Development of an Electronic Trigger to Identify Delayed Follow-up HbA1c Testing for Patients with Uncontrolled Diabetes

2022 ◽  
Author(s):  
Brianna Knoll ◽  
Leora I. Horwitz ◽  
Kira Garry ◽  
Jeanne McCloskey ◽  
Arielle R. Nagler ◽  
...  
Keyword(s):  
Uncontrolled Diabetes

Impact of Physician–Pharmacist Covisits at a Primary Care Clinic in Patients With Uncontrolled Diabetes

2018 ◽  
Vol 33 (3) ◽  
pp. 321-325
Author(s):  
Jasmine Peterson ◽  
April Hinds ◽  
Aida Garza ◽  
Jamie Barner ◽  
Lucas Hill ◽  
...  
Keyword(s):  
Care Delivery ◽  
Medication Management ◽  
Primary Care Clinic ◽  
Collaborative Management ◽  
Multicenter Cohort Study ◽  
Care Clinic ◽  
Uncontrolled Diabetes ◽  
Significant Difference ◽  
The Impact

Purpose: A popular method for enhancing medication management within a patient-centered medical home (PCMH) is the physician–pharmacist collaborative management (PPCM) model. To improve efficiency of health-care delivery within 4 federally qualified health centers (FQHCs), the PPCM model was implemented through coordinated physician–pharmacist covisits. Objective: To evaluate the impact of physician–pharmacist covisits on clinical outcomes among patients with uncontrolled diabetes. Methodology: This was a retrospective multicenter cohort study including adults (≥18 years old) with uncontrolled type 1 or type 2 diabetes (hemoglobin A1c [HbA1c] ≥ 8 %) who had at least one covisit between January 1, 2013, and October 1, 2016. The primary clinical metric was mean change in HbA1c from baseline to follow-up. Secondary outcomes included adherence to select American Diabetes Association (ADA) Standards of Medical Care. Results: A total of 106 patients were included in this analysis. Patients who were managed in the PPCM model experienced a significant decrease in mean change in HbA1c from baseline to follow-up (−1.75 [2.63], P < .001). There was no significant difference in the proportion of patients receiving recommended vaccinations or cardiovascular (CV) risk reduction medications. Conclusion: The results suggest that physician–pharmacist covisits may improve glucose control in patients with uncontrolled diabetes.

scholarly journals Very Severe Hypertriglyceridemia in a Large US County Health Care System: Associated Conditions and Management

2019 ◽  
Vol 3 (8) ◽  
pp. 1595-1607 ◽  
Author(s):  
Maria Isabel Esparza ◽  
Xilong Li ◽  
Beverley Adams-Huet ◽  
Chandna Vasandani ◽  
Amy Vora ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Health Care System ◽  
Serum Triglyceride ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Severe Hypertriglyceridemia ◽  
Uncontrolled Diabetes ◽  
Care System

Abstract Context Patients with very severe hypertriglyceridemia (triglyceride levels ≥2000 mg/dL; 22.6 mmol/L) require aggressive treatment. However, little research exists on the underlying etiologies and management of very severe hypertriglyceridemia. Objective We hypothesized (i) very severe hypertriglyceridemia in adults is mostly associated with secondary causes and (ii) most patients with very severe hypertriglyceridemia lack appropriate follow-up and treatment. Design We queried electronic medical records at Parkland Health and Hospital Systems for lipid measurements in the year 2016 and identified patients with serum triglyceride levels ≥2000 mg/dL (22.6 mmol/L). We extracted data on demographics, underlying causes, lipid-lowering therapy, and follow-up. Results One hundred sixty-four serum triglyceride measurements were ≥2000 mg/dL (22.6 mmol/L) in 103 unique patients. Of these, 60 patients were admitted to the hospital (39 for acute pancreatitis). Most were Hispanic (79%). The major conditions associated with very severe hypertriglyceridemia included uncontrolled diabetes mellitus (74%), heavy alcohol use (10%), medication use (7%), and hypothyroidism (2%). Two patients were known to have monogenic causes of hypertriglyceridemia. After the index measurement of triglycerides ≥2000 mg/dL (22.6 mmol/L), the use of triglyceride-lowering drugs increased, most prominently the use of fish oil supplements, which increased by 80%. However, in follow-up visits, hypertriglyceridemia was addressed in only 50% of encounters, and serum triglycerides were remeasured in only 18%. Conclusion In summary, very severe hypertriglyceridemia was quite prevalent (∼0.1% of all lipid measurements) in our large county health care system, especially in Hispanic men. Most cases were related to uncontrolled diabetes mellitus, and follow-up monitoring was inadequate.

