Castro J, Marcelino M. Continuous Glucose Monitoring vs. Capillary Blood Glucose in Hospitalized Type 2 Diabetes Patients. Cureus 2023; 15:e43832. [PMID: 37736430 PMCID: PMC10509631 DOI: 10.7759/cureus.43832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION The emergence of continuous glucose monitoring devices revolutionized the monitoring of diabetes, allowing real-time measurement of interstitial glucose levels. These devices are especially important for people with diabetes treated with insulin therapy and have been extensively studied in outpatient settings. In hospitalized patients, studies using continuous glucose monitoring have focused mainly on evaluating its accuracy and feasibility, but the results were unclear on whether continuous glucose monitoring was superior to capillary blood glucose in improving glycemic control and further research is needed to support the use of these devices in hospitalized patients with diabetes. OBJECTIVE The primary endpoint of this study was to assess the increase in time-in-range (glycemic readings between 100-180 mg/dL) in hospitalized patients with continuous glucose monitoring, compared to capillary blood glucose. The secondary endpoints included the assessment of reductions in hypoglycemia incidence, mean glucose levels, and glucose coefficient of variation. Additionally, we assessed the intervention's impact on reducing the length of hospital stay, mortality rates, and incidence of inpatient infections. RESEARCH DESIGN AND METHODS This was a retrospective, cohort study of 60 hospitalized patients with type 2 diabetes, divided into two groups of 30 individuals each: an intervention group monitored through continuous glucose monitoring and a control group using capillary blood glucose. RESULTS Both groups were comparable in terms of demographic and clinical characteristics. Continuous glucose monitoring users had a higher number of readings per day (six vs. four, p < 0.001), in-range readings (53.5% vs. 35%, p = 0.027), fewer above-range readings (25.5% vs. 56.5%, p = 0.003), particularly above 250 mg/dL (5% vs. 27.5%, p = 0.001), with no difference in the percentage of hypoglycemia occurence (1% vs. 0%, p = 0.107). Lower mean glucose (161.9 mg/dL vs. 206.5 mg/dL, p < 0.001) was also observed in this group. No difference was observed in mortality, length of stay, or in infection rate (p = 1.000, p = 0.455, and p = 0.606, respectively). CONCLUSIONS This retrospective study supports the use of continuous glucose monitoring in optimizing glycemic control in hospitalized patients with type 2 diabetes on intensive insulin therapy. These findings suggest that continuous glucose monitoring can improve time-in-range and prevent hyperglycemia.
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Affiliation(s)
- David Veríssimo
- Department of Endocrinology, Hospital das Forças Armadas, Lisbon, PRT
| | - Joana Vinhais
- Department of Endocrinology, Hospital das Forças Armadas, Lisbon, PRT
| | - Catarina Ivo
- Department of Endocrinology, Hospital das Forças Armadas, Lisbon, PRT
| | | | | | - Dolores Passos
- Department of Endocrinology, Hospital das Forças Armadas, Lisbon, PRT
| | - Luís Lopes
- Department of Endocrinology, Hospital das Forças Armadas, Lisbon, PRT
| | | | - Mafalda Marcelino
- Department of Endocrinology, Hospital das Forças Armadas, Lisbon, PRT
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Veríssimo D, Vinhais J, Ivo CR, Sousa I, Martins AC, Nunes E Silva J, Lopes L, Passos D, Jácome de Castro J, Marcelino M. Challenges in Management of Concomitant Primary Aldosteronism and Pheochromocytoma. Am J Case Rep 2023; 24:e939659. [PMID: 37365779 DOI: 10.12659/ajcr.939659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
BACKGROUND Primary aldosteronism and pheochromocytoma are endocrine causes of secondary arterial hypertension. The association of primary aldosteronism and pheochromocytoma is rare and the involved mechanisms are poorly understood. Either there is a coexistence of both diseases or the pheochromocytoma stimulates the production of aldosterone. Since management approaches may differ significantly, it is important to properly diagnose the 2 conditions. We describe concomitant pheochromocytoma and primary aldosteronism in a patient with resistant hypertension, which demanded a challenging and individualized approach. CASE REPORT A 64-year-old man was sent for observation in our department for type 2 diabetes and resistant hypertension. Laboratory work-up suggested a primary aldosteronism and a pheochromocytoma. The abdominal CT (before and after intravenous contrast, with portal and delayed phase acquisitions) revealed an indeterminate right adrenal lesion and 3 nodules in the left adrenal gland: 1 indeterminate and 2 compatible with adenomas. A 18F-FDOPA PET-CT showed increased uptake in the right adrenal gland. The patient underwent a right adrenalectomy and a pheochromocytoma was confirmed. An improvement in glycemic control was observed after surgery but the patient remained hypertensive. A captopril test confirmed the persistence of primary aldosteronism, and he was started on eplerenone, achieving blood pressure control. CONCLUSIONS This case highlights the challenges in diagnosing and treating the simultaneous occurrence of pheochromocytoma and primary aldosteronism. Our main goal was surgical removal of the pheochromocytoma due to the risk of an adrenergic crisis.
