Acute hyperglycaemia after COVID-19 vaccination in patients with stable diabetes: A Case Series (Preprint)

2021 ◽  
Author(s):  
Rahila Bhatti ◽  
Sara Adhami ◽  
Amar Khamis ◽  
Glenn Matfin
Keyword(s):  
Blood Glucose ◽  
Glycaemic Control ◽  
Ambulatory Care ◽  
Care Setting ◽  
Fasting Blood Glucose ◽  
Case Series ◽  
Ambulatory Care Setting ◽  
Post Vaccination ◽  
Patients With Diabetes ◽  
History Of

BACKGROUND The COVID-19 pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To date 267,258 cases have been reported in the United Arab Emirates (UAE) with 766 deaths. In United States of America, the Centers for Disease Control and Prevention (CDC) has categorized diabetes in terms of ‘increased risk of severe illness’, if infected with COVID-19. With availability of COVID-19 vaccinations worldwide, patients with diabetes are usually in the highest priority group to be vaccinated.5 Currently 2 vaccines are available in the UAE. These are the Pfizer-BioNTech and Sinopharm vaccines. The Pfizer-BioNTech ribonucleic acid (RNA) vaccine is composed of nucleoside-modified messenger RNA (modRNA) encoding a mutated form of the spike protein of SARS-CoV-2, which is encapsulated in lipid nanoparticles. It is administered by two injections at least 21 days apart. In contrast, Sinopharm is a chemically inactivated whole virus vaccine. It is also given by two injections administered at least 21-28 days apart. OBJECTIVE To describe 2 cases of patients with diabetes with stable glycaemic control who developed hyperglycaemia post COVID-19 vaccination METHODS Case presentation of 2 patients with diabetes who were seen in ambulatory setting in terms of their blood sugars in a private hospital in Dubai. RESULTS Case 1: A 51-year-old Asian male with a history of type 2 diabetes was reviewed in the ambulatory care setting following COVID-19 vaccination. His recent glycaemic control was good with glycosylated haemoglobin (HbA1c) 3 months prior being 7.5%. His usual glucose lowering therapy was xultophy injection (fixed-ratio combination of insulin degludec and liraglutide) 14 units at night, in addition to oral metformin 1000 mg twice daily. He had a history of ischaemic heart disease which was stable on therapy. He took his first dose of Pfizer-BioNTech vaccine on 30th December 2020. His fasting blood glucose values before vaccination was 105 mg/dl and after taking 1st dose of vaccination was 185 mg/dl. Case 2: A 30-year-old female known to have type 1 diabetes was reviewed in the ambulatory care setting following COVID-19 vaccination. She is on continuous subcutaneous insulin infusion (CSII). Her HbA1c within last 3 months was 8.3%. She received Sinopharm vaccination on 18th January 2021. Her continuous glucose monitoring (CGM) data shows fasting blood glucose of 121 mg/dl day before vaccination. On the day of vaccination her fasting blood glucose was 233 mg/dl as her overnight blood sugars were high. Her fasting blood glucose increased to 216 mg/dl and stayed high throughout the day 1 post vaccination. On day 2 post vaccination it came down to 181 mg/dl and on day 3 it settled down to 127 mg/dl. CONCLUSIONS The purpose of this case series is to alert healthcare professionals regarding potential transient hyperglycaemia post-COVID-19 vaccination. The vaccination should be recommended for people with diabetes as benefits far outweighs the risk. However, patients should be educated in advance to keep a close eye on their blood glucose levels post vaccination and regarding sick-day rules. As ADA 2021 recommendations were developed before COVID-19 vaccines were widely available, no detailed information regarding COVID-19 vaccination is captured. 7

Outcomes of Clinical Treatments Among Patients with Diabetes Mellitus in Selangor, Malaysia: A Retrospective Study

2021 ◽  
Vol 17 ◽  
Author(s):  
Zamalia Mahmud ◽  
Syahidatul Alyia Abrahhim ◽  
Saperi Sulong
Keyword(s):  
Diabetes Mellitus ◽  
Retrospective Study ◽  
Blood Glucose ◽  
Family History ◽  
Medical Center ◽  
Fasting Blood Glucose ◽  
Family History Of Diabetes ◽  
Patients With Diabetes ◽  
History Of

Background: It is important to assess how well patients respond towards their medical treatments by observing the results appear during the clinical treatments. As such, it is important that the clinical treatments and results obtain information on how effective recommended treatments were for patients with diabetes. Objective: This study examines how patients with Diabetes Mellitus responded towards their clinical treatments, where the probability distribution of patients and the types of treatment received were derived from the Rasch probabilistic model. Methods: This is a retrospective study wherein data were collected from patients’ medical records at a local public hospital in Selangor, Malaysia. Clinical and demographic information such as fasting blood glucose, hemoglobin A1c (HbA1c), family history, type of diabetes (Type 1 or Type 2), types of medication (oral or insulin), compliance with treatments, gender, race and age were chosen as the agents of measurement. Results: The use of Rasch analysis in the present study helped to compare the patients’ responses towards the DM treatments and identify the types of treatment they received. Results from the Wright map show that a majority of the Diabetes Mellitus patients who were diagnosed with Type 2 diabetes have no controlled readings of HbA1c during their first and second visits to the medical center. However, patients with a family history of Diabetes Mellitus who took oral medication have controlled readings of fasting blood glucose based on the probabilistic outcomes of the treatment received by the patients. Conclusion: Controlled readings were found only in the readings of fasting blood glucose during the first and second visits, followed by family history, types of medication received and compliance with the treatment. This study has recommended that Type 2 patients with diabetes without a family history of Diabetes Mellitus need to exercise more control over the readings of HbA1c.

