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He R, Zhang K, Li H, Gu M. Development and validation of inpatient mortality prediction models for patients with hyperglycemic crisis using machine learning approaches. BMC Endocr Disord 2025; 25:86. [PMID: 40140995 PMCID: PMC11948940 DOI: 10.1186/s12902-025-01873-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/07/2025] [Indexed: 03/28/2025] Open
Abstract
BACKGROUND Hyperglycemic crisis is one of the most common and severe complications of diabetes mellitus, associated with a high motarlity rate. Emergency admissions due to hyperglycemic crisis remain prevalent and challenging. This study aimed to develop and validate predictive models for in-hospital mortality risk among patients with hyperglycemic crisis admitted to the emergency department using various machine learning (ML) methods. METHODS A multi-center retrospective study was conducted across six large general adult hospitals in Chongqing, western China. Patients diagnosed with hyperglycemic crisis were identified using an electronic medical record (EMR) database. Demographics, comorbidities, clinical characteristics, laboratory results, complications, and therapeutic interventions were extracted from the medical records to construct the prognostic prediction model. Seven machine learning algorithms, including support vector machines (SVM), random forest (RF), recursive partitioning and regression trees (RPART), extreme gradient boosting with dart booster (XGBoost), multivariate adaptive regression splines (MARS), neural network (NNET), and adaptive boost (AdaBoost) were compared with logistic regression (LR) for predicting the risk of in-hospital mortality in patients with hyperglycemic crisis. Stratified random sampling was used to split the data into training (80%) and validation (20%) sets. Ten-fold cross validation was performed on the training set to optimize model hyperparameters. The sensitivity, specificity, positive and negative predictive values, area under the curve (AUC) and accuracy of all models were computed for comparative analysis. RESULTS A total of 1668 patients were eligible for the present study. The in-hospital mortality rate was 7.3% (121/1668). In the training set, feature importance scores were calculated for each of the eight models, and the top 10 significant features were identified. In the validation set, all models demonstrated good predictive capability, with areas under the curve value exceeding 0.9 with a F1 score between 0.632 and 0.81, except the MARS model. Six machine learning algorithm models outperformed the referred logistic regression algorithm except the MARS model. Among the selected models, RPART, RF, and SVM achieved the best performance in the selected models (AUC values were 0.970, 0.968 and 0.968, F1 score were 0.652, 0.762, 0.762 respectively). Feature importance analysis identified novel predictors including mechanical ventilation, age, Charlson Comorbidity Index, blood gas index, first 24-hour insulin dosage, and first 24-hour fluid intake. CONCLUSION Most machine learning algorithms exhibited excellent performance predicting in-hospital mortality among patients with hyperglycemic crisis except the MARS model, and the best one was RPART model. These algorithms identified overlapping but different, up to 10 predictors. Early identification of high-risk patients using these models could support clinical decision-making and potentially improve the prognosis of hyperglycemic crisis patients. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Rui He
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Kebiao Zhang
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400016, China.
| | - Hong Li
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400016, China
| | - Manping Gu
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400016, China.
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He R, Zhang K, Li H, Fu S, Chen Z, Gu M. Impact of Charlson Comorbidity Index on in-hospital mortality of patients with hyperglycemic crises: A propensity score matching analysis. J Eval Clin Pract 2024; 30:977-988. [PMID: 38713640 DOI: 10.1111/jep.14005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/17/2024] [Indexed: 05/09/2024]
Abstract
AIM This study was designed to investigate the association between Charlson Comorbidity Index (CCI) and in-hospital mortality and other clinical outcomes among patients with hyperglycemic crises. METHOD This retrospective cohort study was conducted using data from electric medical records. A total of 1668 diabetic patients with hyperglycemic crises from six tertiary hospitals met the inclusion criteria. CCI < 4 was defined as low CCI and CCI ≥ 4 was defined as high CCI. Propensity score matching (PSM) with the 1:1 nearest neighbour matching method and the caliper value of 0.02 was used to match the baseline characteristics of patients with high CCI and low CCI to reduce the confounding bias. In-hospital mortality, ICU admission, hypoglycemia, hypokalemia, acute kidney injury, length of stay (LOS), and hospitalisation expense between low CCI and high CCI were compared and assessed. Univariate and multivariate regression were applied to estimate the impact of CCI on in-hospital and other clinical outcomes. OUTCOME One hundred twenty-one hyperglycemic crisis (HC) patients died with a mortality rate of 7.3%. After PSM, compared with low CCI, patients with high CCI suffered higher in-hospital mortality, ICU admission, LOS, and hospitalisation expenses. After multivariate regression, age (aOR: 1.12, 95% confidence interval [CI]: 1.06-1.18, p < 0.001), CCI(aOR: 4.42, 95% CI: 1.56-12.53, p = 0.005), uninsured (aOR: 22.32, 95% CI: 4.26-116.94, p < 0.001), shock (aOR: 10.57, 95% CI: 1.41-79.09, p = 0.022), mechanical ventilation (aOR: 75.29, 95% CI: 12.37-458.28, p < 0.001), and hypertension (aOR: 4.34, 95% CI: 1.37-13.82, p = 0.013) were independent risk factors of in-hospital mortality of HC patients. Besides, high CCI was an independent risk factor for higher ICU Admission (aOR: 5.91, 95% CI: 2.31-15.08, p < 0.001), hypoglycemia (aOR: 2.19, 95% CI:1.01-4.08, p = 0.049), longer LOS (aOR: 1.23, 95% CI: 1.19-2.27, p = 0.021), and higher hospitalisation expense (aOR: 2089.97, 95% CI: 193.33-3988.61, p = 0.031) of HC patients. CONCLUSION CCI is associated with in-hospital mortality, ICU admission, hypoglycemia, LOS, and hospitalisation expense of HC patients. CCI could be an ideal indicator to identify, monitor, and manage chronic comorbidities among HC patients.
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Affiliation(s)
- Rui He
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kebiao Zhang
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hong Li
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shimin Fu
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhen Chen
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Manping Gu
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Huang CT, Muo CH, Sung FC, Chen PC. Risk of chronic kidney disease in patients with a hyperglycemic crisis as the initial presentation of type 2 diabetes. Sci Rep 2024; 14:16746. [PMID: 39033190 PMCID: PMC11271453 DOI: 10.1038/s41598-024-67678-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024] Open
Abstract
Limited data exist on long-term renal outcomes in patients with hyperglycemic crisis (HC) as initial type 2 diabetes presentation. We evaluated the risk of chronic kidney disease (CKD) development in those with concurrent HC at diagnosis. Utilizing Taiwan's insurance claims from adults newly diagnosed with type 2 diabetes during 2006-2015, we created HC and matched non-HC cohorts. We assessed incident CKD/diabetic kidney disease (DKD) by 2018's end, calculating the hazard ratio (HR) with the Cox model. Each cohort comprised 13,242 patients. The combined CKD and DKD incidence was two-fold higher in the HC cohort than in the non-HC cohort (56.47 versus 28.49 per 1000 person-years) with an adjusted HR (aHR) of 2.00 (95% confidence interval [CI] 1.91-2.10]). Risk increased from diabetic ketoacidosis (DKA) (aHR:1.69 [95% CI 1.59-1.79]) to hyperglycemic hyperosmolar state (HHS) (aHR:2.47 [95% CI 2.33-2.63]) and further to combined DKA-HHS (aHR:2.60 [95% CI 2.29-2.95]). Subgroup analysis in individuals aged ≥ 40 years revealed a similar trend with slightly reduced incidences and HRs. Patients with HC as their initial type 2 diabetes presentation face a higher CKD risk than do those without HC. Enhanced medical attention and customized interventions are crucial to reduce this risk.
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Affiliation(s)
- Chun-Ta Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital, Taipei City, 104217, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, 252005, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung City, 404328, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung City, 404328, Taiwan.
- Department of Health Services Administration, China Medical University College of Public Health, 100 Jingmao Road Section 1, Beitun Dist., Taichung, 406040, Taiwan.
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, 413305, Taiwan.
| | - Pei-Chun Chen
- International Master Program for Public Health, China Medical University, Taichung, 406040, Taiwan
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Xu C, Wen S, Gong M, Dong M, Yuan Y, Li Y, Zhou M, Zhou L. The Implication of Elevated Serum Myoglobin Level in Acute Diabetic Complications of Ketoacidosis and Hyperglycemic Hyperosmolar State: A Real-World Study. Diabetes Metab Syndr Obes 2024; 17:2639-2653. [PMID: 38974952 PMCID: PMC11225959 DOI: 10.2147/dmso.s465311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024] Open
Abstract
Objective To investigate the implications of elevated myoglobin (MYO) in acute diabetic conditions of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Materials and methods This study integrates in-patient data from Shanghai Pudong Hospital from 2019 to 2023. Laboratory data were compared between stable T2D patients (without acute diabetic complications), DKA, and HHS patients. The multilinear regression explored variables relevant to the elevated MYO in DKA and HHS. The dynamics of MYO, the survival rate, and associated risk factors in HHS were determined. Results Except for triglyceride, procalcitonin, low-density lipoprotein, islet cell autoimmune antibodies, N-terminal Pro-brain natriuretic peptide (NT-ProBNP), and brain natriuretic peptide (BNP), there were significant differences in age, gender distribution, duration of diabetes, type of diabetes, and other referred laboratory data (p<0.05). The age, gender, creatine kinase (CK), estimated glomerular filtration rate (eGFR), and free triiodothyronine (FT3) in DKA, whereas osmolar, uric acid (UA), and cardiac troponin I (cTNI) in the HHS, were significant determinants of elevated MYO, respectively (p<0.05). The dynamic of MYO in HHS was in line with the survival trend, where the percentage of death was 29.73%, and aging with higher procalcitonin levels was a key risk factor. Besides, the cumulative survival rates between patients with or without bone fracture or muscle injury were substantially different. Conclusion This real-world study demonstrated DKA and HHS potentially have unique causes for increased MYO. By utilizing the appropriate regression parameters, we could forecast the progression of increased MYO in groups of DKA and HHS, while based on risk factors of aging, severity of infection, and different MYO sources, we could predict the prognosis of HHS.
