Prevalence of previously diagnosed diabetes and glycemic control strategies in Mexican adults: ENSANUT-2016

ObjectiveTo analyze association between different perioperative glycemic control strategies and postoperative outcomes in patients with diabetes undergoing cardiac surgery.MethodsMEDLINE, Cochrane Library, Web of Science, EMBASE, Wanfang Data, China National Knowledge Infrastructure (CNKI) and China Biology Medicine (CBM) databases were searched from inception to January 31, 2019. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias of included studies, and consensus was reached by discussion with a third researcher.ResultsSix RCTs were included in the meta-analysis. We analyzed the effect of liberal (>180 mg/dl or 10.0 mmol/L), moderate (140–180 mg/dl or 7.8–10.0 mmol/L) and strict (<140 mg/dl or 7.8 mmol/L) glycemic control strategies in patients with diabetes undergoing cardiac surgery. The pooled results showed that strict glycemic control strategy was associated with a significant reduction in the risk of atrial fibrillation [OR = 0.48, 95%CI (0.32, 0.72), P < 0.001] and sternal wound infection [OR = 0.28, 95%CI (0.14, 0.54), P < 0.001], while there was no significant differences in postoperative mortality, stroke, and hypoglycemic episodes when compared with moderate control. In addition, there is no significant difference between moderate and liberal glycemic control strategies in postoperative mortality. However, moderate control was beneficial in reducing atrial fibrillation [OR = 0.28, 95%CI (0.13, 0.60), P = 0.001] compared with the liberal glycemic control strategy.ConclusionsThis meta-analysis showed when compared with moderate glycemic control strategy in patients with diabetes undergoing cardiac surgery, maintained strict glycemic control was associated with lower risk of atrial fibrillation and sternal wound infection. No benefit was found with liberal glycemic control strategy, so it could be a poor glycemic control strategy.

Download Full-text

Lack of Association between Past Helicobacter pylori Infection and Diabetes: A Two-Cohort Study

Nutrients ◽

10.3390/nu11081874 ◽

2019 ◽

Vol 11 (8) ◽

pp. 1874

Author(s):

Jeung Hui Pyo ◽

Hyuk Lee ◽

Sung Chul Choi ◽

Soo Jin Cho ◽

Yoon-Ho Choi ◽

...

Keyword(s):

Helicobacter Pylori ◽

Diabetic Nephropathy ◽

Glycemic Control ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Poor Glycemic Control ◽

Hazard Ratios ◽

Cox Proportional Hazard Models ◽

H Pylori ◽

Diagnosed Diabetes

Helicobacter pylori (H. pylori) may be involved in diabetes and other insulin-related processes. This study aimed to investigate the associations between H. pylori infection and the risks of type 2 diabetes, impaired glucose tolerance (IGT), diabetic nephropathy, and poor glycemic control. We retrospectively evaluated 16,091 subjects without diabetes at baseline who underwent repeated health examinations. Subjects were categorized according to whether they were seropositive and seronegative for H. pylori infection. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazard models. The serological results were validated using an independent cohort (n = 42,351) based on a histological diagnosis of H. pylori infection. During 108,614 person-years of follow-up, 1338 subjects (8.3%) developed newly diagnosed diabetes, although the cumulative incidence of diabetes was not significantly related to serological H. pylori status. The multivariate Cox proportional-hazards regression models revealed that H. pylori seropositivity was not significantly associated with diabetes (HR: 1.01, 95% CI: 0.88–1.16; p = 0.854), IGT (HR: 0.98, 95% CI: 0.93–1.04; p = 0.566), diabetic nephropathy (HR: 0.99, 95% CI: 0.82–1.21; p = 0.952), or poor glycemic control (HR: 1.05, 95% CI: 0.90–1.22; p = 0.535). Similarly, histopathological findings of H. pylori infection were not significantly associated with diabetes (p = 0.311), diabetic nephropathy (p = 0.888), or poor glycemic control (p = 0.989). The findings from these large Korean cohorts indicate that there does not appear to be a role for past H. pylori infection in the development of diabetes, IGT, diabetic nephropathy, or poor glycemic control.