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Affiliation(s)
- David Veríssimo
- Endocrinology Service, Armed Forces Hospital, Lisboa, Portugal
| | - Joana Vinhais
- Endocrinology Service, Armed Forces Hospital, Lisboa, Portugal
| | | | - Isabel Sousa
- Imaging Service, Armed Forces Hospital, Lisboa, Portugal
| | | | | | - Luís Lopes
- Endocrinology Service, Armed Forces Hospital, Lisboa, Portugal
| | - Dolores Passos
- Endocrinology Service, Armed Forces Hospital, Lisboa, Portugal
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Ivo CR, Duarte V, Veríssimo D, Silva J, Passos D, Lopes L, Jácome de Castro J, Marcelino M. Thyrotropin and body mass index, are they related? Horm Mol Biol Clin Investig 2022; 44:1-4. [PMID: 36046920 DOI: 10.1515/hmbci-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/17/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES It is well recognized that overt thyroid dysfunction is associated with changes in body mass index (BMI). However, there is ongoing debate regarding the influence of thyroid stimulating hormone (TSH) on BMI, in euthyroid subjects. The aim of this study is to examine the association of TSH with BMI in an outpatient population without evidence of thyroid disease. METHODS Cross-sectional study conducted in an Endocrinology Department. We identified the latest TSH and BMI measurements in 923 patients from the reference euthyroid population. All patients with positive thyroid autoimmunity and nodules were excluded. We performed a linear regression analysis using SPSSv.025. RESULTS 923 adult patients were evaluated. 79.4% were males, with a mean age of 67.6 years old. Mean TSH level was 1.78 mIU/L and mean BMI was 29.2 kg/m2. A significant negative correlation between serum TSH concentration and BMI was evident (p=0.04; r=-0.067). Statistical significance was lost when performing subgroup analysis, for males and females (p=0.19 and p=0.075), elderly (≥65 years) and non-elderly (p=0.55 and p=0.32) and also obese (BMI ≥30 kg/m2) and non-obese (p=0.39 and p=0.13). CONCLUSIONS The relationship between BMI and TSH is not consensual in the literature. This study included a large cohort sample of euthyroid patients, majority men and with negative autoimmunity. Our results support the hypothesis that variation in thyroid status within the normal range, could have a negative effect on BMI, contrary to most published studies.
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Affiliation(s)
- Catarina R Ivo
- Endocrinology Department, Portuguese Armed Forces Hospital (HFAR), Lisbon, Portugal
| | - Vitória Duarte
- Endocrinology Department, Portuguese Armed Forces Hospital (HFAR), Lisbon, Portugal
| | - David Veríssimo
- Endocrinology Department, Portuguese Armed Forces Hospital (HFAR), Lisbon, Portugal
| | - João Silva
- Endocrinology Department, Portuguese Armed Forces Hospital (HFAR), Lisbon, Portugal
| | - Dolores Passos
- Endocrinology Department, Portuguese Armed Forces Hospital (HFAR), Lisbon, Portugal
| | - Luís Lopes
- Endocrinology Department, Portuguese Armed Forces Hospital (HFAR), Lisbon, Portugal
| | | | - Mafalda Marcelino
- Endocrinology Department, Portuguese Armed Forces Hospital (HFAR), Lisbon, Portugal
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Lundberg P, Vainio A, MacMillan DC, Smith RJ, Veríssimo D, Arponen A. The effect of knowledge, species aesthetic appeal, familiarity and conservation need on willingness to donate. Anim Conserv 2019. [DOI: 10.1111/acv.12477] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P. Lundberg
- Ecosystems and Environment Research Programme Faculty of Biological and Environmental Sciences University of Helsinki Helsinki Finland
| | - A. Vainio
- Helsinki Institute of Sustainability Science Faculty of Agriculture and Forestry HELSUS University of Helsinki Helsinki Finland
- Natural Resources Institute Finland (LUKE) Bioeconomy and Environment Helsinki Finland
| | - D. C. MacMillan
- Durrell Institute of Conservation and Ecology School of Anthropology and Conservation University of Kent Canterbury UK
| | - R. J. Smith
- Durrell Institute of Conservation and Ecology School of Anthropology and Conservation University of Kent Canterbury UK
| | - D. Veríssimo
- Department of Zoology University of Oxford Oxford UK
- Oxford Martin School University of Oxford Oxford UK
- Institute for Conservation Research San Diego Zoo Global CA USA
| | - A. Arponen
- Ecosystems and Environment Research Programme Faculty of Biological and Environmental Sciences University of Helsinki Helsinki Finland
- Helsinki Institute of Sustainability Science Faculty of Biological and Environmental Sciences HELSUS University of Helsinki Helsinki Finland
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Veríssimo D, Schmid C, Kimario FF, Eves HE. Measuring the impact of an entertainment-education intervention to reduce demand for bushmeat. Anim Conserv 2018. [DOI: 10.1111/acv.12396] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D. Veríssimo
- David H. Smith Conservation Research Fellow; Department of Environmental Health and Engineering; Whiting School of Engineering; Johns Hopkins University; Baltimore MD USA
| | | | - F. F. Kimario
- Wildlife Tourism Department; College of African Wildlife Management, Mweka; Moshi Tanzania
| | - H. E. Eves
- Virginia Polytechnic Institute and State University; Blacksburg VA USA
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