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1.
BMC Endocr Disord ; 22(1): 229, 2022 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-36104712

RESUMO

BACKGROUND: IDegLira is a fixed-ratio combination of insulin degludec and liraglutide with proven efficacy against simpler regimens and non-inferiority against basal-bolus insulin therapy. However, the evaluation of its real-world effectiveness is hindered by technical issues and requires further exploration. Thus we aimed to compare effectiveness of insulin degludec/liraglutide (IDegLira) versus intensified conventional insulin therapy (ICT) for type 2 diabetes in a real-world setting. METHODS: This retrospective cohort study from an outpatient clinic in Hungary included people who initiated IDegLira due to inadequate glycaemic control (HbA1c > 7.0% [53.0 mmol/mol]) with oral and/or injectable antidiabetic drugs. Data were compared with a historical cohort who initiated ICT. Outcomes included HbA1c, body weight, and hypoglycaemia differences over 18 months of follow-up. RESULTS: Data were included from 227 and 72 people who initiated IDegLira and ICT, respectively. Estimated mean difference (MD) in HbA1c at 18 months favoured IDegLira versus ICT (MD 0.60, 95% CI 0.88-0.32 [MD 6.6 mmol/mol, 95% CI 9.6-3.5]). More people reached target HbA1c ≤7.0% (53.0 mmol/mol) with IDegLira than ICT (odds ratio 3.36, 95% CI 1.52-7.42). IDegLira treatment was associated with weight loss compared with gain for ICT (MD 6.7 kg, 95% CI 5.0-8.5). The hazard ratio for hypoglycaemia comparing IDegLira with ICT was 0.18 (95% CI 0.08-0.49). CONCLUSIONS: Treatment with IDegLira over 18 months resulted in greater HbA1c reductions, weight loss versus gain, and a lower rate of hypoglycaemia versus ICT in people with type 2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2 , Hipoglicemia , Adulto , Glicemia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Combinação de Medicamentos , Hemoglobina A Glicada/análise , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Hipoglicemia/prevenção & controle , Insulina/uso terapêutico , Insulina de Ação Prolongada , Liraglutida/uso terapêutico , Estudos Retrospectivos , Redução de Peso
2.
Pediatr Int ; 64(1): e15278, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35972062

RESUMO

BACKGROUND: Infantile hemangioma (IH), formerly termed strawberry hemangioma, is a benign vascular tumor caused by capillary endothelial cell proliferation. The tumor regresses after 1 year of age, but sequelae occur in approximately half of the patients without systemic treatment. Propranolol (PPL) is currently the first-line therapeutic agent in Japan as well as in Western countries. It is not commonly known that PPL may induce severe hypoglycemia, in addition to cardiovascular and respiratory side effects. METHODS: We retrospectively analyzed patients with severe PPL-induced hypoglycemia in the 3 years since the launch of Hemangiol®, a PPL preparation specific for IH, in Japan in 2016. RESULTS: The incidence of severe hypoglycemia and of hypoglycemic convulsions following PPL treatment was estimated to be 0.54% and 0.35%, respectively. The incidence of hypoglycemic convulsions appeared to be higher in Japan than in Western countries. Severe hypoglycemia was common in infants aged >1 year, when PPL was used for ≥6 months. Severe hypoglycemia often develops from 05:00 a.m. to 09:00 a.m. and is frequently associated with prolonged periods of fasting, poor feeding, or poor physical conditions. CONCLUSION: To avoid the risk of hypoglycemia, the treatment should be initiated by 6 months of age during the proliferative phase at the latest, and should not be extended indiscriminately beyond 1 year of age. Guardians should be advised not to administer PPL on an empty stomach, in the presence of poor feeding, or who are in poor physical condition, not to prolong fasting after PPL administration, and to monitor the child's condition immediately after he or she wakes up.


Assuntos
Hemangioma Capilar , Hemangioma , Hipoglicemia , Neoplasias Cutâneas , Antagonistas Adrenérgicos beta/efeitos adversos , Criança , Feminino , Hemangioma/tratamento farmacológico , Hemangioma Capilar/tratamento farmacológico , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Hipoglicemiantes/uso terapêutico , Lactente , Propranolol/efeitos adversos , Estudos Retrospectivos , Convulsões/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Resultado do Tratamento
3.
Arch. argent. pediatr ; 120(4): 232-239, Agosto 2022. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1371519

RESUMO

Introducción. La hipoglucemia neonatal es una complicación de la diabetes mellitus gestacional Son pocos los estudios que avalan la pesquisa sistemática en este grupo poblacional durante las primeras horas de vida. Objetivos. Evaluar la asociación entre tratamiento materno recibido (dieta versus insulina) y el desarrollo de hipoglucemia, e identificar los factores de riesgo asociados. Población y métodos. Estudio observacional, analítico y retrospectivo realizado en en las sedes de Buenos AIres y San Justo de un hospital general de tercer nivel entre el 1 de enero de 2017 y el 31 de diciembre de 2018. Se estimó la incidencia de hipoglucemia (≤47 mg/dl) en recién nacidos según el manejo de la diabetes materna y se realizó un análisis multivariable para evaluar factores asociados. Resultados. Se incluyeron 195 pacientes. No se encontró diferencia estadística en la incidencia de hipoglucemia según el tratamiento materno recibido (45,3 % versus 39,7 %; p = 0,45) ni se identificaron factores de riesgo asociados. Modificando el valor de corte a ≤40 mg/dl, tampoco se encontraron diferencias en la incidencia (23,4 % versus 19 %, p = 0,48); no obstante, los pacientes hipoglucémicos presentaron un hematocrito significativamente mayor y una menor prevalencia de lactancia exclusiva al egreso. El análisis multivariable mostró una asociación independiente entre alto peso al nacer con hipoglucemia que requiere corrección. Conclusiones. La incidencia de hipoglucemia neonatal en la población estudiada no presentó diferencia según el tratamiento materno recibido. El estudio realizado fundamenta el control de la glucemia en estos niños en la práctica diaria.


