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1.
Medicine (Baltimore) ; 99(2): e18679, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914062

RESUMO

This study aimed to correlate hypoglycemic risk exposures (HREs) with low blood glucose value (BGV) in ambulatory patients to inform selection of a glucose critical action value (CAV).This was a retrospective study of ambulatory patients with at least 1 serum glucose ≤70 mg/dL obtained at 2 laboratories within the Johns Hopkins Health System over 3.8 years. Multivariable logistic regression was used to evaluate association of BGV cut-offs of <60, <54, <50, and <45 mg/dL with HREs. HREs were classified as "high hypoglycemic risk" (HHR), "moderate hypoglycemic risk" (MHR), "low hypoglycemic risk" (LHR), and "no hypoglycemic risk" (NHR).A total of 5404 patient samples of BG ≤70 mg/dL were analyzed, of which 30.3%, 23.2%, 28.5%, 18.0% occurred in NHR, LHR, MHR, and HHR groups, respectively. An inverse relationship was noted between BGV cut-offs and HHR, but no association was observed for LHR or MHR. After adjusting for age, sex, and race, there was an inverse association between BG thresholds and the odds of HHR. For classification of HHR, BGV cut-offs of <60, <54, <50, and <45 mg/dL correctly classified 71.2%, 69.8%, 68.8%, and 67.2% of BG samples, achieved false-positive rates of 13.6%, 4.7%, 1.7%, and 0.5% and positive likelihood ratios of 3.3, 6.0, 11.2, and 23.4, respectively.Nearly 70% of low BGVs occurred in patients with at least 1 HRE, but only ∼20% occurred in HHR patients. Given their high positive likelihood ratios, BGVs <54 or <50 mg/dL are reasonable candidates for CAVs that would allow sufficient clinician response time while minimizing false-positive alerts.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Glicemia/análise , Hipoglicemia/epidemiologia , Adulto , Idoso , Comorbidade , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Reações Falso-Positivas , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Estudos Retrospectivos , Fatores de Risco
2.
BMJ ; 367: l5887, 2019 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690574

RESUMO

Diabetes is a major and costly health concern worldwide, with high morbidity, disability, mortality, and impaired quality of life. The vast majority of people living with diabetes have type 2 diabetes. Historically, the main strategy to reduce complications of type 2 diabetes has been intensive glycemic control. However, the body of evidence shows no meaningful benefit of intensive (compared with moderate) glycemic control for microvascular and macrovascular outcomes important to patients, with the exception of reduced rates of non-fatal myocardial infarction. Intensive glycemic control does, however, increase the risk of severe hypoglycemia and incurs additional burden by way of polypharmacy, side effects, and cost. Additionally, data from cardiovascular outcomes trials showed that cardiovascular, kidney, and mortality outcomes may be improved with use of specific classes of glucose lowering drugs largely independently of their glycemic effects. Therefore, delivering evidence based, patient centered care to people with type 2 diabetes requires a paradigm shift and departure from the predominantly glucocentric view of diabetes management. Instead of prioritizing intensive glycemic control, the focus needs to be on ensuring access to adequate diabetes care, aligning glycemic targets to patients' goals and situations, minimizing short term and long term complications, reducing the burden of treatment, and improving quality of life.


Assuntos
Complicações do Diabetes/prevenção & controle , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemia/epidemiologia , Hipoglicemiantes/administração & dosagem , Qualidade de Vida , Glicemia/análise , Glicemia/efeitos dos fármacos , Complicações do Diabetes/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Humanos , Hiperglicemia/sangue , Hiperglicemia/tratamento farmacológico , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Incidência , Metanálise como Assunto , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/normas , Guias de Prática Clínica como Assunto , Revisão Sistemática como Assunto , Resultado do Tratamento
3.
Pan Afr Med J ; 33: 322, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692874

RESUMO

Introduction: Diabetic ketoacidosis (DKA) is a severe metabolic complication of diabetes. Recent years have seen a marked increase in prevalence of diabetic ketoacidosis, but mortality is low. This study aimed to describe the epidemiological, clinical, therapeutic and prognostic features of patients with severe or moderate DKA admitted to the Emergency Department. Methods: He conducted a prospective, descriptive study including patients with moderate or severe DKA. Standardized care protocol. We studied the epidemiological, clinical, therapeutic and prognostic features of these patients. Results: The study involved 185 patients with moderate or severe DKA. The average age of patients was 38+/-18 years, with a sex ratio of 0.94. Known diabetes was reported in 159 patients (85%) of whom 116 had type 1 diabetes. The most common factors of decompensation were treatment discontinuation in 42% and infection in 32%. Average blood glucose was 32.7+/-12 mmol/L, pH =7.14+/-0.13, HCO3- =7.2+/-3.56 mmol/L. The mean duration of intravenous insulin was 17.3 +/- 16 hours. Hypoglycaemia was reported in 26 patients (14%), hypokalemia in 80 (43%) patients and hyperchloraemic mineral acidosis in 43 patients (23%). Intrahospital mortality was 2.1%. Conclusion: Diabetic ketoacidosis occurs in young subjects treated with insulin therapy. Treatment is based on intravenous insulin associated with correction of fluid deficit. Complications mainly include hypokalemia and hypoglycemia and mortality is low.


Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Cetoacidose Diabética/epidemiologia , Insulina/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia/metabolismo , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Cetoacidose Diabética/tratamento farmacológico , Serviço Hospitalar de Emergência , Feminino , Humanos , Hipoglicemia/epidemiologia , Hipoglicemia/etiologia , Hipoglicemiantes/administração & dosagem , Hipopotassemia/epidemiologia , Hipopotassemia/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
4.
West J Emerg Med ; 20(5): 833-837, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31539342

RESUMO

INTRODUCTION: Hypoglycemia is frequently encountered in the emergency department (ED) and has potential for serious morbidity. The incidence and causes of iatrogenic hypoglycemia are not known. We aim to describe how often the cause of ED hypoglycemia is iatrogenic and to identify its specific causes. METHODS: We included adult patients with a chief complaint or ED diagnosis of hypoglycemia, or an ED glucose value of ≤70 milligrams per deciliter (mg/dL) between 2009-2014. Two independent abstractors each reviewed charts of patients with an initial glucose ≤ 50 mg/dL, or initial glucose ≥ 70 mg/dL with a subsequent glucose ≤ 50 mg/dL, to determine if the hypoglycemia was caused by iatrogenesis. The data analysis was descriptive. RESULTS: We reviewed the charts of 591 patients meeting inclusion criteria. Of these 591 patients, 99 (17%; 95% confidence interval, 14-20%) were classified as iatrogenic. Of these 99 patients, 61 (61%) cases of hypoglycemia were caused by insulin administration and 38 (38%) were caused by unrecognized malnutrition. Of the 61 patients with iatrogenic hypoglycemia after ED insulin administration, 45 and 15 patients received insulin for hyperkalemia and uncomplicated hyperglycemia, respectively. One patient received insulin for diabetic ketoacidosis. CONCLUSION: In ED patients with hypoglycemia, iatrogenic causes are relatively common. The most frequent cause was insulin administration for hyperkalemia and uncomplicated hyperglycemia. Additionally, patients at risk of hypoglycemia in the absence of insulin, including those with alcohol intoxication or poor nutritional status, should be monitored closely in the ED.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Hipoglicemia/epidemiologia , Doença Iatrogênica , Adulto , Glicemia/metabolismo , Feminino , Humanos , Hipoglicemia/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia
5.
Diabetes Metab Syndr ; 13(4): 2585-2591, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405680

RESUMO

BACKGROUND: Illness perceptions (IP) involve coping strategies and behavioural responses that can influence glycaemic control. Despite the importance of good glycaemic control, the majority of patients in Asia are not achieving glycaemic targets. An evaluation of IP in association with glycaemic control, medication adherence and chronic kidney disease (CKD) in Type 2 diabetes mellitus patients (T2DM) was carried out in an outpatient setting in Malaysia METHOD: A cross-sectional study was conducted using the Revised Illness Perception Questionnaire in a purposive sample of 384 T2DM patients. RESULTS: There were 55.7% females, median age was 58.2 years and median duration of diabetes was 13 years. The majority (79.4%) of patients had poor diabetes control (HbA1c ≥ 7.0%) and 39.6% of patients had low medication adherence. Patients with good glycaemic control had a higher Timeline Acute/Chronic and Emotional Representations score, hence they held the correct belief that diabetes is chronic and experienced negative emotions. Highly adherent patients had a higher Illness Coherence (χ2 = 21.385, p < 0.001) score but a lower Consequences (χ2 = 17.592, p < 0.001) and Emotional Representations (χ2 = 16.849, p < 0.001) score indicating good understanding and less negative perceptions of disease burden. Patients in a more advanced stage of CKD had a significantly higher Timeline Cyclical score (χ2 = 18.718, p = 0.001), believing that diabetes was unpredictable. CONCLUSION: Dimensions of IP have been shown to be significantly associated with the assessed variables, therefore intervention studies with education, support and counselling should be conducted in Asia with the ultimate aim of empowering patients through IP-targeted management.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Hiperglicemia/psicologia , Hipoglicemia/psicologia , Hipoglicemiantes/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Insuficiência Renal Crônica/psicologia , Idoso , Biomarcadores/análise , Estudos Transversais , Diabetes Mellitus Tipo 2/psicologia , Feminino , Seguimentos , Humanos , Hiperglicemia/epidemiologia , Hiperglicemia/prevenção & controle , Hipoglicemia/epidemiologia , Hipoglicemia/prevenção & controle , Malásia/epidemiologia , Masculino , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Percepção , Prevalência , Prognóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/prevenção & controle , Inquéritos e Questionários
6.
Mayo Clin Proc ; 94(9): 1731-1742, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31422897

