scholarly journals Clinical characteristics and outcomes of symptomatic and asymptomatic hypoglycemia in hospitalized patients with diabetes

2018 ◽  
Vol 6 (1) ◽  
pp. e000607 ◽  
Author(s):  
Saumeth Cardona ◽  
Patricia C Gomez ◽  
Priyathama Vellanki ◽  
Isabel Anzola ◽  
Clementina Ramos ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Characteristics ◽  
Glycosylated Hemoglobin ◽  
General Medicine ◽  
Signs And Symptoms ◽  
Male Gender ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Insulin Regimen ◽  
Patients With Diabetes

ImportanceThe frequency and impact of asymptomatic hypoglycemia in hospitalized patients with diabetes is not known.ObjectiveWe determined the clinical characteristics and hospital outcomes of general medicine and surgery patients with symptomatic and asymptomatic hypoglycemia.Research design and methodsProspective observational study in adult patients with diabetes and blood glucose (BG) <70 mg/dL. Participants were interviewed about signs and symptoms of hypoglycemia using a standardized questionnaire. Precipitating causes, demographics, insulin regimen, and complications data during admission was collected.ResultsAmong 250 patients with hypoglycemia, 112 (44.8%) patients were asymptomatic and 138 (55.2%) had symptomatic hypoglycemia. Patients with asymptomatic hypoglycemia were older (59±11 years vs 54.8±13 years, p=0.003), predominantly males (63% vs 48%, p=0.014), and had lower admission glycosylated hemoglobin (8.2%±2.6 % vs 9.1±2.9%, p=0.006) compared with symptomatic patients. Compared with symptomatic patients, those with asymptomatic hypoglycemia had higher mean BG during the episode (60.0±8 mg/dL vs 53.8±11 mg/dL, p<0.001). In multivariate analysis, male gender (OR 2.08, 95% CI 1.13 to 3.83, p=0.02) and age >65 years (OR 4.01, 95% CI 1.62 to 9.92, p=0.02) were independent predictors of asymptomatic hypoglycemia. There were no differences in clinical outcome, composite of hospital complications (27% vs 22%, p=0.41) or in-hospital length of stay (8 days (IQR 4–14) vs 7 days (IQR 5–15), p=0.92)) between groups.ConclusionsAsymptomatic hypoglycemia was common among insulin-treated patients with diabetes but was not associated with worse clinical outcome compared with patients with symptomatic hypoglycemia. Older age and male gender were independent risk factors for asymptomatic hypoglycemia.

scholarly journals Insulin Regimens to Treat Hyperglycemia in Hospitalized Patients on Nutritional Support: Systematic Review and Meta-Analyses

2017 ◽  
Vol 71 (3-4) ◽  
pp. 183-194 ◽  
Author(s):  
Marina Verçoza Viana ◽  
Luciana Verçoza Viana ◽  
Ana Laura Tavares ◽  
Mirela Jobim de Azevedo
Keyword(s):  
Length Of Stay ◽  
Nutritional Support ◽  
Randomized Clinical Trials ◽  
Regular Insulin ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Insulin Regimen ◽  
Nph Insulin ◽  
Meta Analyses

Background: The best insulin regimen to treat hyperglycemia in hospitalized patients on nutritional support (NS) is unclear. Methods: We searched electronic databases to identify cohort studies or randomized clinical trials in order to evaluate the efficacy of different insulin regimens used to treat hyperglycemia in hospitalized patients on NS on diverse outcomes: mean blood glucose (MBG), hypoglycemia, length of stay in hospital, and mortality. Results: Seventeen studies from a total of 5,030 were included. Enteral Group included 8 studies; 1,203 patients using rapid, glargine, NPH, or Premix insulin; MBG 108-225 mg/dL; hypoglycemia 0-13%. In indirect meta-analyses, NPH insulin ranked best for glucose control (MD 95% CI -2.50 mg/dL [2.65 to -2.35]). Parenteral Group included 4 studies; 228 patients using regular and glargine or NPH insulin; MBG 137-202 mg/dL; hypoglycemia 0-40%. In meta-analyses comparing regular insulin added to parenteral nutrition bag with glargine, MBG (MD 95% CI -3.78 mg/dL [-11.93 to 4.37]; I2 = 0%) or hypoglycemia frequency (RR 95% CI 1.37 [0.43-4.32]; I2 = 70.7%) did not differ. The description related to hospital length of stay and mortality was inconsistent between groups. Conclusions: The best insulin regimen to treat hyperglycemia in hospitalized patients on NS has not been established; best results using insulin regimens with NPH in enteral nutrition do not seem to be clinically relevant.

