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1.
Medicine (Baltimore) ; 100(5): e24067, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592860

RESUMO

BACKGROUND: As a common medical emergency in individuals with diabetes, hypoglycemia events can impose significant demands on hospital resources. Based on diabetes patients with and without hypoglycemia, we assess the cost of hypoglycemic events on China's hospital system. METHOD: Our study sample comprised 7110 diabetes episodes, including 1417 patients with hypoglycemia (297 patients with severe and 1120 with non-severe hypoglycemia) and 5693 diabetes patients without hypoglycemia. Data on patient social-demographics, length of hospital stay, and hospitalization costs were collected on each patient from Health Information System in Shandong province, China. The additional hospital costs caused by hypoglycemia were assessed by the cost difference between diabetes patients with and without hypoglycemia, including severe and non-severe hypoglycemia. China-wide hospital costs of hypoglycemia were estimated based on adjusted additional hospital costs, comprising inspection, treatment, drugs, materials, nursing, general medical costs, and other costs, caused by hypoglycemia, the prevalence of diabetes and hypoglycemia events, and the rates of hospitalization. Multiple sensitivity analyses were conducted to assess the impact of variations in the key input parameters on the primary estimates. RESULTS: Total hospital costs for patients with hypoglycemia (US$3020.61) were significantly higher than that of patients without hypoglycemia (US$1642.91). The average additional cost caused by hypoglycemia was US$1377.70, with higher average costs of US$1875.89 for severe hypoglycemia and lower average costs of US$1244.76 for non-severe hypoglycemia. The additional hospital cost caused by severe and non-severe hypoglycemia patients was higher for the 60 to 75 year old group, married patients and patients accessing free medical services. Generally, hypoglycemic patients with Urban and Rural Resident Basic Medical Insurance incurred higher additional hospital costs than patients with Urban Employees Basic Medical Insurance. Based on these estimates, the total annual additional hospital costs arising from hypoglycemia events in China were estimated to be US$67.52 million. Sensitivity analyses suggested that the costs of hypoglycemia events ranged up to US$49.99 million to 67.52 million. CONCLUSION: : Hypoglycemic events imposed a substantial cost on China's hospital system, with certain subgroups of patients, such as older patients and those with free health insurance, using medical resources more intensively to treat hypoglycemia events. We recommend more effective planning of prevention and treatment regimes for hypoglycemia patients; further reform to China's health insurance schemes; and better hospital cost control for those accessing free hospital services.


Assuntos
Efeitos Psicossociais da Doença , Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Custos de Cuidados de Saúde/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Hipoglicemia , China/epidemiologia , Custos e Análise de Custo , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Serviços Médicos de Emergência/economia , Serviços Médicos de Emergência/métodos , Feminino , Gastos em Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Hipoglicemia/economia , Hipoglicemia/epidemiologia , Hipoglicemia/etiologia , Hipoglicemia/terapia , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos
2.
Nutr Diabetes ; 11(1): 1, 2021 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-33414391

RESUMO

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


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Pandemias , Quarentena , Telemedicina/tendências , Adulto , Idoso , Glicemia/análise , Automonitorização da Glicemia , Feminino , Humanos , Hiperglicemia/epidemiologia , Hipoglicemia/epidemiologia , Hipoglicemiantes/administração & dosagem , Sistemas de Infusão de Insulina , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
3.
Diabetes Care ; 44(2): 578-585, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33323475

RESUMO

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


Assuntos
/epidemiologia , Diabetes Mellitus/epidemiologia , Hospitalização/estatística & dados numéricos , Adulto , Diabetes Mellitus/metabolismo , Feminino , Mortalidade Hospitalar , Hospitais , Humanos , Hiperglicemia/epidemiologia , Hipoglicemia/epidemiologia , Pacientes Internados/estatística & dados numéricos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
4.
Adv Exp Med Biol ; 1307: 71-84, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32329027