Introduction. Neonatal hypoglycemia is a complication of gestational diabetes mellitus. Few studies have been conducted to support a systematic screening in the first hours of life of this population group. Objectives. To assess the association between the treatment administered to the mother (diet vs. insulin) and the development of hypoglycemia, and to identify associated risk factors. Population and methods. Observational, analytical, and retrospective study carried out at the Buenos Aires and San Justo maternal centers of a general, tertiary care hospital between 01-01-2017 and 12-31-2018. The incidence of neonatal hypoglycemia (≤ 47 mg/dL) based on the management of maternal diabetes was estimated and a multivariate analysis was done to assess related factors. Results. A total of 195 patients were included. No statistical difference was found in the incidence of hypoglycemia based on the treatment administered to the mother (45.3% vs. 39.7%; p = 0.45) and no associated risk factors were identified. Once the cutoff point was changed to ≤ 40 mg/dL, no differences were found in the incidence either (23.4% versus 19%, p = 0.48); however, patients with hypoglycemia had a significantly higher hematocrit level and a lower prevalence of exclusive breastfeeding upon discharge. Multivariate analysis showed an independent association between a high birth weight and hypoglycemia, requiring correction. Conclusions. The incidence of neonatal hypoglycemia in the studied population did not vary based on the treatment received by the mother. This study supports the control of glycemia in these infants in daily practice.


Assuntos
Humanos , Gravidez , Recém-Nascido , Diabetes Gestacional/epidemiologia , Doenças Fetais , Hipoglicemia/etiologia , Hipoglicemia/epidemiologia , Doenças do Recém-Nascido/etiologia , Doenças do Recém-Nascido/epidemiologia , Incidência , Estudos Retrospectivos , Mães
4.
JAMA Netw Open ; 5(8): e2224892, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35917124

RESUMO

Importance: Population-based data are needed to inform the safe prescribing of fluoroquinolone antibiotics to patients with advanced chronic kidney disease (CKD). Objective: To quantify the 14-day risk of a hospital visit with nervous system and/or psychiatric disorders, hypoglycemia, or a collagen-associated event in patients with advanced CKD newly prescribed a fluoroquinolone at a higher vs a lower dose. Design, Setting, and Participants: This population-based cohort study in Ontario, Canada (January 1, 2008, to March 17, 2020) used linked health care data to identify new users of fluoroquinolone antibiotics. Participants included adults 66 years or older with advanced CKD (an estimated glomerular filtration rate [eGFR] <30 mL/min/1.73 m2 but not receiving dialysis). Data analysis was performed from January 1 to April 30, 2021. Exposures: A new prescription for a higher-dose fluoroquinolone (ciprofloxacin, 501-1000 mg/d; levofloxacin, 501-750 mg/d; or norfloxacin, 401-800 mg/d) vs a lower-dose fluoroquinolone (ciprofloxacin, 500 mg/d; levofloxacin, 250-500 mg/d; or norfloxacin, 400 mg/d). Main Outcomes and Measure: The primary outcome was the 14-day risk of a hospital visit with nervous system and/or psychiatric disorders, hypoglycemia, or a collagen-associated event. Secondary outcomes included a hospital visit with sepsis, retinal detachment or other tendinopathies, all-cause hospitalization, all-cause mortality, and sudden cardiac death. Inverse probability of treatment weighting on the propensity score was used to balance comparison groups on baseline health. Weighted risk ratios and risk differences were obtained using modified Poisson regression and binomial regression, respectively. Results: Of 11 917 patients (median age, 83 years [IQR, 77-89 years]; 7438 women [62.4%]; median eGFR, 25 [IQR, 21-28] mL/min/1.73 m2) included in the analysis, 5482 (46.0%) received a higher-dose and 6435 (54.0%) received a lower-dose fluoroquinolone. After weighting, the primary composite outcome-a hospital visit with nervous system and/or psychiatric disorders, hypoglycemia, or a collagen-associated event-occurred in 68 of 5482 patients (1.2%) treated with a higher-dose fluoroquinolone and in 47 of 5516 (0.9%) treated with a lower-dose fluoroquinolone (weighted risk ratio, 1.45 [95% CI, 1.01-2.08]; weighted risk difference, 0.39% [95% CI, 0.01%-0.76%]). The risk of sepsis, retinal detachment, all-cause hospitalization, all-cause mortality, and sudden cardiac death did not differ significantly between groups. Conclusions and Relevance: These findings suggest that older patients with advanced CKD who were prescribed a fluoroquinolone at a higher-than-recommended dose were significantly more likely to experience the composite outcome of a hospital visit with nervous system and/or psychiatric disorders, hypoglycemia, or a collagen-associated event, although the absolute risk of these events was less than 2%.


