Analysis of Reasons For Readmission of Diabetic Patients: 2015-2019

Background: Among patients with diabetes who had been hospitalized, 30% had twice or more hospitalisations rate, accounting for more than 50% of total hospitalizations and hospitalization expense. The purpose of our study was to to find available strategies to reduce the readmission rate of diabetics in rural areas.Methods: This retrospective single-center study used the data from Yongchuan Hospital of Chongqing Medical University. The t-test and the chi-square test or Fisher's exact test were used to compare continuous and categorical variables, respectively. We used the Spearman correlation coefficient to examine the relationship between variables. Multiple linear regression was performed to analyze the influencing factors of hospitalisation time, and dummy variables were set for categorical independent variables. Results: There were a total of 1721 readmissions during a five-year period; among them, 829 were females and 892 males. The readmission rate of diabetic patients in the endocrinology department was 32.40%. The age, times of hospitalisation, and duration of all subjects were 64.67 ± 13.82, 2.69 ± 1.41 and 10.60 ± 6.78, respectively. Among all the diabetic patients, type 2 diabetes accounted for 98.55% (n = 1696). Most of the patients were readmitted due to poor glycemic control, infection, edema, dizziness, and weakness, accounting for approximately 56%. During the 5-year period, the majority of readmitted diabetic patients were hospitalized twice. Times of hospitalisation was weakly positively correlated with age (Rho = 0.206, P≤0.001), diabetic duration (Rho = 0.248, P ≤ 0.001) and hospitalisation expenses (Rho = 0.008, P = 0.035) by Spearman correlation analysis. Age, duration of diabetes, systolic blood pressure (SBP), diastolic blood pressure (DBP) and alanine aminotransferase (ALT) were the main factors affecting times of hospitalisation in diabetes patients (all P < 0.05). Compared with current smokers, non-smokers and cessation smokers had high hospitalisations rate (all P for trend < 0.05). When taking diabetic foot infection as a reference, edema was more accountable than diabetic foot infection for hospitalisation times, which was statistically significant (P for trend = 0.048).Conclusion: Age, duration of diabetes and hospitalisation costs were positively correlated with times of hospitalisation. Age, duration of diabetes, blood pressure, ALT, smoking status and edema are the influencing factors of hospitalisation times. The most common causes of hospitalisation for diabetics are poor glycemic control, infection, edema, dizziness, and weakness. Controlling these factors may be key to developing rational health strategies for rural diabetics.

Association of sensorineural hearing loss in type 2 diabetes mellitus patients: an analytical cross sectional study

<p class="Normal1"><strong>Background: </strong>The association of sensorineural hearing loss in diabetes mellitus patients is known since decades, yet there is no clear consensus among previous studies, with respect to the prevalence of SNHL in type 2 diabetes patients and the effect of duration and control of diabetes on hearing acuity. Hence the objectives of this study are to find the prevalence of SNHL in type 2 diabetes patients and to find the effect of duration and control of diabetes on hearing loss.</p><p class="Normal1"><strong>Methods: </strong>The present study was conducted on 100 type 2 diabetes patients and age and gender matched 100 non- diabetic controls in the age group of &lt;50 years, selected based on inclusion and exclusion criteria. After detailed history taking and clinical examination, all subjects underwent FBS, PPBS estimation and HbA1c evaluation was done for diabetic patients. All underwent pure tone audiometry, DPOAE and BERA and the findings were recorded and analyzed.</p><p class="Normal1"><strong>Results: </strong>Diabetes patients had insidious onset, gradually progressive, bilaterally symmetrical SNHL. SNHL is prevalent in 73% of type 2 diabetes patients compared to 16% of controls. It is aggravated with the increasing age and duration of diabetes. Poor control of diabetes showed increased prevalence of SNHL compared to good control of diabetes.</p><p class="Normal1"><strong>Conclusions: </strong>There is increased prevalence of SNHL in type 2 diabetes patients and it is more evident in patients with long duration of diabetes and more pronounced in patients with poor diabetic control.</p>

Prevalence and risk factors of sarcopenia in patients with diabetes: A meta-analysis