scholarly journals Comparison of Clinical Characteristics and Outcomes between Outpatients and Hospitalized Patients with Diabetes and COVID-19

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Sergio Hernández-Jiménez
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Heart Rate ◽  
Respiratory Rate ◽  
Glucose Concentration ◽  
Clinical Characteristics ◽  
Hospitalized Patients ◽  
Critical Areas ◽  
Patients With Diabetes ◽  
Length Of Hospitalization

Background: Patients with diabetes and COVID-19 have higher rates of complications. Objective: To describe and identify the characteristics and outcomes in patients with diabetes and COVID-19. Methods: From March to June 2020, we included patients with diabetes and probable COVID-19 infection. We compared parameters between outpatients and hospitalized patients. A second analysis compared patients who died vs those who survived. Results: 243 patients, 37.6% women, with 56 ±12 years, and BMI 29.6 ±5.3 kg/m2 were included. Risk factors for hospitalization were oximetry <90% (HR 2.29, 95%CI 1.14-4.58) and mean blood pressure (MBP) <80 mmHg (HR 1.75, 95%CI 1.09-2.81). Age (HR 0.93, 95%CI 0.89-0.97), respiratory rate (RR) (HR 1.05, 95%CI 1.00-1.10) and PaFiO2 (HR 0.99, 95%CI: 0.98-1.00) predicted admission to critical areas. Risk factors for mortality were age ≥65 years (HR 2.88, 95%CI 1.61-5.17), RR ≥25 bpm (HR 3.86, 95%CI 1.33-11.12), heart rate (HR 1.82, 95%CI 0.96-3.42), PaFiO2 <100 (HR 3.70, 95%CI 1.06-6.65) and glucose ≥150 mg/dl (HR 2.57, 95%CI 1.05-6.25). Length of hospitalization was 8.5 (6-14) and 6 (2-10) days for discharged and deceased patients (p=0.003), respectively. Conclusion: Oximetry <90% and MBP <80 mmHg were associated with hospitalization requirement. Glucose concentration >150 mg/dl significantly predicted mortality.

scholarly journals Evaluation of Basal Insulin Dose Reductions in Hospitalized Patients With Diabetes While Unable to Eat

2019 ◽  
Vol 55 (4) ◽  
pp. 246-252
Author(s):  
Sarah E. Petite ◽  
Joseph Huenecke ◽  
Natalie Tuttle
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Basal Insulin ◽  
Insulin Dose ◽  
Severe Hypoglycemia ◽  
Hospitalized Patients ◽  
Intensive Care Unit Setting ◽  
Hospital Length Of Stay ◽  
Insulin Regimen ◽  
The Impact

Background: The American Diabetes Association guidelines recommend a basal plus correction or basal insulin regimen for patients with type 2 diabetes mellitus (T2DM) receiving nothing by mouth (NPO; nil per os) in the non–intensive care unit setting. In the perioperative setting, 60% to 80% of long-acting insulin or half-dose morning insulin NPH is recommended. Objective: The goal of this study was to determine the impact of basal insulin dose reduction for hospitalized patients with insulin-dependent T2DM while NPO. Methods: This retrospective, single-center study evaluated patients admitted to the non–intensive care unit setting. Administration of >50% of home basal insulin was compared with administration of ≤50% of home basal insulin. The primary outcome was the difference in hypoglycemic events (blood glucose [BG] < 70 mg/dL). Secondary outcomes included comparing severe hypoglycemic events (BG < 40 mg/dL), hyperglycemic events (BG > 180 mg/dL), and hospital length of stay (LOS). Results: Two hundred fifty-eight patient encounters were included, of which 85 and 173 patients received ≤50% and >50% of their home basal insulin dose, respectively. There were no significant differences in hypoglycemia (21.2% vs 21.4%; P = .97), severe hypoglycemia (1.2% vs 2.9%; P = .67), and hospital LOS (3 [IQR 2.13-6.74] days vs 4.66 [IQR 2.94-8.17] days; P = .74). Hyperglycemia occurred at a higher rate in patients receiving ≤50% of their home basal insulin dose (97.6% vs 89%; P = .02). Conclusions: No differences were observed in hypoglycemic events between those patients receiving ≤50% and >50% of their home basal insulin.

scholarly journals Epidemiology and Outcomes of Candidaemia among Adult Patients Admitted at Hospital Universiti Sains Malaysia (HUSM): A 5-Year Review

