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1.
Endocr Pract ; 27(2): 95-100, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33551315

RESUMEN

OBJECTIVE: To explore the relationship between hyperglycemia in the presence and absence of diabetes mellitus (DM) and adverse outcomes in critically ill patients with coronavirus disease 2019 (COVID-19). METHODS: The study included 133 patients with COVID-19 admitted to an intensive care unit (ICU) at an urban academic quaternary-care center between March 10 and April 8, 2020. Patients were categorized based on the presence or absence of DM and early-onset hyperglycemia (EHG), defined as a blood glucose >180 mg/dL during the first 2 days after ICU admission. The primary outcome was 14-day all-cause in-hospital mortality; also examined were 60-day all-cause in-hospital mortality and the levels of C-reactive protein, interleukin 6, procalcitonin, and lactate. RESULTS: Compared to non-DM patients without EHG, non-DM patients with EHG exhibited higher adjusted hazard ratios (HRs) for mortality at 14 days (HR 7.51, CI 1.70-33.24) and 60 days (HR 6.97, CI 1.86-26.13). Non-DM patients with EHG also featured higher levels of median C-reactive protein (306.3 mg/L, P = .036), procalcitonin (1.26 ng/mL, P = .028), and lactate (2.2 mmol/L, P = .023). CONCLUSION: Among critically ill COVID-19 patients, those without DM with EHG were at greatest risk of 14-day and 60-day in-hospital mortality. Our study was limited by its retrospective design and relatively small cohort. However, our results suggest the combination of elevated glucose and lactate may identify a specific cohort of individuals at high risk for mortality from COVID-19. Glucose testing and control are important in individuals with COVID-19, even those without preexisting diabetes.


Asunto(s)
Hiperglucemia , Glucemia , Enfermedad Crítica , Mortalidad Hospitalaria , Humanos , Hiperglucemia/epidemiología , Unidades de Cuidados Intensivos , Estudios Retrospectivos
2.
Nutr Diabetes ; 11(1): 1, 2021 01 05.
Artículo en Inglés | MEDLINE | ID: mdl-33414391

RESUMEN

BACKGROUND: Starting March 2020 the Italian Government imposed a lockdown to limit the spread of SARS-CoV-2. During lockdown outpatient visits were limited and telemedicine (TM) was encouraged. METHODS: We retrospectively analyzed data from continuous or flash glucose monitoring systems shared through different cloud systems during the lockdown by subjects with type 1 diabetes and compared data obtained 4 weeks before and 4 weeks after structured telephonic visit. Variables considered were mean glucose, time spent in target (70-180 mg/dl), hypoglycemia (<70 mg/dl) and hyperglycemia (>180 mg/dl), coefficient of variation, and length of sensor use. RESULTS: During the 4 weeks following the telephonic visit there was an improvement of glycemic control, with a significant reduction of mean glucose values (161.1 before vs 156.3 mg/dl after, p = 0.001), an increase of the time spent in target (63.6 vs 66.3, p = 0.0009) and a reduction of time spent in hyperglycemia (33.4 vs 30.5, p = 0.002). No changes were observed regarding glucose variability, time spent in hypoglycemia, and length of sensor use. Similar results were observed in subjects treated with multiple daily injections or continuous subcutaneous insulin infusion. CONCLUSIONS: A structured telephonic visit appears to be an effective way to replace or integrate routine visits in particular conditions.


Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Pandemias , Cuarentena , Telemedicina/tendencias , Adulto , Anciano , Glucemia/análisis , Automonitorización de la Glucosa Sanguínea , Femenino , Humanos , Hiperglucemia/epidemiología , Hipoglucemia/epidemiología , Hipoglucemiantes/administración & dosificación , Sistemas de Infusión de Insulina , Italia/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
3.
Diabetes Care ; 44(2): 578-585, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33323475

