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1.
Arq Bras Cardiol ; 116(2): 285-294, 2021 02.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33656078

RESUMO

BACKGROUND: Increased risk of new-onset diabetes with statins challenges the long-term safety of this drug class. However, few reports have analyzed this issue during acute coronary syndromes (ACS). OBJECTIVE: To explore the association between early initiation of statin therapy and blood glucose levels in patients admitted with ACS. METHODS: This was a retrospective analysis of patients hospitalized with ACS. Statin-naïve patients were included and divided according to their use or not of statins within the first 24 hours of hospitalization. The primary endpoint was incidence of in-hospital hyperglycemia (defined as peak blood glucose > 200 mg/dL). Multivariable linear and logistic regression models were used to adjust for confounders, and a propensity-score matching model was developed to further compare both groups of interest. A p-value of less than 0.05 was considered statistically significant. RESULTS: A total of 2,357 patients were included, 1,704 of them allocated in the statin group and 653 in the non-statin group. After adjustments, statin use in the first 24 hours was associated with a lower incidence of in-hospital hyperglycemia (adjusted OR=0.61, 95% CI 0.46-0.80; p < 0.001) and lower need for insulin therapy (adjusted OR = 0.56, 95% CI 0.41-0.76; p < 0.001). These associations remained similar in the propensity-score matching models, as well as after several sensitivity analyses, such as after excluding patients who developed cardiogenic shock, severe infection or who died during index-hospitalization. CONCLUSIONS: Among statin-naïve patients admitted with ACS, early statin therapy was independently associated with lower incidence of in-hospital hyperglycemia. (Arq Bras Cardiol. 2021; 116(2):285-294).


Assuntos
Síndrome Coronariana Aguda , Inibidores de Hidroximetilglutaril-CoA Redutases , Hiperglicemia , Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome Coronariana Aguda/epidemiologia , Seguimentos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Hiperglicemia/epidemiologia , Incidência , Estudos Retrospectivos
2.
Eur J Endocrinol ; 184(4): 587-596, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33606661

RESUMO

Objective: To investigate the prevalence and risks factors associated with the presence of liver fibrosis in subjects with nonalcoholic fatty liver disease (NAFLD) with and without type 2 diabetes mellitus (T2D). Design and methods: This study was part of a population-based study conducted in the Barcelona metropolitan area among subjects aged 18-75 years old. Secondary causes of steatosis were excluded. Moderate-to-advanced liver fibrosis was defined as a liver stiffness measurement (LSM) ≥ 8.0 kPa assessed by transient elastography. Results: Among 930 subjects with NAFLD, the prevalence of moderate-to-advanced liver fibrosis was higher in subjects with T2D compared those without (30.8% vs 8.7%). By multivariable analysis, one of the main factors independently associated with increased LSM in subjects with NAFLD was atherogenic dyslipidemia but only in those with T2D. The percentage of subjects with LSM ≥ 8.0 kPa was higher in subjects with T2D and atherogenic dyslipidemia than in those with T2D without atherogenic dyslipidemia both for the cut-off point of LSM ≥8.0 kPa (45% vs 24% P = 0.002) and ≥13 kPa (13% vs 4% P = 0.020). No differences were observed in the prevalence of LSM ≥8.0 kPa regarding glycemic control among NAFLD-diabetic subjects. Conclusions: Factors associated with moderate-to-advanced liver fibrosis in NAFLD are different in subjects with and without T2D. Atherogenic dyslipidemia was associated with the presence of moderate-to-advanced liver fibrosis in T2D with NAFLD but not in non-diabetic subjects. These findings highlight the need for an active search for liver fibrosis in subjects with T2D NAFLD and atherogenic dyslipidemia.


