Association between hyperglycemia treatment and mortality in patients with diabetes and COVID-19 in a Peruvian hospital: A retrospective cohort study.

OBJECTIVE: To evaluate the association between hyperglycemia treatment and mortality in patients with diabetes and COVID-19 in a Peruvian hospital. METHODS: A retrospective cohort study was conducted between March and July 2020. Individual-level data were extracted from an implemented virtual platform. We included patients with type 2 diabetes hospitalized with COVID-19. The assessed outcome was in-hospital mortality. The Independent variable of interest was hyperglycemic treatment. We used Poisson regressions with robust variance to obtain crude and adjusted relative risks (RR) and their 95% confidence intervals (95% CI). RESULTS: Out of 1635 patients hospitalized for COVID-19 during the study period, 248 patients with diabetes mellitus were included. The majority were men (66.9%), the median age was 62 years. Ninety-seven patients died in the hospital (39.1%). The median glycemia on admission was 222.5 mg/dL. At 48 h after hospital admission, 125 patients (50.4%) received sliding scale insulin alone (SSI), 46 (18.5%) received a fixed-dose insulin regimen. In the adjusted analysis, the group with SSI at 48 h of hospitalization had higher mortality than those with fixed-dose insulin (adjusted RR: 1.69; 95% CI: 1.01 - 2.83), and those and who continued with SSI in the following days had higher mortality compared to the group that switched to fixed-dose insulin (adjusted RR: 1.64; 95% CI: 1.17 - 2.32). CONCLUSION: Among assessed patients with diabetes and COVID-19, more than a third died during hospitalization. Early and continuous use of the sliding scale was associated with higher mortality compared to fixed-dose insulin regimens.

Daily glucose variation influenced by the use of corticosteroids in COVID-19 patients treated in Lima-Peru.

AIM: The pandemic has generated the need for COVID-19 patients to be treated as best as possible; however, the effect of these treatments on glycemic control has not yet been taken into account. This article aims to determine whether the daily variation of glucose is influenced by the use of corticosteroids in COVID-19 patients treated in Lima-Peru. METHODOLOGY: A prospective cohort study was undertook, in which glucose was measured four times a day in 53 patients hospitalized due to COVID-19. These values were associated with the use of corticosteroids and adjusted for other socio-educational variables, all by means of PA-GEE models. RESULTS: Nested multivariate analysis of daily glucose variation found that those using corticosteroids increased the daily average glucose as well as the first and last glucose measurements, this is, at 6am and 10pm, respectively (all p-values <0.026). An increase in glucose levels was also observed in those with diabetes (all p-values <0.001). In contrast, we found that there was a decrease in the last glucose measurement of the day in obese patients (p-value = 0.044). CONCLUSIONS: The patients who used corticosteroids for the treatment of COVID-19 increased the average glucose per day, especially in the first and last measurement.

Asociación entre percepción de consumo de sal e hipertensión arterial en pobladores peruanos / Association between perception of salt consumption and blood hypertension in peruvian people

INTRODUCCIÓN: El control no farmacológico de los pacientes hipertensos debe ser evaluado pues ha demostrado ser beneficioso junto con el tratamiento farmacológico. No se conoce como es la autopercepción de consumo de sal en grupos hipertensos peruanos. OBJETIVO: Determinar la asociación entre percepción de consumo de sal en la dieta e hipertensión arterial en pobladores peruanos. MÉTODOS: Estudio transversal analítico, mediante la entrevista de datos auto-reportados de la percepción de consumo de sal y el diagnóstico de hipertensión arterial, así como otras co-variables de interés. Se estimaron razones de prevalencia (RP) utilizando modelos lineales generalizados, familia Poisson, y usando ciudad como cluster. RESULTADOS: De 4263 participantes, el 63.1% fueron mujeres y la mediana de edades fue 42 años. El 53.3% manifestó que consumía regular o mucha sal en su dieta. En regresión múltiple, se evidenció asociación positiva entre la percepción del consumo de sal e hipertensión arterial (RP:1.56, IC95%:1.29-1.89, p < 0.001). También resultaron asociadas positivamente la edad en años (RP:1.03, IC95%:1.03-1.04, p < 0.001), presentar infrapeso (RP:1.51, IC95%:1.24-1.84, p < 0.001) y sobrepeso (RP:2.29, IC95%:1.80-2.92, p < 0.001), padecer de diabetes (RP:1.36, IC95%:1.14-1.61, p < 0.001) e hipercolesterolemia (RP:1.56, IC95%:1.40-1.75, p < 0.001). El sexo femenino (RP:0.91, IC95%:0.83-0.99, p = 0.027) y raza china (RP:1.72e-05, IC95%:2.36e-06-1.25e-04, p < 0.001) se asociaron negativamente. CONCLUSIÓN: Más de la mitad percibió consumir regular o mucha sal en su dieta pero la prevalencia de hipertensión fue baja. La percepción de poco consumo de sal fue frecuente en el grupo de hipertensos