RESUMO

Hypoglycemia is one of the most significant factors to affect prognosis, and is detrimental to patients regardless of diabetes mellitus (DM) status. The classical paradigms dictate that hypoglycemia is a result of overtreatment with glucose lowering agents (iatrogenic hypoglycemia), or, as among patients without DM, this condition is attributed to disease severity. New information shows that hypoglycemia occurs among patients that have a tendency for it. Incident hypoglycemia is very prevalent in the hospital setting, occurring in 1:6 patients with DM and in 1:17 patients without DM (Leibovitz E, Khanimov I, Wainstein J, Boaz M; Diabetes Metab Syndr Clin Res Rev. 13:222-226, 2019).One of the major factors associated with incidence of hypoglycemia is the nutritional status on hospital admission and during the hospitalization. Assessment of nutritional status using questionnaires and biomarkers might be helpful in determining risk of hypoglycemia. Moreover, administration of oral nutritional supplements was shown to decrease this risk.It is also well known that a high burden of comorbidities is associated with an increased risk of hypoglycemia. For example, kidney disease, whether acute or chronic, was shown to increase the risk for hypoglycemia, as well as some endocrine disorders.In this review we elaborate on specific findings that are characteristic of patients at risk for developing hypoglycemia, as well as treatment aimed at preventing its occurrence.


Assuntos
Composição Corporal , Hipoglicemia , Desnutrição , Glicemia , Hospitalização , Humanos , Hipoglicemia/epidemiologia , Desnutrição/epidemiologia
5.
Vnitr Lek ; 66(6): 35-42, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33380151

RESUMO

Hypoglycemia related to treatment of type 2 diabetes mellitus patients constantly represents a substantial problem. It is connected with higher mortality and lower quality of life, mostly displayed with elder patients. Therefore it is vital to revise the antidiabetic therapy regularly and to inquire for the associated risks. Nevertheless, elder patiens are often following the inadvisable treatment by sulphonylureas derivates, which represent the second most risky medication causing hypoglycemia after insulin. In our retrospective study we analysed the occurence of serious hypoglycemia, caused by any factor, with severe diabetics urgently hospitalised at The Department of Internal Medicine of Masaryk Hospital in Ústí nad Labem, in relation to the applied antidiabetic therapy. We suspected a negative influence of hypoglycemizing therapy (above all sulphonylureas) with the elderly patiens. In sum, we hospitalised 32 patients with type 2 diabetes mellitus (average age 76,5 ± 8,2 years), 18 of these using sulphonylureas (average age 77,4, with a relatively wide range from 65 to alarming 93 years). The average figure of estimated glomerular filtration rate (eGFR) was 0,745 (±0,293) ml/s/1,73m2. Moreover, the patients manifested polmorbidity - the average of comorbidities was 3,125, and even 3,5 with patiens on sulphonylureas. Following the arguments summarised above, we believe that hypoglycemic episodes are extremely dangerous especially for elder patients with T2DM, and from this point of view, the medication using sulphonylureas derivates seems to be inappropriate.


Assuntos
Diabetes Mellitus Tipo 2 , Hipoglicemia , Idoso , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Hipoglicemiantes/efeitos adversos , Qualidade de Vida , Estudos Retrospectivos , Compostos de Sulfonilureia/efeitos adversos
6.
Cochrane Database Syst Rev ; 12: CD013309, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-33348448

RESUMO

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


Assuntos
Algoritmos , Glicemia/análise , Hiperglicemia/diagnóstico , Hipoglicemia/diagnóstico , Recém-Nascido Prematuro/sangue , Viés , Técnicas Biossensoriais/instrumentação , Mortalidade Hospitalar , Humanos , Hiperglicemia/epidemiologia , Hipoglicemia/epidemiologia , Lactente , Mortalidade Infantil , Recém-Nascido , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Transtornos do Neurodesenvolvimento , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Farm. comunitarios (Internet) ; 12(4): 5-20, oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197487