RESUMEN

OBJECTIVE: Diabetes and hyperglycemia are important risk factors for poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19). We hypothesized that achieving glycemic control soon after admission, in both intensive care unit (ICU) and non-ICU settings, could affect outcomes in patients with COVID-19. RESEARCH DESIGN AND METHODS: We analyzed pooled data from the Glytec national database including 1,544 patients with COVID-19 from 91 hospitals in 12 states. Patients were stratified according to achieved mean glucose category in mg/dL (≤7.77, 7.83-10, 10.1-13.88, and >13.88 mmol/L; ≤140, 141-180, 181-250, and >250 mg/dL) during days 2-3 in non-ICU patients or on day 2 in ICU patients. We conducted a survival analysis to determine the association between glucose category and hospital mortality. RESULTS: Overall, 18.1% (279/1,544) of patients died in the hospital. In non-ICU patients, severe hyperglycemia (blood glucose [BG] >13.88 mmol/L [250 mg/dL]) on days 2-3 was independently associated with high mortality (adjusted hazard ratio [HR] 7.17; 95% CI 2.62-19.62) compared with patients with BG <7.77 mmol/L (140 mg/dL). This relationship was not significant for admission glucose (HR 1.465; 95% CI 0.683-3.143). In patients admitted directly to the ICU, severe hyperglycemia on admission was associated with increased mortality (adjusted HR 3.14; 95% CI 1.44-6.88). This relationship was not significant on day 2 (HR 1.40; 95% CI 0.53-3.69). Hypoglycemia (BG <70 mg/dL) was also associated with increased mortality (odds ratio 2.2; 95% CI 1.35-3.60). CONCLUSIONS: Both hyperglycemia and hypoglycemia were associated with poor outcomes in patients with COVID-19. Admission glucose was a strong predictor of death among patients directly admitted to the ICU. Severe hyperglycemia after admission was a strong predictor of death among non-ICU patients.


Asunto(s)
/epidemiología , Diabetes Mellitus/epidemiología , Hospitalización/estadística & datos numéricos , Adulto , Diabetes Mellitus/metabolismo , Femenino , Mortalidad Hospitalaria , Hospitales , Humanos , Hiperglucemia/epidemiología , Hipoglucemia/epidemiología , Pacientes Internos/estadística & datos numéricos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo
4.
Cochrane Database Syst Rev ; 12: CD013309, 2020 12 21.
Artículo en Inglés | MEDLINE | ID: mdl-33348448

RESUMEN

BACKGROUND: Preterm infants are susceptible to hyperglycemia and hypoglycemia, conditions which may lead to adverse neurodevelopment. The use of continuous glucose monitoring devices (CGM) might help keeping glucose levels in the normal range, and reduce the need for blood sampling. However, the use of CGM might be associated with harms in the preterm infant. OBJECTIVES: Objective one: to assess the benefits and harms of CGM alone versus standard method of glycemic measure in preterm infants. Objective two: to assess the benefits and harms of CGM with automated algorithm versus standard method of glycemic measure in preterm infants. Objective three: to assess the benefits and harms of CGM with automated algorithm versus CGM without automated algorithm in preterm infants. SEARCH METHODS: We adopted the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 9), in the Cochrane Library; MEDLINE via PubMed (1966 to 25 September 2020); Embase (1980 to 25 September 2020); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 25 September 2020). We also searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. SELECTION CRITERIA: Randomized controlled trials (RCTs) and quasi-RCTs in preterm infants comparing: 1) the use of CGM versus intermittent modalities to measure glycemia (comparison 1); or CGM associated with prespecified interventions to correct hypoglycemia or hyperglycemia versus CGM without such prespecified interventions (comparison 2). DATA COLLECTION AND ANALYSIS: We assessed the methodological quality of included trials using Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria (assessing randomization, blinding, loss to follow-up, and handling of outcome data). We evaluated treatment effects using a fixed-effect model with risk ratio (RR) for categorical data and mean, standard deviation (SD), and mean difference (MD) for continuous data. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS: Four trials enrolling 138 infants met our inclusion criteria. Investigators in three trials (118 infants) compared the use of CGM to intermittent modalities (comparison one); however one of these trials was analyzed separately because CGM was used as a standalone device, without being coupled to a control algorithm like in the other trials. A fourth trial (20 infants) assessed CGM with an automated algorithm versus CGM with a manual algorithm. None of the four included trials reported the neurodevelopmental outcome, i.e. the primary outcome of this review. Within comparison one, the certainty of the evidence on the use of CGM on mortality during hospitalization is very uncertain (typical RR 3.00, 95% CI 0.13 to 70.30; typical RD 0.04, 95% CI -0.06 to 0.14; 50 participants; 1  study; very low certainty). The number of hypoglycemic episodes was reported in two studies with conflicting data. The number of hyperglycemic episodes was reported in one study (typical MD -1.40, 95% CI -2.84 to 0.04; 50 participants; 1 study). The certainty of the evidence was very low for all outcomes because of limitations in study design, and imprecision of estimates.  Three studies are ongoing. AUTHORS' CONCLUSIONS: There is insufficient evidence to determine if CGM improves preterm infant mortality or morbidities. Long-term outcomes were not reported. Clinical trials are required to determine the most effective CGM and glycemic management regimens in preterm infants before larger studies can be performed to assess the efficacy of CGM  for reducing mortality, morbidity and long-term neurodevelopmental impairments. The absence of CGM labelled for neonatal use is still a major limit in its use as well as the absence of dedicated neonatal devices.


