scholarly journals Risk factors for recurrent emergency department visits for hyperglycemia in patients with diabetes mellitus

2017 ◽  
Vol 10 (1) ◽  
Author(s):  
Justin W. Yan ◽  
Katherine M. Gushulak ◽  
Melanie P. Columbus ◽  
Kristine van Aarsen ◽  
Alexandra L. Hamelin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Emergency Department ◽  
Emergency Department Visits ◽  
Patients With Diabetes

scholarly journals P131: Risk factors for recurrent emergency department visits for hyperglycemia in patients with diabetes mellitus

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S122 ◽  
Author(s):  
J.W. Yan ◽  
K. Gushulak ◽  
M. Columbus ◽  
K. Van Aarsen ◽  
A. Hamelin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Emergency Department ◽  
Protective Factors ◽  
Diabetic Ketoacidosis ◽  
Initial Presentation ◽  
Patients With Diabetes ◽  
Hyperosmolar Hyperglycemic State ◽  
Ed Visits ◽  
One Year

Introduction: Patients with poorly controlled diabetes mellitus may present repeatedly to the emergency department (ED) for management and treatment of hyperglycemic episodes, including diabetic ketoacidosis and hyperosmolar hyperglycemic state. The objective of this study was to identify risk factors that predict unplanned recurrent ED visits for hyperglycemia in patients with diabetes within 30 days of initial presentation. Methods: We conducted a one-year health records review of patients ≥18 years presenting to one of four tertiary care EDs with a discharge diagnosis of hyperglycemia, diabetic ketoacidosis or hyperosmolar hyperglycemic state. Trained research personnel collected data on patient characteristics and determined if patients had an unplanned recurrent ED visit for hyperglycemia within 30 days of their initial presentation. Multivariate logistic regression models using generalized estimating equations to account for patients with multiple visits determined predictor variables independently associated with recurrent ED visits for hyperglycemia within 30 days. Results: There were 833 ED visits for hyperglycemia in the one-year period. 54.6% were male and mean (SD) age was 48.8 (19.5). Of all visitors, 156 (18.7%) had a recurrent ED visit for hyperglycemia within 30 days. Factors independently associated with recurrent hyperglycemia visits included a previous hyperglycemia visit in the past month (odds ratio [OR] 3.5, 95% confidence interval [CI] 2.1-5.8), age <25 years (OR 2.6, 95% CI 1.5-4.7), glucose >20 mmol/L (OR 2.2, 95% CI 1.3-3.7), having a family physician (OR 2.2, 95% CI 1.0-4.6), and being on insulin (OR 1.9, 95% CI 1.1-3.1). Having a systolic blood pressure between 90-150 mmHg (OR 0.53, 95% CI 0.30-0.93) and heart rate >110 bpm (OR 0.41, 95% CI 0.23-0.72) were protective factors independently associated with not having a recurrent hyperglycemia visit. Conclusion: This unique ED-based study reports five risk factors and two protective factors associated with recurrent ED visits for hyperglycemia within 30 days in patients with diabetes. These risk factors should be considered by clinicians when making management, prognostic, and disposition decisions for diabetic patients who present with hyperglycemia.

Risk Factors for Hypoglycemia in Patients with Diabetes Mellitus

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 2271-PUB
Author(s):  
ASAKO MIZOGUCHI
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Patients With Diabetes

Risk factors of hospital admissions and recurrent emergency department visits among pediatric asthma patients

2020 ◽  
pp. 1011-1015
Author(s):  
Abdullah Aldamigh ◽  
Afaf Alnefisah ◽  
Abdulrahman Almutairi ◽  
Fatima Alturki ◽  
Suhailah Alhtlany ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Hospital Admissions ◽  
Pediatric Asthma ◽  
Emergency Department Visits ◽  
Asthma Patients

scholarly journals Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy: A Cohort Study

