scholarly journals Hyperglycemia at hospital admission is associated with severity of the prognosis in patients hospitalized for COVID-19

2020 ◽  
Author(s):  
Alberto Coppelli ◽  
Rosa Giannarelli ◽  
Michele Aragona ◽  
Giuseppe Penno ◽  
Marco Falcone ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Research Design ◽  
Independent Predictor ◽  
Independent Factor ◽  
Glycemic Status ◽  
Glucose Levels ◽  
Inflammatory Profile ◽  
Design And Methods ◽  
D Dimer

OBJECTIVE <p>To explore whether at-admission hyperglycemia is associated with worse outcomes in patients hospitalized for Covid-19.</p> <p>RESEARCH DESIGN AND METHODS</p> <p>Hospitalized Covid-19 subjects (N=271) were subdivided based on at-admission glycemic status: 1. glucose levels <7.78 mmol/L (NG; N=149; 55.0%; median glucose 5.99 [5.38-6.72] mmol/L), 2. known diabetes (DM; N=56; 20.7%; 9.18 [7.67-12.71] mmol/L), and 3. no diabetes and glucose levels ≥7.78 mmol/L (HG; N=66, 24.3%; 8.57 [8.18-10.47] mmol/L).</p> <p>RESULTS</p> <p>Neutrophils were higher and lymphocytes and PaO<sub>2</sub>/FiO<sub>2</sub> lower in HG than DM and NG. DM and HG had higher D-Dimer and worse inflammatory profile. Mortality was greater in HG (39.4% vs 16.8%; unadjusted HR 2.20, 95%CI 1.27-3.81, p=0.005) than in NG (16.8%), and marginally so in DM (28.6%; HR 1.73, 0.92-3.25, p=0.086). Upon multiple adjustments, only HG remained an independent predictor (1.80, 1.03-3.15, p=0.04). After stratification by quintile of glucose levels, mortality was higher in Q4 (HR 3.57, 1.46-8.76, p=0.005) and marginally in Q5 (29.6%; HR 2.32, 95% CI 0.91-5.96, p=0.079) vs Q1.</p> <p>CONCLUSIONS</p> <p>Hyperglycemia is an independent factor associated with severe prognosis in people hospitalized for COVID-19.<b><br> </b></p>

scholarly journals Hyperglycemia at hospital admission is associated with severity of the prognosis in patients hospitalized for COVID-19

2020 ◽  
Author(s):  
Alberto Coppelli ◽  
Rosa Giannarelli ◽  
Michele Aragona ◽  
Giuseppe Penno ◽  
Marco Falcone ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Research Design ◽  
Independent Predictor ◽  
Independent Factor ◽  
Glycemic Status ◽  
Glucose Levels ◽  
Inflammatory Profile ◽  
Design And Methods ◽  
D Dimer

OBJECTIVE <p>To explore whether at-admission hyperglycemia is associated with worse outcomes in patients hospitalized for Covid-19.</p> <p>RESEARCH DESIGN AND METHODS</p> <p>Hospitalized Covid-19 subjects (N=271) were subdivided based on at-admission glycemic status: 1. glucose levels <7.78 mmol/L (NG; N=149; 55.0%; median glucose 5.99 [5.38-6.72] mmol/L), 2. known diabetes (DM; N=56; 20.7%; 9.18 [7.67-12.71] mmol/L), and 3. no diabetes and glucose levels ≥7.78 mmol/L (HG; N=66, 24.3%; 8.57 [8.18-10.47] mmol/L).</p> <p>RESULTS</p> <p>Neutrophils were higher and lymphocytes and PaO<sub>2</sub>/FiO<sub>2</sub> lower in HG than DM and NG. DM and HG had higher D-Dimer and worse inflammatory profile. Mortality was greater in HG (39.4% vs 16.8%; unadjusted HR 2.20, 95%CI 1.27-3.81, p=0.005) than in NG (16.8%), and marginally so in DM (28.6%; HR 1.73, 0.92-3.25, p=0.086). Upon multiple adjustments, only HG remained an independent predictor (1.80, 1.03-3.15, p=0.04). After stratification by quintile of glucose levels, mortality was higher in Q4 (HR 3.57, 1.46-8.76, p=0.005) and marginally in Q5 (29.6%; HR 2.32, 95% CI 0.91-5.96, p=0.079) vs Q1.</p> <p>CONCLUSIONS</p> <p>Hyperglycemia is an independent factor associated with severe prognosis in people hospitalized for COVID-19.<b><br> </b></p>

scholarly journals Risk of Incident Dementia According to Glycemic Status and Comorbidities of Hyperglycemia: A Nationwide Population-Based Cohort Study

