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1.
Cardiovasc Diabetol ; 20(1): 69, 2021 03 23.
Artículo en Inglés | MEDLINE | ID: mdl-33757510

RESUMEN

BACKGROUND: During COVID-19 pandemic, elective invasive cardiac procedures (ICP) have been frequently cancelled or postponed. Consequences may be more evident in patients with diabetes. OBJECTIVES: The objective was to identify the peculiarities of patients with DM among those in whom ICP were cancelled or postponed due to the COVID-19 pandemic, as well as to identify subgroups in which the influence of DM has higher impact on the clinical outcome. METHODS: We included 2,158 patients in whom an elective ICP was cancelled or postponed during COVID-19 pandemic in 37 hospitals in Spain. Among them, 700 (32.4%) were diabetics. Patients with and without diabetes were compared. RESULTS: Patients with diabetes were older and had a higher prevalence of other cardiovascular risk factors, previous cardiovascular history and co-morbidities. Diabetics had a higher mortality (3.0% vs. 1.0%; p = 0.001) and cardiovascular mortality (1.9% vs. 0.4%; p = 0.001). Differences were especially important in patients with valvular heart disease (mortality 6.9% vs 1.7% [p < 0.001] and cardiovascular mortality 4.9% vs 0.9% [p = 0.002] in patients with and without diabetes, respectively). In the multivariable analysis, diabetes remained as an independent risk factor both for overall and cardiovascular mortality. No significant interaction was found with other clinical variables. CONCLUSION: Among patients in whom an elective invasive cardiac procedure is cancelled or postponed during COVID-19 pandemic, mortality and cardiovascular mortality is higher in patients with diabetes, irrespectively on other clinical conditions. These procedures should not be cancelled in patients with diabetes.


Asunto(s)
Angiografía Coronaria , Diabetes Mellitus , Cardiopatías/diagnóstico por imagen , Cardiopatías/terapia , Intervención Coronaria Percutánea , Tiempo de Tratamiento , Listas de Espera , Factores de Edad , Anciano , Anciano de 80 o más Años , Comorbilidad , Bases de Datos Factuales , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Femenino , Cardiopatías/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Medición de Riesgo , Factores de Riesgo , España/epidemiología , Factores de Tiempo , Listas de Espera/mortalidad
2.
Clin Appl Thromb Hemost ; 27: 1076029621996445, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33760664

RESUMEN

BACKGROUND: To investigate the factors associated with elevated fibrinogen (Fbg) levels in COVID-19 patients with and without diabetes (DM) and impaired fasting glucose (IFG). METHODS: According to whether or not their glucose metabolism was impaired, COVID-19 patients were subdivided into 2 groups: 1) with DM and IFG, 2) control group. Their demographic data, medical history, signs and symptoms, laboratory results, and final clinical results were analyzed retrospectively. RESULTS: 28 patients (16.3%) died during hospitalization, including 21 (29.2%) in group 1 and 7 (7.0%) in group 2 (P < 0.001). Fbg levels in groups 1 and 2 were higher than the normal range, at 5.6 g/L (IQR 4.5-7.2 g/L) and 5.0 g/L (IQR 4.0-6.1 g/L), respectively (P = 0.009). Serum ferritin levels, C-reactive protein (CRP), interleukin-6 (IL-6), IL-8, tumor necrosis factor-α (TNF-α), triglycerides (TG) were significantly increased in group 1 compared to those in the control. TG levels were 1.3 mmol/L in the control, while that in group 1 was 1.8 mmol/L. Multiple linear regression showed that the predicting factors of Fbg in the control group were serum ferritin and CRP, R2 = 0.295; in group 1, serum ferritin, CRP, and TG, R2 = 0.473. CONCLUSIONS: Fbg in all COVID-19 patients is related to serum ferritin and CRP involved in inflammation. Furthermore, in COVID-19 patients with insulin resistance, Fbg is linearly positively correlated with TG. This suggests that regulation of TG, insulin resistance, and inflammation may reduce hypercoagulability in COVID-19 patients, especially those with insulin resistance.