RESUMO

INTRODUCCIÓN: la falta de adherencia implica peor control de la diabetes y aumento del número de complicaciones, lo que a menudo se traduce en un mayor gasto sanitario. Las hipoglucemias, en ocasiones inadvertidas, son una de las principales consecuencias de la no adherencia y su prevención pasa por intervenciones multidisciplinares que ayuden a la mejora de la adherencia. OBJETIVOS: medir la adherencia a hipoglucemiantes, detectar y cuantificar hipoglucemias inadvertidas y recurrentes, conocer la percepción de los pacientes sobre su tratamiento y derivar al médico en casos de no adherencia e hipoglucemias no solucionadas. MATERIAL Y MÉTODOS: estudio observacional, transversal y multicéntrico, en farmacias comunitarias, realizado a partir de abril de 2019 con diabéticos tipo 2 en tratamiento con hipoglucemiantes que lleven ≥12 meses con la misma pauta. Para la detección de hipoglucemias, los que estén en tratamiento con sulfonilureas, glinidas y/o insulinas. Diseño de un cuestionario con datos sociodemográficos, enfermedades y tratamientos. Utilización del test MMAS-8 para detectar no adherencia y del test de Clarke para hipoglucemias. Si se detecta incumplimiento y/o hipoglucemia y no se puede solucionar por el farmacéutico se derivará al médico de familia. ANÁLISIS ESTADÍSTICO: se utilizará el programa STATA13 para Windows®. Se realizarán análisis bivariados y multivariados. La significación se fijará en p < 0,05. Aplicabilidad de los resultados: se espera conocer la falta de adherencia y los factores que la causan y la prevalencia de las hipoglucemias inadvertidas para, en otro proyecto, establecer un programa de intervención farmacéutica que se muestre eficiente para mejorar la adherencia farmacoterapéutica de los pacientes en tratamiento con hipoglucemiantes y disminuir la aparición de hipoglucemias


INTRODUCTION: Lack of adherence results in worse control of diabetes and an increased number of complications, often resulting in higher healthcare spending. Hypoglycemia, which is sometimes unrecognized, is one of the main consequences of non-adherence to treatment. It is prevented through multidisciplinary interventions which help improve adherence. OBJECTIVES: to measure adherence to hypoglycemic agents, to detect and quantify unrecognized and recurrent hypoglycemia, to learn patients' perceptions of their treatment and refer them to doctors in cases of non-adherence and unsolved hypoglycemia. MATERIAL AND METHODS: an observational, cross-sectional, multicenter study in community pharmacies, conducted from April 2019 with type 2 diabetics in treatment with hypoglycemic agents for ≥12 months on the same drug regimen. To detect hypoglycemia, those treated with sulfonylureas, glinides and/or insulin. Design of a questionnaire with sociodemographic data, diseases and treatments. Use of the MMAS-8 test for non-adherence and the Clarke hypoglycemia awareness test. If non-compliance and/or hypoglycemia is detected and cannot be resolved by the pharmacist, it will be referred to the family doctor. Statistical analysis: the STATA13 program will be used for Windows®. Bivariate and multivariate analyses will be conducted. Statistical significance will be set at p < 0.05. APPLICABILITY OF THE RESULTS: we hope to gain awareness of the lack of adherence and its causal factors and the prevalence of unrecognized hypoglycemia so that, in another project, an efficient pharmaceutical intervention program can be established to improve adherence to pharmacotherapy of patients treated with hypoglycemic agents and reduce the occurrence of hypoglycemia


Assuntos
Humanos , Masculino , Feminino , Diabetes Mellitus Tipo 2/prevenção & controle , Adesão à Medicação/estatística & dados numéricos , Hipoglicemiantes/uso terapêutico , Hipoglicemia/epidemiologia , Farmácias/estatística & dados numéricos , Hipoglicemia/induzido quimicamente , Estudos Transversais , Inquéritos e Questionários , Espanha/epidemiologia
10.
Medicine (Baltimore) ; 99(37): e22160, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925778