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S333-S334
Author(s):  
So Lim Kim ◽  
Angela Everett ◽  
Susan J Rehm ◽  
Steven Gordon ◽  
Nabin Shrestha
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Hospital Admission ◽  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Cleveland Clinic ◽  
Emergency Department Visits ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Ed Visits ◽  
Access Complications

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) carries risk of vascular access complications, antimicrobial adverse effects, and worsening of infection. Both OPAT-related and unrelated events may lead to emergency department (ED) visits. The purpose of this study was to describe adverse events that result in ED visits and risk factors associated with ED visits during OPAT. Methods OPAT courses between January 1, 2013 and December 31, 2016 at Cleveland Clinic were identified from the institution’s OPAT registry. ED visits within 30 days of OPAT initiation were reviewed. Reasons and potential risk factors for ED visits were sought in the medical record. Results Among 11,440 OPAT courses during the study period, 603 (5%) were associated with 1 or more ED visits within 30 days of OPAT initiation. Mean patient age was 58 years and 57% were males. 379 ED visits (49%) were OPAT-related; the most common visit reason was vascular access complication, which occurred in 211 (56%) of OPAT-related ED visits. The most common vascular access complications were occlusion and dislodgement, which occurred in 99 and 34 patients (47% and 16% of vascular access complications, respectively). In a multivariable logistic regression model, at least one prior ED visit in the preceding year (prior ED visit) was most strongly associated with one or more ED visits during an OPAT course (OR 2.96, 95% CI 2.38 – 3.71, p-value < 0.001). Other significant factors were younger age (p 0.01), female sex (p 0.01), home county residence (P < 0.001), and having a PICC (p 0.05). 549 ED visits (71%) resulted in discharge from the ED within 24 hours, 18 (2%) left against medical advice, 46 (6%) were observed up to 24 hours, and 150 ED visits (20%) led to hospital admission. Prior ED visit was not associated with hospital admission among patients who visited the ED during OPAT. Conclusion OPAT-related ED visits are most often due to vascular access complications, especially line occlusions. Patients with a prior ED visit in the preceding year have a 3-fold higher odds of at least one ED visit during OPAT compared with patients without a prior ED visit. A strategy of managing occlusions at home and a focus on patients with prior ED visits could potentially prevent a substantial proportion of OPAT-related ED visits. Disclosures All authors: No reported disclosures.

scholarly journals When Uncontrolled Diabetes Mellitus and Severe COVID-19 Converge: The Perfect Storm for Mucormycosis

2021 ◽  
Vol 7 (4) ◽  
pp. 298
Author(s):  
Teny M. John ◽  
Ceena N. Jacob ◽  
Dimitrios P. Kontoyiannis
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Clinical Features ◽  
The Other ◽  
Diabetic Patients ◽  
Epidemiological Factors ◽  
Uncontrolled Diabetes ◽  
Diagnostic Certainty ◽  
Patients With Diabetes ◽  
Perfect Storm

Mucormycosis (MCR) has been increasingly described in patients with coronavirus disease 2019 (COVID-19) but the epidemiological factors, presentation, diagnostic certainty, and outcome of such patients are not well described. We review the published COVID-19-associated mucormycosis (CAMCR) cases (total 41) to identify risk factors, clinical features, and outcomes. CAMCR was typically seen in patients with diabetes mellitus (DM) (94%) especially the ones with poorly controlled DM (67%) and severe or critical COVID-19 (95%). Its presentation was typical of MCR seen in diabetic patients (mostly rhino-orbital and rhino-orbital-cerebral presentation). In sharp contrast to reported COVID-associated aspergillosis (CAPA) cases, nearly all CAMCR infections were proven (93%). Treating physicians should have a high suspicion for CAMCR in patients with uncontrolled diabetes mellitus and severe COVID-19 presenting with rhino-orbital or rhino-cerebral syndromes. CAMR is the convergence of two storms, one of DM and the other of COVID-19.

scholarly journals Lack of association between peroxisome proliferator-activated receptor-gamma-2 gene variants and the occurrence of coronary heart disease in patients with diabetes mellitus