Asunto(s)
Glucemia/análisis , Diabetes Mellitus/sangre , Ayuno/sangre , Fibrinógeno/análisis , Resistencia a la Insulina , Trombofilia/sangre , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Coagulación Sanguínea , Proteína C-Reactiva/análisis , /virología , Diabetes Mellitus/diagnóstico , Femenino , Ferritinas/sangre , Humanos , Mediadores de Inflamación/sangre , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Trombofilia/diagnóstico , Trombofilia/virología , Triglicéridos/sangre , Regulación hacia Arriba , Adulto Joven
3.
Methods Mol Biol ; 2212: 45-53, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33733349

RESUMEN

The genetic epistasis effect has been widely acknowledged as an essential contributor to genetic variation in complex diseases. In this chapter, we introduce a powerful and efficient statistical method, called W-test, for genetic epistasis testing. A wtest R package is developed for the implementation of the W-test method, which provides various functions to measure the main effect, pairwise interaction, higher-order interaction, and cis-regulation of SNP-CpG pairs in genetic and epigenetic data. It allows flexible stagewise and exhaustive association testing as well as diagnostic checking on the probability distributions in a user-friendly interface. The wtest package is available in CRAN at https://CRAN.R-project.org/package=wtest .


Asunto(s)
Algoritmos , Islas de CpG , Diabetes Mellitus/genética , Epistasis Genética , Polimorfismo de Nucleótido Simple , Programas Informáticos , Biología Computacional/métodos , Metilación de ADN , Conjuntos de Datos como Asunto , Diabetes Mellitus/diagnóstico , Pruebas Genéticas , Genotipo , Humanos , Probabilidad , Tamaño de la Muestra
4.
BMC Endocr Disord ; 21(1): 56, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33771154

RESUMEN

BACKGROUND: Diabetes is associated with poor coronavirus disease 2019 (COVID-19) outcomes. However, little is known on the impact of undiagnosed diabetes in the COVID-19 population. We investigated whether diabetes, particularly undiagnosed diabetes, was associated with an increased risk of death from COVID-19. METHODS: This retrospective study identified adult patients with COVID-19 admitted to Tongji Hospital (Wuhan) from January 28 to April 4, 2020. Diabetes was determined using patients' past history (diagnosed) or was newly defined if the hemoglobin A1c (HbA1c) level at admission was ≥6.5% (48 mmol/mol) (undiagnosed). The in-hospital mortality rate and survival probability were compared between the non-diabetes and diabetes (overall, diagnosed, and undiagnosed diabetes) groups. Risk factors of mortality were explored using Cox regression analysis. RESULTS: Of 373 patients, 233 were included in the final analysis, among whom 80 (34.3%) had diabetes: 44 (55.0%) reported a diabetes history, and 36 (45.0%) were newly defined as having undiagnosed diabetes by HbA1c testing at admission. Compared with the non-diabetes group, the overall diabetes group had a significantly increased mortality rate (22.5% vs. 5.9%, p <  0.001). Moreover, the overall, diagnosed, and undiagnosed diabetes groups displayed lower survival probability in the Kaplan-Meier survival analysis (all p <  0.01). Using multivariate Cox regression, diabetes, age, quick sequential organ failure assessment score, and D-dimer ≥1.0 µg/mL were identified as independent risk factors for in-hospital death in patients with COVID-19. CONCLUSIONS: The prevalence of undiagnosed pre-existing diabetes among patients with COVID-19 is high in China. Diabetes, even newly defined by HbA1c testing at admission, is associated with increased mortality in patients with COVID-19. Screening for undiagnosed diabetes by HbA1c measurement should be considered in adult Chinese inpatients with COVID-19.


Asunto(s)
/sangre , Diabetes Mellitus/sangre , Diabetes Mellitus/mortalidad , Hemoglobina A Glucada/metabolismo , Mortalidad Hospitalaria/tendencias , Anciano , China/epidemiología , Diabetes Mellitus/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo
5.
Eur J Endocrinol ; 184(4): 575-585, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33606663

RESUMEN

Objective: Transient neonatal diabetes mellitus (TNDM) is caused by activating mutations in ABCC8 and KCNJ11 genes (KATP/TNDM) or by chromosome 6q24 abnormalities (6q24/TNDM). We wanted to assess whether these different genetic aetiologies result in distinct clinical features. Design: Retrospective analysis of the Italian data set of patients with TNDM. Methods: Clinical features and treatment of 22 KATP/TNDM patients and 12 6q24/TNDM patients were compared. Results: Fourteen KATP/TNDM probands had a carrier parent with abnormal glucose values, four patients with 6q24 showed macroglossia and/or umbilical hernia. Median age at diabetes onset and birth weight were lower in patients with 6q24 (1 week; -2.27 SD) than those with KATP mutations (4.0 weeks; -1.04 SD) (P = 0.009 and P = 0.007, respectively). Median time to remission was longer in KATP/TNDM than 6q24/TNDM (21.5 weeks vs 12 weeks) (P = 0.002). Two KATP/TNDM patients entered diabetes remission without pharmacological therapy. A proband with the ABCC8/L225P variant previously associated with permanent neonatal diabetes entered 7-year long remission after 1 year of sulfonylurea therapy. Seven diabetic individuals with KATP mutations were successfully treated with sulfonylurea monotherapy; four cases with relapsing 6q24/TNDM were treated with insulin, metformin or combination therapy. Conclusions: If TNDM is suspected, KATP genes should be analyzed first with the exception of patients with macroglossia and/or umbilical hernia. Remission of diabetes without pharmacological therapy should not preclude genetic analysis. Early treatment with sulfonylurea may induce long-lasting remission of diabetes in patients with KATP mutations associated with PNDM. Adult patients carrying KATP/TNDM mutations respond favourably to sulfonylurea monotherapy.