RESUMO

INTRODUCTION: Community-acquired pneumonia (CAP) is the main acute complication of type 2 diabetes mellitus (T2DM) and the main cause of hospitalization for infectious diseases. Unfortunately, in the treatment of type 2 diabetes mellitus complicated with community-acquired pneumonia (T2DM-CAP), modern medicine is still faced with enormous challenges because of insulin resistance and drug-resistant bacteria. In recent decades, clinical and experimental evidence shows that Chinese herbal medicine (CHM) has a certain beneficial effect on diabetes and pneumonia. Therefore, this trial aims to assess the efficacy and safety of CHM plus western medicines for the treatment of T2DM-CAP. METHODS: We propose a double-blind, placebo-controlled, randomized superiority trial.A total of 92 participants with T2DM-CAP will be randomly allocated at a 1:1 ratio to either the experimental group, which will receive modified Ban-Xia-Xie-Xin-Decotion and basic treatment, or the control group, which will receive basic treatment only. The study duration will be 14 days. The primary outcome will be the total clinical effective rate. The secondary outcomes are traditional Chinese medicine symptom score scale, pneumonia severity index, usage time of antibiotic, time required for blood sugar to reach the required level, frequency of hypoglycemia, and chest CT. Liquid chromatograph-mass spectrometry method will be used to explore the blood metabolism profiles of the subjects, to explore the pathogenesis of T2DM-CAP and the mechanism of CHM on T2DM-CAP. Adverse events will also be evaluated. DISCUSSION: This trial will provide evidence of the effectiveness and safety of traditional CHM in treating patients with T2DM-CAP. TRIAL REGISTRATION NUMBER: ChiCTR2000035204.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Medicamentos de Ervas Chinesas/uso terapêutico , Pneumonia/tratamento farmacológico , Pneumonia/epidemiologia , Adolescente , Adulto , Idoso , Infecções Comunitárias Adquiridas , Diabetes Mellitus Tipo 2/sangue , Método Duplo-Cego , Feminino , Humanos , Hipoglicemia/epidemiologia , Masculino , Metabolômica , Pessoa de Meia-Idade , Pneumonia/sangue , Radiografia Torácica , Índice de Gravidade de Doença , Fatores de Tempo , Tomografia Computadorizada por Raios X , Adulto Jovem
11.
Med Care ; 58(10): 927-933, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32833937

RESUMO

BACKGROUND: Hypoglycemia related to antidiabetic drugs (ADDs) is important iatrogenic harm in hospitalized patients. Electronic identification of ADD-related hypoglycemia may be an efficient, reliable method to inform quality improvement. OBJECTIVE: Develop electronic queries of electronic health records for facility-wide and unit-specific inpatient hypoglycemia event rates and validate query findings with manual chart review. METHODS: Electronic queries were created to associate blood glucose (BG) values with ADD administration and inpatient location in 3 tertiary care hospitals with Patient-Centered Outcomes Research Network (PCORnet) databases. Queries were based on National Quality Forum criteria with hypoglycemia thresholds <40 and <54 mg/dL, and validated using a stratified random sample of 321 BG events. Sensitivity and specificity were calculated with manual chart review as the reference standard. RESULTS: The sensitivity and specificity of queries for hypoglycemia events were 97.3% [95% confidence interval (CI), 90.5%-99.7%] and 100.0% (95% CI, 92.6%-100.0%), respectively for BG <40 mg/dL, and 97.7% (95% CI, 93.3%-99.5%) and 100.0% (95% CI, 95.3%-100.0%), respectively for <54 mg/dL. The sensitivity and specificity of the query for identifying ADD days were 91.8% (95% CI, 89.2%-94.0%) and 99.0% (95% CI, 97.5%-99.7%). Of 48 events missed by the queries, 37 (77.1%) were due to incomplete identification of insulin administered by infusion. Facility-wide hypoglycemia rates were 0.4%-0.8% (BG <40 mg/dL) and 1.9%-3.0% (BG <54 mg/dL); rates varied by patient care unit. CONCLUSIONS: Electronic queries can accurately identify inpatient hypoglycemia. Implementation in non-PCORnet-participating facilities should be assessed, with particular attention to patient location and insulin infusions.


Assuntos
Registros Eletrônicos de Saúde , Hipoglicemia/epidemiologia , Hipoglicemiantes/efeitos adversos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adulto , Idoso , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Pacientes Internados , Insulina/administração & dosagem , Insulina/efeitos adversos , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Centros de Atenção Terciária/normas
12.
Cardiovasc Ther ; 2020: 3612607, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32774458