2002 ◽  
pp. 545-551 ◽  
Author(s):  
M Bluher ◽  
T Klemm ◽  
T Gerike ◽  
H Krankenberg ◽  
G Schuler ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Multiple Logistic Regression Analysis ◽  
Peroxisome Proliferator ◽  
Haemoglobin A1c ◽  
Peroxisome Proliferator Activated Receptor ◽  
Patients With Diabetes ◽  
Reduced Risk

OBJECTIVE: Recent evidence indicates that peroxisome proliferator-activated receptor-gamma (PPARgamma) is expressed at high levels in foam cells of atherosclerotic lesions, that PPARgamma agonists may directly modulate vessel wall function and that mutations in the PPARgamma-2 gene are associated with a reduced risk of coronary artery disease. METHODS: We investigated whether known variants in the PPARgamma-2 gene are associated with the occurrence of coronary heart disease (CHD) in 365 patients with type 2 diabetes, prospectively characterised for the presence or absence of CHD. The Pro115Gln, Pro12Ala, Pro467Leu, Val290Met mutations and two polymorphisms C478T and C161T of the PPARgamma-2 gene were examined using PCR, denaturing gradient gel electrophoresis and direct sequencing. RESULTS: The distribution of the Pro12Ala, Ala12Ala, C161T and T161T variants was not significantly different between patients with and without CHD, independent of the gender. The Pro12Ala (P=0.011) and the Ala12Ala (P=0.006) variant were associated with a higher body mass index (BMI) compared with the Pro12Pro genotype. A multiple logistic regression analysis introducing the typical risk factors for CHD (age, sex, hypertension, smoking, BMI >26 kg/m2, elevated low density lipoprotein cholesterol and haemoglobin A1c >7%) identified age >60, male gender, hypertension and a higher BMI, but not the PPARgamma-2 variants, as significant risk factors for CHD in our study groups. CONCLUSION: The PPARgamma-2 genotype was not associated with an increased or reduced risk of the occurrence of CHD and can therefore not be regarded as an independent risk factor for CHD in patients with diabetes mellitus.

Prevalence of Toenail Onychomycosis in Patients with Type 2 Diabetes Mellitus and Evaluation of Risk Factors

2011 ◽  
Vol 101 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Aynur Gulcan ◽  
Erim Gulcan ◽  
Sukru Oksuz ◽  
Idris Sahin ◽  
Demet Kaya
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Fasting Blood Glucose ◽  
Diabetic Patients ◽  
Essential Components ◽  
Patients With Diabetes ◽  
Epidemiologic Risk

Background: We sought to determine the frequency of toenail onychomycosis in diabetic patients, to identify the causative agents, and to evaluate the epidemiologic risk factors. Methods: Data regarding patients’ diabetic characteristics were recorded by the attending internal medicine clinician. Clinical examinations of patients’ toenails were performed by a dermatologist, and specimens were collected from the nails to establish the onycomycotic abnormality. All of the specimens were analyzed by direct microscopy and culture. Results: Of 321 patients with type 2 diabetes mellitus, clinical onychomycosis was diagnosed in 162; 41 of those diagnoses were confirmed mycologically. Of the isolated fungi, 23 were yeasts and 18 were dermatophytes. Significant correlations were found between the frequency of onychomycosis and retinopathy, neuropathy, obesity, family history, and duration of diabetes. However, no correlation was found with sex, age, educational level, occupation, area of residence, levels of hemoglobin A1c and fasting blood glucose, and nephropathy. The most frequently isolated agents from clinical specimens were yeasts. Conclusions: Long-term control of glycemia to prevent chronic complications and obesity and to promote education about the importance of foot and nail care should be essential components in preventing onychomycosis and its potential complications, such as secondary foot lesions, in patients with diabetes mellitus. (J Am Podiatr Med Assoc 101(1): 49–54, 2011)

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