scholarly journals Hospital utilization for hypoglycemia among patients with type 2 diabetes using pooled data from six health systems

2021 ◽  
Vol 9 (Suppl 1) ◽  
pp. e002153
Author(s):  
Scott J Pilla ◽  
Jennifer L Kraschnewski ◽  
Erik B Lehman ◽  
Lan Kong ◽  
Erica Francis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Health Systems ◽  
Emergency Department Visits ◽  
Hospital Utilization ◽  
Electronic Health Record Data ◽  
Icd 10

IntroductionHypoglycemia is the most common serious adverse effect of diabetes treatment and a major cause of medication-related hospitalization. This study aimed to identify trends and predictors of hospital utilization for hypoglycemia among patients with type 2 diabetes using electronic health record data pooled from six academic health systems.Research design and methodsThis retrospective open cohort study included 549 041 adults with type 2 diabetes receiving regular care from the included health systems between 2009 and 2019. The primary outcome was the yearly event rate for hypoglycemia hospital utilization: emergency department visits, observation visits, or inpatient admissions for hypoglycemia identified using a validated International Classification of Diseases Ninth Revision (ICD-9) algorithm from 2009 to 2014. After the transition to ICD-10 in 2015, we used two ICD-10 code sets (limited and expanded) for hypoglycemia hospital utilization from prior studies. We identified independent predictors of hypoglycemia hospital utilization using multivariable logistic regression analysis with data from 2014.ResultsYearly rates of hypoglycemia hospital utilization decreased from 2.7 to 1.6 events per 1000 patients from 2009 to 2014 (p-trend=0.023). From 2016 to 2019, yearly event rates were stable ranging from 5.6 to 6.6, or 6.3 to 7.3, using the limited and expanded ICD-10 code sets, respectively. In 2014, the strongest independent risk factors for hypoglycemia hospital utilization were chronic kidney disease (OR 2.86, 95% CI 2.33 to 3.57), ages 18–39 years (OR 2.43 vs age 40–64 years, 95% CI 1.78 to 3.31), and insulin use (OR 2.13 vs no diabetes medications, 95% CI 1.67 to 2.73).ConclusionsRates of hypoglycemia hospital utilization decreased from 2009 to 2014 and varied considerably by clinical risk factors such that younger adults, insulin users, and those with chronic kidney disease were at especially high risk. There is a need to validate hypoglycemia ascertainment using ICD-10 codes, which detect a substantially higher number of events compared with ICD-9.

scholarly journals Differences in Risk Factors for Diabetic Retinopathy in Type 1 and Type 2 Diabetes Mellitus Patients in North-East Poland

Medicina ◽  
2020 ◽  
Vol 56 (4) ◽  
pp. 177
Author(s):  
Wojciech Matuszewski ◽  
Magdalena M. Stefanowicz-Rutkowska ◽  
Magdalena Szychlińska ◽  
Elżbieta Bandurska-Stankiewicz
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Type 2 Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Kidney Disease ◽  
Study Group

Background and Objective: Nowadays, diabetes is one of the main causes of blindness in the world. Identification and differentiation of risk factors for diabetic retinopathy depending on the type of diabetes gives us the opportunity to fight and prevent this complication. Aim of the research: To assess differences in the risk factors for diabetic retinopathy in type 1 and type 2 diabetes mellitus patients in Warmia and Mazury Region, Poland. Materials and Methods: Risk factors for diabetic retinopathy (DR) were assessed on the basis of an original questionnaire, which included: personal data, clinical history of diabetes and eye disease. Elements of clinical examination: blood pressure, BMI, waist circumference. Indicators of diabetes metabolic control: mean glycemia, glycated hemoglobin (HbA1c), total cholesterol and triglycerides, creatinine, glomerular filtration rate (GFR), albumin–creatinine ratio in urine. Results: The study group included 315 (26%) patients with DM1 and 894 (74%) patients with DM2. Risk factors were estimated on the basis of logistic regression and verified with Student’s t-test. Statistically significant dependencies were found in both groups between the occurrence of diabetic retinopathy and diabetes duration, HbA1c, triglyceride concentrations, indicators of kidney function and cigarette smoking status. In the DM2 group, the development of DR was significantly influenced by the implemented models of diabetic treatment. Conclusions: In the whole study group, the risk of DR was associated with the duration of diabetes, HbA1c, triglyceride concentrations and smoking. In DM1 patients, the risk of DR was associated with diabetic kidney disease in the G1A1/A2 stage of chronic kidney disease, and in DM2 patients with the G2 stage of chronic kidney disease. An important risk factor for DR in DM2 patients was associated with late introduction of insulin therapy.