Asunto(s)
Algoritmos , Glucemia/análisis , Hiperglucemia/diagnóstico , Hipoglucemia/diagnóstico , Recien Nacido Prematuro/sangre , Sesgo , Técnicas Biosensibles/instrumentación , Mortalidad Hospitalaria , Humanos , Hiperglucemia/epidemiología , Hipoglucemia/epidemiología , Lactante , Mortalidad Infantil , Recién Nacido , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/métodos , Trastornos del Neurodesarrollo , Ensayos Clínicos Controlados Aleatorios como Asunto
5.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(10): 665-671, dic. 2020. tab
Artículo en Español | IBECS | ID: ibc-197679

RESUMEN

INTRODUCCIÓN: La actividad de los servicios de Endocrinología y Nutrición (EYN) incluye la asistencia en planta de pacientes propios o mediante interconsultas. La actividad asistencial en planta del conjunto de servicios de EYN de un sistema público de salud no ha sido estudiada en nuestro país. MATERIAL Y MÉTODOS: Estudio retrospectivo de la actividad en planta de hospitalización durante 2018 de los Servicios de EYN del Servicio Público de Salud de Castilla-La Mancha para conocer las características de los pacientes atendidos, tanto con carácter de interconsulta como ingresados a cargo de los propios servicios, así como la casuística de la patología de dichos pacientes. Se analizaron todos los pacientes ingresados a cargo de EYN y una muestra del 10% de los atendidos como interconsulta. RESULTADOS: Se registraron 261 ingresos a cargo de los servicios de EYN del Servicio Público de Salud de Castilla-La Mancha. El 82,8% tuvieron carácter urgente y el 53,7% fueron por diabetes mellitus tipo 1. Se atendieron 5955 pacientes en régimen de interconsulta, de los cuales se analizó una muestra de 591. El motivo de interconsulta más frecuente fue la diabetes mellitus/hiperglucemia (28,8%), requiriendo 6,1±6,7 días por paciente. Sin embargo, las interconsultas para nutrición artificial requirieron más días de asistencia por paciente y supusieron un porcentaje mayor del total de días de interconsulta (60,4%). CONCLUSIONES: La actividad en planta de los servicios de EYN del Servicio Público de Salud de Castilla-La Mancha se basa en la asistencia de pacientes con patologías crónicas de alta prevalencia hospitalaria como la diabetes mellitus/hiperglucemia y, especialmente, la Nutrición Clínica


INTRODUCTION: The activity of an Endocrinology and Nutrition (E&N) department consists of inpatient care both by those attached to the department and through consultations with specialists from other departments. The inpatient care activity of all the E&N departments of a public health system has not been studied in Spain. MATERIAL AND METHODS: This was a retrospective study of hospital ward activity during 2018 of the E&N departments of the Castilla-La Mancha Public Health Service. It was undertaken in order to ascertain the characteristics of the patients attended to, both by those in charge of the E&N departments and through interconsultation with other departments, as well as the case-mix of the pathology of these patients. All patients admitted to E&N and a 10% sample of those treated through interconsultation were analysed. RESULTS: 261 admissions were recorded for Castilla-La Mancha Public Health Service E&N departments. 82.8% were urgent and 53.7% were due to type 1 diabetes mellitus. A total of 5955 patients were seen on an interconsultation basis, 591 of whom were analysed. The most frequent reason for interconsultation was diabetes mellitus/hyperglucemia (28.8%), requiring 6.1±6.7 days per patient. However, interconsultations for artificial nutrition required more days of attendance per patient and accounted for a higher percentage of the total number of days of interconsultation (60.4%). CONCLUSIONS: The inpatient care activity of the E&N departments of Castilla-La Mancha Public Health Service mainly consists of attending to patients with chronic pathologies of high hospital prevalence such as diabetes mellitus/hyperglucemia and, especially, clinical nutrition


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Calidad de la Atención de Salud , Servicios de Salud , Hospitalización , Diabetes Mellitus/dietoterapia , Diabetes Mellitus/epidemiología , Apoyo Nutricional , Estudios Retrospectivos , Atención al Paciente , Hiperglucemia/dietoterapia , Hiperglucemia/epidemiología , Estudios Transversales , Tiempo de Internación , Nutrición Enteral/métodos , Nutrición Parenteral/métodos
6.
Niger J Clin Pract ; 23(10): 1431-1436, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33047702

