scholarly journals Glycemic Control & Morbidity in Diabetics With COPD Exacerbation. A Retrospective Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A414-A414
Author(s):  
Ibrahim Naoum ◽  
Abedalghani Abedalhalim ◽  
Amir Aker ◽  
Luai Khalaili ◽  
Sameer Kassem
Keyword(s):  
Mechanical Ventilation ◽  
Glycemic Control ◽  
Population Based ◽  
Chronic Obstructive ◽  
P Value ◽  
Diabetic Patients ◽  
Copd Exacerbation ◽  
Copd Exacerbations ◽  
Significant Difference ◽  
The Impact

Abstract Background: Diabetes and chronic obstructive pulmonary disease (COPD) are widely prevalent and comorbidity with these diseases is quite common. However, there is limited data on the interrelation between glycemic control and COPD exacerbations in diabetic patients. Objective: To study the association between pre-admission glycemic control and COPD clinical outcomes including mortality, risk of hospital readmission and the need for mechanical ventilation. Methods: A retrospective population-based cohort study. We screened for patients with both diabetes and COPD exacerbation aged 35 years and above. Pre-admission glycemic control was defined by the last HBA1C level prior to hospitalization. Patients with HBA1C>8% were defined as uncontrolled. We evaluated the difference between controlled and uncontrolled groups in the rates of mortality, readmission and the need for mechanical ventilation. We examined demographic and clinical parameters that might reflect COPD severity including: COPD medication use, blood hemoglobin, platelets, LDH and CRP levels. Results: 513 hospitalizations with diabetes and COPD were screened. 222 hospitalization were excluded either due to unestablished diagnosis of COPD or due to lack of HBA1C test in the preceding year. Of the remaining 291, 208 admissions were with controlled diabetes whereas 83 were uncontrolled. Although not statistically significant, the rate of re-hospitalization was higher in the uncontrolled group (OR 1.99, CI 0.99–4.0, p-value 0.051). There was no statistically significant difference in mortality (OR 1.6, CI 0.73–3.5, p-value 0.243). The use of oxygen and the need for noninvasive mechanical ventilation were significantly higher in the uncontrolled group (67.5% vs. 52.4%, p-value 0.019, 33.7% versus 18.8%, p-value 0.006, respectively). There was no significant difference in possible confounders tested between the groups. Conclusion: Uncontrolled diabetes may adversely affect patients with COPD exacerbation. Larger studies are needed to conclusively determine the impact of glycemic control on COPD morbidity and mortality.

Characteristics of monitored diabetic patients by glycated haemoglobin (HbA1c)

2016 ◽  
Vol 5 (05) ◽  
pp. 4563
Author(s):  
Tariq A. Zafar
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Glycated Haemoglobin ◽  
Poor Glycemic Control ◽  
Diabetic Patients ◽  
Age Group ◽  
Hba1c Test ◽  
Significant Difference ◽  
Tract Infections ◽  
The Impact

Glycated haemoglobin (HbA1c) test indicates the blood glucose levels for the previous two to three months. Using HbA1c test may overcome many of the practical issues and prevent infections such as urinary tract infections (UTIs). The study aimed to evaluate the impact of glycemic control using HbA1c test to understand patient characteristics and UTIs prevalence. Glycemic control was evaluated by measuring HbA1c for a total of 208 diabetes patients who were regularly attending diabetes center in Al-Noor specialist hospital in Makkah.  The results showed that good and moderate glycemic controlled patients were 14.9% and 16.9% respectively while the poor glycemic patients were 68.3%. Among the good improved glycemic control, 83.9% were females, 48.4% were from age group (15-44y). Among the moderately improved glycemic control, 68.4% were females, 54.3% were from age group (45-64 y) with no significant difference. The total number of the patients with positive UTIs was 55 (26.4%) while the total number of patients with negative was UTIs 153 (73.6%). Among the positive UTIs, 76.3% were with poor glycemic control while only 12.3% and 11% were moderate and good improved glycemic control respectively. Among the negative UTIs, 65.3% were with poor glycemic control while only 19% and 15.7% were with moderate and good improved glycemic control respectively.  Prevalence of UTIs among diabetic patients was not significant (p > 0.05). It was concluded that HbA1c was useful monitoring tool for diabetes mellitus and may lead to improved outcomes. Using a HbA1c test may overcome many of the practical issues that affect the blood glucose tests.