INTRODUCTION: Non-pharmacological control of hypertensive patients should be evaluated as it has been shown to be beneficial along with pharmacological treatment. It is not known how is self-perception of salt consumption in Peruvian hypertensive groups. OBJECTIVE: To determine the association between perception of salt consumption in the diet and arterial hypertension in Peruvian residents. METHODS: Analytical cross-sectional study, through the interview of self-reported data on the perception of salt consumption and the diagnosis of arterial hypertension, as well as other co-variables of interest. Prevalence ratios (PR) were estimated using generalized linear models, Poisson family, and using the city as a cluster. RESULTS: Of 4263 participants, 63.1% were women and the median age was 42 years.53.3% said they consumed regular or a lot of salt in their diet. In multiple regression, there was a positive association between the perception of salt consumption and arterial hypertension (RP: 1.56, 95% CI: 1.29-1.89, p <0.001). Age was also positively associated in years (RP: 1.03, 95% CI: 1.03-1.04, p <0.001), underweight (RP: 1.51, 95% CI: 1.24-1.84, p <0.001) and overweight (RP: 2.29, 95% CI: 1.80-2.92, p <0.001), suffer from diabetes (RP: 1.36, 95% CI: 1.14-1.61, p <0.001) and hypercholesterolemia (RP: 1.56, 95% CI: 1.40-1.75, p <0.001). Female sex (RP: 0.91, 95% CI: 0.83-0.99, p = 0.027) and Chinese race (RP: 1.72e-05, 95% CI: 2.36e-06-1.25e-04, p <0.001) were negatively associated . CONCLUSION: More than half perceived regular or high salt intake in their diet but the prevalence of hypertension was low. The perception of low salt intake was frequent in the hypertensive group

Características de los pacientes diabéticos hospitalizados en dos hospitales de Essalud Piura / Characteristics of diabetic patients hospitalized in two Hospitals of Essalud Piura

Describir la frecuencia de pacientes con diabetes mellitus tipo 2 (DM2) hospitalizados en Piura.Material y Métodos: realizamos un estudio transversal en los dos hospitales de mayor nivel de atención de Essalud en Piura: Hospital III José Cayetano Heredia y Hospital II Jorge Reátegui Delgado. Obtuvimos las características clínico-demográficas de las historias clínicas (HC) de los participantes durante el Día Internacional de la Diabetes 2014.Resultados: De los 183 pacientes hospitalizados en ambos centros, 39 pacientes (21%) padecían DM2, la media de edad fue 67.8± 11.8 años. No reportan la glucemia de ingreso y glucemia diaria 17 y 24 participantes, respectivamente. En 31 participantes no se reportó el peso del paciente. El pie diabético fue la principal causa de hospitalización.Conclusión: La DM2 es muy frecuente en los pacientes hospitalizados de EsSalud Piura, no hay un adecuado registro en las HC de parámetros como peso y control glucémico...

Objective: To describe the frequency of patients with diabetes mellitus type 2 hospitalized in Piura. Material and Methods: we ronrinctpri a cross-sectional study in two hospitals of greater complexity ran. of EsSalmi in Piura: Hospital III Jose Cayetano Heredia and Hospital II Jorge Reategui Delgado. Results: We obtained the clinical-demographic characteristics of the participants during the International Diabetes Day 2014. Of the 183 in patients in both centers, 39 patients (21%) had diabetes mellitus type 2; the mean age was 67.8 ± 11.8. The medical records do not report hospital admission blood glucose and blood glucose during hospitalization in 17 and 24 participants, respectively. The medical records do not report weight of 31 participants. Diabetic foot was the primary cause of hospitalization. Conclusion: We conclude that diabetes mellitus type 2 is common in hospitalized patients of Essalud Piura, there is no proper record in the medical records of parameters such as weight and glycemic control...

Immune Thrombocytopenic Purpura and Gastritis by H. pylori Associated With Type 1 Diabetes Mellitus.