Asunto(s)
Diabetes Mellitus , Enfermedades del Recién Nacido , Conjuntos de Datos como Asunto , Diabetes Mellitus/clasificación , Diabetes Mellitus/congénito , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/genética , Diabetes Mellitus/terapia , Diagnóstico Diferencial , Técnicas de Diagnóstico Endocrino/normas , Femenino , Humanos , Lactante , Recién Nacido , Enfermedades del Recién Nacido/clasificación , Enfermedades del Recién Nacido/diagnóstico , Enfermedades del Recién Nacido/genética , Enfermedades del Recién Nacido/terapia , Italia , Masculino , Mutación , Canales de Potasio de Rectificación Interna/genética , Inducción de Remisión/métodos , Estudios Retrospectivos , Receptores de Sulfonilurea/genética
6.
Curr Probl Cardiol ; 46(5): 100819, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33631706

RESUMEN

OBJECTIVES AND METHODS: the current understanding of the interplay between cardiovascular (CV) risk and Covid-19 is grossly inadequate. CV risk-prediction models are used to identify and treat high risk populations and to communicate risk effectively. These tools are unexplored in Covid-19. The main objective is to evaluate the association between CV scoring systems and chest X ray (CXR) examination (in terms of severity of lung involvement) in 50 Italian Covid-19 patients. Results only the Framingham Risk Score (FRS) was applicable to all patients. The Atherosclerotic Cardiovascular Disease Score (ASCVD) was applicable to half. 62% of patients were classified as high risk according to FRS and 41% according to ASCVD. Patients who died had all a higher FRS compared to survivors. They were all hypertensive. FRS≥30 patients had a 9.7 higher probability of dying compared to patients with a lower FRS. We found a strong correlation between CXR severity and FRS and ASCVD (P < 0.001). High CV risk patients had consolidations more frequently. CXR severity was significantly associated with hypertension and diabetes. 71% of hypertensive patients' CXR and 88% of diabetic patients' CXR had consolidations. Patients with diabetes or hypertension had 8 times greater risk of having consolidations. CONCLUSIONS: High CV risk correlates with more severe CXR pattern and death. Diabetes and hypertension are associated with more severe CXR. FRS offers more predictive utility and fits best to our cohort. These findings may have implications for clinical practice and for the identification of high-risk groups to be targeted for the vaccine precedence.


Asunto(s)
/diagnóstico por imagen , Enfermedades Cardiovasculares/diagnóstico , Indicadores de Salud , Radiografía Torácica , Adulto , Anciano , /terapia , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/terapia , Comorbilidad , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/mortalidad , Italia , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad
7.
High Blood Press Cardiovasc Prev ; 28(2): 159-165, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33548022

RESUMEN

INTRODUCTION: It is unclear whether the increased risk associated with diabetes in patients on dialysis is due to diabetes or a consequence of associated cardiovascular disease (CVD). AIM: The purpose of this work was to answer the question: do diabetes and CVD have a similar impact on the incidence of cardiovascular events in patients undergoing maintenance hemodialysis? METHODS: A prespecified protocol was used to prospectively evaluate and follow up 310 diabetic patients on hemodialysis without clinical evidence of CVD and 395 nondiabetic patients with CVD. Endpoint was the incidence of composite CV events and coronary events. RESULTS: The incidence of composite CV events (log-rank = 0.540) and coronary events (log-rank = 0.400) did not differ between groups. Because of the potential influence of occult CVD in patients with diabetes, we repeated the analysis excluding subjects with altered ejection fraction, a myocardial perfusion scan defect, and coronary artery disease in the group of patients with diabetes. Again we found no difference between groups (log-rank = 0.657). CONCLUSION: In patients on hemodialysis, diabetes and CVD carry similar risks for CV events. These results are congruent with the diabetes mellitus-CVD equivalence risk concept reported in the general population.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus/epidemiología , Diálisis Renal , Insuficiencia Renal Crónica/terapia , Anciano , Enfermedades Cardiovasculares/diagnóstico , Diabetes Mellitus/diagnóstico , Femenino , Humanos , Incidencia , Italia , Masculino , Persona de Mediana Edad , Pronóstico , Diálisis Renal/efectos adversos , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/epidemiología , Estudios Retrospectivos , Medición de Riesgo
8.
Diabetologia ; 64(4): 778-794, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33599800