scholarly journals A 21-Year-Old Woman with Hepatomegaly

2015 ◽  
Vol 10 (3) ◽  
Author(s):  
Caroline R. Barry MD ◽  
Amr M. Zaki MD ◽  
Vicki Munro MD ◽  
Glenn Patriquin MD MSc ◽  
Weei-Yuarn Huang MD ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Liver Enzymes ◽  
Diabetes Mellitus Type 1 ◽  
Insulin Regimen ◽  
Uncontrolled Diabetes ◽  
Elevated Liver Enzymes ◽  
Common Causes

We report the case of a 21-year old woman with uncontrolled diabetes mellitus type 1 presenting with tender hepatomegaly and mildy elevated liver enzymes, with negative investigations for common causes. She was diagnosed by liver biopsy with glycogenic hepatopathy, an uncommon and likely under-recognized complication of poor glycemic control. The disease is typically reversible after weeks to months of appropriate insulin therapy and is unlikely to lead to permanent liver disease. Our patient was treated with a new insulin regimen and analgesics and discharged home. Unfortunately, on follow-up imaging in our patient 10 months later, her hepatomegaly persists. Her glycemic control remains unchanged and she has since been admitted to hospital twice for episodes of diabetic ketoacidosis.

scholarly journals Case Report: Coronavirus Disease 2019-associated Rhinosinusitis Mucormycosis Caused by Rhizopus arrhizus: A Rare but Potentially Fatal Infection Occurring After Treatment with Corticosteroids

2021 ◽  
Author(s):  
Payam Tabarsi ◽  
Neda Khalili ◽  
Mihan Pourabdollah ◽  
Somayeh Sharifynia ◽  
Ali Safavi Naeini ◽  
...  
Keyword(s):  
Rhizopus Oryzae ◽  
Fungal Infections ◽  
Invasive Pulmonary Aspergillosis ◽  
Rhizopus Arrhizus ◽  
Limited Information ◽  
Internal Transcribed Spacer Region ◽  
Systemic Corticosteroids ◽  
Uncontrolled Diabetes ◽  
Facial Swelling

Coronavirus disease 2019 (COVID-19) first emerged in Wuhan, China, in December 2019. Since that time, the frequency of bacterial and fungal coinfections has been continuously increasing. Although invasive pulmonary aspergillosis is being increasingly recognized in association with COVID-19, there is limited information regarding COVID-19-associated mucormycosis. We describe a 50-year-old woman with uncontrolled diabetes who received systemic corticosteroids and remdesevir during her admission for COVID-19. A few days after discharge, the patient was readmitted because of facial swelling and numbness, and a diagnosis of COVID-19-associated rhinosinusitis mucormycosis caused by Rhizopus arrhizus (formerly called Rhizopus oryzae) was confirmed with sequencing of the internal transcribed spacer region of the ribosomal DNA. This report aimed to address the importance of short-term follow-up for COVID-19 patients who have received systemic corticosteroids, particularly those with predisposing conditions, because early detection and prompt, aggressive treatment are essential for the management of invasive fungal infections.

MUCORMYCOSIS EFFECTS ON TURBINO SEPTAL COMPONENTS-OUR EXPERIENCE.