Effects of aleglitazar on cardiovascular risk factors in patients with stage 3 chronic kidney disease and type 2 diabetes

2013 ◽  
Vol 231 (2) ◽  
pp. e3
Author(s):  
Matthias Herz ◽  
Klas Malmberg ◽  
Markolf Hanefeld ◽  
Luis Ruilope ◽  
A. Michael Lincoff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Cardiovascular Risk Factors

scholarly journals Chronic Kidney Disease and Associated Cardiovascular Risk Factors in Chinese with Type 2 Diabetes

2012 ◽  
Vol 36 (6) ◽  
pp. 433 ◽  
Author(s):  
Qing-Lin Lou ◽  
Xiao-Jun Ouyang ◽  
Liu-Bao Gu ◽  
Yong-Zhen Mo ◽  
Ronald Ma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Cardiovascular Risk Factors

scholarly journals Prevalence of chronic kidney disease stages 3-5 among patients with type 2 diabetes mellitus in Bangladesh

2017 ◽  
Vol 11 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Muhammad Abdur Rahim ◽  
Palash Mitra ◽  
Hasna Fahmima Haque ◽  
Tasrina Shamnaz Samdani ◽  
Shahana Zaman ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Type 2 Diabetes Mellitus ◽  
Kidney Disease ◽  
Glycemic Control ◽  
Significant Risk ◽  
Duration Of Diabetes

Background and objectives: Diabetes mellitus is one of the most common causes of chronic kidney disease (CKD). The prevalence of CKD in type 2 diabetes mellitus (T2DM) in Bangladesh is not well described. The present study aimed to find out the prevalence of CKD stages 3-5 and its risk factors among selected Bangladeshi T2DM patients.Methods: This cross-sectional study was conducted in BIRDEM (Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders) General Hospital, Dhaka, Bangladesh from July to December 2015. Diagnosed adult T2DM patients were consecutively and purposively included in this study. Pregnant women, patients with diagnosed kidney disease due to non-diabetic etiology, acute kidney injury (AKI), AKI on CKD and patients on renal replacement therapy were excluded. Age, gender, body mass index (BMI) and laboratory parameters were recorded systematically in a predesigned data sheet. Diagnosis of CKD and its stages were determined according to Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines 2012 and estimated glomerular filtration rate (eGFR). Estimated GFR was calculated by using Modification of Diet in Renal Disease (MDRD), Cockcroft-Gault (CG) and Chronic Kidney Disease Epidemiology (CKDEPI) creatinine based formula.Results: A total of 400 patients with T2DM of various durations were enrolled in the study. Out of 400 patients, 254 (63.5%), 259 (64.75%) and 218 (54.5%) cases had CKD stages 3-5 according to MDRD, C-G and CKD-EPI equations respectively. CKD was significantly more common in females (p<0.001) and in cases with long duration of diabetes (?5 years; p=0.007). CKD stages 3-5 were significantly associated with hypertension (?2=5.2125, p =0.02) and good control of diabetes (HbA1c <7%) as evidenced by higher proportion of CKD in them (73.3%) compared to those with poor glycemic control (52.1%).Conclusions: More than half of T2DM patients had CKD stages 3-5. Female gender, duration of diabetes and hypertension were significant risk factors and should be emphasized for the prevention of CKD in T2DM. Glycemic control may not reduce CKD in diabetes.IMC J Med Sci 2017; 11(1): 19-24

scholarly journals Scoring model to predict risk of chronic kidney disease in Chinese health screening examinees with type 2 diabetes

2021 ◽  
Author(s):  
Xia Cao ◽  
Binfang Yang ◽  
Jiansong Zhou
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Prediction Model ◽  
Scoring System ◽  
Health Screening ◽  
Validation Set