Context The prevalence of sarcopenia in patients with diabetes is three times higher than that in non-diabetic patients and is associated with a poor prognosis. Objective To investigate the global pooled prevalence and risk factors of sarcopenia in patients with diabetes. Data Sources Relevant studies published until November 30, 2020, were identified from the PubMed, Embase, Web of Science, WanFang, CNKI, VIP, and CBM databases. Study Selection Participants with age ≥18 years with clinically diagnosed diabetes. Sex and diabetes type were not restricted. Data Extraction The data were extracted by two reviewers independently using a standard data collection form. Data Synthesis The pooled prevalence of sarcopenia in patients with diabetes was 18% (95% CI,16-20); subgroup analysis showed that sarcopenia was more prevalent in males than in females, as well as being more prevalent in Asia than in South America and Oceania. Age (OR, 1.10), HbA1c (OR, 1.16), visceral fat area (VFA) (OR, 1.03), diabetic nephropathy (OR, 2.54), duration of diabetes (OR, 1.06), and HS-CRP (OR, 1.33) were risk factors for sarcopenia in patients with diabetes. Conclusions Sarcopenia was more prevalent in patients with diabetes. Age, HbA1c, visceral fat area (VFA), diabetic nephropathy, duration of diabetes, and HS-CRP were the probable risk factors. In the future, medical staff should not only pay attention to the early screening of sarcopenia in high-risk groups but also provide information on its prevention.

The Effect of Online Support of an Internet Plus Shared Care Diabetes Management Model on Metabolic Indicators for Patients With Type 2 Diabetes During the COVID-19 Pandemic

Purpose: This study aimed to explore the influences of online support of an Internet plus Shared Care diabetes management model on metabolic indicators and the differences before and after the coronavirus disease 2019 (COVID-19) pandemic. Method: Type 2 diabetes patients who visited the Peking University First Hospital Internet plus Shared Care clinic from May 18, 2020 to June 20, 2020 (after the COVID-19 pandemic subsided) were enrolled in the study. The age, gender, usage of insulin, and duration of diabetes of the patients were collected. The glycosylated hemoglobin (HbA1c), interval between two consecutive visits, communication frequencies with online diabetes educators through an app, online self-monitoring of blood glucose (SMBG) and upload count and SMBG pairing count (before–after meal) were collected before (prior to January 20, 2020) and after (from May 18, 2020 to June 20, 2020) the COVID-19 pandemic for logistic regression analysis. The R-3.4.4 and TWANG programs were used for analysis. The group of patients whose HbA1c did not change during the pandemic was the control group, while the group of patients with improved HbA1c was the dependent variable. Independent variables included age, gender, duration of disease, insulin usage, online communication amount, SMBG count, and SMBG pairing count. Propensity score matching (PSM) was applied with age, duration, gender, body mass index (BMI), HbA1c, low density lipoprotein- cholesterol (LDL-C), and blood pressure (BP) at baseline as the concomitant variable. After the PSM weighting, the average treatment effect (ATE) of post-pandemic BMI, HbA1c, LDL-C, and BP was compared with the baseline. Results: A total of 387 patients were enrolled in the study including 184 female (47.5%). The baseline values were the following: age, 61.7±9.4 year;, duration of diabetes, 11.7±8.2 years; BMI, 25.9±3.8Kg/m2; HbA1c, 7.2±1.3%; LDL-C, 2.49±0.85mmol/L; systolic BP, 130.8±14.9 mmHg; and diastolic BP, 81.1±40.9 mmHg. Among variables, online communication amounted to a statistically significant contribution to the HbA1c improvement after the COVID-19 pandemic (OR=2.178, p=0.003). During the pandemic, each patient received 18 (3, 56) times online communication support per quarter. Patients were divided into four groups by quartiles: Q1 (more than 56 times/quarter, n=95), Q2 (18–56 times/quarter, n=97), Q3 (3–18 times/quarter, n=93), and Q4 (0–3 times/quarter, n=102). After PSM, post-pandemic data showed significant differences. Between-group variance was found in HbA1c (Q1 vs. Q3, -0.42±0.16%, p=0.009; Q1 vs. Q4, -0.53±0.15%, p=0.0009) and BMI (Q1 vs. Q3, -1.2±0.5, p=0.02; Q1 vs. Q4 -1.5±0.7, p=0.01) of patients.Conclusion: During the COVID-19 pandemic, high-quality online support of the Internet plus Shared Care diabetes management model can significantly improve the HbA1c and BMI of type 2 diabetes patients.