RESUMEN

AIMS/HYPOTHESIS: This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19). METHODS: The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days. RESULTS: We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th-75th percentile) 28.4 (25.0-32.4) kg/m2. Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5-14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors. CONCLUSIONS/INTERPRETATION: In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04324736.


Asunto(s)
/diagnóstico , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Alta del Paciente , Anciano , Anciano de 80 o más Años , /terapia , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/mortalidad , Complicaciones de la Diabetes/terapia , Diabetes Mellitus/terapia , Femenino , Estudios de Seguimiento , Francia/epidemiología , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Pronóstico , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , /fisiología
9.
ACS Appl Mater Interfaces ; 13(6): 7801-7811, 2021 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-33534533

RESUMEN

Metal-organic frameworks (MOFs) stand as one of the most promising materials for the development of advanced technologies owing to their unique combination of properties. The conventional synthesis of MOFs involves a direct reaction of the organic linkers and metal salts; however, their postsynthetic modification is a sophisticated route to produce new materials or to confer novel properties that cannot be attained through the traditional methods. This work describes the postsynthetic MOF-to-MOF transformation of a nonluminescent MOF (Zn-based Oxford University-1 material [Zn-BDC, where BDC = 1,4-benzene dicarboxylate] (OX-1)) into a highly luminescent framework (Ag-based Oxford University-2 material [Ag-BDC] (OX-2)) by a simple immersion of the former in a silver salt solution. The conversion mechanism exploits the uncoordinated oxygen atoms of terephthalate linkers found in OX-1, instead of the unsaturated metal sites commonly employed, making the reaction much faster. The materials derived from the OX-1 to OX-2 transformation are highly luminescent and exhibit a selective response to acetone, turning them into a promising candidate for manufacturing fluorometric sensors for the diagnosis and monitoring of diabetes mellitus. Our methodology can be extended to other metals such as lead (Pb). The fabrication of a polymer mixed-matrix membrane containing OX-1 is used as a proof-of-concept for capturing Pb ions (as pollutants) from water. This research instigates the exploration of alternative methodologies to confer MOFs with special aptitudes for photochemical sensing or for environmental applications such as water purification.


Asunto(s)
Acetona/análisis , Diabetes Mellitus/diagnóstico , Plomo/aislamiento & purificación , Luminiscencia , Estructuras Metalorgánicas/química , Contaminantes Químicos del Agua/análisis , Plomo/química , Mediciones Luminiscentes , Estructuras Metalorgánicas/síntesis química , Tamaño de la Partícula , Propiedades de Superficie
10.
Diabetes Metab Syndr ; 15(1): 433-437, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33588200

RESUMEN

BACKGROUND AND AIMS: The COVID-19 pandemic has led to a rapid growth in the use of telemedicine for delivery of ambulatory diabetes care. This study evaluated the feasibility of remote HbA1c monitoring via dried blood spot (DBS) testing to support assessment of glycemic control for telemedicine visits and examined clinical and demographic characteristics associated with patient completion of DBS testing. METHODS: Providers could place orders for DBS HbA1c 3 weeks prior to telemedicine visits. Feasibility was assessed by examining DBS completion rates, time to completion, and availability of DBS results prior to telemedicine visits. Chi-square tests and Mann Whitney tests were used to assess whether completion rates were associated with participant characteristics. RESULTS: Of 303 DBS orders placed for telemedicine visits in June 2020, 162 patients completed the DBS test for a completion rate of (53.4%). Average time from collection at home to result being reported was 6.9 (3.8) days. The DBS result was available in 67.6% of patients who completed successful DBS, before the telemedicine clinic visit. HbA1c was lower in the DBS completion group as compared to the non-completion group (8.2% vs. 8.9%, p = 0.01). No other clinical or demographic characteristics were significantly different between the two groups. CONCLUSION: Remote HbA1c monitoring via DBS is feasible and offers an avenue to support assessment of glycemic control for patients seen via telemedicine. Future work should focus on improving clinic and laboratory processes to support remote DBS collection.