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Affiliation(s)
- Chenglin Xu
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
| | - Song Wen
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
- Fudan Zhangjiang Institute, Fudan University, Shanghai, 201203, People’s Republic of China
| | - Min Gong
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
| | - Meiyuan Dong
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
- Hebei Medical University, Shijiazhuang, 050013, People’s Republic of China
| | - Yue Yuan
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
| | - Yanyan Li
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
| | - Mingyue Zhou
- Clinical Research OB/GYN REI Division, University of California, San Francisco, CA, USA
| | - Ligang Zhou
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
- Hebei Medical University, Shijiazhuang, 050013, People’s Republic of China
- Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai Pudong Hospital, Shanghai, 201399, People’s Republic of China
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Chen H, Wang Y, Ji R, Li M. Association between blood urea nitrogen to serum albumin ratio and in-hospital mortality in critical patients with diabetic ketoacidosis: a retrospective analysis of the eICU database. Front Endocrinol (Lausanne) 2024; 15:1411891. [PMID: 38994011 PMCID: PMC11236567 DOI: 10.3389/fendo.2024.1411891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/13/2024] [Indexed: 07/13/2024] Open
Abstract
Background This study aimed to investigate the association between blood urea nitrogen to serum albumin ratio (BAR) and the risk of in-hospital mortality in patients with diabetic ketoacidosis. Methods A total of 3,962 diabetic ketoacidosis patients from the eICU Collaborative Research Database were included in this analysis. The primary outcome was in-hospital death. Results Over a median length of hospital stay of 3.1 days, 86 in-hospital deaths were identified. One unit increase in LnBAR was positively associated with the risk of in-hospital death (hazard ratio [HR], 1.82 [95% CI, 1.42-2.34]). Furthermore, a nonlinear, consistently increasing correlation between elevated BAR and in-hospital mortality was observed (P for trend =0.005 after multiple-adjusted). When BAR was categorized into quartiles, the higher risk of in-hospital death (multiple-adjusted HR, 1.99 [95% CI, (1.1-3.6)]) was found in participants in quartiles 3 to 4 (BAR≥6.28) compared with those in quartiles 1 to 2 (BAR<6.28). In the subgroup analysis, the LnBAR-hospital death association was significantly stronger in participants without kidney insufficiency (yes versus no, P-interaction=0.023). Conclusion There was a significant and positive association between BAR and the risk of in-hospital death in patients with diabetic ketoacidosis. Notably, the strength of this association was intensified among those without kidney insufficiency.
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Affiliation(s)
- Hua Chen
- Center of Cardiovascular Medicine, Inner Mongolia People’s Hospital, Hohhot, China
- Graduate School, Inner Mongolia Medical University, Hohhot, China
| | - Yufei Wang
- Center of Cardiovascular Medicine, Inner Mongolia People’s Hospital, Hohhot, China
- Graduate School, Inner Mongolia Medical University, Hohhot, China
| | - Rong Ji
- Center of Cardiovascular Medicine, Inner Mongolia People’s Hospital, Hohhot, China
- Graduate School, Inner Mongolia Medical University, Hohhot, China
| | - Minghui Li
- Center of Cardiovascular Medicine, Inner Mongolia People’s Hospital, Hohhot, China
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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González-Vidal T, Lambert C, García AV, Villa-Fernández E, Pujante P, Ares-Blanco J, Menéndez Torre E, Delgado-Álvarez E. Hypoglycemia during hyperosmolar hyperglycemic crises is associated with long-term mortality. Diabetol Metab Syndr 2024; 16:83. [PMID: 38594758 PMCID: PMC11005231 DOI: 10.1186/s13098-024-01329-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/04/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Previous research has indicated that hypoglycemia during hospitalization is a predictor of unfavorable outcomes in patients with diabetes. However, no studies have examined the long-term impact of hypoglycemia in adults admitted for hyperglycemic crises. The study was aimed to investigate the long-term implications of hypoglycemia during hyperosmolar hyperglycemic crises, particularly in terms of all-cause mortality. METHODS This retrospective cohort study included 170 patients (82 men [48.2%], median age 72 years) admitted to a university hospital for hyperosmolar hyperglycemic crises, including pure hyperosmolar hyperglycemic states and hyperosmolar diabetic ketoacidoses. We separately investigated the prognostic significance of hypoglycemia on mortality during the initial intravenous insulin therapy phase and during the later subcutaneous insulin therapy phase, both during hospitalization and in the long term (median follow-up, 652 days; range 2-3460 days). RESULTS Both hypoglycemia during the initial intravenous insulin therapy phase (observed in 26.5% of patients) and hypoglycemia during the later subcutaneous insulin therapy phase (observed in 52.7% of patients) were associated with long-term mortality. After adjusting for potential confounders, hypoglycemia during the initial intravenous insulin therapy phase remained associated with mortality (hazard ratio 2.10, 95% CI 1.27-3.46, p = 0.004). CONCLUSIONS Hypoglycemia during hyperosmolar hyperglycemic crises is a marker of long-term mortality, especially when it occurs during the initial intravenous insulin therapy phase.
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Affiliation(s)
- Tomás González-Vidal
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias/University of Oviedo, Oviedo, Spain.
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.
| | - Carmen Lambert
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Ana Victoria García
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Elsa Villa-Fernández
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Pedro Pujante
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias/University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Jessica Ares-Blanco
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias/University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Department of Medicine, University of Oviedo, Oviedo, Spain
| | - Edelmiro Menéndez Torre
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias/University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Department of Medicine, University of Oviedo, Oviedo, Spain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Elías Delgado-Álvarez
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias/University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Department of Medicine, University of Oviedo, Oviedo, Spain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
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Kaewkrasaesin C, Kositanurit W, Chotwanvirat P, Laichuthai N. Enhancing outcome prediction by applying the 2019 WHO DM classification to adults with hyperglycemic crises: A single-center cohort in Thailand. Diabetes Metab Syndr 2024; 18:103012. [PMID: 38643708 DOI: 10.1016/j.dsx.2024.103012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 04/10/2024] [Accepted: 04/13/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND AND AIMS Hyperglycemic crisis is a metabolic catastrophe which can occur in any type of diabetes. In 2019, the World Health Organization (WHO) revised the classification of diabetes mellitus (DM) and established two new hybrid forms, latent autoimmune diabetes in adults (LADA) and ketosis-prone type 2 diabetes (T2D). This study aimed to determine clinical outcomes after a hyperglycemic crisis event in people with diabetes classified subtypes by 2019 WHO DM classification. METHODS A five-year (2015-2019) retrospective study of adult patients admitted with hyperglycemic crises was conducted. Types of diabetes were recategorized based on the 2019 WHO DM classification. Clinical characteristics, in-admission treatment and complications, long-term follow-up outcomes, and mortality were collected, analyzed, and compared. RESULTS A total of 185 admissions occurred in 136 patients. The mean age was 50.6 ± 18.4 years (49.3 % men). The annual average incidence of hyperglycemic crises was 5.2 events/1000 persons. The proportion of type 1 diabetes, T2D, LADA, ketosis-prone T2D, and pancreatic DM were 15.4 %, 69.1 %, 2.2 %, 11 %, and 2.2 %, respectively. In-hospital mortality was 3.7 % while cumulative mortality totaled 19.1 %. During the 24-month follow-up, ketosis-prone T2D had the highest success of insulin discontinuation (HR 6.59; 95 % CI 6.69-319.4; p < 0.001), while T2D demonstrated the highest mortality compared to others (HR, 2.89; 95%CI 1.15-6.27; p = 0.02). CONCLUSION The reclassification of diabetes based on 2019 WHO DM classification helped elucidate differences in long-term outcomes and mortality among DM types. The new classification, which separates ketosis-prone T2D from standard T2D, should be encouraged in clinical practice for precise and individualized management.
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Affiliation(s)
- Chatchon Kaewkrasaesin
- Division of Medicine, Taksin Hospital, Medical Service Department, Bangkok Metropolitan Administration, Bangkok, 10600, Thailand; Diabetes and Metabolic Care Center, Taksin Hospital, Medical Service Department, Bangkok Metropolitan Administration, Bangkok, 10600, Thailand.
| | - Weerapat Kositanurit
- Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Phawinpon Chotwanvirat
- Diabetes and Metabolic Care Center, Taksin Hospital, Medical Service Department, Bangkok Metropolitan Administration, Bangkok, 10600, Thailand
| | - Nitchakarn Laichuthai
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand; Excellent Center in Diabetes, Hormones and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
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Liao HH, Livneh H, Huang HL, Hung JY, Lu MC, Guo HR, Tsai TY. Reduced risk of dementia in patients with type 2 diabetes mellitus using Chinese herbal medicine: A nested case-control study. World J Diabetes 2023; 14:1632-1642. [DOI: 10.4239/wjd.v14.i11.1632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/14/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Dementia is a prevalent condition in type 2 diabetes mellitus (T2DM) patients. While Chinese herbal medicine (CHM) is often employed as complementary therapy for glycemic control, its effect in controlling likelihood of dementia has not yet been fully elucidated.
AIM To compare the risk of dementia between T2DM patients with and without CHM treatment.
METHODS We undertook a nested case-control study and obtained data on patients 20-70 years of age who received medical care for T2DM between 2001 and 2010 from the National Health Insurance Research database in Taiwan. Cases, defined as those with dementia that occurred at least one year after the diagnosis of T2DM, were randomly matched to controls without dementia from the study cohort at a 1:1 ratio. We applied conditional logistic regression to explore the associations between CHM treatment and dementia.
RESULTS A total of 11699 dementia cases were matched to 11699 non-dementia controls. We found that adding CHM to conventional care was related to a lower risk of dementia [adjusted odds ratio (OR) = 0.51], and high-intensity CHM treatment was associated with an adjusted OR of 0.22.
CONCLUSION This study shows that the cumulative CHM exposure was inversely associated with dementia risk in an exposure-response manner, implying that CHM treatment may be embraced as a disease management approach for diabetic patients to prevent dementia.