2021 ◽  
pp. 56-59
Author(s):  
B. Ganesh Kumar ◽  
Gerald Parisutham ◽  
Prince Peter Dhas ◽  
K. Ramesh Babu
Keyword(s):  
Fungal Infection ◽  
Middle Turbinate ◽  
Inferior Turbinate ◽  
Septal Deviation ◽  
Sinus Surgery ◽  
Fungal Culture ◽  
Posterior Half ◽  
Uncontrolled Diabetes ◽  
Number Of Patients

Introduction: Mucormycosis is a aggressive and most dangerous type of oppurtunistic Fungal infection. This disease starts commonly from Nose and Para nasal Sinuses. Many a times Middle Turbinate alone and some time both Middle and Inferior Turbinate are affected. This Fungi invades the Arteries more than the Veins and produce Thrombus and further reduces blood supply to concerned region and later on resulting in Necrosis of soft and Hard tissues , which was seen clinically as Black coloured “ Eschar”, the characteristic Endoscopic nding of Mucormycosis. Objectives: To Study about the effects Mucormycosis in the Turbinate, Septum and Floor of Nasal Cavity and to know the Effect of Septal Deviation in development of Sinusitis and further development of Mucormycosis. Study Design: Analytical Study, Retrospective Study. Materials And Method: This study was conducted in Govt Thanjavur Medical College, in Department of E.N.T and Head and Neck Surgery, from May 2021 to July 2021. Total Number of cases taken for study was 81 cases. Cases with Orbital and Pterygo Palatine Fossae and Infra Temporal Fossae involvement and Intra cranial involvement are excluded from the study. All cases are subjected to DNE and classied according to ndings. All cases under went Endoscopic Sinus Surgery and tissues sent for HPE and Fungal culture, followed by Systemic Amphotericin and Regular Post Operative Follow up for 4-6 weeks. Results: Males are involved more in numbers (48) than Females. Commonest age group involved are 21 to 40years. Strong Positive association present between Post Covid-19 status and Diabetes. Middle Turbinate involved in more number (34cases), followed by Inferior Turbinate (21 cases) and Septum (18 cases). Most common Anatomical factor present are High Septal Deviation (60 cases) and Osteo Meatal Complex (OMC) crowding (56 cases). Discussion: Mucormycosis is a Fulminant Fungal infection, which is common in Immunodecient individuals. Patients with Uncontrolled Diabetes Mellitus, on Prolonged Steroid therapy and Post COVID_19 status are very much prone for this infections. Angio invasion to Arteries and the resultant formation of Thrombi and Gangrene of involved areas is characteristic of Mucor. Black coloured dead tissue is called as ESCHAR. Depending upon the Arterial involvement Anterior half of Middle Turbinate or Posterior half of Middle Turbinate is involved, Posterior half of septum or entire septum is also involved. High septal deviation gives indirect disturbances to Osteo Meatal Complex functions resulting in development of Sinusitis and further chances of developing Mucormycosis. Early Surgical debridement of dead tissues followed by Inj.Amphotericin is very important in restriction of Disease spread. Proper management of predisposing factors and Postoperative Regular Weekly follow up and Endo Cleaning reduces the Recurrences. Conclusion:In our Study Males are affected more in numbers. 21-40 years are affected more. High Septal Deviation and OMC crowding are present in more number of patients which was responsible for the development of Acute Sinusitis. Post Covid status and Uncontrolled Diabetes was the commonest Predisposing factor the development of Mucormycosis. Middle Turbinate was involved more in numbers followed by Inferior Turbinate and Septum. Routine Examination followed by Nasal Septal Correction plays a major preventive role in development of sinusitis and further dreaded complications like Mucormycosis. Adequate Glycemic Control and Inj Amphotericin plays important role in the management of Mycormycosis. Regular Follow up with Endo Cleaning is reduces the chances of Recurrence.

scholarly journals Endo-Perio Lesion and Uncontrolled Diabetes

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Sara Dhoum ◽  
Kaoutar Laslami ◽  
Fatimazahraa Rouggani ◽  
Amal El Ouazzani ◽  
Mouna Jabri
Keyword(s):  
Female Patient ◽  
General Condition ◽  
Diabetes Type 2 ◽  
Diabetes Type ◽  
Purulent Discharge ◽  
Diagnosis And Prognosis ◽  
Uncontrolled Diabetes

This work is to discuss the management of an endo-perio lesion, which represents a challenge to clinicians when it comes to diagnosis and prognosis of the involved teeth and especially with an altered general condition. A 50-year-old female patient with uncontrolled diabetes type 2 is suffering from a purulent discharge coming from the upper right canine. Endodontic and periodontal treatments were realized with 36 months radiological and clinical follow-up with the collaboration of her internist doctor.