RESUMO

OBJECTIVE: To estimate the contemporary prevalence of intensive glucose-lowering therapy among US adults with diabetes and model the number of hypoglycemia-related emergency department (ED) visits and hospitalizations that are attributable to such intensive treatment. PATIENTS AND METHODS: US adults with diabetes and glycated hemoglobin (HbA1c) levels less than 7.0% who were included in the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2014. Participants were categorized as clinically complex if 75 years or older or with 2 or more activities of daily living limitations, end-stage renal disease, or 3 or more chronic conditions. Intensive treatment was defined as any glucose-lowering medications with HbA1c levels of 5.6% or less or 2 or more with HbA1c levels of 5.7% to 6.4%. First, we quantified the proportion of clinically complex and intensively treated individuals in the NHANES population. Then, we modeled the attributable hypoglycemia-related ED visits/hospitalizations over a 2-year period based on published data for event risk. RESULTS: Almost half (48.8% [10,719,057 of 21,980,034]) of US adults with diabetes (representing 10.7 million US adults) had HbA1c levels less than 7.0%. Among them, 32.3% (3,466,713 of 10,719,057) were clinically complex, and 21.6% (2,309,556 of 10,719,057) were intensively treated, with no difference by clinical complexity. Over a 2-year period, we estimated 31,511 hospitalizations and 30,954 ED visits for hypoglycemia in this population; of these, 4774 (95% CI, 954-9714) hospitalizations and 4804 (95% CI, 862-9851) ED visits were attributable to intensive treatment. CONCLUSION: Intensive glucose-lowering therapy, particularly among vulnerable clinically complex adults, is strongly discouraged because it may lead to hypoglycemia. However, intensive treatment was equally prevalent among US adults, irrespective of clinical complexity. Over a 2-year period, an estimated 9578 hospitalizations and ED visits for hypoglycemia could be attributed to intensive diabetes treatment, particularly among clinically complex patients. Patients at risk for hypoglycemia may benefit from treatment deintensification to reduce hypoglycemia risk and treatment burden.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Hipoglicemiantes/administração & dosagem , Atividades Cotidianas , Fatores Etários , Idoso , Glicemia/análise , Comorbidade , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Hospitalização/estatística & dados numéricos , Humanos , Hipoglicemia/fisiopatologia , Hipoglicemiantes/efeitos adversos , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Prevalência , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Fatores de Tempo , Estados Unidos
7.
J Pak Med Assoc ; 69(Suppl 2)(6): S75-S79, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31369537

RESUMO

Objective: In Vietnam, prevalence of diabetes in adults is estimated at 5.5% and the total cases of diabetes in adults was over 3,5 million in 2017. Hypoglycaemia is one of the most-observed adverse reaction associated with the consumption of insulin and oral hypoglycaemia agents. The objective is to report the hypoglycaemia cases in type 2 diabetes mellitus (T2DM) patients with medication therapies attending a secondary health facility. Methods: We conducted this retrospective research on 1,006 T2DM patients at Lam Dong General Hospital, Lam Dong province in three years between 2016 and 2018 using ICD-10 code of E11. A total of 523 eligible T2DM patients were enumerated to select hypoglycaemia cases while treated with insulin therapy or oral intake of hypoglycaemia agents. Information were extracted from hospital electronic databases, sensitive information was coded. Results: Among 523 eligible T2DM patients, 92.4% (n=483) patients experienced at least one symptom of hypoglycaemia. The mean age of the selected patients was 51.2}5.2. Females were dominated by males in terms of number. Frequency of hypoglycaemia symptoms was 0-1 time per week for most of patients. The main hypoglycaemia symptoms that most of patients with T2DM suffered were sweating and drowsiness (83% and 70% respectively). Seizures, headache and loss of consciousness accounted for lowest percentages. Conclusions: The frequency of hypoglycaemia in T2DM patients in Lam Dong General Hospital was very high. Physician consideration and patient education are necessary in hypoglycaemia management.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemia/epidemiologia , Hipoglicemiantes/efeitos adversos , Insulina/efeitos adversos , Administração Oral , Adulto , Feminino , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/fisiopatologia , Hipoglicemiantes/administração & dosagem , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Estudos Retrospectivos , Centros de Cuidados de Saúde Secundários , Vietnã/epidemiologia
8.
BMC Endocr Disord ; 19(1): 78, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337371

RESUMO

BACKGROUND: Hypoglycaemia, especially nocturnal, remains the main limiting factor of achieving good glycaemic control in type 1 diabetes. The effect of first generation long-acting insulin analogues in reducing nocturnal hypoglycaemia is well documented in patient with type 1 diabetes. The effect of the newer long-acting insulin degludec on risk of nocturnal hypoglycaemia remains undocumented in patients with type 1 diabetes and recurrent severe nocturnal hypoglycaemia. The HypoDeg trial is designed to investigate whether insulin degludec in comparison with insulin glargine U100 is superior in limiting the occurrence of nocturnal hypoglycaemia in patients with recurrent nocturnal severe hypoglycaemia. This paper reports the study design of the HypoDeg trial. METHODS/DESIGN: A Danish investigator-initiated, prospective, randomised, open, blinded endpoint (PROBE), multicentre, two-year cross-over study investigating the effect of insulin degludec versus insulin glargine U100 on frequency of nocturnal hypoglycaemia in patients with type 1 diabetes and one or more episodes of nocturnal severe hypoglycaemia during the preceding two years as the major inclusion criteria. Patients are randomised (1:1) to basal therapy with insulin degludec or insulin glargine. Insulin aspart is used as bolus therapy in both treatment arms. DISCUSSION: In contrast to most other insulin studies the HypoDeg trial includes only patients at high risk of hypoglycaemia. The HypoDeg trial will compare treatment with insulin degludec to insulin glargine U100 in terms of risk of nocturnal hypoglycaemic episodes in patients with type 1 diabetes with the greatest potential to benefit from near-physiological insulin replacement therapy. www.clinicaltrials.gov : NCT02192450.