A comparative study on echocardiographic evaluation of left ventricular mass and function in normotensive diabetic and non-diabetic patient

Background: Cardiovascular complications account for the highest mortality in diabetic patients, mainly due to coronary artery disease and congestive heart failure. Left ventricular hypertrophy (LVH) is an ominous prognostic sign and an independent risk factor for cardiac events which is frequently present in patients living with diabetes. Aims and Objectives: The aim of the study was to evaluate the LV mass and function in normotensive diabetes patients without antihypertensive medication. Materials and Methods: 100 normotensive diabetic patients were in study group and 100 control patients were studied. Hypertension and other known causes of LVH were excluded from the study. Data were analyzed using proper statistical method. Results: Left ventricular mass index (LVMI) is significantly higher in diabetic patients as compared to control population (P<0.001). It was also observed that the means of the left ventricular posterior wall thickness, interventricular septal thickness, and the left ventricular internal diameter during diastole (in all cases P<0.001) were statistically significantly high in diabetic patients in comparison to healthy control subjects. We have found that a significant systolic dysfunction in diabetic group and diastolic dysfunction also very common in diabetic group than the control group. The LVMI also increased in patients who have longer duration of diabetes and poor glycemic control. Conclusion: LVM is significantly higher in patients of type 2 diabetic without having hypertension, albuminuria, and apparent ischemic heart disease as compared to healthy controls. LVM in diabetic patients increases with duration of diabetes and is positively correlated with HbA1c and blood sugar level.

Determining Risk Factors That Affect Progression in Patients with Nonproliferative Diabetic Retinopathy

Purpose. To determine risk factors that affect nonproliferative diabetic retinopathy (NPDR) progression and establish a predictive model to estimate the probability of and time to progression in NPDR. Patients and Methods. Charts of diabetic patients who received an initial eye exam between 2010 and 2017 at our county hospital were included. Patients with proliferative diabetic retinopathy (PDR), fewer than 2 years of follow-up, or fewer than 3 clinic visits were excluded. Demographics and baseline systemic and ocular characteristics were recorded. Follow-up mean annual HbA1c and blood pressure, best-corrected visual acuity, and the number of antivascular endothelial growth factor treatments were recorded. Stage and date of progression were recorded. A 5-state nonhomogeneous continuous-time Markov chain with a backward elimination model was used to identify risk factors and estimate their effects on progression. Results. Two hundred thirty patients were included. Initially, 65 eyes (28.3%) had no retinopathy; 73 (31.7%) mild NPDR; 60 (26.1%) moderate NPDR; and 32 (13.9%) severe NPDR. Patients were followed for a mean of 5.8 years (±2.0 years; range 2.1–9.4 years). 164 (71.3%) eyes progressed during the follow-up. Time-independent risk factors affecting progression rate were age (hazard ratio (HR) = 0.99, P = 0.047 ), duration of diabetes (HR = 1.02, P = 0.018 ), and Hispanic ethnicity (HR = 1.31, P = 0.068 ). Mean sojourn times at mean age, duration of diabetes, and annual HbA1c for a non-Hispanic patient were estimated to be 3.03 (±0.97), 4.63 (±1.21), 6.18 (±1.45), and 4.85 (±1.25) years for no retinopathy, mild NPDR, moderate NPDR, and severe NPDR, respectively. Each 1% increase in HbA1c annually diminished sojourn times by 15%, 10%, 7%, and 10% for no retinopathy, mild NPDR, moderate NPDR, and severe NPDR, respectively. Conclusion. HbA1c level is a significant modifiable risk factor in controlling the progression of DR. The proposed model could be used to predict the time and rate of progression based on an individual’s risk factors. A prospective multicenter study should be conducted to further validate our model.