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Affiliation(s)
- Hou-Hsun Liao
- Department of Chinese Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien 62247, Taiwan
| | - Hanoch Livneh
- Department of Special and Counselor Education, Portland State University, Portland, OR 97207, United States
| | - Hua-Lung Huang
- Department of Rehabilitation, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan
| | - Jui-Yu Hung
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan
| | - Ming-Chi Lu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan 70428, Taiwan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan 70428, Taiwan
- Occupational Safety, Health, and Medicine Research Center, National Cheng Kung University, Tainan 70428, Taiwan
| | - Tzung-Yi Tsai
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien 62247, Taiwan
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan
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Hsu CC, Kao Y, Hsu CC, Chen CJ, Hsu SL, Liu TL, Lin HJ, Wang JJ, Liu CF, Huang CC. Using artificial intelligence to predict adverse outcomes in emergency department patients with hyperglycemic crises in real time. BMC Endocr Disord 2023; 23:234. [PMID: 37872536 PMCID: PMC10594858 DOI: 10.1186/s12902-023-01437-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 08/22/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Hyperglycemic crises are associated with high morbidity and mortality. Previous studies have proposed methods to predict adverse outcomes of patients in hyperglycemic crises; however, artificial intelligence (AI) has never been used to predict adverse outcomes. We implemented an AI model integrated with the hospital information system (HIS) to clarify whether AI could predict adverse outcomes. METHODS We included 2,666 patients with hyperglycemic crises from emergency departments (ED) between 2009 and 2018. The patients were randomized into a 70%/30% split for AI model training and testing. Twenty-two feature variables from the electronic medical records were collected. The performance of the multilayer perceptron (MLP), logistic regression, random forest, Light Gradient Boosting Machine (LightGBM), support vector machine (SVM), and K-nearest neighbor (KNN) algorithms was compared. We selected the best algorithm to construct an AI model to predict sepsis or septic shock, intensive care unit (ICU) admission, and all-cause mortality within 1 month. The outcomes between the non-AI and AI groups were compared after implementing the HIS and predicting the hyperglycemic crisis death (PHD) score. RESULTS The MLP had the best performance in predicting the three adverse outcomes, compared with the random forest, logistic regression, SVM, KNN, and LightGBM models. The areas under the curves (AUCs) using the MLP model were 0.852 for sepsis or septic shock, 0.743 for ICU admission, and 0.796 for all-cause mortality. Furthermore, we integrated the AI predictive model with the HIS to assist decision making in real time. No significant differences in ICU admission or all-cause mortality were detected between the non-AI and AI groups. The AI model performed better than the PHD score for predicting all-cause mortality (AUC 0.796 vs. 0.693). CONCLUSIONS A real-time AI predictive model is a promising method for predicting adverse outcomes in ED patients with hyperglycemic crises. Further studies recruiting more patients are warranted.
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Affiliation(s)
- Chin-Chuan Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
| | - Yuan Kao
- Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
- Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen university, Kaohsiung, Taiwan
| | - Chia-Jung Chen
- Information Systems, Chi Mei Medical Center, Tainan, Taiwan
| | - Shu-Lien Hsu
- Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan
| | - Tzu-Lan Liu
- Information Systems, Chi Mei Medical Center, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen university, Kaohsiung, Taiwan
- Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jhi-Joung Wang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Anesthesiology, National Defense Medical Center, Taipei, Taiwan
| | - Chung-Feng Liu
- Department of Medical Research, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.
- School of Medicine, College of Medicine, National Sun Yat-sen university, Kaohsiung, Taiwan.
- Department of Emergency Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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10
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Nakhleh A, Othman A, Masri A, Zloczower M, Zolotov S, Shehadeh N. Clinical Outcomes of Diabetic Ketoacidosis in Type 2 Diabetes Patients with and without SGLT2 Inhibitor Treatment: A Retrospective Study. Biomedicines 2023; 11:2689. [PMID: 37893063 PMCID: PMC10604468 DOI: 10.3390/biomedicines11102689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
AIM This study aimed to compare the clinical course and outcomes of DKA in T2DM patients who received treatment with SGLT2 inhibitors versus those who did not. METHODS A retrospective analysis was conducted on T2DM patients who were admitted to the Rambam Health Care Campus with DKA between 7/2015 and 9/2020. Demographic, clinical, and laboratory data were obtained from electronic medical records. Outpatient mortality was monitored until 12/2022. RESULTS Of 71 T2DM patients admitted with DKA, 16 (22.5%) were on SGLT2 inhibitor treatment upon admission. SGLT2 inhibitor users had a higher BMI and were less likely to be treated with insulin. During hospitalization, the rates of acute kidney injury, concomitant infections, and inpatient mortality among SGLT2 inhibitor users were comparable to non-users. The median follow-up period was 35.1 months for the SGLT2 inhibitor users and 36.7 months for non-users. The long-term mortality from any cause was lower among the SGLT2 inhibitor users (12.5% vs. 52.7%, p = 0.004). In Cox regression analysis, SGLT2 inhibitor use was associated with a lower risk of long-term mortality from any cause (HR = 0.19, p = 0.04). CONCLUSION T2DM patients with DKA who received SGLT2 inhibitors had lower long-term mortality from any cause compared to those who did not receive SGLT2 inhibitors.
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Affiliation(s)
- Afif Nakhleh
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa 3109601, Israel
- Diabetes and Endocrinology Clinic, Maccabi Healthcare Services, Haifa 3299001, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Areen Othman
- Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3525433, Israel
| | - Amin Masri
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Moshe Zloczower
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Sagit Zolotov
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Naim Shehadeh
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa 3109601, Israel
- Diabetes and Endocrinology Clinic, Maccabi Healthcare Services, Haifa 3299001, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
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11
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Wang C, Cao L, Mei W, Fang Y, Ren X, Hu J, Su F, Tavengana G, Jiang M, Wu H, Wen Y. The V-shaped curve relationship between fasting plasma glucose and human serum albumin in a large health checkup population in China. BMC Endocr Disord 2023; 23:192. [PMID: 37697387 PMCID: PMC10494399 DOI: 10.1186/s12902-023-01441-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 08/24/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND This study aimed to investigate the relationship between fasting plasma glucose (FPG) and human serum albumin (HSA) in a large health checkup population in China. METHODS In this cross-sectional health checkup study, we enrolled a population of 284,635 subjects from Wuhu between 2011 and 2016. All participants completed the physical examination, blood biochemical examination, and blood routine examination. RESULTS The prevalence of diabetes in men and women was 6.11% and 2.98%, respectively. The average level of HSA and FPG was significantly higher in men than in women (48.44 ± 3.25 vs. 47.14 ± 3.22, P < 0.0001; 5.50 ± 1.26 vs. 5.26 ± 0.94, P < 0.0001). There were significant differences in blood biochemistry and blood routine values by gender. After adjusting for confounding factors, the results showed that FPG and HSA were a V-shaped curve, and the threshold value of HSA was 40.7 mmol/L. FPG and HSA still showed a V-shaped curve after stratification by gender and age. In the male group, FPG decreased with HSA when HSA<42.3 mmol/L, and increased when HSA ≥ 42.3 mmol/L. In the female group, FPG decreased with HSA when HSA<35.7 mmol/L, and increased when HSA ≥ 35.7 mmol/L. In the age<65 group, FPG decreased with HSA when HSA<37.5 mmol/L, and increased when HSA ≥ 37.5 mmol/L. In the age ≥ 65 group, FPG decreased with HSA when HSA<43.2 mmol/L, and increased when HSA ≥ 43.2 mmol/L. CONCLUSIONS A V-shape relationship exists between fasting plasma glucose and human serum albumin among the Chinese health checkup population studied.
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Affiliation(s)
- Chenxu Wang
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, 241002, Anhui Province, People's Republic of China
| | - Lei Cao
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, 241002, Anhui Province, People's Republic of China
| | - Wendan Mei
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, 241002, Anhui Province, People's Republic of China
| | - Yicheng Fang
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, 241002, Anhui Province, People's Republic of China
| | - Xia Ren
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, 241002, Anhui Province, People's Republic of China
| | - Jian Hu
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, 241002, Anhui Province, People's Republic of China
| | - Fan Su
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, 241002, Anhui Province, People's Republic of China
| | - Grace Tavengana
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, 241002, Anhui Province, People's Republic of China
| | - Mingfei Jiang
- School of Clinical Medicine, Wannan Medical College, 22 West Wenchang Road, Wuhu, 241002, Anhui Province, People's Republic of China
| | - Huan Wu
- School of Laboratory Medicine, Wannan Medical College, 22 West Wenchang Road, Wuhu, 241002, Anhui Province, People's Republic of China
| | - Yufeng Wen
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, 241002, Anhui Province, People's Republic of China.
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12
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Xie P, Yang C, Yang G, Jiang Y, He M, Jiang X, Chen Y, Deng L, Wang M, Armstrong DG, Ma Y, Deng W. Mortality prediction in patients with hyperglycaemic crisis using explainable machine learning: a prospective, multicentre study based on tertiary hospitals. Diabetol Metab Syndr 2023; 15:44. [PMID: 36899433 PMCID: PMC10007769 DOI: 10.1186/s13098-023-01020-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Experiencing a hyperglycaemic crisis is associated with a short- and long-term increased risk of mortality. We aimed to develop an explainable machine learning model for predicting 3-year mortality and providing individualized risk factor assessment of patients with hyperglycaemic crisis after admission. METHODS Based on five representative machine learning algorithms, we trained prediction models on data from patients with hyperglycaemic crisis admitted to two tertiary hospitals between 2016 and 2020. The models were internally validated by tenfold cross-validation and externally validated using previously unseen data from two other tertiary hospitals. A SHapley Additive exPlanations algorithm was used to interpret the predictions of the best performing model, and the relative importance of the features in the model was compared with the traditional statistical test results. RESULTS A total of 337 patients with hyperglycaemic crisis were enrolled in the study, 3-year mortality was 13.6% (46 patients). 257 patients were used to train the models, and 80 patients were used for model validation. The Light Gradient Boosting Machine model performed best across testing cohorts (area under the ROC curve 0.89 [95% CI 0.77-0.97]). Advanced age, higher blood glucose and blood urea nitrogen were the three most important predictors for increased mortality. CONCLUSION The developed explainable model can provide estimates of the mortality and visual contribution of the features to the prediction for an individual patient with hyperglycaemic crisis. Advanced age, metabolic disorders, and impaired renal and cardiac function were important factors that predicted non-survival. TRIAL REGISTRATION NUMBER ChiCTR1800015981, 2018/05/04.