RESUMEN

Background: Diabetes mellitus (DM) and depression are common chronic disease states of public health importance with huge burden and the potential to impact many aspects of life. They are said to be related though this relationship is not fully understood. The presence of depression among patients with DM is associated with poor glycemic control, complications, and poor self-care. Method: This was a descriptive cross-sectional study conducted at the Diabetes Clinic of the Jos University Teaching Hospital. Three hundred and ten (310) patients with diabetes mellitus were recruited consecutively. The depression module of the Mini International Neuropsychiatric Interview (M.I.N.I.) version 5.0 was used to ascertain depression among these patients. Other demographic data were obtained using a questionnaire. Blood pressure, weight, and height were also measured and the body mass index (BMI) calculated. Results: One hundred and eighty four (59.35%) of the study population were females and the mean age (SD) of the study population was 54 ± 12 years. The mean age (SD) of the females was 53 ± 11 years and that of the males was 54 ± 12 years with no significant statistical difference (P = 0.35). Two hundred and forty nine (80.32%) of the study population were urban dwellers with 140 (45.16%) earning less than N500, 000 (794 USD) yearly. Current major depression was found in 35 (11.3%) patients, among whom 7 (2.3%) had recurrent depression. The presence of DM complications (OR: 3.50, 95% CI 1.16-10.61) and a positive family history of depression (OR: 4.03, 95% CI 1.32-12.29) were found to be correlates of current major depression. Conclusion: The prevalence of current major depression among patients with diabetes mellitus in this study is high. We recommend that all patients with DM should be screened for depression and treated appropriately to reduce its consequences.


Asunto(s)
Depresión/epidemiología , Trastorno Depresivo Mayor/epidemiología , Complicaciones de la Diabetes/epidemiología , Diabetes Mellitus/epidemiología , Adulto , Anciano , Índice de Masa Corporal , Peso Corporal , Estudios Transversales , Trastorno Depresivo Mayor/psicología , Diabetes Mellitus/sangre , Diabetes Mellitus/psicología , Femenino , Hemoglobina A Glucada/análisis , Hospitales de Enseñanza , Humanos , Hiperglucemia/epidemiología , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Prevalencia , Escalas de Valoración Psiquiátrica , Autocuidado , Encuestas y Cuestionarios
7.
Front Endocrinol (Lausanne) ; 11: 574541, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33123093

RESUMEN

Background: Diabetes mellitus is considered a common comorbidity of COVID-19, which has a wide spectrum of clinical manifestations ranging from asymptomatic infection to severe respiratory symptoms and even death. However, the impact of COVID-19 on blood glucose has not been fully understood. This meta-analysis aimed to summarize available data on the association between glycemic parameters and severity of COVID-19. Methods: PubMed, EMBASE, and Cochrane Library were searched from December 1, 2019 to May 15, 2020. Observational studies investigating blood glucose or glycated hemoglobin A1c (HbA1c) according to the severity of COVID-19 were considered for inclusion. Two independent researchers extracted data from eligible studies using a standardized data extraction sheet and then proceeded to cross check the results. Data were pooled using a fixed- or random-effects model to calculate the weighted mean differences (WMDs) and 95% confidence intervals (CIs). Results: Three studies reported blood glucose and HbA1c according to the severity of COVID-19 and were included in this meta-analysis. The combined results showed that severe COVID-19 was associated with higher blood glucose (WMD 2.21, 95% CI: 1.30-3.13, P < 0.001). In addition, HbA1c was slightly higher in patients with severe COVID-19 than those with mild COVID-19, yet this difference did not reach significance (WMD 0.29, 95% CI: -0.59 to 1.16, P = 0.52). Conclusions: This meta-analysis provides evidence that severe COVID-19 is associated with increased blood glucose. This highlights the need to effectively monitor blood glucose to improve prognosis in patients infected with COVID-19.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Glucemia/análisis , Infecciones por Coronavirus/complicaciones , Hemoglobina A Glucada/análisis , Hiperglucemia/epidemiología , Neumonía Viral/complicaciones , Humanos , Hiperglucemia/metabolismo , Hiperglucemia/virología , Pandemias
8.
Medicine (Baltimore) ; 99(36): e21806, 2020 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-32899010