Assuntos
Hipoglicemia , Insuficiência Renal Crônica , Descolamento Retiniano , Sepse , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Ciprofloxacina , Estudos de Coortes , Morte Súbita Cardíaca , Feminino , Fluoroquinolonas/efeitos adversos , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Levofloxacino , Norfloxacino , Ontário/epidemiologia , Diálise Renal , Insuficiência Renal Crônica/induzido quimicamente , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico , Sepse/complicações
5.
Pediatr Int ; 64(1): e15254, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35938585

RESUMO

BACKGROUND: Severe neonatal hypoglycemia may cause irreversible neurological sequelae. Although blood glucose (BG) screening in term neonates without risk factors for hypoglycemia (non-risk neonates) is not recommended in the current guidelines, severe hypoglycemia can occur in such neonates. To evaluate the necessity of BG screening in non-risk neonates, it is important to determine the accurate incidence of severe hypoglycemia in those neonates. METHODS: We conducted a 10 year survey of all normal-weight term neonates diagnosed with severe neonatal hypoglycemia who were treated at secondary- and tertiary-level neonatal centers in Toyama Prefecture, Japan, between January 2011 and December 2020. RESULTS: During the study period, 11 cases of severe neonatal hypoglycemia (six of which occurred in non-risk neonates) were identified. The overall incidence of severe hypoglycemia was 1 in 5,827 normal-weight term births, and the incidence in non-risk neonates was 1 in 10 682 normal-weight term births. All of the cases in non-risk neonates were diagnosed as hyperinsulinemic hypoglycemia. CONCLUSIONS: This is the first population-based study to have identified the actual incidence of severe pathological neonatal hypoglycemia in non-risk neonates. The incidence was not low compared with those of the newborn screening disorders, justifying the necessity of BG screening even in non-risk neonates.


Assuntos
Doenças Fetais , Hipoglicemia , Doenças do Recém-Nascido , Glicemia , Feminino , Glucose , Humanos , Hipoglicemia/diagnóstico , Hipoglicemia/epidemiologia , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Japão/epidemiologia , Triagem Neonatal
6.
Environ Int ; 167: 107410, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35868079

RESUMO

BACKGROUND: An increase in extreme heat events has been reported along with global warming. Heat exposure in ambient temperature is associated with all-cause diabetes mortality and all-cause hospitalization in diabetic patients. However, the association between heat exposure and hospitalization for hyperglycemic emergencies, such as diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), and hypoglycemia is unclear. The objective of our study is to clarify the impact of heat exposure on the hospitalization for DKA, HHS, and hypoglycemia. METHODS: Data of daily hospitalizations for hyperglycemic emergencies (i.e., DKA or HHS) and hypoglycemia was extracted from a nationwide administrative database in Japan and linked with temperature in each prefecture in Japan during 2012-2019. We applied distributed lag non-linear model to evaluate the non-linear and lagged effects of heat exposure on hospitalization for hyperglycemic emergencies. RESULTS: The pooled relative risk for hyperglycemic emergencies of heat effect (the 90th percentile of temperature with reference to the 75th percentile of temperature) and extreme heat effect (the 99th percentile of temperature with reference to the 75th percentile of temperature) over 0-3 lag days was 1.27 (95 %CI: 1.16-1.39) and 1.64 (95 %CI: 1.38-1.93), respectively. The pooled relative risk for heat effect on hospitalization for hypoglycemia and extreme heat effect over 0-3 lag days was 1.33 (95 %CI: 1.17-1.52) and 1.65 (95 %CI: 1.29-2.10), respectively. These associations were consistent by type of hyperglycemic emergencies and type of diabetes and were generally consistent by regions. DISCUSSION: Heat exposure was associated with hospitalizations for DKA, HHS and hypoglycemia. These results may be useful to guide preventive actions for the risk of fatal hyperglycemic emergencies and hypoglycemia.


Assuntos
Diabetes Mellitus , Cetoacidose Diabética , Coma Hiperglicêmico Hiperosmolar não Cetótico , Hipoglicemia , Cetoacidose Diabética/epidemiologia , Cetoacidose Diabética/etiologia , Cetoacidose Diabética/terapia , Emergências , Hospitalização , Temperatura Alta , Humanos , Coma Hiperglicêmico Hiperosmolar não Cetótico/epidemiologia , Coma Hiperglicêmico Hiperosmolar não Cetótico/terapia , Hipoglicemia/complicações , Hipoglicemia/epidemiologia , Japão/epidemiologia
7.
J Diabetes Complications ; 36(8): 108239, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35810146

RESUMO

AIMS: To evaluate the overall association between clinically significant nocturnal hypoglycemia (CsNH) and risk factors in geriatric patients with type 2 diabetes. METHODS: Overall, 606 geriatric with type 2 diabetes were evaluated for CsNH using Freestyle Libre Pro® (Abbott Diabetes Care, Tokyo, Japan) during October 2018-February 2020. We defined CsNH as blood glucose level <54 mg/dL (3.0 mmol/L). We investigated clinical characteristics and efficacies of hypoglycemic agents and insulin and analyzed CsNH risk factors using univariate and multivariate logistic regression analyses. RESULTS: We enrolled 152 patients each for the CsNH and non-nocturnal hypoglycemia groups. Insulin use (OR = 3.77 [95 % CI: 1.92-7.67]; P = 0.0002), age (OR = 1.06 [95 % CI: 1.01-1.12]; P = 0.0492), estimated glomerular filtration rate (OR = 0.97 [95 % CI: 0.95-0.98]; P = 0.0492), and fasting blood glucose level (OR = 0.94 [95 % CI: 0.91-0.94]; P < 0.0001) were independent CsNH risk factors. The combined results demonstrated a higher predictability of CsNH than each of the individual risk factors. CONCLUSIONS: We identified risk factors that could help predict CsNH in geriatric patients with type 2 diabetes and demonstrated a comprehensive risk factor assessment.