We present the 15th case reported worldwide and 3rd case reported in Latin America of immune thrombocytopenic purpura associated with Type 1 diabetes mellitus in Scopus, MEDLINE, and SciELO. An 11-year-old male patient of mixed ethnicity with immune thrombocytopenic purpura, Type 1 diabetes mellitus, and gastritis due to H. pylori presented to the emergency room with petechiae, ecchymosis, and gingival and conjunctival bleeding that had been worsening for the past three months. The patient had a body mass index of 18.85 kg/m(2) (P75). A biochemical analysis showed 1×10(9) platelets/L, increased prothrombin time, increased partial thromboplastin time, and an HbA1C of 7.84% on admission. He was prescribed a single dose of intravenous methylprednisolone 750 mg in 100 mL of NaCl and daily oral 50 mg prednisolone, with intravenous 250 mg tranexamic acid every eight hours. The patient's glycemic control was continued with the administration of insulin glargine (30 units every 24 hours) and prandial insulin glulisine (five to eight units per meal). Before admission, the patient was on a prescribed treatment of sitagliptin 50 mg and metformin 850 mg, but this was suspended in the emergency room. For the eradication of H. pylori he was prescribed amoxicillin 500 mg every eight hours, oral clarithromycin 335 mg every 12 hours, and IV omeprazole 40 mg. After 15 days, he showed disease resolution and he was discharged to his home with orders to follow-up with pediatrics, hematology, and endocrinology services. The first-line treatment for immune thrombocytopenic purpura patients with active bleeding and a platelet count < 30,000 platelets/µl is the administration of corticosteroids and inmunoglobulin.

Actualización de cirugía bariátrica y cirugía metabólica / Update of bariatric surgery anda metabolic surgery

La obesidad aumenta el riesgo de desarrollar o agravar múltiples afecciones particularmente la diabetes tipo 2, una enfermedad crónica de difícil control cuyo tratamiento con distintos fármacos y aún con insulina, frecuentemente no alcanza los objetivos terapéuticos ni reduce el riesgo cardiovascular. Cuando se asocia a obesidad severa, su terapéutica se torna más compleja. Se analiza la utilización de cirugía bariátrica y metabólica en pacientes con obesidad severa y diabetes, se revisan las técnicas quirúrgicas, las hipótesis sobre su mecanismo de acción, la selección de pacientes y los resultados. La cirugíabariátrica ha probado ser efectiva en el tratamiento de la obesidad severa y de la DM2 en pacientes con IMC >35 kg/m2. Es una cirugía de aceptable tolerancia en personas preparadas, de bajo riesgo y con complicaciones subsanables y manejables en la actualidad. La cirugía bariátrica dispone de suficiente respaldo científico. En cambio, en las evidencias disponibles de la cirugía metabólica en pacientes con IMC <35 kg/m2 y más aún con IMC <30 kg/m2 existen resultados promisorios en el corto y mediano plazo, pero no se dispone aún de evidencia suficiente que avale su indicación. Se requieren más investigaciones para establecer la eficacia y seguridad de estas técnicas quirúrgicas en el largo plazo.

Actualización de cirugía bariátrica y cirugía metabólica / Update of bariatric surgery anda metabolic surgery

La obesidad aumenta el riesgo de desarrollar o agravar múltiples afecciones particularmente la diabetes tipo 2, una enfermedad crónica de difícil control cuyo tratamiento con distintos fármacos y aún con insulina, frecuentemente no alcanza los objetivos terapéuticos ni reduce el riesgo cardiovascular. Cuando se asocia a obesidad severa, su terapéutica se torna más compleja. Se analiza la utilización de cirugía bariátrica y metabólica en pacientes con obesidad severa y diabetes, se revisan las técnicas quirúrgicas, las hipótesis sobre su mecanismo de acción, la selección de pacientes y los resultados. La cirugíabariátrica ha probado ser efectiva en el tratamiento de la obesidad severa y de la DM2 en pacientes con IMC >35 kg/m2. Es una cirugía de aceptable tolerancia en personas preparadas, de bajo riesgo y con complicaciones subsanables y manejables en la actualidad. La cirugía bariátrica dispone de suficiente respaldo científico. En cambio, en las evidencias disponibles de la cirugía metabólica en pacientes con IMC <35 kg/m2 y más aún con IMC <30 kg/m2 existen resultados promisorios en el corto y mediano plazo, pero no se dispone aún de evidencia suficiente que avale su indicación. Se requieren más investigaciones para establecer la eficacia y seguridad de estas técnicas quirúrgicas en el largo plazo. (AU)