scholarly journals The Impact of COVID-19 on Hospitalised COPD Exacerbations in Malta

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Yvette Farrugia ◽  
Bernard Paul Spiteri Meilak ◽  
Neil Grech ◽  
Rachelle Asciak ◽  
Liberato Camilleri ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Chronic Obstructive ◽  
Inpatient Mortality ◽  
Obstructive Pulmonary Disease ◽  
Predictors Of Mortality ◽  
Copd Exacerbations ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Difference ◽  
The Impact

Introduction and Aims. The first COVID-19 case in Malta was confirmed on the 7th of March 2020. This study is aimed at investigating a significant difference between the number of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) admissions and their inpatient outcome at Mater Dei Hospital during the COVID-19 pandemic when compared to the same period in 2019. Furthermore, we aim to determine predictors of mortality in AECOPD inpatients. Method. Data was collected retrospectively from electronic hospital records during the periods 1st March until 10th May in 2019 and 2020. Results. There was a marked decrease in AECOPD admissions in 2020, with a 54.2% drop in admissions ( n = 119 in 2020 vs. n = 259 in 2019). There was no significant difference in patient demographics or medical comorbidities. In 2020, there was a significantly lower number of patients with AECOPD who received nebulised medications during admission (60.4% in 2020 vs. 84.9% in 2019; p ≤ 0.001 ). There were also significantly lower numbers of AECOPD patients admitted in 2020 who received controlled oxygen via venturi masks (69.0% in 2020 vs. 84.5% in 2019; p = 0.006 ). There was a significant increase in inpatient mortality in 2020 (19.3% [ n = 23 ] and 8.4% [ n = 22 ] for 2020 and 2019, respectively, p = 0.003 ). Year was found to be the best predictor of mortality outcome ( p = 0.001 ). The lack of use of SABA pre-admission treatment ( p = 0.002 ), active malignancy ( p = 0.003 ), and increased length of hospital stay ( p = 0.046 ) were also found to be predictors of mortality for AECOPD patients; however, these parameters were unchanged between 2019 and 2020 and therefore could not account for the increase in mortality. Conclusions. There was a decrease in the number of admissions with AECOPD in 2020 during the COVID-19 pandemic, when compared to 2019. The year 2020 proved to be a significant predictor for inpatient mortality, with a significant increase in mortality in 2020. The decrease in nebuliser and controlled oxygen treatment noted in the study period did not prove to be a significant predictor of mortality when corrected for other variables. Therefore, the difference in mortality cannot be explained with certainty in this retrospective cohort study.

Efficacy of Liraglutide: GLP 1 Receptor Agonist on Glycemic Control and Weight Loss among Patients with Type 2 Diabetes

2020 ◽  
Author(s):  
Fatima Jehangir
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Glycemic Control ◽  
Care Center ◽  
Standards Of Care ◽  
P Value ◽  
Diabetic Patients ◽  
Health Care Center ◽  
The Impact

