scholarly journals Development and validation of prediction rules to target care intensification in veteran patients with diabetes

2020 ◽  
Vol 27 (1) ◽  
pp. e100130
Author(s):  
Heather M Campbell ◽  
Allison Murata ◽  
Gerald A Charlton ◽  
Glen H Murata
Keyword(s):  
Microvascular Complications ◽  
Glycated Haemoglobin ◽  
Baseline Hba1c ◽  
Psychosocial Screening ◽  
Prediction Rules ◽  
Patients With Diabetes ◽  
The Usa ◽  
Consecutive Number ◽  
Development And Validation ◽  
Hba1c Measurement

BackgroundDiabetes affects 30.3 million people in the USA. Among these people, a major risk factor for microvascular complications is having a glycated haemoglobin (HbA1c) value of ≥75 mmol/mol; therefore, it would be helpful to identify patients who will obtain future HbA1c values of <75 mmol/mol.ObjectivesTo develop and validate two prediction rules among patients with diabetes having a baseline HbA1c value of ≥75 mmol/mol: (1) HbA1c measurement ever <75 mmol/mol and (2) final HbA1c measurement of <75 mmol/mol.MethodsRetrospective cohort study using a registry extracting data from the Department of Veterans Affairs’s (VA’s) electronic health records system. Baseline was 1 Jul 2013–30 June 2014; patients were followed up until 31 July 2016.ResultsOur population consisted of 145 659 patients. Across models, predictors were age, sex, minority status, baseline HbA1c value, time, HbA1c≥75 mmol/mol, receiving insulin treatment and consecutive number of HbA1c values of 75 mmol/mol. The overall likelihood of a patient ever having an HbA1c<75 mmol/mol was 73.65%; with the rule, predicted probabilities were 38.94%, 50.75% and 78.88%. The overall likelihood of patients having a final HbA1c measurement of <75 mmol/mol was 55.35%; the rule provided predicted probabilities of 29.93%, 50.17% and 68.58%.ConclusionsWithin each rule, there were similar observed and predicted tertile probabilities; maintaining HbA1c values of <75 mmol/mol resulted in probability shifts in the majority of patients. We recommend psychosocial screening for 15% of patients for whom there is less than one-third chance of maintaining HbA1c<75 mmol/mol. We plan to conduct additional research to see whether this approach helps.

scholarly journals Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study

Diabetologia ◽  
2021 ◽  
Vol 64 (4) ◽  
pp. 778-794 ◽  
Author(s):  
Matthieu Wargny ◽  
◽  
Louis Potier ◽  
Pierre Gourdy ◽  
Matthieu Pichelin ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Hospital Discharge ◽  
Microvascular Complications ◽  
White Cell Count ◽  
Symptom Duration ◽  
Protein Levels ◽  
Reactive Protein ◽  
Patients With Diabetes ◽  
History Of ◽  
Routine Therapy

Abstract Aims/hypothesis This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19). Methods The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days. Results We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th–75th percentile) 28.4 (25.0–32.4) kg/m2. Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5–14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors. Conclusions/interpretation In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period. Trial registration Clinicaltrials.gov identifier: NCT04324736 Graphical abstract

scholarly journals Prevalence of Anaemia and Its Associated Factors among Type 2 Diabetes Mellitus Patients in University of Gondar Comprehensive Specialized Hospital

Anemia ◽  
2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Sewnet Adem Kebede ◽  
Biruk Shalmeno Tusa ◽  
Adisu Birhanu Weldesenbet
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Associated Factors ◽  
Microvascular Complications ◽  
Combined Treatment ◽  
Factors Associated ◽  
Specialized Hospital ◽  
Patients With Diabetes

