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.

Expression of Circulating MicroRNAs and Myokines and Interactions with Serum Osteopontin in Type 2 Diabetic Patients with Moderate and Poor Glycemic Control: A Biochemical and Molecular Study

Background. Cellular miRNAs are expressed in tissue fluids with sufficient amounts and were identified as potential molecular targets for studying the physiological mechanisms and correlations with many human diseases particularly diabetes. However, molecular-based changes among older adults with diabetes mellitus (DM) are rarely fully elucidated. Aim. This study is aimed at identifying circulating miRNAs, which hold the potential to serve as biomarkers for the immune-inflammatory changes in older T2D patients with moderate and poor glycemic control status. In addition, the association of both myokines and osteopontin (OPN) levels with circulating miRNAs was identified. Methods. A total of 80 subjects aged 20–80 years were invited during the period of October 2017–May 2018 to participate in this descriptive cross-sectional study. All subjects were diagnosed with T2D for more than 5 years. Subjects were grouped based on glycemic control (HbA1c values) into two groups: moderate glycemic control (>7-8% HbA1c, no = 30 ) and poor glycemic control (>8% HbA1c, no = 50 ), respectively. Diabetic control parameters, fasting blood sugar (FS), HbA1c, fasting insulin (IF), insulin resistance (IR), HOMA-IR, inflammatory cytokines (IL-6, IL-8, IL-18, IL-23, TNF-α, and CRP), osteopontin, and myokines (adropin and irisin) were estimated by colorimetric and immune ELISA assays, respectively. In addition, real-time RT-PCR analysis was performed to evaluate the expression of circulating miRNAs, miR-146a and miR-144, in the serum of all diabetic subjects. Results. In this study, T2D patients with poor glycemic control showed a significant increase in the serum levels of IL-6, IL-8, IL-18, IL-23, TNF-α, CRP, and OPN and a reduction in the levels of myokines, adropin and irisin, compared to patients with moderate glycemic control. The results obtained are significantly correlated with the severity of diabetes measured by HbA1c, FS, IF, and HOMA-IR. In addition, baseline expression of miR-146a is significantly reduced and miR-144 is significantly increased in T2D patients with poor glycemic control compared to those with moderate glycemic control. In all diabetic groups, the expression of miR-146a and miR-144 is significantly correlated with diabetic controls, inflammatory cytokines, myokines, and serum levels of OPN. Respective of gender, women with T2D showed more significant change in the expressed miRNAs, inflammatory cytokines, OPN, and serum myokine markers compared to men. ROC analysis identified AUC cutoff values of miR-146a, miR-144, adropin, irisin, and OPN expression levels with considerable specificity and sensitivity which recommends the potential use of adropin, irisin, and OPN as diagnostic biomarkers for diabetes with varying glycemic control status. Conclusion. In this study, molecular expression of certain microRNA species, such as miR-146a and miR-144, was identified and significantly associated with parameters of disease severity, HbA1c, inflammatory cytokines, myokines, and serum osteopontin in T2D patients with moderate and poor glycemic control. The AUC cutoff values of circulating miRNAs, miR-146a and miR-144; myokines, adropin and irisin; and serum OPN were significantly identified by ROC analysis which additionally recommends the potential use of these biomarkers, miR-146a, miR-144, adropin, irisin, and OPN, as diagnostic biomarkers with considerable specificity and sensitivity for diabetes in patients with varying glycemic control status.

Glycemic Control and Aspirin Resistance in Patients Taking Low-Dose Aspirin for Pre-eclampsia Prevention

Objectives To assess the association between aspirin and glycemic control in diabetic, pregnant patients, and the risk for aspirin resistance in those with poor glycemic control across gestation taking low-dose aspirin (LDA) for pre-eclampsia (PEC) prevention. Study Design We performed a secondary analysis of samples collected during the Maternal-Fetal Medicine Units trial of LDA for PEC prevention. A subset of insulin-controlled diabetic patient samples on placebo or 60 mg aspirin daily were evaluated. Glycosylated hemoglobin was measured at randomization, mid-second trimester, and third trimester time points. Thromboxane B2 (TXB2) measurements were previously assessed as part of the original study. Primary outcome was the effect of LDA on glycosylated hemoglobin levels compared with placebo across gestation. Results Levels of glycosylated hemoglobin increased across gestation in the placebo group (2,067.7 [interquartile range, IQR: 1,624.6–2,713.5 µg/mL] vs. 2,461.9 [1,767.0–3,209.9 µg/mL] vs. 3,244.3 [2,691.5–4,187.0 µg/mL]; p < 0.01) compared with no difference in levels of glycosylated hemoglobin across gestation in the LDA group (2,186.4 [IQR: 1,462.3–3,097.7 µg/mL] vs. 2,337.1 [1,327.7–5,932.6 µg/mL] vs. 2,532.9 [1,804.9–5,511.8 µg/mL]; p = 0.78). Higher levels of glycosylated hemoglobin were associated with increased TXB2 levels prior to randomization (r = 0.67, p < 0.05). Incomplete TXB2 was higher in pregnancies with increasing levels of glycosylated hemoglobin compared with those with decreasing levels of glycosylated hemoglobin across gestation (69.2 vs. 18.1%, p = 0.02). Conclusion LDA exposure may be beneficial to glycemic control in this patient population. Additionally, poor glycemic control is associated with a higher level of TXB2 in diabetic pregnant patients on LDA. Higher doses of aspirin may be required in these patients to prevent development of PEC. Key Points

Frequency of Recently Poor Glycemic Control as Assessed by Hba1c in Diabetics Presented with Acute Coronary Syndrome