RESUMEN

BACKGROUND: DM is a common chronic metabolic disease. COVID-19 is an infectious disease infected by enveloped single-stranded RNA coronavirus. Meanwhile, DM is a common comorbidity of SARS-CoV-2 infection. The virus can directly or indirectly damage the pancreatic islets and cause stress hyperglycemia by causing cytokine storms, acute inflammatory reactions, binding to the ACE2 receptor, etc. At the same time, hyperglycemia is a risk factor for severe infection and an independent risk factor for mild to severe disease. However, there is no evidence-based medicine to confirm the relationship between hyperglycemia and the infection of COVID-19 in diabetic patients. Therefore, we will conduct a systematic review and meta-analysis to synthesize the existing clinical evidence. METHODS AND ANALYSIS: We will retrieve each database from December 2019 to July 2020. Chinese literature comes from CNKI, Wanfang, VIP, CBM databases. English literature mainly searches Cochrane Library, PubMed, Web of Science, EMBASE. At the same time, we will look for clinical trial registration and gray literature. This study only included clinical randomized controlled trials. The reviewers independently conduct literature selection, data analysis, bias risk assessment, subgroup and sensitivity analysis. The primary outcomes include fasting blood glucose, 2-hour postprandial blood glucose, glycated hemoglobin, fasting insulin, adverse effects, etc. Finally, we will conduct a meta-analysis through Review Manager software version 5.3. RESULTS: The results will be published in peer-reviewed journals. CONCLUSION: This study will explore the relationship between hyperglycemia and COVID-19 infection in diabetic patients. It will provide evidence-based support for clinical regulation of blood glucose and combating the COVID-19 epidemic. REGISTRATION NUMBER: INPLASY202060114.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Diabetes Mellitus/epidemiología , Hiperglucemia/epidemiología , Neumonía Viral/epidemiología , Betacoronavirus , Análisis de los Gases de la Sangre , Hemoglobina A Glucada , Humanos , Pandemias , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Factores de Riesgo , Índice de Severidad de la Enfermedad
9.
J Prim Care Community Health ; 11: 2150132720958533, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32924762

RESUMEN

BACKGROUND: Patients with hyperglycemia during hospitalization, especially during ICU hospitalizations, often have worse outcomes, even if they do not have a premorbid diagnosis of diabetes. High glucose levels can provide insight into the underlying pathogenesis of a disease and can contribute to tissue injury. Some patients with COVID-19 have hyperglycemia during hospitalizations. METHODS: The Infectious Disease and Control office at University Medical Center in Lubbock, Texas, provided a list of patients with a COVID-19 infection hospitalized between March 1 and May 15, 2020. The medical records were reviewed to collect information on age, gender, history of diabetes, and glucose levels on admission and through the first 7 days of hospitalization. RESULTS: This study included 63 patients with a mean age of 62.1 ± 14.1 years. Thirty-five patients (55.6%) were males. The in-hospital mortality rate was 30.2%. The mean admission glucose level was 129.4 ± 57.1 mg/dL in patients who survived (N = 47) and 189.6 ± 112.2 mg/dL in patients who died during hospitalization (N = 16, P = .007). An admission glucose greater than 180 mg/dL predicted mortality in a model adjusted for a diabetes, age, and male gender. The mean differences between the maximum and minimum glucose levels calculated over the first 7 days of hospitalization were 112.93 ± 115.4 (N = 47) in patients who survived and were 240.5 ± 97.7 (N = 15) in patients who died during hospitalization (P = .0003). A difference between the maximum and minimum glucose level greater than 105 mg/dL was associated with increased mortality. CONCLUSIONS: Patients who died during hospitalization for COVID-19 had higher admission glucose levels than patients who survived. Larger differences between maximum and minimum glucose levels during the first 7 days of hospitalization were associated with increased mortality. These results suggest that high glucose levels identify patients at increased risk for mortality and warrant more study.


Asunto(s)
Glucemia/análisis , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/terapia , Pandemias , Neumonía Viral/sangre , Neumonía Viral/terapia , Anciano , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Hiperglucemia/epidemiología , Hiperglucemia/mortalidad , Masculino , Persona de Mediana Edad , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Medición de Riesgo , Texas/epidemiología , Resultado del Tratamiento
12.
Diabetes Res Clin Pract ; 167: 108382, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32853686

RESUMEN

Hyperglycemia with or without blood glucose in diabetes range is an emerging finding not uncommonly encountered in patients with COVID-19. Increasingly, all evidence currently available hints that both new-onset hyperglycemia without diabetes and new-onset diabetes in COVID-19 is associated with a poorer outcome compared with normoglycemic individuals and people with pre-existing diabetes.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Diabetes Mellitus/epidemiología , Hiperglucemia/epidemiología , Neumonía Viral/mortalidad , Betacoronavirus , Glucemia/metabolismo , Infecciones por Coronavirus/metabolismo , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/metabolismo , Humanos , Hiperglucemia/diagnóstico , Hiperglucemia/metabolismo , Pandemias , Neumonía Viral/metabolismo , Pronóstico
13.
Diabetes Res Clin Pract ; 168: 108374, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32805345