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Affiliation(s)
- Puguang Xie
- Department of Endocrinology and Bioengineering College, Chongqing University Central Hospital, Chongqing Emergency Medical Centre, Chongqing University, NO. 1 Jiankang Road, Yuzhong District, Chongqing, 400014, China
| | - Cheng Yang
- Department of Endocrinology and Bioengineering College, Chongqing University Central Hospital, Chongqing Emergency Medical Centre, Chongqing University, NO. 1 Jiankang Road, Yuzhong District, Chongqing, 400014, China
| | - Gangyi Yang
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China
| | - Youzhao Jiang
- Department of Endocrinology, People's Hospital of Chongqing Banan District, Chongqing, 401320, China
| | - Min He
- General Practice Department, Chongqing Southwest Hospital, Chongqing, 400038, China
| | - Xiaoyan Jiang
- Department of Endocrinology and Bioengineering College, Chongqing University Central Hospital, Chongqing Emergency Medical Centre, Chongqing University, NO. 1 Jiankang Road, Yuzhong District, Chongqing, 400014, China
| | - Yan Chen
- Department of Endocrinology and Bioengineering College, Chongqing University Central Hospital, Chongqing Emergency Medical Centre, Chongqing University, NO. 1 Jiankang Road, Yuzhong District, Chongqing, 400014, China
| | - Liling Deng
- Department of Endocrinology and Bioengineering College, Chongqing University Central Hospital, Chongqing Emergency Medical Centre, Chongqing University, NO. 1 Jiankang Road, Yuzhong District, Chongqing, 400014, China
| | - Min Wang
- Department of Endocrinology and Bioengineering College, Chongqing University Central Hospital, Chongqing Emergency Medical Centre, Chongqing University, NO. 1 Jiankang Road, Yuzhong District, Chongqing, 400014, China
| | - David G Armstrong
- Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90033, USA
| | - Yu Ma
- Department of Endocrinology and Bioengineering College, Chongqing University Central Hospital, Chongqing Emergency Medical Centre, Chongqing University, NO. 1 Jiankang Road, Yuzhong District, Chongqing, 400014, China.
| | - Wuquan Deng
- Department of Endocrinology and Bioengineering College, Chongqing University Central Hospital, Chongqing Emergency Medical Centre, Chongqing University, NO. 1 Jiankang Road, Yuzhong District, Chongqing, 400014, China.
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13
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Duan Z, Song P, Yang C, Deng L, Jiang Y, Deng F, Jiang X, Chen Y, Yang G, Ma Y, Deng W. The impact of hyperglycaemic crisis episodes on long-term outcomes for inpatients presenting with acute organ injury: A prospective, multicentre follow-up study. Front Endocrinol (Lausanne) 2022; 13:1057089. [PMID: 36545333 PMCID: PMC9760800 DOI: 10.3389/fendo.2022.1057089] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/16/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND The long-term clinical outcome of poor prognosis in patients with diabetic hyperglycaemic crisis episodes (HCE) remains unknown, which may be related to acute organ injury (AOI) and its continuous damage after hospital discharge. This study aimed to observe the clinical differences and relevant risk factors in HCE with or without AOI. METHODS A total of 339 inpatients were divided into an AOI group (n=69) and a non-AOI group (n=270), and their differences and risk factors were explored. The differences in clinical outcomes and prediction models for evaluating the long-term adverse events after hospital discharge were established. RESULTS The mortality among cases complicated by AOI was significantly higher than that among patients without AOI [8 (11.59%) vs. 11 (4.07%), Q = 0.034] during hospitalization. After a 2-year follow-up, the mortality was also significantly higher in patients with concomitant AOI than in patients without AOI after hospital discharge during follow-up [13 (21.31%) vs. 15 (5.8%), Q < 0.001]. The long-term adverse events in patients with concomitant AOI were significantly higher than those in patients without AOI during follow-up [15 (24.59%) vs. 31 (11.97%), Q = 0.015]. Furthermore, Blood β-hydroxybutyric acid (P = 0.003), Cystatin C (P <0.001), serum potassium levels (P = 0.001) were significantly associated with long-term adverse events after hospital discharge. CONCLUSIONS The long-term prognosis of HCE patients complicated with AOI was significantly worse than that of HCE patients without AOI. The laboratory indicators were closely correlated with AOI, and future studies should explore the improvement of clinical outcome in response to timely interventions.
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Affiliation(s)
- Zixiao Duan
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
- Department of Endocrinology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peiyang Song
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Cheng Yang
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Liling Deng
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Youzhao Jiang
- Department of Endocrinology, Banan People’s Hospital of Chongqing, Chongqing, China
| | - Fang Deng
- Department of Endocrinology, Chongqing Southwest Hospital, Chongqing, China
| | - Xiaoyan Jiang
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Yan Chen
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Gangyi Yang
- Department of Endocrinology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Ma
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Wuquan Deng
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
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14
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Vásquez-Muñoz M, Arce-Álvarez A, Álvarez C, Ramírez-Campillo R, Crespo FA, Arias D, Salazar-Ardiles C, Izquierdo M, Andrade DC. Dynamic circadian fluctuations of glycemia in patients with type 2 diabetes mellitus. Biol Res 2022; 55:37. [PMID: 36461078 PMCID: PMC9716682 DOI: 10.1186/s40659-022-00406-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) has glucose variability that is of such relevance that the appearance of vascular complications in patients with DM has been attributed to hyperglycemic and dysglycemic events. It is known that T1D patients mainly have glycemic variability with a specific oscillatory pattern with specific circadian characteristics for each patient. However, it has not yet been determined whether an oscillation pattern represents the variability of glycemic in T2D. This is why our objective is to determine the characteristics of glycemic oscillations in T2D and generate a robust predictive model. RESULTS Showed that glycosylated hemoglobin, glycemia, and body mass index were all higher in patients with T2D than in controls (all p < 0.05). In addition, time in hyperglycemia and euglycemia was markedly higher and lower in the T2D group (p < 0.05), without significant differences for time in hypoglycemia. Standard deviation, coefficient of variation, and total power of glycemia were significantly higher in the T2D group than Control group (all p < 0.05). The oscillatory patterns were significantly different between groups (p = 0.032): the control group was mainly distributed at 2-3 and 6 days, whereas the T2D group showed a more homogeneous distribution across 2-3-to-6 days. CONCLUSIONS The predictive model of glycemia showed that it is possible to accurately predict hyper- and hypoglycemia events. Thus, T2D patients exhibit specific oscillatory patterns of glycemic control, which are possible to predict. These findings may help to improve the treatment of DM by considering the individual oscillatory patterns of patients.
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Affiliation(s)
- Manuel Vásquez-Muñoz
- grid.412882.50000 0001 0494 535XExercise Applied Physiology Laboratory, Centro de Investigación en Fisiología Y Medicina de Altura, Departamento Biomedico, Facultad de Ciencias de La Salud, Universidad de Antofagasta, Antofagasta, Chile ,grid.482859.a0000 0004 0628 7639Clínica Santa María, Santiago, Chile ,Navarrabiomed, Hospital Universitario de Navarra (UHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra Spain
| | - Alexis Arce-Álvarez
- grid.441800.90000 0001 2227 4350Escuela de Kinesiología, Facultad de Salud, Universidad Católica Silva Henríquez, Santiago, Chile
| | - Cristian Álvarez
- grid.412848.30000 0001 2156 804XExercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of RehabilitationSciences, Universidad Andres Bello, Santiago, Chile
| | - Rodrigo Ramírez-Campillo
- grid.412848.30000 0001 2156 804XExercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of RehabilitationSciences, Universidad Andres Bello, Santiago, Chile
| | - Fernando A. Crespo
- grid.441791.e0000 0001 2179 1719Departamento de Gestion Y Negocios, Facultad de Economía Y Negocios, Universidad Alberto Hurtado, Santiago, Chile
| | - Dayana Arias
- grid.412882.50000 0001 0494 535XDepartamento de Biotecnología, Facultad de Ciencias del Mar Y Recursos Biológicos, Universidad de Antofagasta, Antofagasta, Chile
| | - Camila Salazar-Ardiles
- grid.412882.50000 0001 0494 535XExercise Applied Physiology Laboratory, Centro de Investigación en Fisiología Y Medicina de Altura, Departamento Biomedico, Facultad de Ciencias de La Salud, Universidad de Antofagasta, Antofagasta, Chile ,Navarrabiomed, Hospital Universitario de Navarra (UHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra Spain
| | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (UHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra Spain ,grid.413448.e0000 0000 9314 1427CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - David C. Andrade
- grid.412882.50000 0001 0494 535XExercise Applied Physiology Laboratory, Centro de Investigación en Fisiología Y Medicina de Altura, Departamento Biomedico, Facultad de Ciencias de La Salud, Universidad de Antofagasta, Antofagasta, Chile
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15
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Shand JAD, Morrow P, Braatvedt G. Mortality after discharge from hospital following an episode of diabetic ketoacidosis. Acta Diabetol 2022; 59:1485-1492. [PMID: 35951132 DOI: 10.1007/s00592-022-01953-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/27/2022] [Indexed: 11/01/2022]
Abstract
AIMS The rate of inpatient mortality associated with diabetic ketoacidosis (DKA) has steadily decreased in recent decades. However, there remains a significantly increased outpatient death rate following an episode of survived DKA. We undertook this study to investigate the observed increase in mortality following an episode of DKA. METHODS We completed a retrospective cohort study to investigate rates and causes of death in people admitted to our hospital with DKA between 2013 and 2018. DKA was confirmed by pre-defined biochemical parameters and cause of death data was extracted from multiple sources. Follow-up was for two years after discharge for all participants with one-year mortality being the main time point for analysis. RESULTS We identified 818 admissions to hospital with DKA, affecting 284 people. Twenty people died as inpatients and a further 40 people died during the two-year follow-up. Of these 60 participants, cause of death was able to be determined for 41 (68%), with most deaths occurring due to infection or macrovascular disease. Risk factors for death within a year of hospital discharge included older age, vascular complications of diabetes, intellectual impairment and residential care living. Those who survived an episode of DKA had a one-year age-corrected mortality rate 13 times higher than the general population. This was more marked in the younger cohort with those aged 15-39 years being 49 times more likely to die in the year after surviving a DKA admission compared to their general population counterparts. CONCLUSION An episode of diabetic ketoacidosis is associated with a significant outpatient mortality risk with most deaths due to infectious or macrovascular causes. This study should prompt investigation of predictive scoring tools to identify those at increased mortality risk after DKA and encourage the development of targeted interventions to reduce mortality.