Abstract Purpose As health screening continues to increase in China, there is an opportunity to integrate a large number of demographic as well as subjective and objective clinical data into risk prediction modeling. The aim of this study was to develop and validate a prediction model for chronic kidney disease (CKD) in Chinese health screening examinees with type 2 diabetes mellitus (T2DM). Methods We conducted a retrospective cohort study consisting of 2051 Chinese T2DM patients between 35 and 78 years old who were enrolled in the XY3CKD Follow-up Program between 2009 and 2010. All participants were randomly assigned into a derivation set or a validation set at a 2:1 ratio. Cox proportional hazards regression model was selected for the analysis of risk factors for the development of the proposed risk model of CKD. We established a prediction model with a scoring system following the steps proposed by the Framingham Heart Study. Results The mean follow-up was 8.52 years, with a total of 315 (23.20%) and 189 (27.27%) incident CKD cases in the derivation set and validation set, respectively. We identified the following risk factors: age, gender, body mass index, duration of type 2 diabetes, variation of fasting blood glucose, stroke, and hypertension. The points were summed to obtain individual scores (from 0 to 15). The areas under the curve of 3-, 5- and 10-year CKD risks were 0.843, 0.799 and 0.780 in the derivation set and 0.871, 0.803 and 0.785 in the validation set, respectively. Conclusions The proposed scoring system is a promising tool for further application of assisting Chinese medical staff for early prevention of T2DM complications among health screening examinees.

scholarly journals The burden of unrecognised chronic kidney disease in patients with type 2 diabetes at a county hospital clinic in Kenya: implications to care and need for screening.

2019 ◽  
Author(s):  
Frederick C. F. Otieno ◽  
Elijah N Ogola ◽  
Mercy W Kimando ◽  
Ken K Mutai
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
County Hospital ◽  
End Stage Kidney Disease ◽  
Long Duration ◽  
End Stage

Abstract Background: Chronic Kidney Disease (CKD) in patients with type 2 diabetes enhances the cardiovascular risk profiles and disease, and is a strong predictor of progression to end-stage kidney disease. Early diagnosis is encouraged for referral to specialist kidney care to initiate active management that would optimize outcomes including forestalling progression to end-stage kidney disease. This study was conducted in a regional referral public health facility in Central Kenya with a high prevalence of type 2 diabetes. It was aimed at finding out the burden of undiagnosed chronic kidney disease in their clinic of ambulatory patients with type 2 diabetes who dwell mainly in the rural area. Methods: A cross-sectional study was conducted at the out-patient of Nyeri County hospital. A total of 385 patients were enrolled over five months. Informed consent was obtained and clinical evaluation was done, a spot sample of urine obtained for albuminuria and venous blood drawn for HbA1c, Lipids and serum creatinine. Estimated GFR (eGFR) was calculated using the Cockroft-Gault equation. Chronic kidney disease (CKD) was classified on KDIGO scale. Albuminuria was reported as either positive or negative. Main outcomes measure: Estimated Glomerular filtration rate and albuminuria as markers of chronic kidney disease. Results: A total of 385 participants were included in the study, 252 (65.5%) were females. There were 39.0 % (95%CI 34.3-44.2) patients in CKD/KDIGO stages 3, 4 and 5 and 32.7% (95%CI, 27.8-37.4) had Albuminuria. The risk factors that were significantly associated with chronic kidney disease/KDIGO stages 3, 4 and 5 were: age >50years, long duration with diabetes >5years and hypertension. Employment and paradoxically, obesity reduced the odds of having CKD, probably as markers of better socio-economic status. Conclusion: Unrecognized CKD of KDIGO stages 3,4 and 5 occurred in over thirty percent of the study patients. The risk factors of hypertension, age above 50, long duration of diabetes should help identify those at high risk of developing CKD, for screening and linkage to care. They are at high risk of progression to end-stage kidney disease and cardiovascular events. The imperative of screening for chronic kidney disease is availing care in publicly-funded hospitals.

scholarly journals The burden of unrecognised chronic kidney disease in patients with type 2 diabetes at a county hospital clinic in Kenya: implications to care and need for screening

2020 ◽  
Author(s):  
Frederick C. F. Otieno ◽  
Elijah N Ogola ◽  
Mercy W Kimando ◽  
Ken K Mutai
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
County Hospital ◽  
End Stage Kidney Disease ◽  
Long Duration ◽  
End Stage