Assuntos
Diabetes Mellitus Tipo 2 , Hipoglicemia , Idoso , Glicemia/análise , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hemoglobina A Glicada/análise , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/diagnóstico , Hipoglicemia/epidemiologia , Hipoglicemiantes/efeitos adversos , Insulina/efeitos adversos , Medição de Risco
8.
Am J Obstet Gynecol MFM ; 4(5): 100687, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35820608

RESUMO

BACKGROUND: Late preterm antenatal corticosteroid administration has been associated with an increased risk of neonatal hypoglycemia. The mechanism is thought to be secondary to transient fetal hyperinsulinemia, which may be more likely if delivery occurs during peak antenatal corticosteroid levels. OBJECTIVE: This study aimed to investigate whether there is a latency interval between antenatal corticosteroid administration and delivery that places neonates at the greatest risk of hypoglycemia. STUDY DESIGN: This was a retrospective matched cohort study of pregnant women who received antenatal corticosteroid vs unexposed women between 34 0/7 and 36 6/7 weeks of gestation from 2016 to 2019. Unexposed women were those who did not receive antenatal corticosteroid matched according to gestational age at delivery, diabetes mellitus status, and maternal body mass index from 2010 to 2015. Latency periods from initial steroid administration to delivery were defined in grouped intervals until ≥72 hours. The primary outcome was neonatal hypoglycemia, defined as a neonatal glucose level of <40 mg/dL within 24 hours of life. Poisson regression was used to generate an adjusted relative risk of hypoglycemia for each latency period adjusting for confounders. RESULTS: A total of 812 women were included in the analysis (406 exposed and 406 unexposed). Women who received antenatal corticosteroids were more likely to be nulliparous (P=.009); moreover, the women were well matched on pregnancy complications and baseline demographics. Neonatal hypoglycemia was more frequently identified in women receiving antenatal corticosteroids than in women not receiving antenatal corticosteroids (42% vs 26%; P<.001). Severe hypoglycemia, defined as a glucose level of <20 mg/dL, was significantly more common in patients receiving antenatal corticosteroids than in patients not receiving antenatal corticosteroids (8.4% vs 2.7%; P<.001). Latency time intervals of 12 to 71 hours from antenatal corticosteroid administration were significantly associated with neonatal hypoglycemia in exposed women compared with unexposed women after adjustment; within this time frame, the highest risk was 24 to 47 hours after antenatal corticosteroid administration (adjusted relative risk, 2.09; 95% confidence interval, 1.29-3.38). CONCLUSION: In the late preterm period, the risk of neonatal hypoglycemia is the greatest in the latency period of 12 to 71 hours between steroid administration and delivery. Neonates exposed to antenatal corticosteroids were more likely to experience severe hypoglycemia within 24 hours of life than unexposed neonates.


Assuntos
Doenças Fetais , Hipoglicemia , Doenças do Recém-Nascido , Nascimento Prematuro , Corticosteroides/efeitos adversos , Estudos de Coortes , Feminino , Glucose , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/prevenção & controle , Estudos Retrospectivos , Esteroides
9.
Arch Argent Pediatr ; 120(4): 232-239, 2022 08.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-35900949

RESUMO

INTRODUCTION: Neonatal hypoglycemia is a complication of gestational diabetes mellitus. Few studies have been conducted to support a systematic screening in the first hours of life of this population group. OBJECTIVE: To assess the association between the treatment administered to the mother (diet vs. insulin) and the development of hypoglycemia, and to identify associated risk factors. MATERIAL AND METHODS: Observational, analytical, and retrospective study carried out at the Buenos Aires and San Justo maternal centers of a general, tertiary care hospital between 01-01-2017 and 12-31-2018. The incidence of neonatal hypoglycemia (≤ 47 mg/dL) based on the management of maternal diabetes was estimated and a multivariate analysis was done to assess related factors. RESULTS: A total of 195patients were included. No statistical difference was found in the incidence of hypoglycemia based on the treatment administered to the mother (45.3% vs. 39.7%; p = 0.45) and no associated risk factors were identified. Once the cutoff point was changed to ≤ 40 mg/dL, no differences were found in the incidence either (23.4% versus 19%, p = 0.48); however, patients with hypoglycemia had a significantly higher hematocrit level and a lower prevalence of exclusive breastfeeding upon discharge. Multivariate analysis showed an independent association between a high birth weight and hypoglycemia, requiring correction. CONCLUSIONS: The incidence of neonatal hypoglycemia in the studied population did not vary based on the treatment received by the mother. This study supports the control of glycemia in these infants in daily practice.