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Affiliation(s)
- James A D Shand
- Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand.
| | - Paul Morrow
- Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand
| | - Geoff Braatvedt
- Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand
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16
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Eledrisi MS, Alkabbani H, Aboawon M, Ali A, Alabdulrazzak I, Elhaj M, Ahmed A, Alqahwachi H, Daghfal J, Beshyah SA, Malik RA. Clinical characteristics and outcomes of care in patients hospitalized with diabetic ketoacidosis. Diabetes Res Clin Pract 2022; 192:110041. [PMID: 35985426 DOI: 10.1016/j.diabres.2022.110041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/25/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022]
Abstract
AIMS To assess the clinical characteristics and outcomes of patients hospitalized with DKA. METHODS We examined the hospital database for patients admitted with DKA to all government hospitals in Qatar over 6 years. RESULTS We evaluated a total of 1330 patients [(37.3 % with type 1 diabetes (T1DM) and 62.7 % with type 2 diabetes (T2DM)] with 1613 episodes of DKA. Patients with T2DM were older than those with T1DM [48.0 (38.0-60.0), 26.0 (21.0-31.0) years] while there was no difference in DKA severity and laboratory values on admission or time to resolution of DKA. Admission to the intensive care unit was higher (38.9 % vs. 26.6 %; P < 0.001) with a longer hospital stay [5 (2.0-9.0) vs. 2 (2.0-4.0) days, P < 0.001] and markedly higher mortality (7.4 % vs. 1 %; P < 0.001) in patients with T2DM compared to T1DM. On multivariable logistic regression analysis, significant predictors of mortality were older age (odds ratio, 1.11; 95 % CI, 1.07-1.15; P = 0.0001), and admission to the intensive care unit (odds ratio, 3.61; 95 % CI, 1.69-7.72;P = 0.001). CONCLUSION In this national cohort of patients hospitalized with DKA, those with T2DM had a 7-fold increase in inpatient mortality associated with older age and admission to the intensive care unit.
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Affiliation(s)
- Mohsen S Eledrisi
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.
| | - Haifaa Alkabbani
- Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Malk Aboawon
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Aya Ali
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Maab Elhaj
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf Ahmed
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Joanne Daghfal
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Salem A Beshyah
- Department of Endocrinology, Yas Clinic, Abu Dhabi, United Arab Emirates; Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Rayaz A Malik
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar; Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
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Deng L, Xie P, Chen Y, Rui S, Yang C, Deng B, Wang M, Armstrong DG, Ma Y, Deng W. Impact of acute hyperglycemic crisis episode on survival in individuals with diabetic foot ulcer using a machine learning approach. Front Endocrinol (Lausanne) 2022; 13:974063. [PMID: 36093085 PMCID: PMC9452661 DOI: 10.3389/fendo.2022.974063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/10/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The outcome of DFUs concomitant with HCE remains unknown. This study aimed to investigate mortality rates and identify risk factors of mortality in patients with DFUs-HCE. METHODS 27 inpatients with DFUs-HCE were retrospectively enrolled in a cohort design, they were compared to 93 inpatients with DFUs in a city designated emergency center, between January 2016 and January 2021. After a 6-year followed-up, clinical characteristic, amputation and survival rates were compared. Extreme gradient boosting was further used to explore the relative importance of HCE and other risk factors to all-cause mortality in DFUs. RESULTS Patients with DFUs-HCE were more likely to havedementia, acute kidney injury and septic shock, whereas DFUs were more likely to have diabetic peripheral neuropathy and ulcer recurrence (P<0.05). No significant difference was observed on the amputation rate and diabetes duration. Both Kaplan-Meier curves and adjusted Cox proportional model revealed that DFUs-HCE was associated with a higher mortality compared with DFUs (P<0.05). HCE significantly increased the risk of mortality in patients with DFUs (hazard ratio, 1.941; 95% CI 1.018-3.700; P = 0.044) and was independent from other confounding factors (age, sex, diabetes duration, Wagner grades and Charlson Comorbidity Index). The XGBoost model also revealed that HCE was one of the most important risk factors associated with all-cause mortality in patients with DFUs. CONCLUSIONS DFUs-HCE had significantly lower immediate survival rates (first 1-6 month) than DFUs alone. HCE is an important risk factor for death in DFUs patients.
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Affiliation(s)
- Liling Deng
- Department of Endocrinology and School of Medicine, Chongqing University Central Hospital, Chongqing University, Chongqing, China
| | - Puguang Xie
- Department of Endocrinology and School of Medicine, Chongqing University Central Hospital, Chongqing University, Chongqing, China
| | - Yan Chen
- Department of Endocrinology and School of Medicine, Chongqing University Central Hospital, Chongqing University, Chongqing, China
| | - Shunli Rui
- Department of Endocrinology and School of Medicine, Chongqing University Central Hospital, Chongqing University, Chongqing, China
| | - Cheng Yang
- Department of Endocrinology and School of Medicine, Chongqing University Central Hospital, Chongqing University, Chongqing, China
| | - Bo Deng
- Department of Endocrinology and School of Medicine, Chongqing University Central Hospital, Chongqing University, Chongqing, China
| | - Min Wang
- Department of Endocrinology and School of Medicine, Chongqing University Central Hospital, Chongqing University, Chongqing, China
| | - David G. Armstrong
- Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Yu Ma
- Department of Endocrinology and School of Medicine, Chongqing University Central Hospital, Chongqing University, Chongqing, China
| | - Wuquan Deng
- Department of Endocrinology and School of Medicine, Chongqing University Central Hospital, Chongqing University, Chongqing, China
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Lin SY, Lin CL, Chang SS, Chang YH, Hsu WH, Lin CC, Kao CH. Risk of diabetes mellitus in patients with prostate cancer receiving injection therapy: A nationwide population-based propensity score-matched study. Int J Clin Pract 2021; 75:e14416. [PMID: 34047432 DOI: 10.1111/ijcp.14416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/24/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES We aimed to investigate whether the risk of diabetes mellitus (DM) is heightened in patients with prostate cancer receiving injection therapy. METHODS Men diagnosed with prostate cancer between 2000 and 2012 were included in the case cohort, and men without prostate cancer were included as controls. Each patient with prostate cancer was matched with a control patient with the same index year, demographic variables and comorbidities, and comparisons were made using propensity score matching. The hazard ratio of DM was estimated using the Cox proportional hazards model. RESULTS This cohort study consisted of 1213 patients with prostate cancer and 1213 control patients. The risk of DM in patients with prostate cancer was 1.60 times (95% CI = 1.12, 2.27) that of patients without prostate cancer. Compared with the controls, the hazard ratios of DM for patients with prostate cancer not receiving oral hormone therapy, patients with prostate cancer receiving oral hormone therapy, and patients with prostate cancer not receiving injection hormone therapy were 1.65 (95% CI = 1.01, 2.70), 1.57 (95% CI = 1.07, 2.70), and 1.94 (95% CI = 1.34, 2.81), respectively. The risk of DM in patients who received injection hormone therapy was 0.45 times (95% CI = 0.25, 0.82) that of patients who did not receive injection hormone therapy. CONCLUSION Patients with prostate cancer had an increased risk of DM compared with patients without prostate cancer. Patients with prostate cancer who received injection therapy had a lower risk of DM compared with those who did not.
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Affiliation(s)
- Shih-Yi Lin
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Shih-Sheng Chang
- Division of Cardiology, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Huei Chang
- Division of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Wu-Huei Hsu
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Pulmonary and Critical Care Medicine, China Medical University Hospital and China Medical University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
- Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
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Chang YS, Ho CH, Chu CC, Wang JJ, Jan RL. Risk of retinal vein occlusion in patients with diabetes mellitus: A retrospective cohort study. Diabetes Res Clin Pract 2021; 171:108607. [PMID: 33310122 DOI: 10.1016/j.diabres.2020.108607] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/18/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
AIMS To investigate the risk of retinal vein occlusion (RVO) in new-onset diabetes mellitus (DM) patients. METHODS This nationwide, retrospective, matched cohort study included 240,761 DM patients registered between January 2003 and December 2005 in the Longitudinal Cohort of Diabetes Patients database. An age- and sex-matched control group comprising 240,761 non-DM patients (case: control = 1:1) was selected from the Taiwan Longitudinal Health Insurance Database 2000. Information for each patient from the index date until December 2013 was collected. The incidence and risk of RVO were compared between the two groups. Cox proportional hazard regression analysis was performed to calculate the adjusted hazard ratio (HR) for RVO after adjustment for potential confounders. The RVO cumulative incidence rate was obtained using Kaplan-Meier analysis. RESULTS During the follow-up period, 1,456 DM patients developed RVO (491, central retinal vein occlusion; 965, branch retinal vein occlusion). There was a significantly elevated risk of RVO in DM patients compared with the controls (incidence rate ratio = 1.91, 95% confidence interval [CI] = 1.75-2.08). Patients with DM showed significant risk of RVO after adjustment for potential confounders (hypertension, hyperlipidemia, congestive heart failure, coronary artery disease, and chronic renal disease) in the full cohort (adjusted HR = 1.76, 95% CI = 1.61-1.93). Additionally, patients with hypertension had a significantly higher risk of RVO than patients without hypertension after adjustment for other confounders in the cohort (adjusted HR = 1.50, 95% CI = 1.36-1.65). CONCLUSIONS We found that patients with DM have increased risks of RVO. In addition to blood pressure control, we recommend educating patients with DM about RVO, to prevent its subsequent occurrence.
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Affiliation(s)
- Yuh-Shin Chang
- Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan; Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi-Mei Medical Center, Tainan, Taiwan; Department of Recreation and Health-Care Management, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Department of Anesthesiology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Ren-Long Jan
- Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan; Department of Pediatrics, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
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20
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Chou CH, Feng IJ, Chen YC, Chen JH, Lin HJ, Wang JJ, Hsu CC, Huang CC. Risk of Dementia in Diabetic Patients with Hyperglycemic Crisis: A Nationwide Taiwanese Population-Based Cohort Study. Neuroepidemiology 2020; 54:419-426. [PMID: 32841952 DOI: 10.1159/000509754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 06/24/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A hyperglycemic crisis episode (HCE) signifies poor control of diabetes and may increase the risk of dementia via microvascular and macrovascular injuries. OBJECTIVES We conducted this study to clarify this issue, which remains unclear. METHODS Using the Taiwan National Health Insurance Database, we identified 9,466 diabetic patients with HCE and the identical number of diabetic patients without HCE who were matched by age and sex for this nationwide population-based cohort study. The risk of dementia was compared between the 2 cohorts by following up until 2014. Investigation of independent predictors of dementia was also done. RESULTS In the overall analysis, the risk of dementia between the 2 cohorts was not different. However, stratified analyses showed that patients with HCE had a higher risk of subsequent dementia in the age subgroup of 45-54 and 55-64 years (adjusted odds ratio [AOR]: 2.4, 95% confidence interval [CI]: 1.6-3.6, and AOR: 1.2, 95% CI: 1.0-1.5, respectively). In the overall analysis, older age, female sex, ≥3 HCEs, hypertension, hyperlipidemia, depression, cerebrovascular disease, Parkinson's disease, and head injury were independent predictors. CONCLUSIONS HCE increased the risk of dementia in diabetic patients aged 45-64 years. Dementia was predicted by ≥3 HCEs. Prevention of recurrent HCE, control of comorbidities, and close follow-up of cognitive decline and dementia are suggested in patients with HCE.