Assuntos
Aterosclerose/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Dislipidemias/epidemiologia , Hiperglicemia/epidemiologia , Cirrose Hepática/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Adolescente , Adulto , Idoso , Aterosclerose/etiologia , Comorbidade , Diabetes Mellitus Tipo 2/complicações , Dislipidemias/complicações , Técnicas de Imagem por Elasticidade , Feminino , Humanos , Hiperglicemia/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/etiologia , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/complicações , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Espanha/epidemiologia , Adulto Jovem
3.
Diabetes Metab Syndr ; 15(1): 407-413, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33581594

RESUMO

BACKGROUND AND AIMS: Diabetes and coronavirus disease 2019 (COVID-19) share a bidirectional relationship. Hyperglycemia occurring in the setting of either previously diagnosed or undiagnosed diabetes is known to be associated with poor outcomes. Here, we aim to provide a simple and practical guidance on the diagnosis and management of hyperglycemia in admitted patients with COVID-19. METHODS: The guidance is formulated based on experience of authors and relevant literature on the subject searched using Pubmed. RESULTS: Every patient admitted to a COVID care facility should be investigated for hyperglycemia using a combination of tests including capillary blood glucose, fasting plasma glucose and HbA1c. Oral glucose lowering drugs can be considered in patients with mild COVID illness who have mild hyperglycemia [pre-meal blood glucose of <180 mg/dl (10 mmol/L) and post-meal blood glucose of <250 mg/dl (13.9 mmol/L)] and no contraindication to the use of these agents.. All patients with moderate-severe disease and/or hyperglycemia of greater severity should be initiated on insulin therapy. Hyperglycemia should be aggressively screened for and managed in patients receiving systemic glucocorticoids. CONCLUSION: This document provides a broad overview on the diagnosis and management of hyperglycemia at COVID care facilities and should be useful to a wide range of healthcare personnel involved in care of patients with COVID-19.


Assuntos
/diagnóstico , Hospitalização/tendências , Hiperglicemia/diagnóstico , Hiperglicemia/epidemiologia , Programas de Rastreamento/tendências , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Gerenciamento Clínico , Humanos , Hiperglicemia/terapia , Hipoglicemiantes/farmacologia , Hipoglicemiantes/uso terapêutico , Índia/epidemiologia , Programas de Rastreamento/normas
4.
Diabetes Metab Syndr ; 15(1): 403-406, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33588198

RESUMO

Diabetes and hyperglycemia occurring during COVID-19 era have implications for COVID-19 related morbidity/mortality. In this brief review, we have attempted to categorise and classify such heterogenous hyperglycemic states. During COVID-19 pandemic broadly two types of hyperglycemia were seen: one in patients without COVID-19 infection and second in patients with COVID-19 infection. Patients not inflicted with COVID-19 infection and diagnosed with either type 2 diabetes mellitus (T2DM) or type 1 diabetes mellitus (T1DM) show more severe hyperglycemia and more ketoacidosis, respectively. In former, it could be attributed to weight gain, decreased exercise, stress and in both type of diabetes, due to delayed diagnosis during lockdown and pandemic. In patients with COVID-19 and associated pneumonia, altered glucose metabolism leading to hyperglycemia could be due to corticosteroids, cytokine storm, damage to pancreatic beta cells, or combination of these factors. Some of these patients present with diabetic ketoacidosis, hyperglycemic hyperosmolar state or both. We have provided a framework for categorisation of hyperglycemic states, which could be consolidated/revised in future based on new research data.


Assuntos
/classificação , Hiperglicemia/classificação , Hiperglicemia/epidemiologia , Glicemia/metabolismo , Cetoacidose Diabética/classificação , Cetoacidose Diabética/diagnóstico , Cetoacidose Diabética/epidemiologia , Humanos , Hiperglicemia/diagnóstico , Pandemias
5.
Adv Clin Exp Med ; 30(2): 127-134, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33599404