scholarly journals COVID-19 associated rhinosinusitis mucormycosis due to Rhizopus oryzae: A rare but potentially fatal infection occurring after treatment with corticosteroids

2021 ◽  
Author(s):  
Payam Tabarsi ◽  
Neda Khalili ◽  
Mihan Pourabdollah ◽  
Somayeh Sharifynia ◽  
Ali Safavi Naeini ◽  
...  
Keyword(s):  
Rhizopus Oryzae ◽  
Fungal Infections ◽  
Invasive Pulmonary Aspergillosis ◽  
Limited Information ◽  
Short Term ◽  
Pulmonary Aspergillosis ◽  
Systemic Corticosteroids ◽  
Uncontrolled Diabetes ◽  
Facial Swelling

Abstract Coronavirus disease 2019 (COVID-19) first emerged in Wuhan, China in December 2019, and since then the frequency of bacterial and fungal coinfections has been continuously rising. While invasive pulmonary aspergillosis is increasingly being recognized in association with COVID-19, there is limited information with regards to COVID-19 associated mucormycosis. Here, we describe a 50-year-old woman with uncontrolled diabetes who received systemic corticosteroids and remdesevir during her admission for COVID-19. Few days after discharge, the patient was readmitted due to facial swelling and numbness, and a diagnosis of COVID-19 associated rhinosinusitis mucormycosis due to Rhizopus oryzae was confirmed with PCR and DNA sequencing. This report aims to address the importance of short-term follow-up in COVID-19 patients who have received systemic corticosteroids, particularly those with predisposing conditions, as early detection and prompt, aggressive treatment is essential for the management of invasive fungal infections.

scholarly journals COVID-19 and Mucormycosis: The Double Edge Sword

2021 ◽  
Author(s):  
Siddheesh Rajpurohit ◽  
Annam Prathiba ◽  
Kangan Ghadiali ◽  
Kanav Khera ◽  
Sheetal Chauhan ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Mortality And Morbidity ◽  
Double Edge ◽  
Sanitation And Hygiene ◽  
Uncontrolled Diabetes ◽  
Double Edge Sword ◽  
Delay Of Diagnosis ◽  
Timely Treatment

Background and aim India has declared mucormycosis as an epidemic. The incidence rate is rising day by day as there are more than 29000 cases in 28 states until March 2021. COVID-19 is already burdening the health care system, and post-COVID mucormycosis leads to mortality and morbidity in patients treated with COVID-19. This article aims to understand the various complications of mucormycosis and how it is impacting COVID-19 infected patients. Methods A thorough literature search was performed using PubMed, Google Scholar, and Embase from May 2021 to June 2021. The authors selected the articles based on relevance. Mucormycosis, black fungus, fungal infection, COVID-19, pathogenesis, corticosteroids, treatment, antifungals were the major keywords searched. Secondary resources included from the published news articles. Results Through the literature, we observed that patients after COVID-19 are more vulnerable to these fungal infections, especially immunocompromised patients, patients with long-term steroid use, and uncontrolled diabetes. This review enlightens the manifestations, pathogenesis, and various treatment and anticipation policies for mucormycosis. Conclusion Awareness about the possibility of the disease is necessary to reduce the delay of diagnosis and timely treatment to prevent further implications of the disease. In addition, prevention of the disease with strict follow-up measures with sanitation and hygiene maintenance is also essential.

scholarly journals Diabetic Myonecrosis: A Rare Condition That Present With Pain

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A378-A378
Author(s):  
Amelia Guzman Bicchi ◽  
Antonio E Lubrano Heinsen ◽  
Joaquin Gomez-Daspet ◽  
John Tourtelot
Keyword(s):  
Glycemic Control ◽  
Low Dose ◽  
Thigh Muscle ◽  
Ischemic Necrosis ◽  
Normal Limits ◽  
Dose Aspirin ◽  
Uncontrolled Diabetes ◽  
Low Dose Aspirin ◽  
History Of