RESUMEN

AIMS: We investigated whether pre-existing diabetes, newly-diagnosed diabetes, and admission hyperglycemia were associated with COVID-19 severity independently from confounders. METHODS: We retrospectively analyzed data on patients with COVID-19 hospitalized between February and April 2020 in an outbreak hospital in North-East Italy. Pre-existing diabetes was defined by self-reported history, electronic medical records, or ongoing medications. Newly-diagnosed diabetes was defined by HbA1c and fasting glucose. The primary outcome was a composite of ICU admission or death. RESULTS: 413 subjects were included, 107 of whom (25.6%) had diabetes, including 21 newly-diagnosed. Patients with diabetes were older and had greater comorbidity burden. The primary outcome occurred in 37.4% of patients with diabetes compared to 20.3% in those without (RR 1.85; 95%C.I. 1.33-2.57; p < 0.001). The association was stronger for newly-diagnosed compared to pre-existing diabetes (RR 3.06 vs 1.55; p = 0.004). Higher glucose level at admission was associated with COVID-19 severity, with a stronger association among patients without as compared to those with pre-existing diabetes (interaction p < 0.001). Admission glucose was correlated with most clinical severity indexes and its association with adverse outcome was mostly mediated by a worse respiratory function. CONCLUSION: Newly-diagnosed diabetes and admission hyperglycemia are powerful predictors of COVID-19 severity due to rapid respiratory deterioration.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Complicaciones de la Diabetes/diagnóstico , Diabetes Mellitus/diagnóstico , Hiperglucemia/complicaciones , Hiperglucemia/diagnóstico , Admisión del Paciente , Neumonía Viral/diagnóstico , Edad de Inicio , Anciano , Anciano de 80 o más Años , Betacoronavirus/fisiología , Glucemia/análisis , Glucemia/metabolismo , Comorbilidad , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Complicaciones de la Diabetes/sangre , Complicaciones de la Diabetes/epidemiología , Complicaciones de la Diabetes/patología , Diabetes Mellitus/sangre , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Femenino , Humanos , Hiperglucemia/epidemiología , Hiperglucemia/terapia , Italia/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
14.
Lancet Diabetes Endocrinol ; 8(9): 793-800, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32822601

RESUMEN

Gestational diabetes, the most common medical disorder in pregnancy, is defined as glucose intolerance resulting in hyperglycaemia that begins or is first diagnosed in pregnancy. Gestational diabetes is associated with increased pregnancy complications and long-term metabolic risks for the woman and the offspring. However, the current diagnostic and management strategies recommended by national and international guidelines are mainly focused on short-term risks during pregnancy and delivery, except the Carpenter-Coustan criteria, which were based on the risk of future incidence of type 2 diabetes post-gestational diabetes. In this Personal View, first, we summarise the evidence for long-term risk in women with gestational diabetes and their offspring. Second, we suggest that a shift is needed in the thinking about gestational diabetes; moving from the perception of a short-term condition that confers increased risks of large babies to a potentially modifiable long-term condition that contributes to the growing burden of childhood obesity and cardiometabolic disorders in women and the future generation. Third, we propose how the current clinical practice might be improved. Finally, we outline and justify priorities for future research.


Asunto(s)
Salud del Niño/tendencias , Diabetes Gestacional/terapia , Salud Materna/tendencias , Niño , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiología , Femenino , Humanos , Hiperglucemia/diagnóstico , Hiperglucemia/epidemiología , Hiperglucemia/terapia , Obesidad Pediátrica/diagnóstico , Obesidad Pediátrica/epidemiología , Obesidad Pediátrica/prevención & control , Embarazo
15.
Diabetes Res Clin Pract ; 167: 108338, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32712122