Assuntos
Ritmo Circadiano/efeitos dos fármacos , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemia/epidemiologia , Hipoglicemiantes/uso terapêutico , Insulina de Ação Prolongada/uso terapêutico , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Biomarcadores/análise , Glicemia/análise , Estudos Cross-Over , Esquema de Medicação , Feminino , Seguimentos , Humanos , Hipoglicemia/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Adulto Jovem
9.
J Pediatr Endocrinol Metab ; 32(8): 843-849, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31318694

RESUMO

Background To evaluate the safety of fasting during the holy month of Ramadan among children and adolescent with type 1 diabetes (T1D). Methods A retrospective cohort study of 50 children and adolescents with T1D whose mean age was 12.7 ± 2.1 years was conducted. Twenty-seven patients (54%) were on multiple daily injections (MDI) insulin regimen and 23 (46%) were on insulin pump therapy. Before fasting for Ramadan, children and their families were evaluated and educated about diabetes management during Ramadan. Hemoglobin A1c (HbA1c), weight, number of days fasted, hypoglycemia and hyperglycemia episodes, and emergency hospital visits were collected and analyzed after completing the month. Participants were compared according to the insulin treatment regimen and their glycemic control level before Ramadan. Results The children were able to fast 20 ± 9.9 days of Ramadan, and the most common cause for breaking the fast was mild hypoglycemia (7.8% among all cases). There was no significant difference between the two insulin regimen groups in breaking fast days, frequency of hypo- or hyperglycemia, weight and HbA1c changes post Ramadan. Patients with HbA1c ≤ 8.5% were able to fast more days during Ramadan with significantly less-frequent hypoglycemic attacks as compared to patients with HbA1c > 8.5 (1.2 ± 1.5 vs. 3.3 ± 2.9 days of hypoglycemia, p = 0.01, respectively). Conclusions Fasting for children with T1D above the age of 10 years is feasible and safe in both pump and non-pump users, and well-controlled patients are less likely to develop complications. Education of the families and their children before Ramadan, along with intensive monitoring of fasting children during the month are crucial.


Assuntos
Peso Corporal , Diabetes Mellitus Tipo 1/tratamento farmacológico , Jejum/efeitos adversos , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Sistemas de Infusão de Insulina/efeitos adversos , Insulina/administração & dosagem , Adolescente , Biomarcadores/análise , Glicemia/análise , Criança , Diabetes Mellitus Tipo 1/sangue , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/induzido quimicamente , Hiperglicemia/epidemiologia , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Incidência , Insulina/efeitos adversos , Islamismo , Kuweit/epidemiologia , Masculino , Prognóstico , Estudos Retrospectivos
10.
Diabetes Res Clin Pract ; 155: 107783, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31325541

RESUMO

AIM: The study aimed to assess the prevalence of hypoglycaemia in subjects with type 1 diabetes (T1D) attending a public health tertiary diabetes clinic in Durban, South Africa. METHODS: Patients with T1D were enrolled at the time of clinic attendance. Data on hypoglycaemia over the previous 12 weeks were obtained from glucose meter downloads as well as diary records. Each patient completed the Hypoglycaemia Fear Survey questionnaire as well as an in-house questionnaire on hypoglycaemic episodes in the previous 12 months. RESULTS: A total of 151 subjects (58% female, 54% black African) were enrolled. "Any" hypoglycaemia occurred in 144 (95.4%) in the 12 months prior to clinic attendance. Of these, "severe" hypoglycaemia occurred in 107 (74.3%) and 22 (20.6%) had five or more severe episodes. The most frequent behavioural change in response to hypoglycaemia was insulin dose self-adjustment and the commonest worry was the possibility of becoming emotionally upset during hypoglycaemia. CONCLUSIONS: In a tertiary diabetes clinic in Durban, South Africa, there was a high frequency of hypoglycaemia in patients with T1D and in the majority, at least one severe episode occurred in the 12 months prior to clinic attendance. The results indicate a need for further study and strategies to reduce the frequency and severity of hypoglycaemia.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemia/epidemiologia , Hipoglicemiantes/efeitos adversos , Atenção Terciária à Saúde/estatística & dados numéricos , Adolescente , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Hipoglicemia/induzido quimicamente , Incidência , Masculino , Prognóstico , África do Sul/epidemiologia , Adulto Jovem
11.
Med Care ; 57(9): 702-709, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31356411