Background: American Diabetes Association (ADA) made conspicuous changes in its 2019 Standards of Care Diabetes guidelines by choosing Glucagon like Polypeptide 1 (GLP1) receptor agonists and Sodium Glucose co-transporter 2 (SGLT2) inhibitors as the second line treatment options after metformin because both classes of drugs are cardiovascular friendly as proved in the Cardiovascular Outcome Trials (CVOT) trials. GLP analogs show massive weight loss benefits apart from offering good glycemic control. We aimed to determine the impact of liraglutide on correction of hyperglycemia and body weight in Asian population. Methods: A cross sectional pre-post observational study enrolling 49 Type 2 diabetic patients with uncontrolled blood glucose, 15 years and above who agreed to use liraglutide apart from standard care, for glycemic control were recruited in the study. Study site was general practice clinic in Clifton and family medicine health care center Ziauddin University. Pre and post treatment HbA1C and BMI were observed after adding on Liraglutide 1.8 mg to metformin 1 gm bid, over a period of 12 weeks. Differences in the changes in BMI and HbA1C were examined using McNemar’s test. Results: Mean age of the participants was 44.4 years. Duration of Diabetes was 65.1 months i.e. 5.4 years. At week 12, liraglutide 1.8 mg significantly reduced HbA1C levels by 0.94% (8.53+1.07 vs. 7.56+1.04 p-value <0.05) and BMI by 6.2kg (37.23+ 5.3 vs. 31.27.6+5.5 p-value <0.05) statistically significant. Conclusion: Liraglutide 1.8 mg over a period of 12 weeks, significantly reduced body weight (6.2kg p-value 0.05) and improved glycemic control (0.94% p-value<0.05) without causing hypoglycemia.

122 In Patients with Lower Extremity Burns and Osteomyelitis, Diabetes Mellitus Increases Amputation Rate

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S81-S82
Author(s):  
Kathleen A Iles ◽  
Lori Chrisco ◽  
Stephen Heisler ◽  
Booker King ◽  
Felicia N Williams ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Lower Extremity ◽  
Burn Injury ◽  
Healing Process ◽  
Common Mechanism ◽  
P Value ◽  
Diabetic Patients ◽  
Significant Difference ◽  
History Of ◽  
The Impact

Abstract Introduction Diabetes mellitus (DM) is a critical comorbidity with burn injury due to the disrupted healing process. Previous reports have confirmed the increased rate of osteomyelitis (OM) and subsequent amputation in this cohort, however this has yet to be studied in comparison to non-diabetic patients. In this retrospective analysis, we investigate OM and amputation in both the diabetic and non-diabetic lower extremity burn populations to determine the impact of DM on these outcomes. Methods The burn registry was used to identify all patients admitted to our tertiary burn center from January 1, 2014 to December 31, 2018. Only patients with lower extremity burns (foot and/or ankle) were included. Patients with burns to additional body areas were excluded. Amputations were categorized by time from injury. Statistical analysis was performed using Student’s t test, chi-squared test, and Fischer’s exact test. Results Of the 315 patients identified, 103 had a known diagnosis of DM and 212 did not. Scald injury was the most common mechanism and average TBSA was similar. Differences were observed in average length of stay (LOS) and admission cost, with diabetics demonstrating both a higher LOS (13.7 days vs 9.2 days, p-value= 0.0016) and cost ($72,883 vs $50,500, p-value= 0.0058) (Table 1). In total, 17 patients were found to have radiologically confirmed OM within three months of the burn injury. Fifteen of these patients had a history of DM and two had no history of DM (p-value= &lt; 0.001) (Table 2). The DM OM patients were found to have a higher blood glucose level on admission (219 mg/dL vs 110 mg/dL, p-value= 0.0452). No significant difference was seen in Hgb A1c in diabetics with or without OM (9.26% vs 8.81%, p= 0.2743). Notably, when non-diabetics were diagnosed with OM, significant differences were observed in both LOS and cost in comparison to their counterparts without OM (36 days vs 9 days; p= 0.0003; $226,289 vs $48,818, p=0.0001). Of the 11 patients who required an amputation, 10 (90.9%) of these patients had comorbid DM. Conclusions DM patients with lower extremity burns are more likely to develop OM than their non-diabetic counterparts. When radiologically confirmed OM is present, DM patients have an increased rate of amputation. OM incurs significant healthcare utilization and cost in both the diabetic and non-diabetic populations.

scholarly journals IMPACT OF PHYSICIAN LED LIFE STYLE MODIFICATIONS (DIET AND DAILY STEP COUNT BY USING PEDOMETER) ON GLYCEMIC CONTROL OF PATIENTS WITH TYPE II DIABETIC