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Affiliation(s)
- Chih-Ho Chou
- Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - I-Jung Feng
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Jiann-Hwa Chen
- Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan.,Fu Jen Catholic University School of Medicine, Taipei, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan, .,Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan, .,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan,
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Risk of Corneal Ulcer in Patients with Diabetes Mellitus: A Retrospective Large-Scale Cohort Study. Sci Rep 2020; 10:7388. [PMID: 32355281 PMCID: PMC7193550 DOI: 10.1038/s41598-020-64489-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/16/2020] [Indexed: 11/13/2022] Open
Abstract
This nationwide, retrospective, matched cohort study was designed to investigate the risk of corneal ulcer in patients with diabetes mellitus (DM). It included 238,701 patients with DM, recruited between 2003 and 2005 from the Longitudinal Cohort of Diabetes Patients database. The control group included the same number of age- and sex-matched non-DM patients selected from the Taiwan Longitudinal Health Insurance Database, 2000. The data of each patient were collected from the index date until December 2013. The incidence of corneal ulcer was compared between the two groups. In total, 2,549 patients with DM and 1,988 controls developed corneal ulcer during the follow-up period, resulting in an incidence rate for corneal ulcers that was 1.27 times (95% confidence interval [CI] = 1.20–1.35; P < 0.001) higher in patients with DM than in controls. After adjustment for potential confounders, including hyperlipidemia, hypertension, congestive heart failure, coronary artery disease, and chronic renal disease, patients with DM were 1.31 times (95% CI, 1.24–1.40; P < 0.05) more likely than the cohort to develop corneal ulcers. In conclusion, this study shows that DM increases the risk of corneal ulcer. Therefore, close collaboration between ophthalmologists and endocrinologists is important to ensure timely ophthalmology visits.
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Huang YL, Tsay WI, Her SH, Ho CH, Tsai KT, Hsu CC, Wang JJ, Huang CC. Chronic pain and use of analgesics in the elderly: a nationwide population-based study. Arch Med Sci 2020; 16:627-634. [PMID: 32399112 PMCID: PMC7212229 DOI: 10.5114/aoms.2020.92894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 05/16/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Chronic pain may cause many comorbidities in the elderly; however, nationwide data about this issue remain insufficient. We conducted this study to address the data gap. MATERIAL AND METHODS We identified geriatric participants (≥ 65 years) with chronic pain between 2000 and 2013 from the Taiwan National Health Insurance Research Database. The causes of chronic pain and use of analgesics between two sexes and among three age subgroups were compared. RESULTS A total of 21,018 participants were identified with the mean age (standard deviation) of 72.7 years (5.6) and the female percentage of 50.8%. The prevalence of chronic pain in the elderly was 21.5%, and it was higher in the females than males. The proportions of each age subgroup were 65-74 (66.8%), 75-84 (29.4%), and ≥ 85 years (3.8%). Common causes of chronic pain were osteoarthritis (21.9%), spinal disorders (19.0%), peripheral vascular diseases (12.4%), and osteoporosis (11.4%). Non-steroidal anti-inflammatory drugs were the most common medication, followed by acetaminophen and opioids. The most commonly used opioid was morphine. The use of opioids increased with age. CONCLUSIONS This study delineated the causes of chronic pain and use of analgesics in a geriatric population, which may help further studies about this issue in the future.
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Affiliation(s)
- Yu-Ling Huang
- Department of Family Medicine, Madou Sin-Lau Hospital, Tainan, Taiwan
- Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Wen-Ing Tsay
- Division of Controlled Drugs, Food and Drug Administration, Ministry of Health and Welfare, Taiwan
| | - Shwu-Huey Her
- Division of Controlled Drugs, Food and Drug Administration, Ministry of Health and Welfare, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Kang-Ting Tsai
- Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chien-Cheng Huang
- Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Long-term mortality in older adults with chronic pain: a nationwide population-based study in Taiwan. Eur Geriatr Med 2019; 10:777-784. [PMID: 34652710 DOI: 10.1007/s41999-019-00228-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE This study was conducted to clarify the long-term mortality in the older population with chronic pain (CP), which is still unclear. METHODS We identified 17,568 older participants (aged ≥ 65 years) with CP and an identical number of comparison cohort without CP matched 1:1 by age and sex between 1996 and 2000 from the Taiwan National Health Insurance Research Database. Causes of CP, underlying comorbidities, living areas, and mortality were collected for analyses. The long-term mortality and the causes of mortality were compared between the two cohorts through follow-up since 2000 until 2015. RESULTS The mean age (± standard deviation) was 73.5 ± 5.7 years, and female participants comprised 55.1% in both cohorts. The most common causes of CP were osteoarthritis (24.2%), spinal disorders (22.4%), peripheral vascular diseases (14.0%), and osteoporosis (9.5%). Older participants with CP had an increased rate of long-term mortality compared to that among their counterparts without CP after adjusting for the underlying comorbidities and the causes of CP (adjusted hazard ratio [AHR]: 1.18; 95% confidence interval [CI] 1.14-1.21). The increased mortality rate was observed even after the follow-up of 6 years (AHR 1.15; 95% CI 1.10-1.20). No significant difference was observed in the causes of mortality between the two cohorts. The most common cause of mortality was malignancy, followed by cardiovascular and cerebrovascular diseases. CONCLUSIONS Chronic pain was associated with an increased rate of long-term mortality in the older population. Early detection and intervention for treating CP are suggested for this population.
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Risk of hyperglycemic crisis episode in diabetic patients with bipolar disorder: A nationwide population-based cohort study. J Affect Disord 2019; 257:281-286. [PMID: 31302516 DOI: 10.1016/j.jad.2019.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/05/2019] [Accepted: 07/04/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Suboptimal management of diabetes can lead to a hyperglycemic crisis episode (HCE), which could be further enhanced in the presence of bipolar disorder (BD) and the prescription of antipsychotics. This study aims to investigate the risk of HCE in diabetic patients with BD. Additionally, the duration of antipsychotic prescription on HCE risk is examined. METHODS Using the Taiwan National Health Insurance Research Database, 6099 diabetic patients with BD and 24,378 diabetic patients without BD matched by gender, age, index year, and Charlson Comorbidity Index score were enrolled between 1999 and 2010 and followed to the end of 2013. Participants who developed HCE during the follow-up period were identified. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence interval (CI) of the HCE incidence rate between two groups studied. RESULTS Diabetic patients with BD were associated with an increased risk of HCE compared with unaffected controls after adjusted for baseline demographics and duration of antipsychotic prescription (3.84 versus 2.71 per 1,000 person-years, HR: 1.41, 95% CI: 1.15-1.71). Also, this study revealed that male gender, more comorbidities, and a longer duration of antipsychotic prescription were potential risk factors for developing HCE. LIMITATIONS This study only deals with data on the duration of antipsychotic prescription, without showing the effects of different antipsychotics on HCE risk. CONCLUSION This study highlights the need to pay attention to the risk of HCE in diabetic patients with BD and the importance of careful prescription of antipsychotics to reduce the HCE incident.
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You JH, Song SO, Park SH, Park KH, Nam JY, Kim DW, Kim HM, Kim DJ, Lee YH, Lee BW. Trends in Hyperglycemic Crisis Hospitalizations and in- and out-of-Hospital Mortality in the Last Decade Based on Korean National Health Insurance Claims Data. Endocrinol Metab (Seoul) 2019; 34:275-281. [PMID: 31565880 PMCID: PMC6769342 DOI: 10.3803/enm.2019.34.3.275] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hyperglycemic crisis is a metabolic emergency associated with diabetes mellitus. However, accurate epidemiologic information on cases of hyperglycemic crisis in Korea remains scarce. We evaluated trends in hyperglycemic crisis hospitalizations and in- and out-of-hospital mortality in Korea. We also predicted future trends. METHODS We extracted claims data with hyperglycemic crisis as the principal diagnosis from the National Health Insurance Service database in Korea from January 2004 to December 2013. We investigated the numbers of claims with hyperglycemic crisis and identified trends in hyperglycemic crisis based on those claims data. We predicted future trends by statistical estimation. RESULTS The total annual number of claims of hyperglycemic crisis increased from 2,674 in 2004 to 5,540 in 2013. Statistical analysis revealed an increasing trend in hyperglycemic crisis hospitalizations (P for trend <0.01). In contrast, the hospitalization rate per 1,000 diabetes cases showed a decreasing trend (P for trend <0.01) during this period. The mortality rate per 1,000 diabetes cases also showed a decreasing trend (P for trend <0.0001). However, no distinct linear trend in the case-related fatality rate at <60 days over the last decade was observed. The predicted number of annual claims of hyperglycemic crisis will increase by 2030. CONCLUSION The number of hyperglycemic crisis hospitalizations in Korea increased in the last decade, although the hospitalization rate per 1,000 diabetes cases and mortality rate decreased. Also, the predicted number of annual claims will increase in the future. Thus, it is necessary to establish long-term healthcare policies to prevent hyperglycemic crisis.
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Affiliation(s)
- Ji Hong You
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sun Ok Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
| | - Se Hee Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Kyoung Hye Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Joo Young Nam
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Dong Wook Kim
- Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyun Min Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dong Jun Kim
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Yong Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Risk of diabetes mellitus in physicians: a nationwide study in Taiwan. BMC Public Health 2019; 19:1047. [PMID: 31383022 PMCID: PMC6683438 DOI: 10.1186/s12889-019-7403-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/30/2019] [Indexed: 02/08/2023] Open
Abstract
Background The heavy workload of physicians in Taiwan may contribute to poor lifestyles and increased risk for diabetes mellitus (DM). We conducted this study to determine the risk for DM among physicians in Taiwan. Methods We used the Taiwan National Health Insurance Research Database to identify 28,440 physicians and 56,880 comparisons (general population) matched at a ratio of 1:2 by age and sex. Participants who had been diagnosed with DM before 2007 were excluded. We compared the risk for DM between physicians and comparisons by following up since 2007 to 2013. Comparisons among physician subgroups were also performed. Results After adjustment for hypertension, hyperlipidemia, hyperuricemia, coronary artery disease, congestive heart failure, hyperthyroidism, hypothyroidism, and polycystic ovary syndrome, physicians had a lower risk for DM than the comparisons (adjusted odds ratio [AOR]: 0.75; 95% confidence interval [CI]: 0.68–0.82). In comparisons among physicians, emergency physicians (AOR: 2.21; 95% CI: 1.44–3.40) and surgeons (AOR: 1.26; 95% CI: 1.05–1.52) had a higher risk for DM than other specialists. Conclusions This study found that physicians have a lower risk for DM than the general population and emergency physicians and surgeons have a higher risk for DM than other specialists. Thus, more attention should be paid to the occupational health of these doctors.