Background. Anaemia is one of the commonest blood disorders seen in patients with diabetes. In Ethiopia, chronic illnesses are tremendously raising with their complications. But very little research has been conducted, particularly on anaemia among diabetes mellitus (DM) patients. Therefore, this study aimed at assessing the prevalence of anaemia and associated factors among type 2 diabetes mellitus patients in Northwest Ethiopia. Methods. A cross-sectional study design was employed at University of Gondar Comprehensive Specialized Hospital from March 1 to April 15, 2019, among 372 type 2 diabetes mellitus patients (T2DM). Multivariable logistic regression analysis was fitted, and the corresponding adjusted odds ratio (AOR) and 95% CI were used to identify factors associated with anaemia. Level of significance was declared at the p value less than 0.05. Results. The study revealed 8.06% (95% CI: 5.68–11.31%) of the participants were anaemic. Being male (AOR = 2.74, CI: 1.02, 7.38), combined type of treatment (AOR = 8.38, CI: 1.66, 42.25), having diabetes-related microvascular complications (AOR = 3.24, CI: 1.14, 9.26), and hypertension (AOR = 0.01, CI: 0.002, 0.06) were the significant factors associated with anaemia. Conclusions. The finding of the current study revealed low prevalence of anaemia among T2DM patients. Sex, type of treatment, diabetes-related microvascular complications, and hypertension were factors associated with anaemia. Assessment of haemoglobin levels among T2DM patients may help to prevent ensuing microvascular complications. Incorporate anaemia screening into the routine assessment of diabetic complication particularly for those who are hypertensive and took combined treatment to allow early appreciation and treatment of anaemia and later improve the overall care of patients with diabetes.

scholarly journals Special aspects of concentrated insulins: basic characteristics and research findings

2020 ◽  
Vol 22 (5) ◽  
pp. 481-490
Author(s):  
Tatiana Y. Demidova ◽  
Olga V. Balutina
Keyword(s):  
Clinical Practice ◽  
Insulin Glargine ◽  
Microvascular Complications ◽  
Severe Hypoglycemia ◽  
Glucose Lowering ◽  
Practice Experience ◽  
Patients With Diabetes ◽  
Research Findings ◽  
Basic Characteristics ◽  
Diabetic Microvascular Complications

The appearance of concentrated insulins in clinical practice determines the need to analyze product priorities in appropriate groups of patients with diabetes. The aim of this article is to summarize the literature on concentrated insulins (i.e. insulin lispro 200 units/mL, insulin degludec 200 units/mL, insulin glargine 300 units/mL) from randomized controlled trials, derive guidance on appropriate and safe use of these agents and demonstrate experience in real clinical practice. Severe hypoglycemia in all studies was generally low (though higher with prandial plus concentrated basal analogue therapy), and statistical improvements in other hypoglycemia categories were observed for concentrated basal insulins versus insulin glargine 100 units/mL. In all analyzed data hypoglycemic effect of insulin glargine 300 units/mL was equitable to insulin glargine 100 units/mL. Other important findings demonstrate more constant and prolonged insulin action with low within-subject/ between-day variability for insulin glargine 300 units/mL versus insulin glargine 100 units/mL, therefore, more physiological treatment might prevent from diabetic microvascular complications. The results of randomized trials are comparable with our clinical practice experience and indicate efficacious and safe glucose-lowering properties without risk of severe hypoglycemia.

MO050GLYCEMIC CONTROL AND THE RISK OF AKI IN PATIENTS WITH DIABETES AND CKD: PARALLEL POPULATION-BASED COHORT STUDIES IN U.S. AND SWEDEN ROUTINE CARE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yang Xu ◽  
Aditya Surapaneni ◽  
Jim Alkas ◽  
Alexander Chang ◽  
Morgan Grams ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Cohort Studies ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Sensitivity Analyses ◽  
Time Varying ◽  
Baseline Hba1c ◽  
Patients With Diabetes ◽  
Swedish Cohort ◽  
The U.S