Asunto(s)
/epidemiología , Diabetes Mellitus/sangre , Diabetes Mellitus/epidemiología , Pruebas con Sangre Seca/métodos , Hemoglobina A Glucada/metabolismo , Telemedicina/métodos , Adaptación Psicológica , Adolescente , Niño , Diabetes Mellitus/diagnóstico , Pruebas con Sangre Seca/tendencias , Estudios de Factibilidad , Femenino , Humanos , Masculino , Telemedicina/tendencias
12.
BMJ Open ; 11(1): e044526, 2021 01 31.
Artículo en Inglés | MEDLINE | ID: mdl-33518528

RESUMEN

OBJECTIVES: To determine if obesity and diabetes are risk factors for severe outcomes in COVID-19 and to compare patient outcomes in those two conditions. DESIGN: Retrospective cohort study. SETTING: Urban tertiary care center in New York City. PARTICIPANTS: 302 patients admitted in an inpatient setting, ≥18 years old, with a laboratory-confirmed diagnosis of COVID-19 via nasal PCR swab were randomly selected. Patients were separated into two cohorts based on their body mass index and hemoglobin A1c. 150 patients were placed in the non-obese, non-diabetic cohort and 152 patients were placed in the corresponding cohort (obesity alone, obesity and diabetes, and diabetes alone). MEASUREMENTS: Primary outcomes were development of acute kidney injury, commencement of renal replacement therapy, aminotransferase elevation, troponin elevation, lactic acidosis, development of septic shock, use of vasopressors, presence of acute respiratory distress syndrome (ARDS) and intubation. The secondary outcomes were length of stay in days and mortality. RESULTS: Patients with obesity and/or diabetes were more likely to develop ARDS (79 patients vs 57 patients, p<0.0001) and to be intubated (71 patients vs 45 patients, p=0.0031). Patients with obesity and/or diabetes were more likely to require vasopressors (60 patients vs 41 patients, p=0.0284) and to develop lactic acidosis (median 3.15 mmol/L, IQR 1.8 to 5.2 mmol/L, p=0.0432). When comparing patients with diabetes with and without obesity against patients with obesity alone, they were more likely to develop ARDS (87.5%, p=0.0305). Despite these findings, there was no difference in mortality. CONCLUSIONS: In patients hospitalised with COVID-19, those with obesity and/or diabetes were more likely to suffer severe complications, but had negligible differences in mortality. This highlights the importance of close monitoring of patients with these conditions and additional areas of research needed to explain the mortality findings.


Asunto(s)
Diabetes Mellitus , Hemoglobina A Glucada/análisis , Obesidad , /aislamiento & purificación , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , Índice de Masa Corporal , /complicaciones , /terapia , Comorbilidad , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Ciudad de Nueva York/epidemiología , Obesidad/diagnóstico , Obesidad/epidemiología , Evaluación de Procesos y Resultados en Atención de Salud , Distribución Aleatoria , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo
13.
Cochrane Database Syst Rev ; 2: CD012707, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33634854