RESUMO

OBJECTIVE: As part of a multidisciplinary team managing patients with type-2 diabetes, pharmacists need a consistent approach of identifying and prioritizing patients at highest risk of adverse outcomes. Our objective was to identify which predictors of adverse outcomes among type-2 diabetes patients were significant and common across 7 outcomes and whether these predictors improved the performance of risk prediction models. Identifying such predictors would allow pharmacists and other health care providers to prioritize their patient panels. RESEARCH DESIGN AND METHODS: Our study population included 120,256 adults aged 65 years or older with type-2 diabetes from a large integrated health system. Through an observational retrospective cohort study design, we assessed which risk factors were associated with 7 adverse outcomes (hypoglycemia, hip fractures, syncope, emergency department visit or hospital admission, death, and 2 combined outcomes). We split (50:50) our study cohort into a test and training set. We used logistic regression to model outcomes in the test set and performed k-fold validation (k=5) of the combined outcome (without death) within the validation set. RESULTS: The most significant predictors across the 7 outcomes were: age, number of medicines, prior history of outcome within the past 2 years, chronic kidney disease, depression, and retinopathy. Experiencing an adverse outcome within the prior 2 years was the strongest predictor of future adverse outcomes (odds ratio range: 4.15-7.42). The best performing models across all outcomes included: prior history of outcome, physiological characteristics, comorbidities and pharmacy-specific factors (c-statistic range: 0.71-0.80). CONCLUSIONS: Pharmacists and other health care providers can use models with prior history of adverse event, number of medicines, chronic kidney disease, depression and retinopathy to prioritize interventions for elderly patients with type-2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Prioridades em Saúde/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , /estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Hipoglicemia/epidemiologia , Modelos Logísticos , Masculino , Admissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Síncope/epidemiologia
12.
Diabetes Res Clin Pract ; 154: 138-145, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31150723

RESUMO

AIM: To evaluate the predictive factors of glycemic control in children and adolescents with type 1 diabetes mellitus (T1DM). METHODS: Cross-sectional study at a referral service in Rio de Janeiro, Brazil. Sociodemographic, anthropometric, clinical, and dietary factors were evaluated. Food consumption was evaluated by 24 h dietary recall and the NOVA system was adopted for classifying the foods according to the extent and purpose of industrial processing. The predictive factors were evaluated by multivariate linear regression, adopting p < 0.05. RESULTS: One hundred and twenty children and adolescents participated, with a mean age of 11.74 years (±2.88) and HbA1c of 8.13% (±1.26). The mean diabetes duration was 6.68 years (±3.33) and the insulin used was 1.05 units per kilogram of ideal weight (IU/kg of ideal weight; ±0.46) About 80% (n = 96) used carbohydrate counting and it was verified that 24.27% (±17.89) of the participants' total calories came from ultraprocessed foods. For each year of diagnosis with T1DM and for each IU/kg of weight used, HbA1c increased by 0.087% (ß = 0.087, p = 0.007) and 0.651%, respectively (ß = 0.651; p = <0.001). Use of carbohydrate counting was associated with a 1.058% reduction in HbA1c (ß = -1.058; p = 0.001). CONCLUSION: Disease duration and insulin dose were directly reflected in HbA1c concentrations, while carbohydrate counting showed an inverse association.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hemoglobina A Glicada/análise , Hiperglicemia/diagnóstico , Hipoglicemia/diagnóstico , Insulina/administração & dosagem , Encaminhamento e Consulta , Adolescente , Peso Corporal , Brasil/epidemiologia , Criança , Estudos Transversais , Diabetes Mellitus Tipo 1/fisiopatologia , Ingestão de Energia , Feminino , Humanos , Hiperglicemia/epidemiologia , Hiperglicemia/prevenção & controle , Hipoglicemia/epidemiologia , Hipoglicemia/prevenção & controle , Masculino , Valor Preditivo dos Testes , Prevalência
13.
Diabetes Res Clin Pract ; 152: 166-170, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31150726

RESUMO

OBJECTIVES: Fasting in summer months for Muslim people with diabetes during Ramadan is challenging, particularly in temperate climates, where duration of fasting is prolonged. Risk of fasting may be greater in people with diabetes and chronic kidney disease (CKD). We aimed to prospectively monitor the outcomes of patients with diabetes and CKD stage 3 during Ramadan 2018 in East London. METHODS: Patients with type 2 diabetes (T2D) and CKD stage 3 attending community diabetes clinics were approached prior to Ramadan 2018 to discuss fasting. Patients were risk categorised according to Diabetes and Ramadan Alliance guidelines. If they chose to fast, Ramadan education was given, and biomedical assessments were undertaken within one week prior to and one week after fasting. Outcomes between patients fasting and non-fasting groups were compared. RESULTS: Fasting (n = 68) and non-fasting groups (n = 71) were similar apart from slightly higher insulin use in the non-fasting group. Median days fasted was 21 (range 12-29). There were no significant changes in weight, blood pressure, creatinine, glycated haemoglobin, cholesterol and urinary PCR pre- and post-Ramadan, and no significant differences between the fasting and non-fasting groups. There was no difference in adverse events (acute kidney injury, hypoglycaemia or cardiovascular events) between the fasting and non-fasting groups. CONCLUSIONS: No significant differences were seen in clinical or biochemical parameters, or adverse events between fasting and non-fasting patients. Patients with T2D and stable CKD stage 3 may be able to fast safely during Ramadan.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Nefropatias Diabéticas/diagnóstico , Jejum/fisiologia , Islamismo , Insuficiência Renal Crônica/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Peso Corporal/fisiologia , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/epidemiologia , Jejum/sangue , Feminino , Hemoglobina A Glicada/análise , Hemoglobina A Glicada/metabolismo , Humanos , Hipoglicemia/sangue , Hipoglicemia/epidemiologia , Hipoglicemia/etiologia , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Inquéritos e Questionários
14.
BMC Endocr Disord ; 19(1): 57, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170961