RESUMO

BACKGROUND: Currently, the only effective method to control the spread of the COVID-19 pandemic is social distancing. The lockdown measures during the epidemic may have an impact on the presentation of diabetes and may disturb metabolic control. OBJECTIVES: In order to address the hypothesis that the COVID-19 lockdown affected the incidence rate (IR) of type 1 diabetes (T1D) in the pediatric population of Lower Silesia and the patients' clinical status, the incidence of T1D during the COVID-19 pandemic was analyzed. MATERIAL AND METHODS: Incidence estimates were obtained from the T1D pediatric registry for Lower Silesia which has been maintained since January 1, 2000. The observation was completed on April 30, 2020. RESULTS: A total of 1961 cases were diagnosed (1054 boys, 53.72%). An increase in the T1D IR was observed, from 10.43/100,000/year in 2000 to 22.06/100,000/year in 2019. The seasonality of T1D incidence was also observed, with the highest IR appearing in January and February. There were half as many cases of T1D in March and April 2020 as in the same months in 2019 (p > 0.05). Diabetic ketoacidosis (DKA) occurred in 31.75% of patients in years 2000-2019, comparably (p > 0.05) to 2020 (36.67% patients), including March and April (50% of patients). The duration of hyperglycemia symptoms was 20.2 ±25.4 days, which was comparable to 2020 (13.1 ±10.96 days; p = 0.1675) and March and April of 2020 (9.67 ±5.63 days; p = 0.0831). Glycated hemoglobin (HbA1c) level was 11.79 ±2.63%, which was comparable to March and April of 2020 (13.06 ±2.35%; p = 0.1171), while in all of 2020 it was 13.41 ±2.50% (p = 0.0003). CONCLUSIONS: The IR of T1D in Lower Silesian children in the months of the COVID-19 pandemic was comparable to previous years, while their clinical condition at the time of diagnosis was worse than in previous years.


Assuntos
/epidemiologia , Diabetes Mellitus Tipo 1/epidemiologia , Criança , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/diagnóstico , Feminino , Hemoglobina A Glicada , Humanos , Hiperglicemia/epidemiologia , Incidência , Masculino , Pandemias , Polônia/epidemiologia
6.
Endocr Pract ; 27(2): 95-100, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33551315

RESUMO

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.


Assuntos
Hiperglicemia , Glicemia , Estado Terminal , Mortalidade Hospitalar , Humanos , Hiperglicemia/epidemiologia , Unidades de Terapia Intensiva , Estudos Retrospectivos
7.
Diabetes Metab Syndr ; 15(1): 221-227, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33450531

RESUMO

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.


Assuntos
Glicemia/metabolismo , /diagnóstico , Hospitalização/tendências , Sinais Vitais/fisiologia , /epidemiologia , Estado Terminal/epidemiologia , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Hiperglicemia/epidemiologia , Hipoglicemia/sangue , Hipoglicemia/diagnóstico , Hipoglicemia/epidemiologia , Prognóstico
8.
Lancet Diabetes Endocrinol ; 9(3): 174-188, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33515493

RESUMO

Hyperglycaemia in people with and without diabetes admitted to the hospital is associated with a substantial increase in morbidity, mortality, and health-care costs. Professional societies have recommended insulin therapy as the cornerstone of inpatient pharmacological management. Intravenous insulin therapy is the treatment of choice in the critical care setting. In non-intensive care settings, several insulin protocols have been proposed to manage patients with hyperglycaemia; however, meta-analyses comparing different treatment regimens have not clearly endorsed the benefits of any particular strategy. Clinical guidelines recommend stopping oral antidiabetes drugs during hospitalisation; however, in some countries continuation of oral antidiabetes drugs is commonplace in some patients with type 2 diabetes admitted to hospital, and findings from clinical trials have suggested that non-insulin drugs, alone or in combination with basal insulin, can be used to achieve appropriate glycaemic control in selected populations. Advances in diabetes technology are revolutionising day-to-day diabetes care and work is ongoing to implement these technologies (ie, continuous glucose monitoring, automated insulin delivery) for inpatient care. Additionally, transformations in care have occurred during the COVID-19 pandemic, including the use of remote inpatient diabetes management-research is needed to assess the effects of such adaptations.


Assuntos
/terapia , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Gerenciamento Clínico , Hospitalização/tendências , Hiperglicemia/terapia , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , /epidemiologia , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Hiperglicemia/sangue , Hiperglicemia/epidemiologia , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem
9.
Nutr Diabetes ; 11(1): 1, 2021 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-33414391

RESUMO

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.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Pandemias , Quarentena , Telemedicina/tendências , Adulto , Idoso , Glicemia/análise , Automonitorização da Glicemia , Feminino , Humanos , Hiperglicemia/epidemiologia , Hipoglicemia/epidemiologia , Hipoglicemiantes/administração & dosagem , Sistemas de Infusão de Insulina , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
10.
Diabetes Res Clin Pract ; 172: 108592, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33310126