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Haydar A
Keyword(s):  
Candida Albicans ◽  
Solid Tumor ◽  
Fungal Pathogens ◽  
Clinical Characteristics ◽  
Laboratory Data ◽  
Hospitalized Patients ◽  
Contributory Factor ◽  
Candida Spp ◽  
Patients With Diabetes ◽  
Surgical Conditions

Introduction: Candida organisms are opportunistic fungal pathogens that have become a major cause of nosocomial infections worldwide. We investigated the clinical characteristics and outcomes of hospitalized patients with candidaemia caused by Candida albicans and non-albicans Candida spp at HUSM. Materials and Methods: We retrospectively evaluated all hospitalized patients with candidaemia from January 2010 till December 2014 based on inpatient hospital records and laboratory data. Results: A total of 134 patients with candidaemia were enrolled. Candida albicans and non-albicans Candida spp were responsible for 20% (27/134) and 80% (107/134) of candidaemia cases, respectively. Hospitalized patients with diabetes mellitus, surgical conditions, or concomitant septicaemia and those who received instrumentations such as CVC or CBD, and those admitted under medical settings were prone to develop candidaemia caused by either C. albicans or non-albicans Candida spp. All isolates were susceptible to Fluconazole except for C. krusei isolates. All-cause mortality within 30 days post diagnosis of candidaemia was 59%. Factors associated with mortality were solid tumor (p =0.014), surgical illness (p=0.128), central venous catheterization (p= 0.096) and leucocytosis (p=0.116). Only solid tumor was an independent contributory factor for mortality among patients with C. albicans candidaemia in the multivariate analyses (OR 5.09, 95% CI 1.38,18.74, p=0.014). Conclusions: The patients’ clinical characteristics were fairly comparable between Candida albicans and non-albicans candidaemia. The changing epidemiology of candidaemia at this centre was in fact alarming. The outcome associated with candidaemia was poor.

scholarly journals The Effects of Nurse Specialty Certification and Medical Treatments on Glycemic Control Outcomes: A Retrospective Study

2020 ◽  
Author(s):  
Maria M. Ojeda
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Critically Ill ◽  
Nursing Care ◽  
Hospitalized Patients ◽  
Insulin Regimen ◽  
Medical Treatments ◽  
Patients With Diabetes ◽  
Specialty Certification ◽  
The Impact

AbstractAIMSTo describe and explore the impact of the presence of specialty certified nurses on the unit on glycemic control among non-critically ill hospitalized patients with Diabetes mellitus.BACKGROUNDPoor glycemic control during hospitalization has been associated adverse patient outcomes. Staff nurses administer much of the diabetes-specific care delivered to patients during hospitalization. Nurse specialty certification is a recognized indicator of nursing care quality.METHODSA retrospective sample of medical records data was analyzed to describe and explore the impact of specialty certified nurses on glycemic control among a group of 293 non-critically ill hospitalized patients with Diabetes mellitus. Regression analysis was performed to assess the impact of the percentage of certified nurses on the unit as a mediator or moderator of the relationship between medical treatments and glycemic control outcomes.RESULTSIncreases in the percentage of specialty certified nurses on the unit were associated with significant decreases in mean blood glucose levels among patients who received a basal-bolus insulin regimen or enteral nutritional feedings.CONCLUSIONSPatients who received specific medical treatments during hospitalization had superior outcomes when nursing care was delivered during times in which the relative proportion of certified nurses on the unit were higher.

Good Glycemic Control for a Low Cardiovascular Risk in Children Suffering from Diabets

2017 ◽  
Vol 68 (2) ◽  
pp. 358-361
Author(s):  
Camelia Busila ◽  
Mariana Cretu Stuparu ◽  
Aurel Nechita ◽  
Camelia Ana Grigore ◽  
Gabriela Balan
Keyword(s):  
Glycosylated Hemoglobin ◽  
Control Group ◽  
Sex Distribution ◽  
Good Glycemic Control ◽  
Rural And Urban ◽  
Lipid Panel ◽  
Patients With Diabetes ◽  
Kolmogorov Smirnov ◽  
Low Cardiovascular Risk

The study is a prospective and operational one, ant its was conducted on 58 patients with diabetes type 1 and 2. The patients sex distribution was homogenious and they come from both rural and urban environment. The statistical analisys was carried out using the programme SPSS 17.0 for Windows. The distribution normality was cheked using the Kolmogorov - Smirnov Z test. he values of glycemia, glycosylated hemoglobin, lipid panel, blood pressure have been measured and compared to the ones belonging to the control group.

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