RESUMO

BACKGROUND: Although exercise seems to be beneficial for type 2 diabetes mellitus (T2DM) patients, there is limited research elucidating the optimal accessible indices of adiposity and insulin resistance for identifying elderly T2DM patients with poor glycemic control, which could be improved by performing regular exercise. METHODS: A community-based, cross-sectional study was conducted with 918 Chinese elderly individuals with T2DM in Zhejiang. Relevant risk factors for poor glycemic control, as determined using glycated haemoglobin A1c (HbA1c) > 7%, were explored using logistic regression analyses and included body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), fasting blood glucose (FBG), triglycerides (TGs), total cholesterol (TC), the product of fasting triglycerides and glucose (TyG), visceral adiposity index (VAI), lipid accumulation product (LAP), TyG-BMI, and TyG-WC. Comparisons of the risk factors' ability to discriminate poor glycemic control as well as their optimal cutoff values were determined using receiver operating characteristic (ROC) analyses, and then the extent of poor glycemic control risk reduction through regular exercise was examined using multivariate logistic regression analyses. RESULTS: The overall poor glycemic control rate was 49.3%. The factors associated with poor glycemic control included FBG > 3.869, TyG > 8.73, TyG-BMI > 222.45, and TyG-WC > 713.48 in logistic regression analyses. The optimal cutoff points of FBG, TyG, TyG-WC, and TyG-BMI in discriminating poor glycemic control were 7.38, 9.22, 813.33, and 227.77, and their corresponding areas under the ROC curves were 0.864(0.840-0.886), 0.684(0.653-0.714), 0.604(0.571-0.635), and 0.574(0.541-0.606), respectively. Occasional and regular exercise reduced the odds ratios (95% confidence interval) of poor glycemic control to 0.187 (0.063-0.557) and 0.183 (0.059-0.571) for subjects with TyG-WC > 813.33 (p = 0.008), to 0.349 (0.156-0.782) and 0.284 (0.123-0.652) for subjects with TyG > 9.22 (p = 0.011), and to 0.390 (0.175-0.869) and 0.300(0.130-0.688) for subjects with TyG-BMI > 227.77 (p = 0.017), respectively, after adjusting for multiple confounding factors. CONCLUSION: Among elderly individuals with T2DM, poor glycemic control risk might be identified using indices calculated from FBG, TG, BMI, and WC measurements, which are indicative of adiposity and insulin resistance. TyG-WC seems to be an accessible and useful indicator to identify which elderly T2DM patients would benefit from performing regular exercise to achieve good glycemic control.


Assuntos
Automonitorização da Glicemia/estatística & dados numéricos , Diabetes Mellitus Tipo 2/fisiopatologia , Hiperglicemia/diagnóstico , Hipoglicemia/diagnóstico , Vida Independente/estatística & dados numéricos , Resistência à Insulina , Obesidade Abdominal/complicações , Adiposidade , Idoso , Biomarcadores/análise , China/epidemiologia , Estudos Transversais , Terapia por Exercício , Feminino , Seguimentos , Humanos , Hiperglicemia/epidemiologia , Hiperglicemia/prevenção & controle , Hipoglicemia/epidemiologia , Hipoglicemia/prevenção & controle , Masculino , Prognóstico , Curva ROC , Fatores de Risco
15.
Diabetes Educ ; 45(4): 349-369, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31210091

RESUMO

PURPOSE: The primary purpose of this study is to report a systematic review of evidence and gaps in the literature among well-conducted studies assessing the impact of diabetes education on hypoglycemia outcomes and secondarily reporting the impact on other included target outcomes. METHODS: The authors used a modified Cochrane method to systematically search and review English-language titles, abstracts, and full-text articles published in the United States between January 2001 and December 2017, with diabetes education specified as an intervention and a directly measurable outcome for hypoglycemia risk or events included. RESULTS: Fourteen quasi-experimental, experimental, and case-control studies met the inclusion criteria, with 8 articles reporting a positive impact of diabetes self-management education and support (DSMES) on hypoglycemia outcomes; 2 of the 8 reported decreased hypoglycemia events, and 1 reported decreased events in both the intervention and control groups. In addition, 5 studies targeted change in reported hypoglycemia symptoms, with all 5 reporting a significant decrease. DSMES also demonstrated an impact on intermediate (knowledge gain, behavior change) and long-term (humanistic and economic/utilization) outcomes. An absence of common hypoglycemia measures and terminology and suboptimal descriptions of DSMES programs for content, delivery, duration, practitioner types, and participants were identified as gaps in the literature. CONCLUSIONS: Most retained studies reported that diabetes education positively affected varied measures of hypoglycemia outcomes (number of events, reported symptoms) as well as other targeted outcomes. Diabetes education is an important intervention for reducing hypoglycemia events and/or symptoms and should be included as a component of future hypoglycemia risk mitigation studies.