RESUMEN

AIMS: The objective of this study is to explore the association between documented diabetes, fasting plasma glucose (FPG), and the clinical outcomes of Coronavirus disease 2019 (COVID-19). METHODS: This retrospective study included 255 patients with COVID-19. Of these, 214 were admitted to isolation wards and 41were admitted to intensive care units (ICUs). Demographic, clinical, treatment, and laboratory data were collected and compared between ICU and non-ICU patients. Multivariable logistic regression models were used to explore the risk factors associated with poor clinical outcomes (ICU admission or death). RESULTS: There were significant changes in several clinical parameters in ICU patients (leukopenia, lymphopenia, elevated D-dimer, as well as higher levels of FPG, cardiac troponin, serum ferritin, IL-6, and high-sensitivity C-reactive protein)compared with non-ICU patients. The prevalence of known diabetes was substantially higher in ICU than non-ICU patients (31.7% vs. 17.8%, P = 0.0408). Multivariable regression analysis showed that a history of diabetes [odds ratio (OR), 0.099; 95% confidence interval (CI), 0.016-0.627; P = 0.014], high FPG at admission (OR, 1.587; 95% CI, 1.299-1.939, P < 0.001), high IL-6 (OR, 1.01; 95% CI, 1.002-1.018, P = 0.013), and D-dimer higher than 1 mg/L at admission (OR, 4.341; 95% CI, 1.139-16.547, P = 0.032) were independent predictors of poor outcomes. Cox proportional hazards analysis showed that compared with FPG < 7 mmol/L, FPG levels of 7.0-11.1 mmol/L and ≥ 11.1 mmol/L were associated with an increased hazard ratio (HR) for poor outcome (HR, 5.538 [95% CI, 2.269-13.51] and HR, 11.55 [95% CI, 4.45-29.99], respectively). CONCLUSION: Hyperglycemia and a history of diabetes on admission predicted poor clinical outcomes in COVID-19.


Asunto(s)
Glucemia/metabolismo , Infecciones por Coronavirus/metabolismo , Diabetes Mellitus/metabolismo , Hiperglucemia/metabolismo , Unidades de Cuidados Intensivos , Neumonía Viral/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus , China/epidemiología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Diabetes Mellitus/epidemiología , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Hospitalización , Humanos , Hiperglucemia/epidemiología , Interleucina-6/metabolismo , Modelos Logísticos , Masculino , Persona de Mediana Edad , Mortalidad , Análisis Multivariante , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Adulto Joven
16.
Isr Med Assoc J ; 7(22): 365-368, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32692498

RESUMEN

BACKGROUND: Stress hyperglycemia (SH) is a common finding in patients in pediatric emergency departments (PED) and has been related to increased morbidity and mortality. OBJECTIVES: To assess the incidence of SH among children visiting the PED. To identify which diseases predispose patients to SH and whether they indicate a worse outcome. METHODS: Data were collected retrospectively from the medical records of all children aged 0-18 years who visited the PED during the years 2010-2014 and who had a glucose level of ≥ 150 mg/dl. Data collected included age, gender, weight, blood glucose level, presence or absence of a pre-existing or a new diagnosis of diabetes mellitus, and previous treatment with medications affecting blood glucose levels or with intravenous fluids containing dextrose. Data were collected regarding hospitalization, duration of hospitalization, discharge diagnosis, and survival status. RESULTS: The study population included 1245 children with SH, which comprised 2.6% of all patients whose blood glucose level was measured in the PED during the study period. The mean age of children with SH was 49 months; 709 (56.9%) were male. The mean blood glucose level was 184 mg/dl. The rate of hospitalization was 57.8%. The mean duration of hospital stay was 5.6 days and mortality rate was 0.96%. The majority were diagnosed with a respiratory illness. CONCLUSIONS: SH is a common phenomenon among children evaluated in the PED and is associated with a high incidence of hospitalization. It may serve as an additional clinical indicator of disease severity.


Asunto(s)
Diabetes Mellitus/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hiperglucemia/epidemiología , Estrés Fisiológico/fisiología , Adolescente , Glucemia , Niño , Preescolar , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Lactante , Recién Nacido , Tiempo de Internación/estadística & datos numéricos , Masculino , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
18.
Diabetes Res Clin Pract ; 166: 108345, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32710999

RESUMEN

Many specialists use the remote management of people with chronic disease as diabetes, but structured management protocols have not been developed yet. The COVID-19 pandemic has given a big boost to the use of telemedicine, as it allows to maintain the physical distance, essential to the containment of contagion having regular health contact. Encouraging results related to the use of telemedicine in women with hyperglycaemia in pregnancy, have been recently published. It is well known that hyperglycaemia alters the immune response to infections, that inflammation, in turn, worsens glycaemic control and that any form of hyperglycaemia in pregnancy (HIP) has effects not only on the mother but also on development of the foetus. Therefore, the Italian Diabetes and Pregnancy Study Group, together with a group of experts, developed these recommendations in order to guide physicians in the management of HIP, providing specific diagnostic, therapeutic and assistance pathways (PDTAs) for the COVID-19 emergency. Three detailed PDTAs were developed, for type 1, type 2 and gestational diabetes.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/prevención & control , Diabetes Gestacional/tratamiento farmacológico , Hiperglucemia/prevención & control , Insulina/uso terapéutico , Pandemias/prevención & control , Neumonía Viral/prevención & control , Guías de Práctica Clínica como Asunto/normas , Complicaciones Infecciosas del Embarazo/prevención & control , Glucemia/análisis , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Diabetes Gestacional/fisiopatología , Diabetes Gestacional/virología , Manejo de la Enfermedad , Femenino , Humanos , Hiperglucemia/epidemiología , Hiperglucemia/virología , Hipoglucemiantes/uso terapéutico , Italia/epidemiología , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Neumonía Viral/virología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/virología , Telemedicina/métodos
19.
Diabetes Metab Syndr ; 14(5): 1213-1216, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32679527