Abstract Background : Chronic Kidney Disease (CKD) in patients with type 2 diabetes enhances their cardiovascular risk and diseases, and a strong predictor of progression to end-stage kidney disease. Early diagnosis is encouraged for referral to specialist kidney care to initiate active management that optimizes outcomes, including forestalling progression to end-stage kidney disease. This study was conducted in a regional referral public health facility in Central Kenya with a high prevalence of type 2 diabetes. It was aimed at finding out the burden of undiagnosed chronic kidney disease in their clinic of ambulatory patients with type 2 diabetes who dwell mainly in the rural area. Methods : A cross-sectional study was conducted at the out-patient of Nyeri County hospital where 385 patients were enrolled over five months. Informed consent was obtained and clinical evaluation was done. A spot sample of urine was obtained for albuminuria and venous blood drawn for HbA1c, Lipids and serum creatinine. Estimated GFR (eGFR) was calculated using the Cockroft-Gault equation. Chronic kidney disease (CKD) was classified on KDIGO scale. Albuminuria was reported as either positive or negative. Main outcomes measure: Estimated Glomerular filtration rate and albuminuria as markers of chronic kidney disease. Results : A total of 385 participants were included in the study, 252 (65.5%) were females. There were 39.0 % (95%CI 34.3-44.2) patients in CKD/KDIGO stages 3, 4 and 5 and 32.7% (95%CI, 27.8-37.4) had Albuminuria. The risk factors that were significantly associated with chronic kidney disease/KDIGO stages 3, 4 and 5 were: age >50years, long duration with diabetes >5years and hypertension. Employment and paradoxically, obesity reduced the odds of having CKD, probably as markers of better socio-economic status. Conclusion : Unrecognized CKD of KDIGO stages 3,4 and 5 occurred in over thirty percent of the study patients. The risk factors of hypertension, age above 50, long duration of diabetes should help identify those at high risk of developing CKD, for screening and linkage to care. They are at high risk of progression to end-stage kidney disease and cardiovascular events. The imperative of screening for chronic kidney disease is availing care in publicly-funded hospitals.

scholarly journals The Burden of Unrecognised Chronic Kidney Disease in Patients With Type 2 Diabetes at a County Hospital Clinic in Kenya: Implications to Care and Need for Screening

2019 ◽  
Author(s):  
Frederick C. F. Otieno ◽  
Elijah N Ogola ◽  
Mercy W Kimando ◽  
Ken K Mutai
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Strong Predictor ◽  
Active Management ◽  
County Hospital ◽  
End Stage Kidney Disease ◽  
End Stage

Abstract Background Chronic Kidney Disease (CKD) in patients with type 2 diabetes enhances the cardiovascular risk profiles and disease, and a strong predictor of progression to end-stage kidney disease. Early diagnosis is encouraged for referral to specialist kidney care to initiate active management that would optimize outcomes including forestalling progression to end-stage kidney disease. This study was conducted in a regional referral public health facility in Central Kenya with a higher prevalence of type 2 diabetes. It was aimed at finding out the burden of chronic kidney disease in their clinic of ambulatory patients with type 2 diabetes from, mainly, the rural area. Methods This was a cross-sectional survey conducted at the out-patient diabetes clinic of Nyeri County hospital. A total of 385 participants with type 2 diabetes were enrolled over five (5) months. Each subject gave informed consent to participate wherein clinical evaluation was done, a spot sample of urine obtained for albuminuria and venous blood drawn for HbA1c, Lipids and serum creatinine. Estimated GFR (eGFR) was calculated using the Cockroft-Gault equation. Chronic kidney disease (CKD) was classified on KDIGO scale. Albuminuria was reported as either positive or negative. Main outcomes measure Estimated Glomerular filtration rate and albuminuria as markers of chronic kidney disease. Results Of the 385 participants included in the study, 252 (65.5%) were females. Thirty nine per cent, 39.0%(95%CI 34.3-44.2) had CKD/KDIGO stages 3, 4 and 5 while 32.7% (95%CI, 27.8-37.4) had Albuminuria. The risk factors that were significantly associated with chronic kidney disease/KDIGO stages 3, 4 and 5 were: age >50years, long duration with diabetes >5years and hypertension. Employment and, paradoxically, obesity reduced the odds of having CKD, probably as markers of better socio-economic status. Conclusion Therefore, patients with type 2 diabetes should be screened for CKD using spot-urine albuminuria and eGFR, then risk-stratified further for cardiovascular disease and likelihood of progression to ESRD. Reducing proteinuria and optimizing control of the modifiable risk factors, especially unawareness, hypertension and hyperglycaemia, by linkage to and retention in quality care is the imperative of screening for chronic kidney disease which is the challenge in publicly-funded hospitals.

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