Assuntos
Complicações do Diabetes/epidemiologia , Diabetes Mellitus/terapia , Educação em Saúde , Hipoglicemia/epidemiologia , Efeitos Psicossociais da Doença , Complicações do Diabetes/etiologia , Humanos , Hipoglicemia/etiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
16.
Osteoporos Int ; 30(8): 1663-1670, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31129687

RESUMO

People with diabetes have an increased risk of fractures, and in this study, the effect of hypoglycaemia and insulin on this risk was investigated. Type 1 diabetes and hypoglycaemia did increase the fracture risk, and prevention of hypoglycaemia is thus an important focus area in the prevention of fractures. INTRODUCTION: Studies have shown that type 1 diabetes (T1D) and type 2 diabetes (T2D) are associated with increased risk of fractures. Especially, subjects with T1D have an increased risk of fractures. The purpose of this study was to investigate the association of T1D, hypoglycaemia and insulin on fracture risk. METHODS: A cohort study with T1D subjects (n = 19,896) and T2D subjects (n = 312,188) matched with subjects from the general populated (n = 996,252) and a nested case-control study with T1D subjects with fracture (n = 895) as cases and T1D subjects without (n = 2685) as controls were conducted based on subjects from the Danish National Patient Registry (DNPR). RESULTS: T1D (HR = 2.47, 95% CI 2.37 to 2.59), age (HR = 1.05, 95% CI 1.05 to 1.05), previous fracture (HR = 1.95, 95% CI 1.92 to 1.99) and being female (HR = 2.06, 95% CI 2.04 to 2.09) increased the risk of fractures. Also, T2D (HR = 1.14, 95% CI 1.11 to 1.18) increased the risk of proximal upper arm and shoulder fractures. T1D (HR = 2.41, 95% CI 2.20 to 2.65) increased the risk of hip and femoral region fractures. Hypoglycaemia (OR = 1.58, 95% CI 1.27 to 1.97) increased the risk of fractures, whereas insulin use did not change the risk. CONCLUSIONS: Hypoglycaemic episodes are associated with increased fracture risk, and the frequency of hypoglycaemic episodes leading to hospital admission was above 16% for T1D subjects. Prevention of hypoglycaemia is thus an important focus area in the prevention of fractures.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Hipoglicemia/complicações , Fraturas por Osteoporose/etiologia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Estudos de Coortes , Dinamarca/epidemiologia , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Hipoglicemia/tratamento farmacológico , Hipoglicemia/epidemiologia , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/epidemiologia , Modelos de Riscos Proporcionais , Sistema de Registros , Medição de Risco/métodos , Adulto Jovem
17.
Diabetes Res Clin Pract ; 152: 58-64, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31102682

RESUMO

AIM: To report glycemic control and pregnancy outcome in pregnant women with type 1 diabetes on insulin degludec. METHODS: Twenty-two women with type 1 diabetes on degludec from conception to delivery between 2014 and 2018 were compared with 51 pregnant women with type 1 diabetes on glargine. RESULTS: Baseline characteristics were comparable, however HbA1c was higher at median 9 (range 5-19) weeks in women on degludec compared to women on glargine (6.9% (5.7-8.7); (52 (39-72) mmol/mol) versus 6.4% (5.1-10.1); (46 (32-87) mmol/mol), p = 0.04). HbA1c was similar in late pregnancy (6.3% (5.6-7.1); (45 (38-54) mmol/mol) versus 6.1% (5.2-9.0); (43 (33-75) mmol/mol), p = 0.28). The prevalence of severe hypoglycemia was 3 (14%) versus 6 (12%), p = 1.00 during pregnancy and 0 versus 1, p = 1.00 during hospital admittance after delivery. Most women on degludec used one daily injection in early (20 (91%) versus 25 (49%), p = 0.001) and late pregnancy (21 (96%) versus 19 (37%), p < 0.001). No significant differences in obstetrical and neonatal outcomes were found between the groups. Maternal hospital admittance after delivery was 2 (1-5) versus 3 (2-11) days (p = 0.004). CONCLUSIONS: Glycemic control in late pregnancy, severe hypoglycemia during and immediately after pregnancy as well as pregnancy outcome were comparable in women on degludec or glargine. Degludec initiated preconceptionally may be continued in pregnancy.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Insulina de Ação Prolongada/administração & dosagem , Gravidez em Diabéticas/tratamento farmacológico , Adulto , Glicemia/metabolismo , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Hemoglobina A Glicada/análise , Hemoglobina A Glicada/metabolismo , Hospitalização/estatística & dados numéricos , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Insulina Glargina/administração & dosagem , Insulina Glargina/efeitos adversos , Insulina de Ação Prolongada/efeitos adversos , Pessoa de Meia-Idade , Gravidez , Resultado da Gravidez/epidemiologia , Gravidez em Diabéticas/sangue , Gravidez em Diabéticas/epidemiologia , Prevalência , Resultado do Tratamento , Adulto Jovem
18.
J Int Med Res ; 47(6): 2404-2412, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30991869