2021 ◽  
Author(s):  
Woo Jung Kim ◽  
Seo Jung Lee ◽  
Eun Lee ◽  
Eun Young Lee ◽  
Kyungdo Han
Keyword(s):  
Fasting Glucose ◽  
Population Based ◽  
Glycemic Status ◽  
Glucose Levels ◽  
Onset Diabetes ◽  
Hazard Ratios ◽  
Incident Dementia ◽  
Dementia Prevention ◽  
Design And Methods ◽  
New Onset

Objective: To investigate the risk of incident dementia according to fasting glucose levels and presence of comorbidities. <p>Research Design and Methods:<b> </b>Using a health insurance claims database and the results of biennial health examinations in South Korea, we selected 8,400,950 subjects aged ≥40 years who underwent health examinations in 2009–2010. We followed them until 2016. Subjects’ baseline characteristics were categorized by presence of diabetes (yes/no) and glycemic status (normoglycemia/impaired fasting glucose (IFG)/new-onset diabetes/known diabetes (duration <5 years or ≥5 years). We estimated adjusted hazard ratios (aHRs) for dementia occurrence in each category. </p> <p>Results: During the observation period of 48,323,729 person-years, all-cause dementia developed in 353,392 (4.2%) subjects. Compared with normoglycemia, aHRs (95% confidence interval) were 1.01 (1.01–1.02) in IFG, 1.45 (1.44–1.47) in new-onset diabetes, 1.32 (1.30–1.33) in known diabetes <5 years, and 1.62 (1.60–1.64) in known diabetes ≥5 years. We found that associations between ischemic heart disease and chronic kidney disease with incident dementia were affected by the presence of diabetes. Ischemic stroke showed a greater association with incident dementia than diabetes. </p> Conclusions:<b> </b>Mild degrees of hyperglycemia and presence of comorbidities were associated with incident dementia. Intervention during the prodromal stage of a chronic disease (e.g., prediabetes) could be considered for dementia prevention.

scholarly journals Intraperitoneal insulin administration in pigs: effect on circulating insulin and glucose levels

2021 ◽  
Vol 9 (1) ◽  
pp. e001929
Author(s):  
Ilze Dirnena-Fusini ◽  
Marte Kierulf Åm ◽  
Anders Lyngvi Fougner ◽  
Sven Magnus Carlsen ◽  
Sverre Christian Christiansen
Keyword(s):  
Systemic Circulation ◽  
Subcutaneous Insulin ◽  
Insulin Levels ◽  
Glucose Levels ◽  
Endogenous Insulin ◽  
Blood Glucose Levels ◽  
Intraperitoneal Insulin ◽  
A Minor ◽  
Design And Methods ◽  
Mean Blood Glucose

IntroductionThe effect of intraperitoneal insulin infusion has limited evidence in the literature. Therefore, the aim of the study was to investigate the pharmacokinetics and pharmacodynamics of different intraperitoneal insulin boluses. There is a lack of studies comparing the insulin appearance in the systemic circulation after intraperitoneal compared with subcutaneous insulin delivery. Thus, we also aimed for a comparison with the subcutaneous route.Research design and methodsEight anesthetized, non-diabetic pigs were given three different intraperitoneal insulin boluses (2, 5 and 10 U). The order of boluses for the last six pigs was randomized. Endogenous insulin and glucagon release were suppressed by repeated somatostatin analog injections. The first pig was used to identify the infusion rate of glucose to maintain stable glucose values throughout the experiment. The estimated difference between insulin boluses was compared using two-way analysis of variance (GraphPad Prism V.8).In addition, a trial of three pigs which received subcutaneous insulin boluses was included for comparison with intraperitoneal insulin boluses.ResultsDecreased mean blood glucose levels were observed after 5 and 10 U intraperitoneal insulin boluses compared with the 2 U boluses. No changes in circulating insulin levels were observed after the 2 and 5 U intraperitoneal boluses, while increased circulating insulin levels were observed after the 10 U intraperitoneal boluses. Subcutaneously injected insulin resulted in higher values of circulating insulin compared with the corresponding intraperitoneal boluses.ConclusionsSmaller intraperitoneal boluses of insulin have an effect on circulating glucose levels without increasing insulin levels in the systemic circulation. By increasing the insulin bolus, a major increase in circulating insulin was observed, with a minor additive effect on circulating glucose levels. This is compatible with a close to 100% first-pass effect in the liver after smaller intraperitoneal boluses. Subcutaneous insulin boluses markedly increased circulating insulin levels.