Download Full-text

The Impact of Glyco-Metabolic Status in Patients Treated for Acute Coronary Syndrome

PRILOZI ◽

10.2478/prilozi-2018-0022 ◽

2018 ◽

Vol 39 (1) ◽

pp. 37-50

Author(s):

Marija Vavlukis ◽

Biljana Zafirovska ◽

Emilija Antova ◽

Bekim Pocesta ◽

Enes Shehu ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Glycemic Control ◽

Morbidity And Mortality ◽

Newly Diagnosed ◽

Stress Hyperglycemia ◽

Coronary Syndrome ◽

Hospital Morbidity ◽

Diagnosed Diabetes ◽

Newly Diagnosed Diabetes ◽

The Impact

Abstract Objective: The aim of the study was to assess the prevalence of newly diagnosed diabetes in patients with acute coronary syndrome and estimate the relationship between stress hyperglycemia, glyco-regulation and newly diagnosed diabetes with hospital morbidity and mortality. Methods: This was an observational study which included all patients hospitalized due to acute coronary syndrome (January 2015 until April 2017) at the University Clinic of Cardiology in Skopje, Macedonia. We analyzed demographic, clinical, biochemical variables and hospital morbidity and mortality. Five investigated groups were compared using a single biochemical parameter glycated hemoglobin (HgbA1c) depending on the presence of known diabetes before the acute event: 0-without DM (HgbA1c <5.6%), 1-newly diagnosed pre-diabetes (HgbA1c 5.6-6.5%), 2-newly diagnosed diabetes (HgbA1c ≥ 6.5%), 3-known well controlled diabetes (HgbA1c <7%) and 4-known un-controlled diabetes (HgbA1c ≥7%). Results: 860 patients were analyzed. Impaired glucose metabolism was confirmed in 35% of patients, 9% of which were with newly diagnosed diabetes. Stress hyperglycemia was reported in 27.3% (3.6% were without diabetes). The highest values of stress hyperglycemia were reported in newly diagnosed and known un-controlled diabetes. In-hospital morbidity and mortality were 15% and 5% accordingly and the rate was highest in patients with newly diagnosed and known, but un-controlled diabetes. HgbA1c, stress hyperglycemia, and poor glycemic control have emerged as significant independent predictors of hospital morbidity and mortality in patients with acute coronary syndrome. Conclusion: High prevalence of newly diagnosed diabetes was observed in patients with acute coronary syndrome. Stress hyperglycemia and failure to achieve glycemic control are independent predictors of hospital morbidity and mortality.

Download Full-text

BIABHIG PATIENTS;

The Professional Medical Journal ◽

10.29309/tpmj/2007.14.01.3621 ◽

2007 ◽

Vol 14 (01) ◽

pp. 37-42

Author(s):

MUHAMMAD AHMAD GHAZI, ◽

YASIR AKRAM ◽

MUHAMMAD ARSHAD CHEEMA

Keyword(s):

Diabetes Mellitus ◽

Glycemic Control ◽

Diabetic Foot ◽

Surgical Complications ◽

Surgical Debridement ◽

Good Glycemic Control ◽

Surgical Ward ◽

Diagnosed Diabetes ◽

Study Setting ◽

Patient Department

Objective: Diabetics develop complications as a result ofinfection, microangiopathic and neuropathic changes. All these complication can be anticipated andprevented with good glycemic control and maintaining good podiatric care. This study was conducted todetermine the presentation and out come of diabetics in general surgical ward. Design: Observational crosssectional study Setting: Emergency and out patient department of South Surgical Ward, Mayo HospitalLahore. Period: Six months (1st June to 30th November 2004), Material and methods: 51 patients withdiabetes mellitus presenting, it included all the patients with diagnosed diabetes mellitus presenting withsurgical complications relating to their diabetes. All other patients who were normoglycemic or knowndiabetics without any surgical complications were excluded. Patients presenting with ulcerations on foot andlegs were classified on the basis of Wegners classification. Results: Out of 51 patients, 43.1%( 22) had adiagnosis of diabetic foot, 33.3%( 17) had an abscess and 23.5%( 12) had an abscess. According to theWagener's classification*. Class 2 was most common at presentation 34.8% and 23.5% of the patientspresenting with diabetic foot had to undergo an amputation thus suffering from a permanent disability.Conclusion: Good surgical debridement and proper use of antibiotics is required as well as good glycemiccontrol for early and safe recovery.

Download Full-text

Glycemic Control Strategies for Prevention of Microvascular and Atherosclerotic Cardiovascular Disease Complications in Type 2 Diabetes

Diabetes and Cardiovascular Disease: Evaluation, Prevention, and Management ◽

10.5005/jp/books/12293_7 ◽

2015 ◽

pp. 96-96

Author(s):

Paul Rosenblit ◽

Elliott Groves

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Glycemic Control ◽

Control Strategies ◽

Atherosclerotic Cardiovascular Disease

Download Full-text

Enroller Experience and Parental Familiarity of Disease Influence Participation in a Pediatric Trial

Western Journal of Emergency Medicine ◽

10.5811/westjem.2021.4.54647 ◽

2021 ◽

Vol 22 (5) ◽

pp. 1176-1182

Author(s):

Jeff Schunk ◽

Kammy Jacobsen ◽

Dilon Stephens ◽

Amy Watson ◽

Cody Olsen ◽

...