RESUMEN

BACKGROUND: To support patient-centred care, healthcare organisations increasingly offer patients access to data stored in the institutional electronic health record (EHR). OBJECTIVES: Primary objective 1. To assess the effects of providing adult patients with access to electronic health records (EHRs) alone or with additional functionalities on a range of patient, patient-provider, and health resource consumption outcomes, including patient knowledge and understanding, patient empowerment, patient adherence, patient satisfaction with care, adverse events, health-related quality of life, health-related outcomes, psychosocial health outcomes, health resource consumption, and patient-provider communication. Secondary objective 1. To assess whether effects of providing adult patients with EHR access alone versus EHR access with additional functionalities differ among patient groups according to age, educational level, or different status of disease (chronic or acute). SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and Scopus in June 2017 and in April 2020. SELECTION CRITERIA: Randomised controlled trials and cluster-randomised trials of EHR access with or without additional functionalities for adults with any medical condition. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. MAIN RESULTS: We included 10 studies with 78 to 4500 participants and follow-up from 3 to 24 months. Nine studies assessed the effects of EHR with additional functionalities, each addressing a subset of outcomes sought by this review. Five studies focused on patients with diabetes mellitus, four on patients with specific diseases, and one on all patients. All studies compared EHR access alone or with additional functionalities plus usual care versus usual care only. No studies assessing the effects of EHR access alone versus EHR access with additional functionalities were identified. Interventions required a variety of data within the EHR, such as patient history, problem list, medication, allergies, and lab results. In addition to EHR access, eight studies allowed patients to share self-documented data, seven offered individualised disease management functions, seven offered educational disease-related information, six supported secure communication, and one offered preventive reminders. Only two studies were at low or unclear risk of bias across domains. Meta-analysis could not be performed, as participants, interventions, and outcomes were too heterogeneous, and most studies presented results based on different adjustment methods or variables. The quality of evidence was rated as low or very low across outcomes. Overall differences between intervention and control groups, if any, were small. The relevance of any small effects remains unclear for most outcomes because in most cases, trial authors did not define a minimal clinically important difference. Overall, results suggest that the effects of EHR access alone and with additional functionalities are mostly uncertain when compared with usual care. Patient knowledge and understanding: very low-quality evidence is available from one study, so we are uncertain about effects of the intervention on patient knowledge about diabetes and blood glucose testing. Patient empowerment: low-quality evidence from three studies suggests that the intervention may have little or no effect on patient empowerment measures. Patient adherence: low-quality evidence from two studies suggests that the intervention may slightly improve adherence to the process of monitoring risk factors and preventive services. Effects on medication adherence are conflicting in two studies; this may or may not improve to a clinically relevant degree. Patient satisfaction with care: low-quality evidence from three studies suggests that the intervention may have little or no effect on patient satisfaction, with conflicting results. Adverse events: two small studies reported on mortality; one of these also reported on serious and other adverse events, but sample sizes were too small for small differences to be detected. Therefore, low-quality evidence suggests that the intervention may have little to no effect on mortality and other adverse events. Health-related quality of life: only very low-quality evidence from one study is available. We are uncertain whether the intervention improves disease-specific quality of life of patients with asthma. Health-related outcomes: low-quality evidence from eight studies suggests that the intervention may have little to no effect on asthma control, glycosylated haemoglobin (HbA1c) levels, blood pressure, low-density lipoprotein or total cholesterol levels, body mass index or weight, or 10-year Framingham risk scores. Low-quality evidence from one study suggests that the composite scores of risk factors for diabetes mellitus may improve slightly with the intervention, but there is uncertainty about effects on ophthalmic medications or intraocular pressure. Psychosocial health outcomes: no study investigated psychosocial health outcomes in a more than anecdotal way. Health resource consumption: low-quality evidence for adult patients in three studies suggests that there may be little to no effect of the intervention on different measures of healthcare use. Patient-provider communication: very low-quality evidence is available from a single small study, and we are uncertain whether the intervention improves communication measures, such as the number of messages sent. AUTHORS' CONCLUSIONS: The effects of EHR access with additional functionalities in comparison with usual care for the most part are uncertain. Only adherence to the process of monitoring risk factors and providing preventive services as well as a composite score of risk factors for diabetes mellitus may improve slightly with EHR access with additional functionalities. Due to inconsistent terminology in this area, our search may have missed relevant studies. As the overall quality of evidence is very low to low, future research is likely to change these results. Further trials should investigate the impact of EHR access in a broader range of countries and clinical settings, including more patients over a longer period of follow-up, as this may increase the likelihood of detecting effects of the intervention, should these exist. More studies should focus on assessing outcomes such as patient empowerment and behavioural outcomes, rather than concentrating on health-related outcomes alone. Future studies should distinguish between effects of EHR access only and effects of additional functionalities, and investigate the impact of mobile EHR tools. Future studies should include information on usage patterns, and consider the potential for widening health inequalities with implementation of EHR access. A taxonomy for EHR access and additional functionalities should be developed to promote consistency and comparability of outcome measures, and facilitate future reviews by better enabling cross-study comparisons.


Asunto(s)
Registros Electrónicos de Salud , Acceso de los Pacientes a los Registros , Adulto , Asma/terapia , Sesgo , Glucemia/análisis , Comprensión , Diabetes Mellitus/sangre , Diabetes Mellitus/diagnóstico , Registros Electrónicos de Salud/estadística & datos numéricos , Glaucoma/tratamiento farmacológico , Conocimientos, Actitudes y Práctica en Salud , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Insuficiencia Cardíaca/terapia , Humanos , Hipertensión/terapia , Persona de Mediana Edad , Acceso de los Pacientes a los Registros/estadística & datos numéricos , Cooperación del Paciente , Participación del Paciente , Satisfacción del Paciente , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
14.
Diabetes Care ; 44(4): 976-982, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33574126