RESUMO

Introduction: Severe hypoglycemia can be life-threatening; therefore, it is important to identify the characteristics of the hypoglycemic patients. The aim of this study is to analyze the type and characteristics of diabetic patients with hypoglycemia who visited an emergency room. Methods: We included diabetic patients with hypoglycemia who visited the emergency room of St. Mary's Hospital in Seoul from January 2009 to August 2018 in the study. Hypo_S group patients visited the emergency room once whereas Hypo_M group patients visited twice or more. We also compared the incidence of cardiovascular disease between the groups within 5 years after hypoglycemia. Results: A total of 843 patients were included in this study, with a mean age of 71 ± 14 years and average glycated hemoglobin (HbA1c) level of 6.7 ± 1.4%. For patients with hypoglycemia, lower body mass index, lower HbA1c, shorter diabetes duration, and lower glomerular filtration rate have a statistically significant relationship with patient characteristics in the emergency room group (all p < 0.001). Hypoglycemia symptoms were most frequently observed between 6:00 and 12:00 am (p < 0.001). Cardiovascular diseases within 5 years after discharge were more frequent in the Hypo_S group than in the Hypo_M group; however, there was no statistical significance. The frequency of aneurysms was significantly higher in patients with hypoglycemia than in other patients in the emergency room (p < 0.05). Conclusion: Relatively thin older patients with a diabetes duration shorter than 10 years and good blood sugar control showed higher frequency of visits to the emergency room due to hypoglycemia. For these patients, medical staff should always be mindful of their susceptibility to hypoglycemia when prescribing insulin or OHA and educate them on the prevention of hypoglycemia.


Assuntos
Glicemia/efeitos dos fármacos , Diabetes Mellitus/tratamento farmacológico , Serviço Hospitalar de Emergência , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Glicemia/metabolismo , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Hipoglicemia/sangue , Hipoglicemia/diagnóstico , Hipoglicemia/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Seul/epidemiologia , Índice de Gravidade de Doença , Fatores de Tempo
13.
Clin Med (Lond) ; 20(4): e87-e90, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32628128

RESUMO

COVID-19 and diabetes are both pandemics with major impacts on global public health. While the response to COVID-19 has been rapid and progressive to reduce risk of harm, the response to the diabetes pandemic has been somewhat more muted. People with diabetes have been disproportionately affected by COVID-19, with growing evidence of higher mortality and morbidity. In this article, we discuss the impact of COVID-19 on our diabetes service in an urban area in the UK. We discuss the impact on our patients and ourselves, and the possible lessons we can carry into the future.


Assuntos
Assistência Ambulatorial/organização & administração , Infecções por Coronavirus/epidemiologia , Complicações do Diabetes/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Pandemias , Pneumonia Viral/epidemiologia , Betacoronavirus , Comorbidade , Complicações do Diabetes/terapia , Hospitais Urbanos , Humanos , Hipoglicemia/epidemiologia , Hipoglicemia/terapia , Londres/epidemiologia , Telemedicina
14.
Diabetes Metab Syndr ; 14(5): 1143-1146, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32668399

RESUMO

BACKGROUND: Hypoglycemia is the limiting factor in the glycemic management of diabetes, which need to be addressed critically to avoid complications. Lockdown because of new coronavirus strain (COVID-19) pandemic has further complicated the issue of hypoglycemia due to limitations in access to food, outpatient clinics, pathological services and medicines. AIM: To assess the factors associated with the risk of hypoglycemia during April-May 2020 lockdown in people with type 2 diabetes mellitus. METHODOLOGY: We analyzed the data retrospectively from 146 patients of type 2 diabetes mellitus (T2DM) reporting to the emergency department (ED) during lockdown period with symptoms suggestive of hypoglycemia. RESULTS: The majority of patients were male (90/146) with a mean age of 59.88 ± 10.09 years and a mean random blood glucose level of 57.67 ± 9.00 mg/dL. Two-third of patients (70.83%) had level 1 hypoglycemia, while level 2 hypoglycemia was reported in 29.16% of patients. A combination of Metformin and Sulfonylureas (SU) was most commonly associated with the risk of hypoglycemia (65.75%) followed by insulin (33.56%). Subjects who received insulin reported a lower blood glucose value (50.75 ± 8.20 mg/dL) as compared to those receiving a combination of metformin and SU (60.95 ± 7.10 mg/dl). 330.56% of patients who had received prophylaxis hydroxychloroquine (HCQ) 400 mg twice a day along with the routine anti-hyperglycemic agents without their dose adjustment reported hypoglycemia. Patients with hypertension, micro-vascular, macro-vascular complications, and coexistent with each other had a higher propensity to the risk of hypoglycemia (46.58%, 33.56%, 23.29%, and 32.88%) respectively. CONCLUSION: The COVID-19 lockdown has shown to influence the risk of hypoglycemia in patients with T2DM, especially those receiving SU, insulin, HCQ especially in patients with associated co-morbidities. Patient education, support, and telemedicine plays a pivotal role to prevent hypoglycemia.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Hipoglicemia/epidemiologia , Pneumonia Viral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Glicemia/análise , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hipoglicemia/virologia , Incidência , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Prognóstico , Estudos Retrospectivos
15.
Curr Diab Rep ; 20(8): 39, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-32699971