Keyword(s):

Glycemic Control ◽

Disease Process ◽

Pediatric Emergency ◽

Research Network ◽

Insurance Status ◽

Parental Permission ◽

Pediatric Trial ◽

Pediatric Emergency Care ◽

Diagnosed Diabetes ◽

New Onset

Introduction: Acquiring parental consent is critical to pediatric clinical research, especially in interventional trials. In this study we investigated demographic, clinical, and environmental factors associated with likelihood of parental permission for enrollment in a study of therapies for diabetic ketoacidosis (DKA) in children. Methods: We analyzed data from patients and parents who were approached for enrollment in the Pediatric Emergency Care Applied Research Network (PECARN) Fluid Therapies Under Investigation in DKA (FLUID) trial at one major participating center. We determined the influence of various factors on patient enrollment, including gender, age, distance from home to hospital, insurance status, known vs new onset of diabetes, glycemic control (hemoglobin A1c), DKA severity, gender of the enroller, experience of the enroller, and time of enrollment. Patients whose parents consented to participate were compared to those who declined participation using bivariable and multivariable analyses controlling for the enroller. Results: A total of 250 patient/parent dyads were approached; 177 (71%) agreed to participate, and 73 (29%) declined. Parents of patients with previous episodes of DKA agreed to enroll more frequently than those with a first DKA episode (94.3% for patients with 1-2 previous DKA episodes, 92.3% for > 2 previous episodes, vs 64.9% for new onset diabetes and 63.2% previously diagnosed but no previous DKA). Participation was also more likely with more experienced enrollers (odds ratio [95% confidence interval] of participation for an enroller with more than two years’ experience vs less than two years: 2.46 [1.53, 3.97]). After adjusting for demographic and clinical factors, significant associations between participation and both DKA history and enroller experience remained. Patient age, gender, distance of home from hospital, glycemic control, insurance status, and measures of DKA severity were not associated with likelihood of participation. Conclusion: Familiarity with the disease process (previously diagnosed diabetes and previous experience with DKA) and experience of the enroller favorably influenced the likelihood of parental permission for enrollment in a study of DKA in children.

Download Full-text

Association of Early-Phase In-Hospital Glycemic Fluctuation With Mortality in Adult Patients With Coronavirus Disease 2019

10.2337/figshare.13517381.v1 ◽

2021 ◽

Author(s):

Liangkai Chen ◽

Wenwu Sun ◽

Yanli Liu ◽

Lijuan Zhang ◽

Yanling Lv ◽

...

Keyword(s):

Glycemic Control ◽

Early Phase ◽

Fasting Glucose ◽

Control Strategies ◽

Case Series ◽

Severe Pneumonia ◽

Adverse Outcomes ◽

Glucose Levels ◽

Increased Risk ◽

Prolonged Hospital

<a>OBJECTIVE—</a><a></a><a> </a><a></a><a>To investigate the association of in-hospital early-phase glycemic control with adverse outcomes among inpatients with coronavirus disease 2019 (COVID-19) in Wuhan, China.</a> RESEARCH DESIGN AND METHODS—<a></a><a> The study is a large case series and data were obtained regarding consecutive patients hospitalized with COVID-19 in the Central Hospital of Wuhan between January 2 and February 15, 2020. All patients with definite outcomes (death or discharge) were included. Demographic, clinical, treatment, and laboratory information were extracted from electronic medical records. We collected daily fasting glucose data from standard morning fasting blood biochemistry to determine glycemic status and fluctuation (calculated as the square root of the variance of daily fasting glucose levels) during the first week of hospitalization.</a> RESULTS— A total of 548 patients were included in the study (median age 57 years; =298 [54%] women; n=99 diabetes [18%]), 215 suffered acute respiratory distress syndrome (ARDS), 489 survived, and 59 died. <a></a><a></a><a></a><a>Patients who had higher mean levels of glucose during their first week of hospitalization were older and more likely to have a comorbidity</a> and abnormal laboratory markers, prolonged hospital stays, increased expenses, and greater risks of severe pneumonia, ARDS, and death. <a></a><a>Compared with patients with the lowest quartile of glycemic fluctuation</a>, those had the highest quartile of fluctuation magnitude had an increased risk of ARDS (risk ratio 1.97 [95% CI: 1.01, 4.04]) and mortality (hazard ratio 2.73 [95% CI: 1.06, 7.73]). CONCLUSIONS—<a></a><a></a><a></a><a> </a>These results may have implications for optimizing glycemic control strategies in COVID-19 patients during the early phase of hospitalization.

Download Full-text