RESUMEN

OBJECTIVE: Although elevated glucose levels are reported to be associated with adverse outcomes of coronavirus disease 2019 (COVID-19), the optimal range of glucose in patients with COVID-19 and diabetes remains unknown. This study aimed to investigate the threshold of glycemia and its association with the outcomes of COVID-19. RESEARCH DESIGN AND METHODS: Glucose levels were assessed through intermittently scanned continuous glucose monitoring in 35 patients for an average period of 10.2 days. The percentages of time above range (TAR), time below range (TBR), time in range (TIR), and coefficient of variation (CV) were calculated. Composite adverse outcomes were defined as either the need for admission to the intensive care unit, need for mechanical ventilation, or morbidity with critical illness. RESULTS: TARs using thresholds from 160 to 200 mg/dL were significantly associated with composite adverse outcomes after adjustment of covariates. Both TBR (<70 mg/dL) and TIR (70-160 mg/dL), but not mean sensor glucose level, were significantly associated with composite adverse outcomes and prolonged hospitalization. The multivariate-adjusted odds ratios of the CV of sensor glucose across tertiles for composite adverse outcomes of COVID-19 were 1.00, 1.18, and 25.2, respectively. CONCLUSIONS: Patients with diabetes and COVID-19 have an increased risk of adverse outcomes with glucose levels >160 mg/dL and <70 mg/dL and a high CV. Therapies that improve these metrics of glycemic control may result in better prognoses for these patients.


Asunto(s)
Glucemia/metabolismo , /diagnóstico , Diabetes Mellitus/sangre , Anciano , Glucemia/análisis , Automonitorización de la Glucosa Sanguínea , /epidemiología , China/epidemiología , Complicaciones de la Diabetes/sangre , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/epidemiología , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , /fisiología
15.
Eur J Endocrinol ; 184(4): R151-R163, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33460395

RESUMEN

Diabetes in the setting of diseases of the exocrine pancreas has long existed as a known, but underdiagnosed or misdiagnosed, disorder. It currently finds itself in a state of taxonomic dereliction and requires a long overdue refurbishment. Correct conceptualisation is a key precondition for knowledge development in this disorder. This article lays out the epistemological foundation for diabetes of the exocrine pancreas (DEP) and presents a synthesis of the current interdisciplinary discourse on diagnosing and classifying DEP. A diagnosis of DEP in people with no medical records of pre-existing diabetes is generally based on the most up-to-date biochemical criteria endorsed by the American Diabetes Association and European Association for the Study of Diabetes. The presence of exocrine pancreatic dysfunction is not considered a mandatory diagnostic criterion for DEP but is rather a significant risk factor for developing DEP. DEP principally comprises post-pancreatitis diabetes mellitus, pancreatic cancer-related diabetes, and cystic fibrosis-related diabetes, which are mutually exclusive with autoimmune diabetes and type 2 diabetes. Other exclusions and stipulations apply. The DEP criteria will be instrumental in aiding optimal design and conduct of clinical studies, uniform collection of health utilisation data, meaningful comparison of scientific findings across countries, and clear communication among stakeholders (healthcare providers, patients, medical regulatory authorities, pharmaceutical industry).


Asunto(s)
Diabetes Mellitus , Técnicas de Diagnóstico Endocrino , Páncreas Exocrino/patología , Pancreatitis/complicaciones , Pancreatitis/diagnóstico , Diabetes Mellitus/clasificación , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/etiología , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/etiología , Enfermedades del Sistema Endocrino/diagnóstico , Humanos , Páncreas Exocrino/diagnóstico por imagen
17.
Diabetes Metab Syndr ; 15(1): 229-235, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33445071

RESUMEN

BACKGROUND AND AIMS: Diabetes mellitus is highly prevalent among critical cases of coronavirus disease 2019 (COVID-19) with poor outcomes. This study aimed to describe the clinical characteristics and outcomes of COVID-19 patients with diabetes, admitted in the intensive care unit (ICU) of the southern region of Bangladesh. METHODS: Epidemiological, clinical, laboratory, treatments, complications, and clinical outcomes data were extracted from electronic medical records of 168 COVID-19 patients admitted into ICU of two COVID-19 dedicated hospitals of Chattogram, Bangladesh and compared between diabetes (n = 88) and non-diabetes (n = 80) groups. RESULTS: The prevalence of diabetes was high among 51-70 years old patients. All the diabetic patients had at least one other comorbidity, with a significantly higher incidence of hypertension (53.4% vs 27.5%, P < 0.05). Prevalence of male patients (74/88; 84.1%) was slightly higher among diabetic patients than the non-diabetic patients (60/80; 75%). Even though not significant, Kaplan-Meier survival curve showed that COVID-19 patients with diabetes had a shorter overall survival time than those without diabetes. In subgroup analysis, diabetic patients were classified into insulin-requiring and non-insulin-requiring groups based on their requirement of insulin during the stay in ICU. COVID-19 infected diabetic patients requiring insulin have high risk of disease progression and shorter survival time than the non-insulin required group. CONCLUSIONS: Diabetes is an independent risk factor for the poor prognosis of COVID-19. More attention should be paid to the prevention and prompt treatment of diabetic patients, to maintain good glycaemic control especially those who require insulin therapy.