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Affiliation(s)
- Lutz Heinemann
- Science Consulting in Diabetes GmbH,
Neuss, Germany
- Lutz Heinemann, PhD, Science-Consulting in
Diabetes GmbH, Geulenstr. 50, 40462 Neuss, Germany.
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Longo M, Bellastella G, Maiorino MI, Meier JJ, Esposito K, Giugliano D. Diabetes and Aging: From Treatment Goals to Pharmacologic Therapy. Front Endocrinol (Lausanne) 2019; 10:45. [PMID: 30833929 PMCID: PMC6387929 DOI: 10.3389/fendo.2019.00045] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/21/2019] [Indexed: 12/13/2022] Open
Abstract
Diabetes is becoming one of the most widespread health burning problems in the elderly. Worldwide prevalence of diabetes among subjects over 65 years was 123 million in 2017, a number that is expected to double in 2045. Old patients with diabetes have a higher risk of common geriatric syndromes, including frailty, cognitive impairment and dementia, urinary incontinence, traumatic falls and fractures, disability, side effects of polypharmacy, which have an important impact on quality of life and may interfere with anti-diabetic treatment. Because of all these factors, clinical management of type 2 diabetes in elderly patients currently represents a real challenge for the physician. Actually, the optimal glycemic target to achieve for elderly diabetic patients is still a matter of debate. The American Diabetes Association suggests a HbA1c goal <7.5% for older adults with intact cognitive and functional status, whereas, the American Association of Clinical Endocrinologists (AACE) recommends HbA1c levels of 6.5% or lower as long as it can be achieved safely, with a less stringent target (>6.5%) for patients with concurrent serious illness and at high risk of hypoglycemia. By contrast, the American College of Physicians (ACP) suggests more conservative goals (HbA1c levels between 7 and 8%) for most older patients, and a less intense pharmacotherapy, when HbA1C levels are ≤6.5%. Management of glycemic goals and antihyperglycemic treatment has to be individualized in accordance to medical history and comorbidities, giving preference to drugs that are associated with low risk of hypoglycemia. Antihyperglycemic agents considered safe and effective for type 2 diabetic older patients include: metformin (the first-line agent), pioglitazone, dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists. Insulin secretagogue agents have to be used with caution because of their significant hypoglycemic risk; if used, short-acting sulfonylureas, as gliclazide, or glinides as repaglinide, should be preferred. When using complex insulin regimen in old people with diabetes, attention should be paid for the risk of hypoglycemia. In this paper we aim to review and discuss the best glycemic targets as well as the best treatment choices for older people with type 2 diabetes based on current international guidelines.
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Affiliation(s)
- Miriam Longo
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppe Bellastella
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Maria Ida Maiorino
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Juris J. Meier
- Diabetes Division, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Katherine Esposito
- Diabetes Unit, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Dario Giugliano
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
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Kao Y, Feng IJ, Hsu CC, Wang JJ, Lin HJ, Huang CC. Association of hyperglycemic crisis with an increased risk of end-stage renal disease: A nationwide population-based cohort study. Diabetes Res Clin Pract 2018; 138:106-112. [PMID: 29409767 DOI: 10.1016/j.diabres.2018.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/23/2017] [Accepted: 01/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND A hyperglycemic crisis episode (HCE) is associated with poor management of diabetes, which is a risk factor for end-stage renal disease (ESRD); however, the association between an HCE and ESRD has not been clarified. We conducted a nationwide population-based cohort study with the purpose of delineating this issue. METHODS We identified 9208 diabetic patients with an HCE and an identical number of diabetic patients with matched age, sex, and index date without an HCE between 2000 and 2002. A comparison of the risk of ESRD between the diabetic patients with and without an HCE was achieved by a follow-up until 2014. RESULTS A Cox proportional hazard regression analysis showed that the diabetic patients with an HCE were at a higher risk of ESRD than those without an HCE (the adjusted hazard ratio [AHR]: 1.47; 95% confidence interval [CI]: 1.34-1.62) by adjusting for renal disease, hypertension, hyperlipidemia, coronary artery disease, hyperuricemia, anemia, chronic obstructive pulmonary disease, liver disease, malignancy, connective tissue disease, non-steroid anti-inflammatory drug use, and monthly income. The increased risk of ESRD was more prominent in the age subgroup of 15-25 years (AHR: 4.91; 95% CI: 1.92-12.56); 25-35 years (AHR: 2.42; 95% CI: 1.51-3.86); 35-45 years (AHR: 3.01; 95% CI: 2.21-4.09); and 45-55 years (AHR: 1.75; 95% CI: 1.41-2.19). CONCLUSIONS An HCE was associated with an increased risk of ESRD, especially in the younger diabetic patients (15-55 years). A close follow-up for the control of diabetes and for monitoring renal function is proposed.
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Affiliation(s)
- Yuan Kao
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - I-Jung Feng
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan; Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Bachelor Program of Senior Service, Southern Taiwan University of Science and Technology, Tainan, Taiwan; Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan; Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
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Quartuccio M, Buta B, Kalyani RR. Comparative Effectiveness for Glycemic Control in Older Adults with Diabetes. CURRENT GERIATRICS REPORTS 2017; 6:175-186. [PMID: 28920012 PMCID: PMC5585298 DOI: 10.1007/s13670-017-0215-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW To review and summarize the current data for comparative effectiveness of glycemic control in older adults. RECENT FINDINGS In the last several years, professional societies have released guidelines for glycemic control in older adults, generally recommending individualized HbA1c goals. However, recent observational studies demonstrate that many older adults remain aggressively managed and are at increased risk of hypoglycemia. Large randomized trials of older adults with diabetes have failed to show cardiovascular benefit from intensive glycemic control and show only minimal microvascular benefit. Additionally, a few studies suggest that suboptimal glycemic control can increase the risk for geriatric syndromes. Emerging research suggests similar safety and efficacy of glucose-lowering therapies in older versus younger adults. SUMMARY Overall, there is a paucity of data supporting the benefit of intensive glycemic control in older adults. More research is needed in this vulnerable population.
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Affiliation(s)
- Michael Quartuccio
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287 USA
| | - Brian Buta
- Department of Medicine, Johns Hopkins University, Baltimore, MD USA
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD USA
| | - Rita Rastogi Kalyani
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287 USA
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD USA
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Wu CJ, Huang CC, Weng SF, Chen PJ, Hsu CC, Wang JJ, Guo HR, Lin HJ. Septic arthritis significantly increased the long-term mortality in geriatric patients. BMC Geriatr 2017; 17:178. [PMID: 28793879 PMCID: PMC5550948 DOI: 10.1186/s12877-017-0561-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 07/23/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The elderly are predisposed to septic arthritis (SA) because of the aging nature and increasing comorbidities. SA may in turn increase the long-term mortality in the geriatric patients; however, it remains unclear. We conducted this prospective nationwide population-based cohort study to clarify this issue. METHODS Using Taiwan National Health Insurance Research Database (NHIRD), we identified 1667 geriatric participants (≥ 65 years) with SA and 16,670 geriatric participants without SA matched at a ratio of 1:10 by age, sex, and index date between 1999 and 2010. A comparison of the long-term mortality between the two cohorts through follow-up until 2011 was performed. RESULTS Geriatric participants with SA had a significantly increased mortality than those without SA [Adjusted hazard ratio (AHR): 1.49, 95% confidence interval (CI): 1.34-1.66], particularly the old elderly (≥ 85 years, AHR: 2.12, 95% CI: 1.58-2.84) and males (AHR: 1.54, 95% CI: 1.33-1.79). These results were stated after adjustment for osteoarthritis, diabetes, gout, renal disease, liver disease, cancer, rheumatoid arthritis, systemic lupus erythematosus, alcoholism, and human immunodeficiency virus infection. The increased mortality risk was highest in the first month (AHR: 3.93, 95% CI: 2.94-5.25) and remained increased even after following up for 2-4 years (AHR: 1.30, 95% CI: 1.03-1.65). After Cox proportional hazard regression analysis, SA (AHR: 1.37, 95% CI: 1.20-1.56), older age (≥ 85 years, AHR: 1.79, 95% CI: 1.59-2.02, 75-84 years, AHR: 1.65, 95% CI: 1.53-1.78), male sex, diabetes, renal disease, liver disease, cancer, and gout were independent mortality predictors. There was no significant difference in the mortality for SA between upper limb affected and lower limb affected. CONCLUSIONS This study delineated that SA significantly increased the long-term mortality in geriatric participants. For the increasing aging population worldwide, strategies for the prevention and treatment of SA and concomitant control of comorbidities are very important.
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Affiliation(s)
- Chia-Jung Wu
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710 Taiwan
- Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710 Taiwan
- Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan
- Bachelor Program of Senior Service, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ping-Jen Chen
- Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan
- Bachelor Program of Senior Service, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Palliative Care Center, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710 Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710 Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
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Fayfman M, Pasquel FJ, Umpierrez GE. Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. Med Clin North Am 2017; 101:587-606. [PMID: 28372715 PMCID: PMC6535398 DOI: 10.1016/j.mcna.2016.12.011] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are the most serious and life-threatening hyperglycemic emergencies in diabetes. DKA is more common in young people with type 1 diabetes and HHS in adult and elderly patients with type 2 diabetes. Features of the 2 disorders with ketoacidosis and hyperosmolality may coexist. Both are characterized by insulinopenia and severe hyperglycemia. Early diagnosis and management are paramount. Treatment is aggressive rehydration, insulin therapy, electrolyte replacement, and treatment of underlying precipitating events. This article reviews the epidemiology, pathogenesis, diagnosis, and management of hyperglycemic emergencies.
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Affiliation(s)
- Maya Fayfman
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, 69 Jesse Hill Jr. Drive Southeast, 2nd Floor, Atlanta, GA 30303, USA
| | - Francisco J Pasquel
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, 69 Jesse Hill Jr. Drive Southeast, 2nd Floor, Atlanta, GA 30303, USA
| | - Guillermo E Umpierrez
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, 69 Jesse Hill Jr. Drive Southeast, 2nd Floor, Atlanta, GA 30303, USA.