RESUMO

OBJECTIVE: Hypoglycaemia is a common complication of diabetes mellitus. Previous studies suggest that hypoglycaemic episodes may occur with other comorbidities, influencing the outcome of recovery. Recognising the predisposing factors for hypoglycaemic episodes in the emergency department is important. Therefore, we investigated the characteristics of and predisposing factors for hypoglycaemia in the emergency department. METHODS: Data from 186 patients were retrospectively collected from a medical centre in northern Taiwan. We divided the patients into the advanced-age group (132 patients) and the younger group (54 patients). Associated data collected for statistical analysis included vital signs on arrival, first measured blood glucose level, laboratory results, related comorbidities, length of hospital stay, and survival to discharge. RESULTS: Hypoglycaemia was more frequently observed in women in the advanced-age group than in the younger group. Tachycardia and elevated systolic blood pressure were less predominant in the advanced-age group than younger group. More patients in the advanced-age group had concurrent infection, and more patients in the younger group had liver dysfunction, elevated liver enzymes, liver cirrhosis, and concurrent stroke. CONCLUSIONS: Closer attention should be paid to the possibility of infection in patients of advanced age. Liver disease and stroke need to be ruled out in younger patients.


Assuntos
Glicemia/análise , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hipoglicemia/epidemiologia , Tempo de Internação/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Seguimentos , Humanos , Hipoglicemia/diagnóstico , Hipoglicemia/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Taiwan/epidemiologia , Centros de Atenção Terciária
19.
Int J Med Inform ; 126: 1-8, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31029250

RESUMO

BACKGROUND: Predicting insulin-induced postprandial hypoglycemic events is critical for the safety of type 1 diabetes patients because an early warning of hypoglycemia facilitates correction of the insulin bolus before its administration. The postprandial hypoglycemic event counts can be lowered by reducing the size of the bolus based on a reliable prediction but at the cost of increasing the average blood glucose. METHODS: We developed a method for predicting postprandial hypoglycemia using machine learning techniques personalized to each patient. The proposed system enables on-line therapeutic decision making for patients using a sensor augmented pump therapy. Two risk-based approaches were developed for a window of 240 min after the meal/bolus, and they were tested based on real retrospective data from 10 patients using 70 mg/dL and 54 mg/dL as thresholds according to the consensus for Level 1 and Level 2 hypoglycemia, respectively. Due to the small size of the patient cohort, we trained personalized models for each patient. RESULTS: The median specificity and sensitivity were 79% and 71% for Level 1 hypoglycemia, respectively, and 81% and 77% for Level 2. CONCLUSIONS: The results demonstrated that it is feasible to anticipate hypoglycemic events with a reasonable false-positive rate. The accuracy of the results and the trade-off between performance metrics allow its use in decision support systems for patients who wear insulin pumps.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Hipoglicemia/epidemiologia , Período Pós-Prandial , Aprendizado de Máquina Supervisionado , Feminino , Previsões , Humanos , Hipoglicemia/diagnóstico , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Sistemas de Infusão de Insulina , Masculino , Estudos Retrospectivos
20.
Acta Diabetol ; 56(8): 931-938, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30929079

RESUMO

OBJECTIVE: To determine the role of hypoglycemia, hyperglycemia or the combination of both as independent risk factors for falls in a hospital population. Secondary objectives included evaluation of other risk factors for falling and their relationships with glucose levels. RESEARCH DESIGN AND METHODS: Retrospective cohort study over 2 years on hospitalized subjects (N = 57411) analyzing in-hospital-falls and capillary glucose values. Bivariate analysis (χ2 test) and multivariate analysis (logistic regression) were performed to test for correlation of glucose values, age, sex, Charlson index, service of care, diagnosis at discharge and diabetes treatment with risk of in-hospital-falls. RESULTS: The comparison of patients who experienced a fall (fall population) with the non-fall population suggested that: glucose determinations were significantly more frequent in the fall population (OR 3.45; CI 2.98-3.99; p < 0.0001); values of glucose below 70 mg/dl and over 200 mg/dl were significantly associated to falls during hospitalization (OR 1.76; CI 1.42-2.19; p < 0.001) as compared to glycemic values between 70 and 200 mg/dl; diabetes treatment was significantly correlated to risk of fall (OR 2.97; CI 2.54-3.49; p < 0.001); the frequency of glycemia measurements below 70 mg/dl and over 200 mg/dl in the same subject was significantly associated to falls during hospitalization (OR 1.01; CI 1.01-1.02; p < 0.001). CONCLUSION: Hypoglycemia and hyperglycemia during hospital stays are correlated with an increased risk for falls in the hospitalized population. Presence of diabetes, use of insulin or glucose variability could potentially constitute risk factors for falls inside the hospital as well.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Diabetes Mellitus/epidemiologia , Hiperglicemia/epidemiologia , Hipoglicemia/epidemiologia , Pacientes Internados/estatística & dados numéricos , Idoso , Feminino , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade
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