Introducción. La hipoglucemia neonatal es una complicación de la diabetes mellitus gestacional. Son pocos los estudios que avalan la pesquisa sistemática en este grupo poblacional durante las primeras horas de vida. OBJETIVOS: Evaluar la asociación entre tratamiento materno recibido (dieta versus insulina) y el desarrollo de hipoglucemia, e identificar los factores de riesgo asociados. Población y métodos. Estudio observacional, analítico y retrospectivo realizado en en las sedes de Buenos AIres y San Justo de un hospital general de tercer nivel entre el 1 de enero de 2017 y el 31 de diciembre de 2018. Se estimó la incidencia de hipoglucemia (≤47 mg/dl) en recién nacidos según el manejo de la diabetes materna y se realizó un análisis multivariable para evaluar factores asociados. RESULTADOS: Se incluyeron 195 pacientes. No se encontró diferencia estadística en la incidencia de hipoglucemia según el tratamiento materno recibido (45,3 % versus 39,7 %; p = 0,45) ni se identificaron factores de riesgo asociados. Modificando el valor de corte a ≤40 mg/ dl, tampoco se encontraron diferencias en la incidencia (23,4 % versus 19 %, p = 0,48); no obstante, los pacientes hipoglucémicos presentaron un hematocrito significativamente mayor y una menor prevalencia de lactancia exclusiva al egreso. El análisis multivariable mostró una asociación independiente entre alto peso al nacer con hipoglucemia que requiere corrección. CONCLUSIONES: La incidencia de hipoglucemia neonatal en la población estudiada no presentó diferencia según el tratamiento materno recibido. El estudio realizado fundamenta el control de la glucemia en estos niños en la práctica diaria.


Assuntos
Diabetes Gestacional , Doenças Fetais , Hipoglicemia , Doenças do Recém-Nascido , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Hipoglicemia/epidemiologia , Hipoglicemia/etiologia , Incidência , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Mães , Gravidez , Estudos Retrospectivos
10.
Front Endocrinol (Lausanne) ; 13: 900153, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35813638

RESUMO

There is an emerging Muslim and diabetic population in the United States and other Western countries and majority of pregnant women and patients with diabetes mellitus choose to fast during Ramadan. Fasting during Ramadan in pregnant women with diabetes may represent a 'perfect storm' of metabolic disturbances including hyperglycemia, hypoglycemia and ketosis. Recent continuous and flash glucose monitoring data suggests increased glycemic variability (fasting hypo- and post-Iftar hyperglycemia) in non-pregnant patients with diabetes during Ramadan. Only five small-scale studies, predominantly focused on women with gestational diabetes mellitus in Muslim-majority nations have explored maternal glycemic outcomes during Ramadan which is associated with lower mean blood glucose levels and higher frequency of fasting hypoglycemia. Data is limited however on important clinical outcomes such as symptomatic and serious hypoglycemia requiring hospitalization. Results have been conflicting regarding maternal Ramadan fasting and association with fetal outcomes in women without diabetes. Only one recently published study reported on perinatal outcomes in pregnant women with gestational diabetes which found no effect of Ramadan exposure on mean birthweight or macrosomia frequency but lower neonatal hypoglycemia prevalence, however a significant limitation was lack of documentation of maternal fasting status. At this stage, due to paucity of data, the current medical recommendation is against Ramadan fasting for pregnant Muslim women with diabetes. Large-scale population-based studies are warranted regarding maternal and fetal outcomes in pregnant fasting women with diabetes and such studies should characterize maternal fasting status and have meaningful and consistent clinical outcomes. High-quality data derived from these studies can assist clinicians in providing more evidence-based advice to safely navigate both mother and fetus through a potentially challenging pregnancy.


Assuntos
Diabetes Gestacional , Hiperglicemia , Hipoglicemia , Glicemia , Automonitorização da Glicemia , Jejum , Feminino , Feto , Humanos , Hipoglicemia/epidemiologia , Recém-Nascido , Gravidez , Gestantes , Estados Unidos
11.
Stud Health Technol Inform ; 290: 373-376, 2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35673038

RESUMO

Electronic Health Records offer an opportunity to improve patient care (in terms of quality and/or safety) by making available patient health information stored in a single Clinical Data Repository. We aimed to estimate the frequency of hypoglycemic recurrences in hospitalized adult patients in non-critical areas. We designed a cross sectional study with hospitalizations between 2017 and 2018, which included patients with at least one hypoglycemia health record (defined as a value <70 mg/dL, either by capillary glycemic monitoring or serum measurement). Recurrence was defined as those who presented a second event, with at least 2 hours of difference. We included 1884 patients, and 573 presented recurrences, yielding a global prevalence of 30.41% (95%CI 28.34-32.54). Due to the high frequency, it is important to identify vulnerable populations, to implement preventive measures to assist clinicians for decision-making tasks, as a clinical decision support system.