scholarly journals Usefulness of the PRECISE DAPT score as a predictor of ischaemic stroke after an acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Gonzalez Ferrero ◽  
B.A.A Alvarez Alvarez ◽  
C.C.A Cacho Antonio ◽  
M.P.D Perez Dominguez ◽  
P.A.M Antunez Muinos ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Ischaemic Stroke ◽  
Independent Predictor ◽  
Multivariable Logistic Regression Analysis ◽  
Funding Source ◽  
Independent Factor ◽  
Prediction Ability ◽  
Coronary Syndrome ◽  
Grace Score

Abstract Introduction Ischaemic stroke (IS) risk after acute coronary syndrome is increasing. The aim of our study was to evaluate the stroke rate in a multicentre study and to determine the prediction ability of the PRECISE DAPT score, added to the prediction power of the GRACE score, already demonstrated. Methods This was a retrospective study, carried out in two centres with 5916 patients, with ACS discharged between 2011 and 2017 (median 66±13 years, 27.7% women). The primary endpoint was the occurrence of ischaemic stroke and its risk during follow up (median 5.5, IQR 2.6–7.0). Results A multivariable logistic regression analysis was made, where GRACE (HR 1.01, IC 95% 1.00–1.02) and PRECISE DAPT score (HR 1.03, IC 95% 1.01–1.05) were both an independent predictor of ischaemic stroke after ACS, in a model adjusted by age and AF, which was found to be the independent factor with highest risk (HR 1.67, IC 95% 1.09–2.55). Conclusions GRACE and PRECISE DAPT scores are ischaemic stroke predictors used during follow-up for patients after acute coronary syndrome. We should use both of them not only trying to predict ischaemic/haemorrhagic risk respectively but also as ischaemic stroke predictors. Figure 1. AUC Curves Funding Acknowledgement Type of funding source: None

scholarly journals Seventy two-hour glucose monitoring profiles in mild gestational diabetes mellitus: differences from healthy pregnancies and influence of diet counseling

2016 ◽  
Vol 175 (3) ◽  
pp. 201-209 ◽  
Author(s):  
Marina Pimenta Carreiro ◽  
Márcio W Lauria ◽  
Gabriel Nino T Naves ◽  
Paulo Augusto C Miranda ◽  
Ricardo Barsaglini Leite ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Glucose Monitoring ◽  
Glucose Variability ◽  
Healthy Controls ◽  
Dietary Counseling ◽  
Glucose Levels ◽  
Glucose Profiles ◽  
Diet Counseling ◽  
Glucose Exposure ◽  
Design And Methods

Objective To study glucose profiles of gestational diabetes (GDM) patients with 72 h of continuous glucose monitoring (CGM) either before (GDM1) or after (GDM2) dietary counseling, comparing them with nondiabetic (NDM) controls. Design and methods We performed CGM on 22 GDM patients; 11 before and 11 after dietary counseling and compared them to 11 healthy controls. Several physiological and clinical characteristics of the glucose profiles were compared across the groups, including comparisons for pooled 24-h measures and hourly median values, summary measures representing glucose exposure (area under the median curves) and variability (amplitude, standard deviation, interquartile range), and time points related to meals. Results Most women (81.8%) in the GDM groups had fasting glucose <95mg/dL, suggesting mild GDM. Variability, glucose levels 1 and 2h after breakfast and dinner, peak values after dinner and glucose levels between breakfast and lunch, were all significantly higher in GDM1 than NDM (P<0.05 for all comparisons). The GDM2 results were similar to NDM in all aforementioned comparisons (P>0.05). Both GDM groups spent more time with glucose levels above 140mg/dL when compared with the NDM group. No differences among the groups were found for: pooled measurements and hourly comparisons, exposure, nocturnal, fasting, between lunch and dinner and before meals, as well as after lunch (P>0.05 for all). Conclusion The main differences between the mild GDM1 group and healthy controls were related to glucose variability and excursions above 140mg/dL, while glucose exposure was similar. Glucose levels after breakfast and dinner also discerned the GDM1 group. Dietary counseling was able to keep glucose levels to those of healthy patients.