Aim: To find the frequency of recently poor glycemic control as assessed by HbA1c in diabetic patients with acute coronary syndrome Study design & Setting: Observational study. Methods: The study included 60 diabetic patients presented with acute coronary syndrome. Diagnosis of acute coronary syndrome was based on patient’s symptoms, ECG changes and cardiac enzyme results. HBA1c level report was collected for all patients from their hospital record. SPSS 21 version was used to analyze the collected data. The qualitative data was presented in the form of graphs while the quantitative data was presented by simple descriptive statistics in the form of mean, range and standard deviation. Results: Out of sixty patients enrolled in this study 2(45%) were females and 33(55%) were males. 28(46.67%) patients presented with ST-elevation MI (STEMI) whereas 25(41.66%) patients presented with non ST-elevation MI. 7(11.66%) had unstable angina. Out of sixty patients 21(35%) patients were having poor glycemic control (HBA1C >7%) whereas 39(65%) patients had fair glycemic control (HBA1C< 7%). Fifty eight (96%) patients were using oral anti diabetic tablets whereas 2(3.33%) patients were using insulin before hospital admission. Conclusion: This study shows that amongst patients admitted with acute coronary syndrome a significant proportion of patients (35%) had poor glycemic control over past three months as assessed by HBA1C implying that recent poor glycemic control is a significant risk factor for acute coronary events in diabetic patients. Keywords: Acute coronary syndrome, Glycemic control, Diabetes mellitus.

Bursting the bubble: hereditary spherocytosis masking poor glycemic control

Hemoglobin A1c (HbA1c) is a very common measure utilized to diagnose diabetes and to monitor the level of glycemic control during the course of management. Despite the high utility of HbA1c, it has some limitations. Physiological conditions that affect the lifespan of red blood cells (RBCs) can falsely elevate or lower HbA1c results. In this case report, we present a case of a patient who was found to have hereditary spherocytosis (HS) after developing nephrotic range proteinuria. The patient had diabetes that was previously thought to be well controlled, but his HS was masking his poor glycemic control. This case highlights the importance of understanding the limitations of the HbA1c in managing patients with diabetes.

Hypomagnesemia and Poor Glycemic Control Among Palestinian Type 2 Diabetic Patients: A Cross-Sectional Study

Background: Hypomagnesemia has been shown to have a significant impact on both glycemic control and diabetes complications in type 2 Diabetes Mellitus (T2DM) patients. This study aims to assess the prevalence of hypomagnesemia in T2DM patients and find the association between serum magnesium levels and outcomes relevant to glycemic control and diabetic complications.Methods: A cross-sectional study was conducted and included 373 patients (222 males and 151 females). Serum magnesium levels were measured by the Colorimetric Endpoint Method using the Cobas C501system. Hypomagnesemia was determined to be a serum magnesium level <1.6 mg/dL. In addition, the following data were also obtained; patients' characteristics, anthropometric measurements, smoking status, HbA1c, co-morbidities, and therapeutic management. Results: Patients' mean age was 56.2 ±10.8 years, 24.6% were smokers, and most were overweight or obese. About 60% have a history of hypertension, and the majority have had diabetes for more than ten years. Their mean HbA1c level was 8.5±2. The prevalence of hypomagnesemia was 11% (95% CI: 8%-14.6%). It was found to be significantly higher among females (adjusted OR: 2.7, 95%CI: 1.2%-5.8%), patients with HbA1c ≥ 8% (adjusted OR: 2.4, 95%CI: 1.1%-5.5%), and patients with a history of diabetic retinopathy (adjusted OR: 2.7, 95%CI: 1.1%-7.1%). Conclusions: the study showed that hypomagnesemia is more prevalent in females and is associated with diabetic retinopathy and poor glycemic control. Having a sufficient magnesium level may be associated with better glycemic control and a reduced occurrence of complications.

Utility of Triglyceride-Glucose index in predicting glycemic control in type 2 diabetes mellitus

Introduction: Insulin resistance (IR) and glycemic control are two very important aspects to be considered during management of patients with Type 2 Diabetes Mellitus (T2DM). The triglyceride-glucose (TyG) index has been proposed as a simple and inexpensive parameter that correlates well with IR and glycemic control. Objectives: To explore the association of TyG index (and other TyG derived indices) with glycated hemoglobin (HbA1c) and evaluate their predictive ability for glycemic control in patients with T2DM. Methodology: This cross-sectional study comprised of 160 adult patients diagnosed with T2DM visiting the medical outpatient department of Chitwan Medical College, Bharatpur, Chitwan between July–December 2019. Socio-demographic data and anthropometric measurements were collected. Glycemic control was assessed by HbA1c. TyG index was calculated by the formula: ln [fasting TG (mg/dl) x fasting glucose (mg/dl)/2]. Receiver operating characteristic (ROC) curve analysis was performed to analyze the predictive ability of TyG-index for poor glycemic control. Results: One hundred and sixty patients (mean age: 53.6 ± 10.7 years, 55.0% males) were included in the study. Eighty (50.0%) had good glycemic control (HbA1c <7.0%). TyG index, along with TyG-BMI and TyG-WC (other TyG derived indices) were significantly increased in the poor glycemic control group. TyG index had a good predictive ability for poor glycemic control (AUC: 0.803, 95% CI: 0.731 – 0.874). A TyG cutoff ≥ 9.12 was optimal for predicting poor glycemic control, with 86.1% sensitivity and 61.5% specificity. Conclusion: TyG index could be a simple and cost-effective screening tool for assessment of glycemic control in patients with T2DM.