Abstract Background and Aims Patients with diabetes and chronic kidney disease (CKD) have increased susceptibility to acute kidney injury (AKI), but the underlying mechanisms are not well known. We here explore the association between glycemic control and risk of AKI. Method We created two parallel observational cohort studies of Swedish (SCREAM project, Stockholm, 2006-2011) and U.S. (Geisinger Heath system, Pennsylvania, 1996-2018) adult patients with diabetes mellitus and confirmed CKD stages G3-G5. Glycemic control was evaluated through repeated HbA1c measurements, which were categorized into 5 levels of glycemic control intensity, with HbA1c 6-6.9% as referent category, and continuously using cubic splines. We evaluated the association between baseline and time-varying HbA1c levels with AKI (defined as increase in creatinine &gt;=0.3 mg/d over 48 hours or 1.5x creatinine over 7 days) using Cox proportional hazards regression and, in sensitivity analyses, Fine and Gray competing risk models accounting for death. Results In the Swedish cohort, there were 13932 patients with median age 76 years, 51% women, median eGFR 50.8 (Interquartile Range (IQR) 41.4-57.1) ml/min/1.73. In the U.S. cohort, there were 26520 patients with median age 71 years, 55% women and 52.1 (IQR 43.4-57.5) ml/min/1.73 m2. During a median of 2.3 and 3.1 years of follow up, 3172 and 8671 AKI events were recorded in the Swedish and US cohorts, respectively. The adjusted association between baseline HbA1c and AKI was similar in both cohorts, with the lowest risk between 6-6.9% and higher risk at higher levels of HbA1c. Compared to baseline HbA1c 6-6.9%, baseline HbA1c&gt;9% associated with a 1.28 fold (95% CI 1.11-1.47) higher risk of AKI in the Swedish cohort, and a 1.14 (95% CI 1.04-1.25) higher risk in the U.S. cohort. Conversely, baseline HbA1c&lt;6% did not associate with AKI. When using time-varying HbA1c, AKI risk was higher for HbA1c&gt;9% (HR 1.18, 95% CI 1.03-1.37 in Swedish cohort and 1.27, 1.17-1.37 in U.S. cohort); AKI risk was also higher for HbA1c&lt;6% in the U.S. cohort (1.12, 1.04-1.19), but not in the Swedish cohort (1.06, 0.97-1.16)). Conclusion Higher A1c was associated with AKI in adults with diabetes and CKD, suggesting that better glycemic control may also reduce risk of AKI.

scholarly journals The Mitochondria-Targeted Methylglyoxal Sequestering Compound, MitoGamide, Is Cardioprotective in the Diabetic Heart

2019 ◽  
Vol 33 (6) ◽  
pp. 669-674 ◽  
Author(s):  
Mitchel Tate ◽  
Gavin C. Higgins ◽  
Miles J. De Blasio ◽  
Runa Lindblom ◽  
Darnel Prakoso ◽  
...  
Keyword(s):  
Experimental Diabetes ◽  
Therapeutic Potential ◽  
Glycated Haemoglobin ◽  
Wild Type ◽  
Oral Gavage ◽  
Glycation End Products ◽  
Diabetic Myocardium ◽  
Patients With Diabetes ◽  
Akita Mice ◽  
Targeted Approach

Abstract Purpose Methylglyoxal, a by-product of glycolysis and a precursor in the formation of advanced glycation end-products, is significantly elevated in the diabetic myocardium. Therefore, we sought to investigate the mitochondria-targeted methylglyoxal scavenger, MitoGamide, in an experimental model of spontaneous diabetic cardiomyopathy. Methods Male 6-week-old Akita or wild type mice received daily oral gavage of MitoGamide or vehicle for 10 weeks. Several morphological and systemic parameters were assessed, as well as cardiac function by echocardiography. Results Akita mice were smaller in size than wild type counterparts in terms of body weight and tibial length. Akita mice exhibited elevated blood glucose and glycated haemoglobin. Total heart and individual ventricles were all smaller in Akita mice. None of the aforementioned parameters was impacted by MitoGamide treatment. Echocardiographic analysis confirmed that cardiac dimensions were smaller in Akita hearts. Diastolic dysfunction was evident in Akita mice, and notably, MitoGamide treatment preferentially improved several of these markers, including e′/a′ ratio and E/e′ ratio. Conclusions Our findings suggest that MitoGamide, a novel mitochondria-targeted approach, offers cardioprotection in experimental diabetes and therefore may offer therapeutic potential for the treatment of cardiomyopathy in patients with diabetes.