scholarly journals STROKE OUTCOMES IN NON-DIABETIC, DENOVO DIABETIC AND DIABETIC INDIAN PATIENTS MEASURED BY MODIFIED RANKIN SCALE: AN OBSERVATIONAL STUDY

2017 ◽  
Vol 9 (8) ◽  
pp. 94
Author(s):  
Syed Junaid Ahmed ◽  
Abdur Rahman Mohd Masood ◽  
Safiya Sumana ◽  
Khadeer Ahmed Ghori ◽  
Javed Akhtar Ansari ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Observational Study ◽  
Hospital Admission ◽  
Acute Stroke ◽  
Mean Difference ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
The Mean

Objective: Hyperglycemia is a known risk factor which adversely impacts the outcomes in stroke patients compared to patients with normal blood glucose levels. Patients suffering from an acute stroke who are previously nonhyperglycemic may show elevated blood glucose levels. The present study was designed to measure the outcomes in denovo diabetic and diabetic stroke patients compared to nondiabetics.Methods: A prospective observational study over a period of 6 mo, in which 103 patients were divided into three cohorts based on their blood glucose levels (nondiabetic, denovo diabetic and diabetics). The modified Rankin scale (mRS) score was calculated at in-hospital admission and discharge in these three cohorts. The initial and final scores were correlated and mean differences with respect to outcomes between all the three cohorts was calculated.Results: The mean mRS at the time of hospital admission in diabetics and nondiabetics was 3.6±0.81 and 3.3±0.78 which decreased to 2.8±0.95 and 2.9±0.83 respectively at the time of discharge. The mean mRS score in denovo diabetic stroke patients during in-hospital admission was 4±0.81 which was calculated as 3.7±0.85 at the time of discharge. The mean difference in mRS score in diabetics vs non-diabetics was found to be 0.73±0.8 (p =<0.001). The mean difference in mRS score of denovo diabetics vs non-diabetics and denovo diabetics vs diabetics was 0.30±0.63 and 0.38±0.61 respectively (p = 0.1).Conclusion: Results of these observational study in Indian patients, highlights the need for controlling hyperglycemia in stroke patients to improve outcomes and to prevent mortality arising out of acute stroke attacks.

scholarly journals Glycated Hemoglobin Levels in Patients with Decompensated Cirrhosis

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Jeffrey Nadelson ◽  
Sanjaya K. Satapathy ◽  
Satheesh Nair
Keyword(s):  
Glycemic Control ◽  
American Diabetes Association ◽  
Independent Predictor ◽  
Decompensated Cirrhosis ◽  
University Of Tennessee ◽  
Glucose Levels ◽  
Reliable Predictor ◽  
Group A ◽  
Group B ◽  
Hba1c Levels

Introduction. Aim of this study is to determine if HbA1c levels are a reliable predictor of glycemic control in patients with decompensated cirrhosis.Methods. 200 unique patients referred for liver transplantation at University of Tennessee/Methodist University Transplant Institute with a HbA1c result were included. Three glucose levels prior to the “measured” A1c (MA1c) were input into an HbA1c calculator from the American Diabetes Association website to determine the “calculated” A1c (CA1c). The differences between MA1c and CA1c levels were computed. Patients were divided into three groups: group A, difference of <0.5; group B, 0.51–1.5; and group C, >1.5.Results. 97 (49%) patients had hemoglobin A1c of less than 5%. Discordance between calculated and measured HbA1c of >0.5% was seen in 47% (n=94). Higher level of discordance of greater than >1.5 was in 12% of patients (n=24). Hemoglobin was an independent predictor for higher discordance (odds ratio 0.77 95%, CI 0.60–0.99, andpvalue 0.04). HbA1c was an independent predictor of occurrence of HCC (OR 2.69 955, CI 1.38–5.43, andpvalue 0.008).Conclusion. HbA1c is not a reliable predictor of glycemic control in patients with decompensated cirrhosis, especially in those with severe anemia.

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