RESUMEN

BACKGROUND AND AIMS: COVID 19 is a novel pandemic affecting globally. Although no reliable data suggests that patients of well controlled Type 1 Diabetes Mellitus (T1DM) being at increased risk of becoming severely ill with SARS-CoV2, but lockdown may impact patients with T1DM requiring regular medications and follow up. Hence this study was planned to see the impact of lockdown on glycemic control in patients with T1DM. METHODS: A cross sectional study was done in T1DM patients in whom a structured questionnaire was administered on follow up within 15 days after lockdown. Data regarding hypoglycemic and hyperglycemic episodes, Diabetic ketoacidosis (DKA), insulin dose missed, regular glucose monitoring, dietary compliance, physical activity, hospitalization during the phase of lockdown was taken. Average blood glucose and HbA1C of lockdown phase was compared with the readings of prelockdown phase. RESULTS: Out of 52 patients, 36.5% had hyperglycemic and 15.3% had hypoglycemic episodes. Insulin dose was missed in 26.9%, glucose monitoring not done routinely in 36.5% and 17.4% were not diet compliant during lockdown. Average blood glucose during lockdown phase was 276.9 ± 64.7 mg/dl as compared to 212.3 ± 57.9 mg/dl during prelockdown phase. Mean HbA1c value of lockdown (10 ± 1.5%) which was much higher that of pre lockdown (8.8 ± 1.3%) and the difference was statistically significant (p < 0.05). CONCLUSION: Glycemic control of T1DM patients has worsened mainly due to non availability of insulin/glucostrips during lockdown period. There is a need for preparedness in future so that complications can be minimised.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/complicaciones , Diabetes Mellitus Tipo 1/fisiopatología , Hiperglucemia/epidemiología , Hipoglucemia/epidemiología , Neumonía Viral/complicaciones , Cuarentena/estadística & datos numéricos , Adolescente , Adulto , Biomarcadores/análisis , Glucemia/análisis , Niño , Preescolar , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Estudios Transversales , Femenino , Estudios de Seguimiento , Hemoglobina A Glucada/análisis , Humanos , Hiperglucemia/virología , Hipoglucemia/virología , Incidencia , India/epidemiología , Lactante , Masculino , Pandemias , Neumonía Viral/transmisión , Neumonía Viral/virología , Pronóstico , Adulto Joven
20.
Lancet Diabetes Endocrinol ; 8(9): 782-792, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32687793

RESUMEN

Since the initial COVID-19 outbreak in China, much attention has focused on people with diabetes because of poor prognosis in those with the infection. Initial reports were mainly on people with type 2 diabetes, although recent surveys have shown that individuals with type 1 diabetes are also at risk of severe COVID-19. The reason for worse prognosis in people with diabetes is likely to be multifactorial, thus reflecting the syndromic nature of diabetes. Age, sex, ethnicity, comorbidities such as hypertension and cardiovascular disease, obesity, and a pro-inflammatory and pro-coagulative state all probably contribute to the risk of worse outcomes. Glucose-lowering agents and anti-viral treatments can modulate the risk, but limitations to their use and potential interactions with COVID-19 treatments should be carefully assessed. Finally, severe acute respiratory syndrome coronavirus 2 infection itself might represent a worsening factor for people with diabetes, as it can precipitate acute metabolic complications through direct negative effects on ß-cell function. These effects on ß-cell function might also cause diabetic ketoacidosis in individuals with diabetes, hyperglycaemia at hospital admission in individuals with unknown history of diabetes, and potentially new-onset diabetes.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapia , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/terapia , Infecciones por Coronavirus/sangre , Diabetes Mellitus Tipo 2/sangre , Humanos , Hiperglucemia/sangre , Hiperglucemia/epidemiología , Hiperglucemia/terapia , Hipertensión/sangre , Hipertensión/epidemiología , Hipertensión/terapia , Obesidad/sangre , Obesidad/epidemiología , Obesidad/terapia , Pandemias , Neumonía Viral/sangre , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
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