Asunto(s)
/epidemiología , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Unidades de Cuidados Intensivos/tendencias , Admisión del Paciente/tendencias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bangladesh/epidemiología , Niño , Estudios de Cohortes , Diabetes Mellitus/diagnóstico , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Hipertensión/terapia , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto Joven
18.
Diabetes Metab Syndr ; 15(1): 221-227, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33450531

RESUMEN

BACKGROUND AND AIMS: The measurement of vital signs is an important part of clinical work up. Presently, measurement of blood glucose is a factor for concern mostly when treating individuals with diabetes. Significance of blood glucose measurement in prognosis of non-diabetic and hospitalized patients is not clear. METHODS: A systematic search of literature published in the Electronic databases, PubMed and Google Scholar was performed using following keywords; blood glucose, hospital admissions, critical illness, hospitalizations, cardiovascular disease (CVD), morbidity, and mortality. This literature search was largely restricted to non-diabetic individuals. RESULTS: Blood glucose level, even when in high normal range, or in slightly high range, is an important determinant of morbidity and mortality, especially in hospitalized patients. Further, even slight elevation of blood glucose may increase mortality in patients with COVID-19. Finally, blood glucose variability and hypoglycemia in critically ill individuals without diabetes causes excess in-hospital complications and mortality. CONCLUSION: In view of these data, we emphasize the significance of blood glucose measurement in all patients admitted to the hospital regardless of presence of diabetes. We propose that blood glucose be included as the "fifth vital sign" for any hospitalized patient.


Asunto(s)
Glucemia/metabolismo , /diagnóstico , Hospitalización/tendencias , Signos Vitales/fisiología , /epidemiología , Enfermedad Crítica/epidemiología , Diabetes Mellitus/sangre , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Humanos , Hiperglucemia/sangre , Hiperglucemia/diagnóstico , Hiperglucemia/epidemiología , Hipoglucemia/sangre , Hipoglucemia/diagnóstico , Hipoglucemia/epidemiología , Pronóstico
19.
Diabetes Metab Syndr ; 15(1): 343-350, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33503583

RESUMEN

BACKGROUND & AIMS: Greater COVID-19 related mortality has been reported among persons with various non-communicable diseases (NCDs). We performed an ecological study to determine the association of state-level cases and deaths with NCD risk factors and healthcare and social indices. METHODS: We obtained cumulative national and state-level data on COVID-19 cases and deaths from publicly available database www.covid19india.org from February to end November 2020. To identify association with major NCD risk factors, NCDs, healthcare related and social variables we obtained data from public sources. Association was determined using univariate and multivariate statistics. RESULTS: More than 9.5 million COVID-19 cases and 135,000 deaths have been reported in India towards end of November 2020. There is significant positive correlation (Pearson r) of state-level COVID-19 cases and deaths per million, respectively, with NCD risk factors- obesity (0.64, 0.52), hypertension (0.28, 0.16), diabetes (0.66, 0.46), NCD epidemiological transition index (0.58, 0.54) and ischemic heart disease mortality (0.22, 0.33). Correlation is also observed with indices of healthcare access and quality (0.71, 0.61), urbanization (0.75, 0.73) and human (0.61, 0.56) and sociodemographic (0.70, 0.69) development. Multivariate adjusted analyses shows strong correlation of COVID-19 burden and deaths with NCD risk factors (r2 = 0.51, 0.43), NCDs (r2 = 0.32, 0.16) and healthcare (r2 = 0.52, 0.38). CONCLUSIONS: COVID-19 disease burden and mortality in India is ecologically associated with greater state-level burden of NCDs and risk factors, especially obesity and diabetes.


Asunto(s)
/epidemiología , Costo de Enfermedad , Enfermedades no Transmisibles/epidemiología , /diagnóstico , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Humanos , India/epidemiología , Enfermedades no Transmisibles/terapia , Obesidad/diagnóstico , Obesidad/epidemiología , Obesidad/terapia , Factores de Riesgo
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