2021 ◽  
Vol 71 (2) ◽  
pp. 478-81
Author(s):  
Rimsha Azhar ◽  
Khurshid Uttra ◽  
Andaleeb Khan ◽  
Marriam Hussain Awan ◽  
Ayesha Anwer ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Life Style ◽  
Step Count ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Type Ii ◽  
Daily Step ◽  
Significant Difference ◽  
Daily Step Count ◽  
The Impact

Objective: To determine the impact of physician led life style modifications (diet and daily step count by using pedometer) on glycemic control of type II diabetic patients Study Design: Quasi experimental study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, Aug 2018 to Feb 2019. Methodology: The sample population comprised of 200 diabetic patients reporting for the routine follow-up at a tertiary care hospital in Rawalpindi. Patients were divided into two groups by random method. Group A had the patients with continuation of the routine anti-diabetic medication while group received the physician led life style modifications in addition to the routine anti diabetic medication. Values of HBA1c among the groups were compared three months after the start of study. Results: Mean age of the patients was 42.19 ± 6.175 years. Mean duration of DM in the study participants was 4.52 ± 4.166 years. Out of 115 patients were male while 85 were female. HBA1c in the intervention group was 7.96% ± 0.39 while in the control group was 7.04% ± 0.81. Difference between the two groups was statistically significant (p-value<0.01). Conclusion: This study showed a significant difference in glycemic control of patients who received physician led life style modification in addition to conventional biological treatment than those who only received the routine anti-diabetic medication. Physicians should be trained to impart this sort of education to the diabetic patients in routine diabetic clinics.

scholarly journals The Prevalence of Metabolic Syndrome, Scoring and Comparison in People with and without COPD: Evidence From Shahrekord PERSIAN Cohort Study

2021 ◽  
Author(s):  
Fatemeh Zeynab Kiani ◽  
Ali Ahmadi
Keyword(s):  
Metabolic Syndrome ◽  
Density Lipoprotein ◽  
Population Based ◽  
Chronic Obstructive ◽  
P Value ◽  
Chi Square ◽  
Common Component ◽  
Respiratory Problems ◽  
Logistic Regression Models ◽  
Significant Difference

Abstract Background Comorbidities are common in patients with Chronic obstructive pulmonary disease (COPD), including metabolic syndrome (MetS). This study aimed to determine the prevalence of MetS and its components in people with and without COPD. Methods This population-based study was performed on 6961 adult years in the Shahrekord Prospective epidemiological research studies in Iran. Data collection, spirometry indexes and COPD diagnosis were performed according to the cohort protocol from 2015 to 2019. The data were analyzed by two-independent sample t-tests, chi-square, and logistic regression models. P-value < 0.05 was considered as statistically significant. All analyses were conducted using stata statistical software: release 16 (stata Corp, College Station, Texas 77845 USA). Result The prevalence of MetS in patients with and without COPD was 28.4% and 31%, respectively. The most common component of MetS in people with COPD was low high-density lipoprotein cholesterol (HDL-c) (47.4%), waist circumference (WC) (43.9%), and High fasting blood sugar (FBS) (39.3%). There was a statistically significant difference in the frequency of respiratory problems between people with and without MetS. The age above 60 years (OR = 2.20, 95% CI: 1.72–2.80), woman gender (OR = 1.36, 95%CI: 1.49–1.97), obesity (OR = 11.17, 95%CI: 9.02–13.62), illiterate education (OR = 1.80, 95%CI: 1.49–2.17), and living in urban (OR = 1.96, 95%CI: 1.64–2.35) are stronger predictors of MetS in this population. Conclusion There was no significant difference in the prevalence of MetS between patients with and without COPD. spirometry parameters and respiratory problems in subjects with and without metabolic syndrome were significance.

scholarly journals The impact of demographic and clinical characteristics on diabetic painful neuropathy

2020 ◽  
Vol 58 (1) ◽  
pp. 13-19
Author(s):  
António Assunção ◽  
Dina Campos ◽  
Rui Marques ◽  
Inês Cunha ◽  
Patrícia Santos ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Disease Progression ◽  
Clinical Characteristics ◽  
Categorical Variables ◽  
P Value ◽  
Diabetic Patients ◽  
Painful Neuropathy ◽  
Convenience Sample ◽  
Significant Difference ◽  
The Impact