RESUMO

PURPOSE OF REVIEW: Infants of women with diabetes are at risk for specific morbidities including congenital anomalies, abnormalities of fetal growth, neonatal hypoglycemia, electrolyte abnormalities, polycythemia, hyperbilirubinemia, and respiratory distress syndrome. Recent studies have shed light on long-term outcomes of these infants and presented advances in treatment. The purpose of this review is to outline the most common neonatal morbidities affecting infants of women with diabetes, the pathophysiology and prevalence of these conditions, and contemporary approaches to treatment. RECENT FINDINGS: Recent investigative findings have led to advances in treatment approaches for these infants, particularly regarding risks of neonatal hypoglycemia. Optimizing maternal glycemic control during pregnancy is imperative to improving infant outcomes. However, on a population level, maternal diabetes still poses significant risks to the infant. Timely and appropriate treatment of infants of women with diabetes is imperative to decrease short- and long-term morbidity.


Assuntos
Diabetes Gestacional , Hipoglicemia , Glicemia , Feminino , Humanos , Hipoglicemia/epidemiologia , Lactente , Gravidez
16.
Diabetes Metab Syndr ; 14(5): 1213-1216, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32679527

RESUMO

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


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Diabetes Mellitus Tipo 1/fisiopatologia , Hiperglicemia/epidemiologia , Hipoglicemia/epidemiologia , Pneumonia Viral/complicações , Quarentena/estatística & dados numéricos , Adolescente , Adulto , Biomarcadores/análise , Glicemia/análise , Criança , Pré-Escolar , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Estudos Transversais , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/virologia , Hipoglicemia/virologia , Incidência , Índia/epidemiologia , Lactente , Masculino , Pandemias , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Prognóstico , Adulto Jovem
17.
Obstet Gynecol ; 136(2): 411-416, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32649492

RESUMO

OBJECTIVE: To examine whether an insulin protocol for intrapartum glucose control among parturients with diabetes was associated with improved outcomes. METHODS: This is a retrospective cohort study of women with pregestational or gestational diabetes delivering a liveborn neonate at Northwestern Memorial Hospital. Before 2011, women with diabetes were given intravenous (IV) insulin or glucose during labor at the discretion of the on-call endocrinologist. In 2011, a standardized protocol was designed to titrate insulin and glucose infusions. Outcomes were compared between two time periods: January 2005-December 2010 (before implementation) and January 2012-December 2017 (after implementation) with 2011 excluded to account for a phase-in period. Maternal outcomes included intrapartum hyperglycemia (blood glucose greater than 125 mg/dL) and hypoglycemia (blood glucose less than 60 mg/dL). Neonatal outcomes included hypoglycemia (blood glucose less than 50 mg/dL), intensive care admission, and IV dextrose therapy. t tests, Wilcoxon rank sum tests, and χ tests were used for bivariable analyses. Linear and logistic multivariable regression were used to account for confounding factors. RESULTS: Of 3,689 women, 928 (25.2%) delivered before 2011. After protocol implementation, frequencies of both maternal intrapartum hyperglycemia (51.3% vs 37.9%) and hypoglycemia decreased (6.1% vs 2.5%), both P<.001; respective adjusted odds ratio [aOR] 0.64, 95% CI 0.54-0.77 and 0.50, 95% CI 0.33-0.78. The frequency of neonatal hypoglycemia, however, increased (36.6% vs 49.2%, P<.001; aOR 1.73, 95% CI 1.45-2.07). Admission to the neonatal intensive care unit and need for IV dextrose therapy were similar across time periods. CONCLUSION: A formal protocol to manage insulin and glucose infusions for parturients with diabetes was associated with improved intrapartum maternal glucose control, but an increased frequency of neonatal hypoglycemia.