Assuntos
Registros Eletrônicos de Saúde , Hipoglicemia , Adulto , Glicemia , Estudos Transversais , Hospitalização , Humanos , Hipoglicemia/epidemiologia , Hipoglicemia/terapia , Hipoglicemiantes , Recidiva
12.
Diabetes Obes Metab ; 24(10): 1957-1966, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35642463

RESUMO

AIM: To compare the efficacy and safety of basal insulin glargine 100 units/ml (Gla) + 2-3 oral antihyperglycaemic drugs (OADs) with twice-daily premixed insulin aspart 70/30 (Asp30) + metformin (MET) after short-term intensive insulin therapy in adults with type 2 diabetes in China. MATERIALS AND METHODS: This open-label trial enrolled insulin-naïve adults with type 2 diabetes and an HbA1c of 7.5%-11.0% (58-97 mmol/mol) despite treatment with 2-3 OADs. All participants stopped previous OADs except MET, then received short-term intensive insulin therapy during the run-in period, when those with a fasting plasma glucose of less than 7.0 mmol/L and 2-hour postprandial glucose of less than 10.0 mmol/L were randomized to Gla + MET + a dipeptidyl peptidase-4 inhibitor or twice-daily Asp30 + MET. If HbA1c was more than 7.0% (>53 mmol/mol) at week 12, participants in the Gla group were added repaglinide or acarbose, at the physician's discretion, and participants in the Asp30 group continued to titrate insulin dose. The change in HbA1c from baseline to week 24 was assessed in the per protocol (PP) population (primary endpoint). RESULTS: There were 384 enrollees (192 each to Gla and Asp30); 367 were included in the PP analysis. The threshold for non-inferiority of Gla + OADs versus Asp30 + MET was met, with a least squares mean change from baseline in HbA1c of -1.72% and -1.70% (-42.2 and -42.1 mmol/mol), respectively (estimated difference -0.01%; 95% CI -0.20%, 0.17% [-0.1 mmol/mol; 95% CI -2.2, 1.9]). Achievement of HbA1c less than 7.0% (<53 mmol/mol) was comparable between the groups (60% vs. 57%). The proportion of participants with any (24% vs. 38%; P = .003), symptomatic (19% vs. 31%; P = .007) or confirmed hypoglycaemia (18% vs. 33%; P < .001) was lower in the Gla + OADs group. CONCLUSIONS: Compared with Asp30 + MET, Gla + 2-3 OADs showed similar efficacy but a lower hypoglycaemia risk in Chinese individuals with type 2 diabetes who had undergone short-term intensive insulin therapy.


Assuntos
Diabetes Mellitus Tipo 2 , Hipoglicemia , Metformina , Adulto , Glicemia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hemoglobina A Glicada/análise , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Hipoglicemia/prevenção & controle , Hipoglicemiantes/uso terapêutico , Insulina/efeitos adversos , Insulina Glargina/efeitos adversos , Insulina Regular Humana/uso terapêutico , Metformina/uso terapêutico
13.
Diabetes Care ; 45(8): 1907-1910, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35678724

RESUMO

OBJECTIVE: Very young children with type 1 diabetes often struggle to achieve glycemic targets, putting them at risk for long-term complications and creating an immense management burden for caregivers. We conducted the first evaluation of the Omnipod 5 Automated Insulin Delivery System in this population. RESEARCH DESIGN AND METHODS: A total of 80 children aged 2.0-5.9 years used the investigational system in a single-arm study for 13 weeks following 14 days of baseline data collection with their usual therapy. RESULTS: There were no episodes of severe hypoglycemia or diabetic ketoacidosis. By study end, HbA1c decreased by 0.55% (6.0 mmol/mol) (P < 0.0001). Time with sensor glucose levels in target range 70-180 mg/dL increased by 10.9%, or 2.6 h/day (P < 0.0001), while time with levels <70 mg/dL declined by median 0.27% (P = 0.0204). CONCLUSIONS: Use of the automated insulin delivery system was safe, and participants experienced improved glycemic measures and reduced hypoglycemia during the study phase compared with baseline.


Assuntos
Diabetes Mellitus Tipo 1 , Hipoglicemia , Glicemia , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/epidemiologia , Hemoglobina A Glicada/análise , Humanos , Hipoglicemia/epidemiologia , Hipoglicemiantes/efeitos adversos , Insulina/efeitos adversos , Sistemas de Infusão de Insulina , Insulina Regular Humana/uso terapêutico
14.
Int J Pharm Pract ; 30(4): 398-400, 2022 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-35652466

RESUMO

OBJECTIVE: The objective of this study is to validate the glycaemic safety of a simple insulin protocol using weight-based insulin rates adapted from American guidance for the management of adult diabetic ketoacidosis. METHODS: Measures of hypoglycaemia were retrospectively assessed in a single cohort of inpatient adults. The primary outcome was incidence of hypoglycaemia during insulin infusion. KEY FINDINGS: Hypoglycaemia during infusion occurred in 6/81 patients (7% [95% CI 3-16%]). Five of these occurrences were associated with protocol nonadherence. CONCLUSIONS: The glycaemic safety of a novel, variable-rate insulin protocol directly incorporating weight-based infusion rates is supported by this single-centre study.


Assuntos
Diabetes Mellitus Tipo 1 , Cetoacidose Diabética , Hipoglicemia , Adulto , Glicemia , Diabetes Mellitus Tipo 1/complicações , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Hipoglicemiantes/efeitos adversos , Incidência , Insulina/efeitos adversos , Estudos Retrospectivos
15.
Endocrinol Metab (Seoul) ; 37(3): 444-454, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35654578