AbstractIntroduction. Diabetic neuropathy (DN) is one of the most devastating complications of diabetes mellitus; however, in contrast to other countries, there are no scientific studies in Portugal evaluating the impact of demographic and clinical characteristics of this pathological entity. The aim of this study was to evaluate the impact of gender, metabolic control, age of diabetic patients, as well as time of disease progression, the appearance of complaints related to neuropathic pain.Material and methods. A multicentre study with a non-probabilistic, convenience sample of 359 patients was performed employing the quantitative method, using the Statistical Package for Social Science 24 software. The p-value of p < 0.05 was defined to consider a result statistically significant. The Spearman correlation coefficient (r) was determined to determine the relationship between categorical variables.Results. There was no statistically significant difference in the prevalence of DN between genders (p = 0.633 and r = 0.025). There was a statistically significant relationship between the value of HbA1c and DN, with p = 0.010 and r = 0.136. There is a relationship between age and complaints of neuropathic pain, with p = 0.034 and r = 0.112. The variable, time of disease progression, is also correlated with the appearance of complaints of neuropathic pain with p = 0.020 and r = 0.112.Conclusion. The prevalence of neuropathic pain in subjects with diabetes is not negligible and is associated with modifiable risk factors that can be identified, possibly modified and prevented. The correct approach for these patients, which involves screening and early treatment, is decisive improving functionality and quality of life.

Impact of antibiotic choice on readmission in adults experiencing an acute COPD exacerbation

2020 ◽  
Author(s):  
Jason W Lancaster ◽  
Laura McAuliffe ◽  
Elizabeth O’Gara ◽  
Cyrille Cornelio ◽  
Jennifer Hum ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Antibiotic Therapy ◽  
Hospital Stay ◽  
Academic Medical Center ◽  
Hospital Length Of Stay ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Readmission Rates ◽  
Copd Exacerbations ◽  
The Impact

Abstract Purpose The impact of antibiotic therapy in managing acute chronic obstructive pulmonary disease (COPD) exacerbations requiring hospitalization remains unclear. We conducted a study to assess the impact of antibiotic therapy on the rate of 30-day readmission after discharge from a hospital stay for an acute COPD exacerbation. Additional study outcomes analyzed included the effects of antibiotic therapy on hospital length of stay, in-hospital mortality, 90-day and 12-month readmission rates, and time to next COPD exacerbation. Methods The study was an institutional review board–approved, retrospective, observational review of adult patients at a tertiary academic medical center. The medical records of patients 18 years of age or older who were hospitalized for an acute COPD exacerbation between January 2008 and December 2014 were evaluated. Included patients were stratified by receipt of guideline-appropriate, guideline-inappropriate, or no antibiotic therapy. Nonparametric data were analyzed using the Kruskal-Wallis test (nonparametric) and categorical data via χ 2 test, respectively. Results Three hundred twenty-five subjects were included; there were no significant differences in baseline characteristics in the 3 study groups. Sixty-eight percent of patients (n = 223) received antibiotics. The percentage of patients readmitted within 30 days did not differ between cohorts: 11.9% (appropriate therapy) vs 13.2% (nonappropriate therapy) vs 12.2% (no antibiotics) (P = 0.95 for all comparisons). Additionally, no detectable differences in 90-day or 12-month readmission rate, length of hospital day, or in-hospital mortality were found. However, a trend toward increased time to next COPD exacerbation was noted in those receiving antibiotics vs no antibiotics (352 days vs 192 days, P = 0.07). Conclusion Treatment of COPD exacerbations with antibiotics did not impact readmission rates, length of hospital stay, in-hospital mortality, or time to next exacerbation. More investigation is warranted to assess the effect of antibiotics on time to next exacerbation, as well as comparative effectiveness between antibiotic classes.