Assuntos
Diabetes Gestacional/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Trabalho de Parto , Gravidez em Diabéticas/tratamento farmacológico , Adulto , Glicemia/análise , Protocolos Clínicos/normas , Diabetes Mellitus/tratamento farmacológico , Feminino , Glucose/administração & dosagem , Humanos , Hiperglicemia/epidemiologia , Hipoglicemia/epidemiologia , Infusões Intravenosas , Unidades de Terapia Intensiva Neonatal , Gravidez , Estudos Retrospectivos
18.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(6): 394-400, jun.-jul. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193364

RESUMO

OBJETIVO: Evaluar la frecuencia de las hipoglucemias desapercibidas (HD) en pacientes con diabetes tipo 1, trasladados de pediatría, que siguen programa específico de atención y educación terapéutica (PAET) en el hospital de adultos. PACIENTES Y MÉTODOS: Jóvenes trasladados entre 2009-2011. El PAET incluyó proceso de traslado coordinado, visitas individuales y en grupo. Al inicio y a los 12 meses se valoran: HbA1c, frecuencia de hipoglucemias graves paciente/año (HG) y no graves. Los pacientes fueron clasificados y comparados en 2 grupos: hipoglucemia percibida e HD, según los resultados del Test de Clarke < 3R o > 3R respectivamente. RESULTADOS: Realizaron PAET 56 pacientes (edad 18,1±0,3 años, 46% chicas, HbA1c 8,0 ± 1,2%). En la valoración inicial el 16% presentaba HD. El número de episodios de HG fue superior en el grupo HD (0,33 ± 0,50 vs. 0,09 ± 0,28 p < 0,05). El porcentaje de pacientes con > 2 hipoglucemias no graves/semana fue superior en el grupo HD, aunque sin significación estadística (66% vs. 34%, p = 0,06). A los 12 meses todavía un 11% de pacientes presentaba HD. El número de HG siguió siendo superior en el grupo con HD (0,38 ± 1,06 vs. 0,02 ± 0,15, p = 0,04). CONCLUSIONES: El porcentaje de jóvenes con diabetes tipo 1 e HD es considerable en el momento del traslado. El PAET mejora su pronóstico, pero no lo soluciona a medio plazo. Los pacientes con HD presentan mayor frecuencia de HG. La detección de HD es necesaria para reducir las HG que todavía son una asignatura pendiente


OBJECTIVE: To evaluate frequency of hypoglycaemia unawareness (HU) in patients with type 1 diabetes (T1D) transferred from Paediatrics following a specific therapeutic education programme (TEP) in an adult hospital. PATIENTS AND METHODS: Young patients transferred from 2009-2011 were evaluated. The TEP included a coordinated transfer process, individual appointments and a group course. At baseline and at 12 months we evaluated glycated haemoglobin (HbA1c) frequency of severe (SH) hypoglycaemia/patient/year and non severe hypoglycaemia (NSH). The patients were classified into two groups and compared: hypoglycaemia awareness (HA) and HU according to the Clarke Test < 3R or > 3R respectively. RESULTS: Fifty-six patients (age 18.1 ± 0.3 years, 46% females, HbA1c 8.0 ± 1.2%) underwent the TEP. In the baseline evaluation 16% presented HU. The number of SH was higher in the HU Group (0.33 ± 0.50 vs. 0.09 ± 0.28 P < .05). The percentage of patients with > 2 NSH/week was higher, albeit not significantly, in the HU group (66% vs. 34%, p = 0.06). At 12 months 11% of the patients continued to present HU. The number of SH remained higher in the HU group (0.38 ± 1.06 vs. 0.02 ± 0.15 P = .04). CONCLUSIONS: The percentage of young people with T1D with HU is quite high at transfer. Although the TEP improves hypoglycaemia awareness it does not solve this important problem. Patients with HU more frequently present SH. It is necessary to identify HU in order to reduce SH which continues to be a problem in people with T1D