RESUMO

AIM(S): Ramadan fasting (RF) can represent various challenges to glycaemic control especially in insulin-treated patients with diabetes. We aimed to assess the effect of RF on several glucose metrics using flash glucose monitoring (FGM). METHODS: Complete FGM data for 29-30 days before, during and after Ramadan were available for 40 patients with type 1 (n = 13) and type 2 diabetes (n = 27) on insulin (with or without oral hypoglycaemic) treatment. Indicators of mean glucose, glucose variability (GV) and time in different glycaemic ranges were analysed. RESULTS: RF was associated with increase in time in hyperglycaemia (38.5 ± 18.2 vs 48.7 ± 20.7%; P < 0.001) and decrease in time in hypoglycaemia (3.2 ± 2.8 vs 2.1 ± 2.1%; P = 0.003), and time in target range (56.3 ± 17.2 vs 47.9 ± 19.7%, P < 0.001). There were no significant differences in markers of GV with RF; however, RF was associated with a significant reduction in GV during the day but not night time with an increase in the ensuing non-fasting period. CONCLUSIONS: In insulin-treated patients, RF is associated with an increase in time in hyperglycaemia, a reduced time in target range and nocturnal increase in GV, indicating a need for more refined management algorithms.


Assuntos
Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Jejum/efeitos adversos , Glucose/análise , Hiperglicemia/epidemiologia , Insulina/efeitos adversos , Islamismo , Glicemia/efeitos dos fármacos , Feminino , Humanos , Hiperglicemia/etiologia , Hipoglicemiantes/efeitos adversos , Incidência , Masculino , Pessoa de Meia-Idade , Emirados Árabes Unidos/epidemiologia
11.
Diabetes Res Clin Pract ; 172: 108640, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33359083

RESUMO

AIMS: To evaluate proposals considering HbA1c and fasting plasma glucose (FPG) measurement as a substitute for oral glucose tolerance test (OGTT) to diagnose hyperglycaemia in pregnancy (HIP) during COVID-19 pandemic. METHODS: Of the 7,334 women who underwent the OGTT between 22 and 30 weeks gestation, 966 had HIP (WHO diagnostic criteria, reference standard). The 467 women who had an available HbA1c were used for analysis. French-speaking Society of Diabetes (SFD) proposal to diagnose HIP during COVID-19 pandemic was retrospectively applied: HbA1c ≥5.7% (39 mmol/mol) and/or FPG level ≥5.1 mmol/l. SFD proposal sensitivity for HIP diagnosis and the occurrence of HIP-related events (preeclampsia, large for gestational age infant, shoulder dystocia or neonatal hypoglycaemia) in women with false negative (FN) and true positive (TP) HIP-diagnoses were evaluated. RESULTS: The sensitivity was 57% [95% confidence interval 52-62]. FN women had globally lower plasma glucose levels during OGTT, lower HbA1c and body mass index than those TP. The percentage of HIP-related events was similar in FN (who were cared) and TP cases, respectively 19.5 and 16.9% (p = 0.48). We observed similar results when women at high risk for HIP only were considered. CONCLUSION: The SFD proposal has a poor sensitivity to detect HIP. Furthermore, it fails to have any advantages in predicting adverse outcomes.


Assuntos
Glicemia/metabolismo , Jejum/sangue , Hemoglobina A Glicada/metabolismo , Hiperglicemia/sangue , Complicações na Gravidez , Adulto , Comorbidade , Feminino , Teste de Tolerância a Glucose , Humanos , Hiperglicemia/epidemiologia , Recém-Nascido , Pandemias , Gravidez , Prognóstico , Estudos Retrospectivos , Fatores de Risco
12.
Diabetes Metab Syndr ; 15(1): 169-175, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33360081