Elevated Circulating Levels of Motilin are Associated with Diabetes in Individuals after Acute Pancreatitis

2019 ◽  
Vol 128 (01) ◽  
pp. 43-51 ◽  
Author(s):  
Fuchsia D. Gold-Smith ◽  
Ruma G. Singh ◽  
Maxim S. Petrov
Keyword(s):  
Acute Pancreatitis ◽  
Blood Glucose ◽  
Glycaemic Control ◽  
Confidence Interval ◽  
Gastrointestinal Motility ◽  
Fasting Blood Glucose ◽  
Glycated Haemoglobin ◽  
Symptom Index ◽  
Plasma Motilin ◽  
Cardinal Symptom

Abstract Aim The study aimed to investigate the associations between glycaemic control after acute pancreatitis and gastrointestinal motility, using plasma motilin concentration and gastroparesis cardinal symptom index score as proxies. Methods This cross-sectional study recruited a total of 93 individuals after acute pancreatitis. Gastroparesis cardinal index scores, demographic and anthropometric factors, as well as pancreatitis-related factors were analysed. Fasting venous blood was collected to measure motilin, glycated haemoglobin, and fasting blood glucose. Linear regression analyses were conducted to investigate the associations between glycaemic control and gastrointestinal motility in unadjusted and adjusted models. Results Motilin was significantly higher in individuals with diabetes across all adjusted models, with the highest ß-coefficient (95% confidence interval) of 588.89 (138.50, 1039.28); P=0.010. Fasting blood glucose was significantly associated with motilin across all models, with the highest ß-coefficient (95% confidence interval) of 156.30 (55.49, 257.10); P=0.002. Glycated haemoglobin was significantly associated with motilin in one adjusted model with ß-coefficient (95% confidence interval) of 18.78 (1.53, 36.02); P=0.033. Gastroparesis cardinal symptom index was not significantly associated with any measure of glycaemic control. Conclusions Diabetes in individuals after acute pancreatitis appears to be characterised by elevated plasma motilin but not gastroparesis cardinal symptom index. The role of motilin in this setting warrants further investigations.

Glucose responses to acute and chronic exercise during pregnancy: a systematic review and meta-analysis

2018 ◽  
Vol 52 (21) ◽  
pp. 1357-1366 ◽  
Author(s):  
Margie H Davenport ◽  
Frances Sobierajski ◽  
Michelle F Mottola ◽  
Rachel J Skow ◽  
Victoria L Meah ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Glucose ◽  
Glycaemic Control ◽  
Acute Exercise ◽  
Exercise Intervention ◽  
Meta Analysis ◽  
Fasting Blood Glucose ◽  
Chronic Exercise ◽  
Prenatal Exercise ◽  
Frequency Intensity

ObjectiveTo perform a systematic review and meta-analysis to explore the relationship between prenatal exercise and glycaemic control.DesignSystematic review with random-effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were included (except case studies and reviews) if they were published in English, Spanish or French, and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of acute or chronic exercise, alone (‘exercise-only’) or in combination with other intervention components (eg, dietary; ‘exercise+cointervention’) at any stage of pregnancy), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcome (glycaemic control).ResultsA total of 58 studies (n=8699) were included. There was ‘very low’ quality evidence showing that an acute bout of exercise was associated with a decrease in maternal blood glucose from before to during exercise (6 studies, n=123; mean difference (MD) −0.94 mmol/L, 95% CI −1.18 to −0.70, I2=41%) and following exercise (n=333; MD −0.57 mmol/L, 95% CI −0.72 to −0.41, I2=72%). Subgroup analysis showed that there were larger decreases in blood glucose following acute exercise in women with diabetes (n=26; MD −1.42, 95% CI −1.69 to −1.16, I2=8%) compared with those without diabetes (n=285; MD −0.46, 95% CI −0.60 to −0.32, I2=62%). Finally, chronic exercise-only interventions reduced fasting blood glucose compared with no exercise postintervention in women with diabetes (2 studies, n=70; MD −2.76, 95% CI −3.18 to −2.34, I2=52%; ‘low’ quality of evidence), but not in those without diabetes (9 studies, n=2174; MD −0.05, 95% CI −0.16 to 0.05, I2=79%).ConclusionAcute and chronic prenatal exercise reduced maternal circulating blood glucose concentrations, with a larger effect in women with diabetes.

PDA-Based Documentation of Medication Interventions in an Ambulatory Care Setting

2007 ◽  
Vol 23 (1) ◽  
pp. 9-15 ◽  
Author(s):  
Kathy E Fit ◽  
Jill S Burkiewicz ◽  
Brooke L Sweeney
Keyword(s):  
Ambulatory Care ◽  
Care Setting ◽  
Ambulatory Care Setting
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