RESUMO

BACKGRUOUND: No consensus exists regarding the early use of subcutaneous (SC) basal insulin facilitating the transition from continuous intravenous insulin infusion (CIII) to multiple SC insulin injections in patients with severe hyperglycemia other than diabetic ketoacidosis. This study evaluated the effect of early co-administration of SC basal insulin with CIII on glucose control in patients with severe hyperglycemia. METHODS: Patients who received CIII for the management of severe hyperglycemia were divided into two groups: the early basal insulin group (n=86) if they received the first SC basal insulin 0.25 U/kg body weight within 24 hours of CIII initiation and ≥4 hours before discontinuation, and the delayed basal insulin group (n=79) if they were not classified as the early basal insulin group. Rebound hyperglycemia was defined as blood glucose level of >250 mg/dL in 24 hours following CIII discontinuation. Propensity score matching (PSM) methods were additionally employed for adjusting the confounding factors (n=108). RESULTS: The rebound hyperglycemia incidence was significantly lower in the early basal insulin group than in the delayed basal insulin group (54.7% vs. 86.1%), despite using PSM methods (51.9%, 85.2%). The length of hospital stay was shorter in the early basal insulin group than in the delayed basal insulin group (8.5 days vs. 9.6 days, P=0.027). The hypoglycemia incidence did not differ between the groups. CONCLUSION: Early co-administration of basal insulin with CIII prevents rebound hyperglycemia and shorten hospital stay without increasing the hypoglycemic events in patients with severe hyperglycemia.


Assuntos
Cetoacidose Diabética , Hiperglicemia , Hipoglicemia , Cetoacidose Diabética/induzido quimicamente , Cetoacidose Diabética/complicações , Humanos , Hiperglicemia/tratamento farmacológico , Hiperglicemia/prevenção & controle , Hipoglicemia/epidemiologia , Hipoglicemiantes , Insulina/uso terapêutico
16.
Clin Perinatol ; 49(2): 405-426, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35659094

RESUMO

This article summarizes the available evidence reporting the relationship between perinatal dysglycemia and long-term neurodevelopment. We review the physiology of perinatal glucose metabolism and discuss the controversies surrounding definitions of perinatal dysglycemia. We briefly review the epidemiology of hypoglycemia and hyperglycemia in fetal, preterm, and term infants. We discuss potential pathophysiologic mechanisms contributing to dysglycemia and its effect on neurodevelopment. We highlight current strategies to prevent and treat dysglycemia in the context of neurodevelopmental outcomes. Finally, we discuss areas of future research and the potential role of continuous glucose monitoring.


Assuntos
Doenças do Sistema Endócrino , Hiperglicemia , Hipoglicemia , Glicemia , Automonitorização da Glicemia , Feminino , Humanos , Hiperglicemia/epidemiologia , Hipoglicemia/epidemiologia , Lactente , Recém-Nascido , Gravidez
17.
An Pediatr (Engl Ed) ; 97(1): 22-29, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35725820

RESUMO

BACKGROUND AND AIMS: To face the rapid spread of SARS-CoV2 coronavirus pandemic, home lockdown in Spain was decreed on 15th March 2020. The main objective of this study is to evaluate the impact of this constraint on glycemic control in children and adolescents with type 1 diabetes mellitus (T1D). PATIENTS AND METHODS: Observational, retrospective study in children and adolescents with T1D users of interstitial glucose monitoring systems. The following information corresponding to the last 2 weeks of lockdown was collected for subsequent comparison with data of 2 weeks prior to quarantine: daily insulin needs, mean interstitial glucose, estimated HbA1c, coefficient of variation (CV), time in range (70-180mg/dl), hypoglycemia (<70 and <54mg/dl) and hyperglycemia (>180 and> 250mg/dl), sensor use and number of blood glucose measurements. Data about meal routines, physical exercise, need for adjustments in therapy, acute complications and lockdown of caregivers were assessed via a survey. RESULTS: 80 patients were studied (mean age 12.61±3.32 years, mean time of evolution of the disease 5.85±3.92 years), 66.2% treated with an insulin pump, users of following glucose monitoring systems: Guardian 3 (65%), FreeStyle Libre (18.8%) and Dexcom G6 (16.2%). Time in range in the cohort increased significantly during confinement (72.1±10.5 vs 74.8±10.5%; P=0.011) with lower time in hypoglycemia both <70mg/dl (4.6±3.2 vs 3.2±2.7%; P<0.001) and <54mg/dl (1.2±1.6 vs 0.7±1.2%; P<0.001) and hyperglycemia >250mg/dl (4.6±3.9 vs 3.7±3.7%; P=0.038). CV also decreased (35.8±6.3 vs 33.1±6.1%; P<0.001). Patients treated with multiple doses of insulin and poorer baseline glycemic control experienced greatest improvement. Daily insulin requirements remained stable. Regular practice of physical exercise and caregivers' confinement did not have a significant impact. CONCLUSIONS: Glycemic control in children and adolescents with T1D improved during quarantine, particularly in those with worse baseline control.


Assuntos
COVID-19 , Diabetes Mellitus Tipo 1 , Hiperglicemia , Hipoglicemia , Adolescente , Glicemia , Automonitorização da Glicemia , Criança , Controle de Doenças Transmissíveis , Diabetes Mellitus Tipo 1/tratamento farmacológico , Humanos , Hipoglicemia/epidemiologia , Hipoglicemia/prevenção & controle , Insulina/uso terapêutico , Insulina Regular Humana/uso terapêutico , RNA Viral/uso terapêutico , Estudos Retrospectivos , SARS-CoV-2
18.
BMC Res Notes ; 15(1): 231, 2022 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-35765104