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Affiliation(s)
- Rita R Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University, Baltimore, MD .,Center on Aging and Health, The Johns Hopkins University, Baltimore, MD.,Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD
| | - Sherita H Golden
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University, Baltimore, MD.,Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD
| | - William T Cefalu
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
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Appel SJ. Extreme hyperglycemia and hyperosmolar hyperglycemic syndrome. Nurse Pract 2016; 41:1-4. [PMID: 27861271 DOI: 10.1097/01.npr.0000508175.20325.ca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Susan J Appel
- Susan J. Appel is a professor at Capstone College of Nursing, University of Alabama, Tuscaloosa, Ala
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Nathaniel TI, Cochran T, Chaves J, Fulmer E, Sosa C, Yi S, Fredwall M, Sternberg S, Blackhurst D, Nelson A, Leacock R. Co-morbid conditions in use of recombinant tissue plasminogen activator (rt-PA) for the treatment of acute ischaemic stroke. Brain Inj 2016; 30:1261-5. [DOI: 10.1080/02699052.2016.1186840] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Er KC, Hsu CY, Lee YK, Huang MY, Su YC. Effect of glycemic control on the risk of pancreatic cancer: A nationwide cohort study. Medicine (Baltimore) 2016; 95:e3921. [PMID: 27311001 PMCID: PMC4998487 DOI: 10.1097/md.0000000000003921] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although the relationship between diabetes and pancreatic cancer has been studied, the effects of glycemic control on pancreatic cancer have never been evaluated. This study investigates the relationship between glycemic control and pancreatic cancer.Data from 1 million National Health Insurance beneficiaries were screened. The study cohort consisted of 46,973 diabetic patients and 652,142 nondiabetic subjects. Of the patients with diabetes, 1114 who had been admitted for hyperglycemic crisis episodes were defined as having poorly controlled diabetes. All adult beneficiaries were followed from January 1, 2005 to December 31, 2013, to determine whether pancreatic cancer was diagnosed. The Cox regression model was applied to compare the adjusted hazards for potential confounders.After controlling for age, sex, urbanization level, socioeconomic status, chronic liver disease, hypertension, coronary artery disease, hyperlipidemia, malignancies, smoking, chronic obstructive pulmonary disease, obesity, history of alcohol intoxication, chronic renal insufficiency, biliary tract disease, chronic pancreatitis, Charlson Comorbidity Index score, and high-dimensional propensity score, the adjusted hazard ratio of pancreatic cancer was 2.53 (95% confidence interval 1.96-3.26) in patients with diabetes. In diabetic patients with poor glycemic control, the hazard ratio of pancreatic cancer was significantly higher (hazard ratio 3.61, 95% confidence interval 1.34-9.78).This cohort study reveals a possible relationship between diabetes and pancreatic cancer. Moreover, poorly controlled diabetes may be associated with a higher possibility of pancreatic cancer.
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Affiliation(s)
- Kian-Ching Er
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Chen-Yang Hsu
- Department of Public Heath, National Taiwan University, Taipei, Taiwan
| | - Yi-Kung Lee
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Ming-Yuan Huang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yung-Cheng Su
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
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Engelmann J, Manuwald U, Rubach C, Kugler J, Birkenfeld AL, Hanefeld M, Rothe U. Determinants of mortality in patients with type 2 diabetes: a review. Rev Endocr Metab Disord 2016; 17:129-37. [PMID: 27068710 DOI: 10.1007/s11154-016-9349-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
UNLABELLED We aimed to review and summarize the evidence from accomplished trials analyzing factors influencing mortality in patients with T2DM and to provide some recommendations for targets and treatment in the European region. The following databases were searched for relevant trials: PubMed and the Cochrane Library. Of 3.806 citations, 134 trials met our inclusion criteria. RESULTS The reduction in lifetime for 65 + -years-old patients having less than 10 years T2DM amounts to 1.8 years. Having T2DM for more than 10 years lifetime will be reduced by 2.7 years. However, the lifetime shortening factor of T2DM will even be stronger for 40 + -years-old patients at onset. Males will lose 11.6 years of life and 18.6 QUALYs. T2DM among females will reduce life by 14 QUALYs by 22 years. From a statistical point of view, the highest mortality rate will occur in an over 55-years-old European smoking and non-compliant diabetic woman with alcohol abuse living in a rural area with a low level of education and a low socio-economic status. Furthermore, other co-morbidities such as cardiovascular diseases, gout, and depression affect mortality. Additionally, mortality will increase with a BMI over 35 and also with a BMI under 20-25. This refers to the obesity paradox indicating a higher mortality rate among normal weight patients with T2DM compared to overweight patients with T2DM. HbA1c-levels between 6.5 % and 7 % are associated with the lowest impact on mortality.
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Affiliation(s)
- Jana Engelmann
- Health Sciences/Public Health, Faculty of Medicine, TUD, Fetscherstraße 74, D-01307, Dresden, Germany
| | - Ulf Manuwald
- Health Sciences/Public Health, Faculty of Medicine, TUD, Fetscherstraße 74, D-01307, Dresden, Germany
| | - Constanze Rubach
- Health Sciences/Public Health, Faculty of Medicine, TUD, Fetscherstraße 74, D-01307, Dresden, Germany
| | - Joachim Kugler
- Health Sciences/Public Health, Faculty of Medicine, TUD, Fetscherstraße 74, D-01307, Dresden, Germany
| | - Andreas L Birkenfeld
- Medical Clinic III, University Clinic, Faculty of Medicine, TUD, Fetscherstraße 74, D-01307, Dresden, Germany
- Study Center Prof. Hanefeld, Research for Metabolic Vascular Syndrome, GWT-TUD GmbH, Fiedlerstraße 34, D-01307, Dresden, Germany
| | - Markolf Hanefeld
- Study Center Prof. Hanefeld, Research for Metabolic Vascular Syndrome, GWT-TUD GmbH, Fiedlerstraße 34, D-01307, Dresden, Germany
| | - Ulrike Rothe
- Health Sciences/Public Health, Faculty of Medicine, TUD, Fetscherstraße 74, D-01307, Dresden, Germany.
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Kao Y, Hsu CC, Weng SF, Lin HJ, Wang JJ, Su SB, Huang CC, Guo HR. Subsequent mortality after hyperglycemic crisis episode in the non-elderly: a national population-based cohort study. Endocrine 2016; 51:72-82. [PMID: 26115971 DOI: 10.1007/s12020-015-0669-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/16/2015] [Indexed: 01/14/2023]
Abstract
Hyperglycemic crisis episodes (HCEs)-diabetic ketoacidosis and the hyperosmolar hyperglycemic state-are the most serious acute metabolic complications of diabetes. We aimed to investigate the subsequent mortality after HCE in the non-elderly diabetic which is still unclear. This retrospective national population-based cohort study reviewed, in Taiwan's National Health Insurance Research Database, data from 23,079 non-elder patients (≤65 years) with new-onset diabetes between 2000 and 2002: 7693 patients with HCE and 15,386 patients without HCE (1:2). Both groups were compared, and follow-up prognoses were done until 2011. One thousand eighty-five (14.1%) patients with HCE and 725 (4.71%) patients without HCE died (P < 0.0001) during follow-up. Incidence rate ratios (IRR) of mortality were 3.24 times higher in patients with HCE than in patients without HCE (P < 0.0001). Individual analysis of diabetic ketoacidosis and hyperosmolar hyperglycemic state also showed the similar result with combination of both. After stratification by age, mortality was significant higher in the middle age (40-64 years) [IRR 3.29; 95% confidence interval (CI) 2.98-3.64] and young adult (18-39 years) (IRR 3.91; 95% CI 3.28-4.66), but not in the pediatric subgroup (<18 years) (IRR 1.28; 95% CI 0.21-7.64). The mortality risk was highest in the first month (IRR 54.43; 95% CI 27.98-105.89), and still high after 8 years (IRR 2.05; 95% CI 1.55-2.71). After adjusting for age, gender, and selected comorbidities, the mortality hazard ratio for patients with HCE was still four times higher than for patients without HCE. Moreover, older age, male gender, stroke, cancer, chronic obstructive pulmonary disease, congestive heart failure, and liver disease were independent mortality predictors. HCE significantly increases the subsequent mortality risk in the non-elderly with diabetes. Strategies for prevention and control of comorbidities are needed as soon as possible.
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Affiliation(s)
- Yuan Kao
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Shih-Feng Weng
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Shih-Bin Su
- Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.
- Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, No.1, Daxue Rd., East Dist., Tainan City, 701, Taiwan.
- Department of Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
- Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan.
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, No.1, Daxue Rd., East Dist., Tainan City, 701, Taiwan.
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
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Lee YK, Huang MY, Hsu CY, Su YC. Bidirectional Relationship Between Diabetes and Acute Pancreatitis: A Population-Based Cohort Study in Taiwan. Medicine (Baltimore) 2016; 95:e2448. [PMID: 26765434 PMCID: PMC4718260 DOI: 10.1097/md.0000000000002448] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The proposed bidirectional relationship between acute pancreatitis (AP) and diabetes has never been examined with the same source of data. Furthermore, the effects of disease severity on this relationship have not been fully evaluated. The present study employed the findings from a single database to measure the strength of the association between AP and diabetes.Findings from 1 million National Health Insurance beneficiaries were utilized. Two cohort studies with this database were selected to evaluate the linkage between diabetes and AP. The first cohort analysis addressed the risk of AP among diabetic patients and was comprised of 42,080 diabetic patients and 672,146 unexposed subjects. The second cohort analysis considered the risk of diabetes among patients with AP and enrolled 3187 patients with AP and 709259 unexposed subjects. All adult beneficiaries were followed from January 1, 2005 to December 31, 2012 to identify outcomes of interest. Cox regression models were applied to compare hazards adjusted for potential confounders.For the first cohort, the adjusted hazard ratio (HR) of AP was significantly increased by the presence of diabetes (1.72; 95% confidence interval [CI], 1.52-1.96). In diabetic patients with a history of hyperglycemic crisis episodes (HCEs), the HR was even higher (6.32; 95% CI, 4.54-8.81). For the second cohort, the adjusted HR of diabetes in patients with AP was increased compared to the general population (2.15; 95% CI, 1.92-2.41). For patients with severe AP, the HR was also higher (2.22; 95% CI, 1.50-3.29) but did not differ significantly from that for patients with nonsevere AP.The 2 cohort studies provided evidence for the bidirectional relationship between diabetes and AP. Moreover, diabetic patients with history of HCEs may be associated with higher risk of AP.
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Affiliation(s)
- Yi-Kung Lee
- From the School of Medicine, Tzu Chi University, Hualien, Taiwan, R.O.C. (Y-KL, Y-CS); Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, R.O.C. (Y-KL, Y-CS); Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C. (M-YH); and Department of Public Heath, National Taiwan University, Taipei, Taiwan, R.O.C. (C-YH)
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