Abstract Diabetic myonecrosis is the term used for spontaneous ischemic necrosis of skeletal muscle, unrelated to atheroembolism or occlusion of major arteries. This is an uncommon manifestation of long-standing and poorly controlled diabetes mellitus. A 65-year-old Hispanic female presented to the Hospital with one-week history of worsening right thigh pain. She denied associated fever, trauma, history of blood clots, past surgery, recent travel, ect. Patient has history of uncontrolled diabetes type 2, diabetic neuropathy and End-Stage Kidney Disease on hemodialysis for the last 3 years. Home medications include gabapentin 300 mg daily and insulin 70/30 20 units twice a day. On physical exam, vital signs appeared within normal limits. There was right medial and anterior thigh fullness, warmth and tenderness without erythema or fluctuance. Laboratory studies are pertinent for HbA1C 8.8% (n &lt;6.5%), C-reactive protein (CRP) 12.97 (n &lt;0.5 mg/dL), Erythrocyte sedimentary rate (ESR) &gt;130 (n 0–30 mm/hr), Creatinine: 6.2 (n 0.57–1.11 mg/dL), BUN 77 (n 6–20 mg/dL), CO2 19 (n 22–29 mEq/L) and albumin 2.7(n 3.5–5.0 gm/dL). Other labs including CPK, glucose, ANA panel and CBC are within normal limits. Patient was admitted with initial diagnosis of cellulitis without improvement in clinical status after 3 days of antibiotics. MRI of the right thigh showed proximal thigh muscle, cutaneous and subcutaneous edema. Right thigh muscle biopsy showed marked myonecrosis with surrounding endomysial edema, foci of histiocytes, fibroblasts, and regenerating muscle fibers. Histologic features, together with localized muscle pain, normal CPK, negative microbiologic studies and uncontrolled diabetes are consistent with diabetic myonecrosis. Insulin was adjusted for tight glucose control and patient was started on low dose aspirin with outpatient follow-up. Diabetic myonecrosis presents with acute onset of painful swelling that evolves over days or weeks. The most common affected areas are the front and back of the thigh and calf. The pathophysiology is not well understood but appears related to thromboembolic events secondary to microvascular endothelial damage leading to tissue ischemia, which triggers an inflammatory cascade causing local tissue damage and ischemic necrosis. Common laboratory findings include elevated ESR, CRP and HbA1C level. Treatment involves symptomatic management, rest, glycemic control, analgesia and low-dose aspirin. The optimal approach is uncertain and current treatment is based upon published case reports and case series; there have been no randomized trials to compare approaches or specific agents. Close patient follow-up and tight glycemic control are key elements to prevent progression of this condition.

scholarly journals A descriptive study of the patients with orbital complication of acute and chronic sinusitis

2018 ◽  
Vol 4 (4) ◽  
pp. 990
Author(s):  
Ahamed Nauphal Pullarat ◽  
Mohamed Faisal C. K. ◽  
Muraleedhran P. Nampoothiri ◽  
Suma R.
Keyword(s):  
Chronic Sinusitis ◽  
Descriptive Study ◽  
Diabetic Control ◽  
Fungal Culture ◽  
Fungal Sinusitis ◽  
Preseptal Cellulitis ◽  
Medical College ◽  
Uncontrolled Diabetes ◽  
Orbital Complication

<p class="abstract"><strong>Background:</strong> This is a descriptive study of all of the patients with orbital complication of acute and chronic sinusitis presented in ENT and Ophthalmology department, Government Medical College Calicut, Kerala from January 2013 to September 2014. The purpose of this study is to evaluate clinical and radiological presentation, outcome of treatment and postsurgical complications of diagnosed case of orbital complications of acute and chronic sinusitis.</p><p class="abstract"><strong>Methods:</strong> All the patients were subjected to thorough clinical examination, ophthalmological evaluation and radiological evaluation. Computerized tomography of paranasal sinuses both axial and coronal planes, MRI in selected cases, histopathology, fungal culture, a semistructured proforma are the study tools in this study. All the patients in this study received appropriate medical and surgical treatment and done a follow up evaluation at first month and at 3 months.  </p><p class="abstract"><strong>Results:</strong> Preseptal cellulitis is the most common complication in our study. Fungal sinusitis due to uncontrolled diabetes mellitus is the most common condition causing orbital complication in our study.</p><p class="abstract"><strong>Conclusions:</strong> Strict diabetic control, appropriate surgical and medical management and a vigilant follow up resulted in good outcome.</p>

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