scholarly journals The frequency of testing for glycated haemoglobin, HbA1c, is linked to the probability of achieving target levels in patients with suboptimally controlled diabetes mellitus

2018 ◽  
Vol 57 (2) ◽  
pp. 296-304 ◽  
Author(s):  
Christopher J. Duff ◽  
Ivonne Solis-Trapala ◽  
Owen J. Driskell ◽  
David Holland ◽  
Helen Wright ◽  
...  
Keyword(s):  
Diabetes Management ◽  
Clinical Biochemistry ◽  
Healthcare Services ◽  
Glycated Haemoglobin ◽  
Suboptimal Control ◽  
Linear Mixed Effects ◽  
Monitoring Frequency ◽  
Patients With Diabetes ◽  
Clinical Biochemistry Laboratory ◽  
Changes Over Time

Abstract Background We previously showed, in patients with diabetes, that >50% of monitoring tests for glycated haemoglobin (HbA1c) are outside recommended intervals and that this is linked to diabetes control. Here, we examined the effect of tests/year on achievement of commonly utilised HbA1c targets and on HbA1c changes over time. Methods Data on 20,690 adults with diabetes with a baseline HbA1c of >53 mmol/mol (7%) were extracted from Clinical Biochemistry Laboratory records at three UK hospitals. We examined the effect of HbA1c tests/year on (i) the probability of achieving targets of ≤53 mmol/mol (7%) and ≤48 mmol/mol (6.5%) in a year using multi-state modelling and (ii) the changes in mean HbA1c using a linear mixed-effects model. Results The probabilities of achieving ≤53 mmol/mol (7%) and ≤48 mmol/mol (6.5%) targets within 1 year were 0.20 (95% confidence interval: 0.19–0.21) and 0.10 (0.09–0.10), respectively. Compared with four tests/year, having one test or more than four tests/year were associated with lower likelihoods of achieving either target; two to three tests/year gave similar likelihoods to four tests/year. Mean HbA1c levels were higher in patients who had one test/year compared to those with four tests/year (mean difference: 2.64 mmol/mol [0.24%], p<0.001). Conclusions We showed that ≥80% of patients with suboptimal control are not achieving commonly recommended HbA1c targets within 1 year, highlighting the major challenge facing healthcare services. We also demonstrated that, although appropriate monitoring frequency is important, testing every 6 months is as effective as quarterly testing, supporting international recommendations. We suggest that the importance HbA1c monitoring frequency is being insufficiently recognised in diabetes management.

A Review of Pramlintide in the Management of Diabetes

2009 ◽  
Vol 1 ◽  
pp. CMT.S2369
Author(s):  
Caroline Messer ◽  
Dina Green
Keyword(s):  
Microvascular Complications ◽  
Effective Means ◽  
Postprandial Glucose ◽  
Tight Glycemic Control ◽  
Minimal Risk ◽  
Patients With Diabetes ◽  
Insulin Dependent

Tight glycemic control in type 1 and type 2 diabetes reduces the risk for microvascular complications, including retinopathy, nephropathy, and neuropathy. Yet, despite intensive insulin regimens, many insulin-dependent patients are unable to achieve euglycemic states. This review will focus on pramlintide, an equipotent amylin analog, and its role in the management of diabetes. Pramlintide lowers glucose through the same mechanisms as amylin: it slows gastric emptying, suppresses the postprandial rise of glucagon in patients with diabetes, and promotes satiety. Long-term clinical trials have shown that the use of pramlintide as an adjunct to insulin minimizes postprandial glucose excursions and reduces both HbA1C and body weight when compared to placebo. Although its effects on HbA1C are modest, pramlintide has gained popularity as a result of its relatively few contraindications, limited side effects, minimal risk for hypoglycemia, and potential for weight loss. The combination of insulin and pramlintide may provide an effective means for patients with diabetes to meet their HbA1C goals.