Abstract P093: Influence of Comorbidities on Outcomes in Atrial Fibrillation: A Population-based Case-control Study

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Alanna Chamberlain ◽  
Alvaro Alonso ◽  
Bernard Gersh ◽  
Sheila Manemann ◽  
Jill Killian ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Conditions ◽  
Cox Regression ◽  
Smoking Status ◽  
Population Based ◽  
Chronic Obstructive ◽  
P Value ◽  
Specific Patient ◽  
The Impact ◽  
Population Controls

Background: Differences in the impact of comorbid conditions on outcomes in atrial fibrillation (AF) patients compared to population controls have not been well documented. Methods: The prevalence of 19 chronic conditions and smoking status was obtained in 1430 patients with incident AF from 2000-2010 and 1430 controls matched 1:1 on sex and age (within 5 years) from Olmsted County, MN. Andersen-Gill models determined associations of each condition with all-cause hospitalizations in AF cases and controls after adjusting for all other conditions and accounting for the matching. Cox regression determined associations of each condition with death. Results: Among 1430 matched pairs (median age 76 years, 48.6% men), the prevalence of chronic conditions was higher in AF cases compared to controls for all conditions except asthma, dementia, depression, hepatitis, and osteoporosis. Over a mean follow-up of 6.3 years, 2678 hospitalizations and 812 deaths occurred. The rates of hospitalization were 59 and 26 per 100 person-years and the rates of death were 10 and 5 per 100 person-years in AF cases and controls, respectively. After adjusting for all other conditions, the risk of hospitalization was lower in AF patients compared to controls for those with coronary artery disease, arthritis, cancer, chronic obstructive pulmonary disease, and osteoporosis (figure). In contrast, the risk of hospitalization was higher in AF cases for those with diabetes and substance abuse. For deaths, the only comorbidity with different associations between AF cases and controls was depression. The hazard ratios (95% CI) for death were 2.02 (1.26-3.24) in AF cases and 0.90 (0.58-1.38) in controls (p-value for interaction=0.008). Conclusions: AF patients have a higher prevalence of chronic conditions compared to population controls. The associations of comorbidities with hospitalizations differed between AF cases and controls, suggesting that management of comorbidities in patients with AF may need to be tailored to this specific patient population.

scholarly journals Glycemic control in type 2 diabetic patients during the COVID-19 virus pandemic

2021 ◽  
Vol 9 (1) ◽  
pp. 094-103
Author(s):  
Kanyakamon Kunkitikad ◽  
Veerasak Sarinnapakorn ◽  
Chaicharn Deerochanawong ◽  
Sathit Niramitmahapanya ◽  
Navaporn Napartivaumnuay ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Lifestyle Changes ◽  
Disease Spread ◽  
P Value ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Outdoor Activities ◽  
Social Distancing ◽  
The Impact

Background: The Coronavirus disease 2019 (COVID-19) disease is a pandemic disease spread worldwide and results in lifestyle changes in areas affected by COVID-19. The ongoing social distancing and lockdowns may negatively impact access to medical care and management of type 2 diabetes mellitus (T2DM). Accordingly, we examined the impact of the COVID-19 virus pandemic in Thailand on the glycemic control of patients with T2DM. Method: This study focused on T2DM outpatients at Rajavithi Hospital. Three hundred and fifty participants were included. Baseline characteristics, data on exercise, outdoor activities, and access to foods and blood chemistries, including hemoglobin A1C (A1C) and fasting plasma glucose (FPG), were reviewed, and collected from electronic medical records before and after the COVID-19 pandemic. Results: There was a significant increase in mean A1C (g/L) ± SD (74.8 ± 13.7 vs. 76.0 ± 15.3, p-value <0.016), the mean duration of outdoor activities (hours/day) ± SD during the COVID-19 virus pandemic was significantly decreased. (5.35 ± 4.48 vs. 4.03 ± 4.37, p-value <0.001) Conclusion: The present study showed that mean A1C was significantly increased during the COVID-19 virus pandemic. Nevertheless, a statistical difference was not observed in FPG. The impact of quarantine, social distancing, and community containment during the epidemic on lifestyles may be the essential factor in increasing A1C.

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