Clinical and psychopathological features of patients with type II diabetes mellitus

Today, type II diabetes mellitus (T2DM) is considered to be the most important nosological cause of decreased cognitive functions. A number of studies have found that hyperglycemia and duration of diabetes are associated with cognitive deficits, with the prevalence of cognitive impairment in type 2 diabetes mellitus being 20% in men and 18% in women over 60 years of age. To achieve this goal, it was conducted a comprehensive clinical-psychopathological and psychodiagnostic examination of 82 patients with moderate type 2 diabetes mellitus (46 women and 36 men) aged 35.9±10.1 years in accordance with the principles of bioethics and deontology. The mean duration of diabetes was 7.9±5.2 years. The severity of diabetes in most cases was defined as moderate (84.1%), and in 15.9% of cases corresponded to severe. 30.2% of patients used insulin as a basic hypoglycemic therapy, 69.8% - tablets. According to the analysis of the emotional state of patients with T2DM were characterized by complaints of low, depressed mood (69.5% of examined patients), uncontrolled emotional reactions (46.2%), feelings of anxiety, constant internal tension (44.7%), paresthesias (29.1%), sleep-wake cycle disorders (56.2%), general weakness, lethargy and fatigue (58.2%), fatigue (90.0%), frequent mood swings, with a predominance of decreased mood background (23.3%), emotional lability with excessive vulnerability and sensitivity (16.6%), irritability (16.6%). The clinical and psychopathological structure of emotional disorders is represented by anxious (43.4%), depressive (26.6%), astheno-hypochondriac (19.8%), hysteroform (10.2%) syndromes. Clinical examination of patients with DM showed that more often (in 95.0% of cases) in patients with T2DM there is a decrease in memory of auditory and visual modality, impaired intellectual abilities, slow thinking, lack of attention and information processing.

Evaluation of Diabetes Control Status in Children Aged 3 to 18 Years with Type 1 Diabetes: Retrospective Study

Introduction: Diabetes mellitus is one of the most common metabolic diseases that is associated with many complications. Type 1 diabetes is an autoimmune disease caused by a lack of insulin production due to high blood glucose levels. It is the third most severe and chronic childhood illness, affecting approximately 15 million children worldwide. Given the importance of controlling type 1 diabetes, especially in children, in this study we aimed to examine the status of diabetes control in children 3 to 18 with type 1 diabetes. Methods: This study was a retrospective analytical cross-sectional study. The study population included 121 children aged 3-18 years with type 1 diabetes referred to Yazd Diabetes Center in 2018 to 2019. The information, including age, sex, BMI, patient maturity stage, duration of diabetes, mean A1C, daily insulin dose, number of blood glucose measurements per day and number of DKA attacks were extracted. The collected data were entered into SPSS version 16, using statistical tests were analyzed. Results: The results showed that the mean age of participants was 12.92± 3.96 years and the mean of A1c in patients was 8.63 ± 1.94. The results of our study on diabetes control status in the studied patients showed that 38.8% of patients had partial diabetes control status, 32.2% had good diabetes control status and 28.9% had poor diabetes control status. In addition, according to the results of the study, there was no statistically significant difference was found among the frequency distribution of diabetes control status in terms of variables of puberty stage (p = 0.228), BMI (p = 0.508), age (p = 0.275), daily dose of bisal / bolus insulin (p = 0.479), dose Daily NPH / regular insulin (p = 0.386), number of blood glucose checks (p = 0.090), number of hospitalizations due to DKA (p = 0.539), duration of diabetes (p = 0.093) and gender (p = 0.263). . Conclusion: According to the results of the study, it can be concluded that none of the studied variables affect the control status of diabetes in children aged 3-18 years with type 1 diabetes.

EVALUATION OF CARDIAC SYSTOLIC FUNCTION IN ASYMPTOMATIC DIABETES PATIENTS AND ITS CORRELATION WITH DURATION OF DIABETES

Echocardiography is a universally availabe and economical test for detecting early LV systolic dysfunction in normotensive and asymptomatic type 2 diabetic patients. This is a cross sectional study of such patients evaluating cardiac systolic function using 2D-Echocardiography. Ejection fraction and Fractional shortening are the two most sensitive indicators of it. Only 18% of patients had decreased LVEf and 6% showed reduced fractional shortening . Although longer duration of diabetes was positively correlated with reduction in systolic functioning of heart. Early identification of subclinical signs of heart failure by these noninvasive and less expensive methods may improve outcomes in type 2 diabetes patients.