Development and validation of the Leadership Effectiveness in Africa and the Diaspora (LEAD) scale

2020 ◽  
Vol 20 (3) ◽  
pp. 361-384
Author(s):  
James Michaud ◽  
Elena Lvina ◽  
Bella L Galperin ◽  
Terri R Lituchy ◽  
Betty Jane Punnett ◽  
...  
Keyword(s):  
Factor Analysis ◽  
African Diaspora ◽  
Leadership Effectiveness ◽  
Culturally Sensitive ◽  
Theory Approach ◽  
Cultural Leadership ◽  
Sensitive Measure ◽  
The Usa ◽  
Combination Of Methods ◽  
Development And Validation

This article contributes to the literature on cross-cultural leadership by describing the development and validation of the Leadership Effectiveness in Africa and the Diaspora (LEAD) Scale. The LEAD Scale is a culturally sensitive measure of leadership effectiveness in the understudied settings of Africa and the African diaspora. A combination of methods and four studies using samples from Africa and the African diaspora based in Canada, the USA, and the Caribbean were used to develop the measure. Using the grounded theory approach and the Delphi technique ( n = 192), followed by a set of increasingly rigorous tests including exploratory factor analysis ( n = 441), confirmatory factor analysis ( n = 116), and a test of measure invariance ( n =1384), we developed and validated a culturally sensitive measure of effective leadership. Our results demonstrate that spirituality, tradition and community-centredness are important and culturally specific components of leadership in Africa and the African diaspora. This paper provides a validated measure of leadership and offers recommendations regarding the use of the measure by managers and researchers working in Africa or with African diaspora.

scholarly journals Anxiety among patients with diabetes mellitus evaluated using generalized anxiety disorder 7-item scale

2016 ◽  
Vol 04 (02) ◽  
pp. 133-136 ◽  
Author(s):  
Amit Thour ◽  
Ramninder Nagra ◽  
Arunjeet Gosal ◽  
Tejasav Sehrawat ◽  
Subhash Das ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Tertiary Care Hospital ◽  
Microvascular Complications ◽  
Tertiary Care ◽  
Generalized Anxiety ◽  
Care Hospital ◽  
Cross Sectional ◽  
Patients With Diabetes

Abstract Background: Anxiety has been shown to be associated with poor outcomes in people with diabetes. However, there has been limited data, especially from India, which has specifically examined whether diabetes mellitus is associated with an increased likelihood of comorbid anxiety. Aim: The aim was to estimate the prevalence of anxiety in patients with diabetes and to determine the association of anxiety with age, sex, and other related parameters. Setting: Endocrine clinic, tertiary care hospital. Design: Cross-sectional. Materials and Methods: The study was cross-sectional carried out in endocrinology clinic of tertiary care hospital in North India. Cases were patients with type 2 diabetes mellitus above 30 years of age. Anxiety was assessed using the generalized anxiety disorders 7-item (GADs-7) scale. The relationship with a sociodemographic profile, duration of diabetes, hypertension, and microvascular complications was also analyzed. Results: Seventy-three subjects (42.5% females) with mean age 50.8 ± 9.2 years were evaluated. The prevalence of anxiety was 34%. Severe anxiety (GAD-7 score ≥15) was present in three (4%) subjects, moderate anxiety (GAD-7 score ≥10) was present in six (8%) subjects, and mild anxiety was present in 16 (22%) of subjects. Anxiety increased with fasting plasma glucose, hypertension, was more in women, but the differences were not statistically significant. Conclusions: Our study demonstrates a higher prevalence of anxiety in patients with type 2 diabetes. No factor was significantly associated with anxiety. Therefore, anxiety should be assessed in each and every patient, irrespective of other factors.

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