RESUMO

OBJECTIVE: Periparturient period is associated with multiple changes including serum concentration of macro minerals and drop in feed intake. Therefore, it is essential to know the actual concentrations of major macro minerals, glucose and ketone bodies in blood during the periparturient period. The objectives of the study were to study the dynamics of calcium, magnesium, phosphorus, and glucose in serum and ketone bodies in the urine of periparturient cows and to estimate the incidence of subclinical metabolic diseases. RESULTS: Results showed that all the urine samples were negative for ketone bodies. Incidence of subclinical form of hypocalcaemia, hypomagnesaemia, hypophosphatemia, and hypoglycemia in periparturient cows was 31.03%, 48.28%, 17.24% and 55.17%, respectively. Older cows with high BCS and milk yield were mostly affected with a subclinical form of hypocalcaemia and hypoglycemia. No significant differences were observed in serum level of macro minerals and glucose at different time points of periparturient period of cows fed with a balanced ration, and between two groups of cows those were given IV injection of calcium and magnesium on the day of parturition and those were not given. Age, parity, and milk yield had no significant effect on the concentration of calcium, magnesium, phosphorus, and glucose.


Assuntos
Doenças dos Bovinos , Hipocalcemia , Hipoglicemia , Doenças Metabólicas , Animais , Cálcio , Cálcio na Dieta , Bovinos , Doenças dos Bovinos/epidemiologia , Feminino , Glucose , Hipocalcemia/epidemiologia , Hipocalcemia/veterinária , Hipoglicemia/epidemiologia , Hipoglicemia/veterinária , Corpos Cetônicos , Lactação , Magnésio , Minerais , Fósforo , Gravidez
19.
Can J Diabetes ; 46(3): 244-252, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35568425

RESUMO

BACKGROUND: Patients with diabetes facing psychosocial challenges often struggle with diabetes self-management, and thereby are at risk of complications arising from hyperglycemia and hypoglycemia. Despite the Diabetes Canada Clinical Practice Guidelines' recommendations for diabetes centres to offer psychosocial services for the screening and support of patients with psychosocial barriers, the extent to which these recommendations have been implemented in centres across Canada is unknown. METHODS: Tertiary adult diabetes centres affiliated with academic institutions were invited to participate in our quantitative survey (n=40). At each centre, a structured telephone interview was administered to a manager, as well as a social worker and psychologist (if employed at the centre), to inquire regarding the psychosocial services offered. RESULTS: Thirty diabetes centres (75%) completed at least one questionnaire. Participating diabetes centres varied considerably in capacity, employing from 3 to more than 50 diabetes educators and from 0 to 20 endocrinologists. Approximately 80% of centres reported providing patients with access to psychosocial services, but only about 50% had a dedicated, internal psychosocial team. Stratified results showed centres that are the main centres affiliated with academic teaching hospitals were more likely to have embedded psychosocial services and to make referrals for psychosocial concerns when compared with satellite centres. The majority of managers reported that their staffing and funding model provided inadequate psychosocial support and that increased funding for psychosocial care was either somewhat of a priority or a high priority. CONCLUSIONS: Diabetes centres across Canada struggle to offer adequate psychosocial services; greater funding and training for staff is required to uphold the Diabetes Canada Clinical Practice Guidelines.


Assuntos
Diabetes Mellitus , Hipoglicemia , Reabilitação Psiquiátrica , Adulto , Canadá/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Humanos , Hipoglicemia/epidemiologia , Hipoglicemia/prevenção & controle , Centros de Atenção Terciária
20.
Can J Diabetes ; 46(3): 294-301.e2, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35568431

RESUMO

OBJECTIVES: The clinical relevance of fasting and postprandial hypoglycemia in patients with cystic fibrosis (CF) is poorly characterized. Our aim in this study was to characterize the prevalence of hypoglycemia in adult patients during oral glucose tolerance test (OGTT) screening and determine its impact on the risk of developing CF-related diabetes (CFRD). METHODS: We analyzed 2 cohorts of pancreatic insufficient patients with CF exposed to comparable treatment recommendations in France (Lyon CF cohort [DIAMUCO]) and Canada (Montréal CF cohort [MCFC]). Patients were classified into 3 groups based on hypoglycemia absence or presence as well as its severity at baseline. We defined the groups as follows: level 2 hypoglycemia (L2H; plasma glucose [PG]<3.0 mmol/L), level 1 hypoglycemia (L1H; PG 3.0 to <4.0 mmol/L) and no hypoglycemia (NH) during an OGTT. RESULTS: A total of 153 MCFC and 114 DIAMUCO subjects were included in the study. In total, 22% of the patients experienced hypoglycemia, with 5% having it on 2 or more OGTTs. The L1H and L2H groups tended to have a lower 2-hour glucose and higher early-phase insulin secretion (insulin area under the curve at 0 to 30 minutes) compared with NH patients. In both cohorts, a greater proportion of men and patients with normal glucose tolerance had hypoglycemia. Over a 5-year period, there were no cases of CFRD in the L2H group, whereas 4 subjects in the L1H group and 36 in the NH group developed CFRD. CONCLUSIONS: Patients with hypoglycemia were at lower risk of developing CFRD, but at higher risk of early-phase insulin secretion and unsuppressed insulin secretion. This could potentially lead to further hypoglycemia after the 2-hour OGTT, suggesting high clinical relevance.


Assuntos
Fibrose Cística , Diabetes Mellitus , Intolerância à Glucose , Hipoglicemia , Adulto , Glicemia , Fibrose Cística/complicações , Fibrose Cística/epidemiologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Masculino , Prevalência
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