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Diabetes Mellitus Tipo 1/complicações , Hipoglicemia/etiologia , Hipoglicemia/epidemiologia , Conscientização , Educação de Pacientes como Assunto , Hipoglicemia/diagnóstico , Hipoglicemia/tratamento farmacológico , Mudança das Instalações de Saúde , Estudos Retrospectivos , Índice de Massa Corporal , Desenvolvimento de Programas
19.
MMWR Morb Mortal Wkly Rep ; 69(24): 740-743, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32555139

RESUMO

In August 2019, the Virginia Poison Center (VPC) and the Blue Ridge Poison Center (BRPC) were contacted concerning patients experiencing repeated episodes of marked hypoglycemia following ingestion of a male enhancement supplement tablet marketed as "V8" in convenience stores in central Virginia. Over the following 3 months, the Virginia Department of Agriculture and Consumer Services (VDACS) and the Virginia Department of Health (VDH) conducted an investigation and identified 17 patients meeting the case definition (severe hypoglycemia within 48 hours of consuming an over-the-counter male enhancement supplement in a man with no history of use of insulin or other medication used to control blood glucose). Analysis of the V8 tablets revealed that most contained glyburide, a sulfonylurea oral hypoglycemic used in the treatment of diabetes and associated with prolonged hypoglycemia following overdose (1). To stem this outbreak, V8 was removed from stores when found, and public service announcements were released. The public health implications of V8 use include the potential for substantial morbidity from hypoglycemic episodes and the potential for mortality if health care services are not accessed in a timely manner when hypoglycemia occurs. The presence of V8 in the market poses a serious threat to public health because of its potentially life-threatening adverse effects.


Assuntos
Suplementos Nutricionais/toxicidade , Surtos de Doenças , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Índice de Gravidade de Doença , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Virginia/epidemiologia
20.
Pharm. pract. (Granada, Internet) ; 18(2): 0-0, abr.-jun. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-194060

RESUMO

OBJECTIVE: This study aims to estimate the length of stay and hospitalisation cost of hypoglycaemia, and to identify determinants of variation in the length of stay and hospitalisation cost among individual patients with type 1 or 2 diabetes mellitus. METHODS: A cross-sectional study was conducted using inpatients records for patients with diabetes mellitus who had been hospitalised due to hypoglycaemic events in two private hospitals in Amman, Jordan between January 2009 and May 2017. All hospitalisation costs were inflated to the equivalent costs in 2017. Hospitalisation cost was estimated from the patient's perspective in Jordanian dinars (JOD). Descriptive analyses and correlation between sociodemographic or clinical characteristics with the cost and length of stay were explored. Predictors of hypoglycaemic hospitalisation cost and length of stay were determined using logistic regression. RESULTS: During the study period a total of 126 patients with diabetes mellitus were hospitalised due to an incident of hypoglycaemia. The mean patient age was 64.2 (SD=19.6) years; half were male. Patients admitted for hypoglycaemia stayed in hospital for a median duration of two days (IQR=2 days). The median cost of hospitalisation for hypoglycaemia was 163.2 JOD (USD 230.1) (IQR=216.3 JOD). We found that the Glasgow coma score was positively associated with length of stay (0.345, p = 0.008), and older age was correlated with higher hospitalisation cost (0.207, p = 0.02). Patients with a family history of diabetes had higher hospitalisation costs and longer duration of stay (0.306 and 0.275, p < 0.05). In addition, being a male patient (0.394, p < 0.05) and with an absence of smoking history was associated with longer duration of stay (0.456, p < 0.01), but not with higher hospitalisation cost. CONCLUSIONS: Costs associated with the incidence of hypoglycaemic events are not low and constitute a large cost component of managing and treating diabetes mellitus. Male patients and patients having a family history of diabetes should receive extra care and education on the prevention of hypoglycaemic events, and a treatment de-intensification approach should be considered if necessary, so we can prevent its associated hospitalisation costs and length of stay


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Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Hospitalização/economia , Tempo de Internação/economia , Hipoglicemia/economia , Hipoglicemia/epidemiologia , Hipoglicemia/etiologia , Complicações do Diabetes , Estudos Transversais , Modelos Logísticos
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