RESUMO

BACKGROUND AND AIMS: To study the prevalence and impact of diabetes mellitus and other comorbidities among hospitalized patients with COVID-19. METHODS: In a prospective, observational study including consecutive adults hospitalized with COVID-19, clinical outcomes and inflammatory markers were compared in those with and without diabetes. Participants were classified as having mild or severe COVID-19 disease using the WHO ordinal scale. RESULTS: 401 patients (125 females) with median age of 54 years (range 19-92) were evaluated. Of them 189 (47.1%) had pre-existing diabetes and21 (5.2%) had new-onset hyperglycaemia. Overall, 344 (85.8%) and 57 (14.2%) cases had mild and severe COVID-19 disease respectively. The group with diabetes had a higher proportion of severe cases (20.1% vs 9%, p-0.002), mortality (6.3 vs 1.4%, p-0.015), ICU admission (24.3 vs 12.3%, p-0.002), and oxygen requirement (53.4 vs 28.3%, p < 0.001). Baseline Hba1c (n = 331) correlated significantly with outcome severity scores (r 0.136, p-0.013) and 12/15 (80%) of those who succumbed had diabetes. Hypertension, coronary artery disease, and chronic kidney disease were present in 164 (40.9%), 35 (8.7%) and 12 (2.99%) patients respectively. Hypertension was associated with a higher proportion of severe cases, mortality, ICU admission and oxygen administration. CONCLUSIONS: We report a high prevalence of diabetes in a hospitalized COVID-19 population. Patients with diabetes or hypertension had more severe disease and greater mortality.


Assuntos
/sangue , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Hospitalização/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Estudos Transversais , Diabetes Mellitus/diagnóstico , Feminino , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Hiperglicemia/epidemiologia , Hipertensão/sangue , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Índia/epidemiologia , Mediadores da Inflamação/sangue , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Resultado do Tratamento , Adulto Jovem
13.
Diabetes Care ; 44(2): 578-585, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33323475

RESUMO

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.


Assuntos
/epidemiologia , Diabetes Mellitus/epidemiologia , Hospitalização/estatística & dados numéricos , Adulto , Diabetes Mellitus/metabolismo , Feminino , Mortalidade Hospitalar , Hospitais , Humanos , Hiperglicemia/epidemiologia , Hipoglicemia/epidemiologia , Pacientes Internados/estatística & dados numéricos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
14.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(10): 665-671, dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197679

RESUMO

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


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde , Serviços de Saúde , Hospitalização , Diabetes Mellitus/dietoterapia , Diabetes Mellitus/epidemiologia , Apoio Nutricional , Estudos Retrospectivos , Assistência ao Paciente , Hiperglicemia/dietoterapia , Hiperglicemia/epidemiologia , Estudos Transversais , Tempo de Internação , Nutrição Enteral/métodos , Nutrição Parenteral/métodos
15.
Cochrane Database Syst Rev ; 12: CD013309, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-33348448

RESUMO

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.


Assuntos
Algoritmos , Glicemia/análise , Hiperglicemia/diagnóstico , Hipoglicemia/diagnóstico , Recém-Nascido Prematuro/sangue , Viés , Técnicas Biossensoriais/instrumentação , Mortalidade Hospitalar , Humanos , Hiperglicemia/epidemiologia , Hipoglicemia/epidemiologia , Lactente , Mortalidade Infantil , Recém-Nascido , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Transtornos do Neurodesenvolvimento , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
Front Endocrinol (Lausanne) ; 11: 574541, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33123093

RESUMO

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.


Assuntos
Betacoronavirus/isolamento & purificação , Glicemia/análise , Infecções por Coronavirus/complicações , Hemoglobina A Glicada/análise , Hiperglicemia/epidemiologia , Pneumonia Viral/complicações , Humanos , Hiperglicemia/metabolismo , Hiperglicemia/virologia , Pandemias
17.
Niger J Clin Pract ; 23(10): 1431-1436, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33047702

RESUMO

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.


Assuntos
Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Complicações do Diabetes/epidemiologia , Diabetes Mellitus/epidemiologia , Adulto , Idoso , Índice de Massa Corporal , Peso Corporal , Estudos Transversais , Transtorno Depressivo Maior/psicologia , Diabetes Mellitus/sangue , Diabetes Mellitus/psicologia , Feminino , Hemoglobina A Glicada/análise , Hospitais de Ensino , Humanos , Hiperglicemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prevalência , Escalas de Graduação Psiquiátrica , Autocuidado , Inquéritos e Questionários
20.
Medicine (Baltimore) ; 99(36): e21806, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899010

RESUMO

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.


Assuntos
Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/epidemiologia , Hiperglicemia/epidemiologia , Pneumonia Viral/epidemiologia , Betacoronavirus , Gasometria , Hemoglobina A Glicada , Humanos , Pandemias , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Fatores de Risco , Índice de Gravidade de Doença
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