Presence and Risk Factors for Glaucoma in Patients with Diabetes

Diabetes mellitus represents a growing international public health issue with a near quadrupling in its worldwide prevalence since 1980. Though it has many known microvascular complications, vision loss from diabetic retinopathy is one of the most devastating for affected individuals. In addition, there is increasing evidence to suggest that diabetic patients have a greater risk for glaucoma as well. Though the pathophysiology of glaucoma is not completely understood, both diabetes and glaucoma appear to share some common risk factors and pathophysiologic similarities with studies also reporting that the presence of diabetes and elevated fasting glucose levels are associated with elevated intraocular pressure—the primary risk factor for glaucomatous optic neuropathy. While no study has completely addressed the possibility of detection bias, most recent epidemiologic evidence suggests that diabetic populations are likely enriched with glaucoma patients. As the association between diabetes and glaucoma becomes better defined, routine evaluation for glaucoma in diabetic patients, particularly in the telemedicine setting, may become a reasonable consideration to reduce the risk of vision loss in these patients.     

Perioperative Management of Patients with Diabetes Undergoing Ambulatory Elective Surgery

Objective

The objective was to assess processes of care for patients with diabetes undergoing elective surgery.

Methods

A retrospective review of medical records was conducted to determine frequency of perioperative glucose monitoring, changes in glucose control, and treatment of intraoperative hyperglycemia.

Results

A total of 268 patients underwent 287 elective procedures. Mean age was 67 years, 63% were men, 97% had type 2 diabetes, and most (57%) were treated with oral hypoglycemic agents. Average perioperative time was approximately 8 h. Mean preoperative hemoglobin A1c was 7.0%; however, this value was checked in only 52% of cases. A glucose measurement was obtained in 89% of cases in the preoperative area and in 87% in the postanesthesia care unit, but in only 33% of cases did a value get checked intraoperatively. Average glucose was 139 mg/dl preoperatively, increasing to 166 mg/dl postoperatively (p <.001). Glucose levels increased regardless of type of outpatient medical therapy used to treat hyperglycemia, except for those on combination oral agents plus insulin (p =.06).

Conclusions

These data indicate suboptimal documentation of outpatient hemoglobin A1c. Intraoperative glucose monitoring seldom occurred, despite prolonged periods under anesthesia and perioperative deterioration of glycemic control. Standards need to be developed and interventions are needed to enhance management of diabetes patients undergoing elective procedures.     

加强糖尿病患者的多重危险因素综合防治

糖尿病患者的心血管并发症是影响糖尿病患者预后的主要因素。糖尿病患者常常并存多重危险因素。综合防治高血糖、高血压、高血脂等动脉粥样硬化性心血管疾病的多重危险因素,预防其心血管并发症,对糖尿病的防治具有重要临床意义。     

Risk of Postpartum Flare Hospitalizations in Patients with Inflammatory Bowel Disease Persists After Six Months

Digestive Diseases and Sciences - Although patients with IBD are at higher risk for flares during the postpartum period, little is known about the risk factors, timeline, and healthcare-associated...     

Comorbid Depression Is Associated with an Increased Risk of Dementia Diagnosis in Patients with Diabetes: A Prospective Cohort Study

BACKGROUND  

Both depression and diabetes have been found to be risk factors for dementia. This study examined whether comorbid depression in patients with diabetes increases the risk for dementia compared to those with diabetes alone.     

Risk of Cardiovascular Events after Infection-Related Hospitalizations in Older Patients on Dialysis

Summary

Background and objectives

Infection and cardiovascular disease are leading causes of hospitalization and death in patients on dialysis. The objective of this study was to determine whether an infection-related hospitalization increased the short-term risk of a cardiovascular event in older patients on dialysis.

Design, setting, participants, & measurements

With use of the United States Renal Data System, patients aged 65 to 100 years who started dialysis between January 1, 2000, and December 31, 2002, were examined. All hospitalizations were examined from study entry until time of transplant, death, or December 31, 2004. All discharge diagnoses were examined to determine if an infection occurred during hospitalization. Only principal discharge diagnoses were examined to ascertain cardiovascular events of interest. We used the self-controlled case-series method to estimate the relative incidence of a cardiovascular event within 90 days after an infection-related hospitalization as compared with other times not within 90 days of such a hospitalization.

Results

A total of 16,874 patients had at least one cardiovascular event and were included in the self-controlled case-series analysis. The risk of a cardiovascular event was increased by 25% in the first 30 days after an infection and was overall increased 18% in the 90 days after an infection-related hospitalization relative to control periods.

Conclusions

The first 90 days, and in particular the first 30 days, after an infection-related hospitalization is a high-risk period for cardiovascular events and may be an important timeframe for cardiovascular risk reduction, monitoring, and intervention in older patients on dialysis.     

护理干预对糖尿病患者焦虑抑郁的效果研究

目的研究护理干预对糖尿病患者焦虑抑郁的效果。方法选择2014年1月—2015年1月该院收治的糖尿病患者100例,采用随机数字表法分为实验组和对照组,对照组采用常规护理模式,实验组采用护理干预模式,比较两组改善患者焦虑抑郁、护理满意度、患者血糖水平情况。结果实验组护理满意度96.0%明显高于对照组64.0%,实验组SAS与SDS护理后评分明显低于对照组,实验组空腹血糖、餐后2 h血糖明显低于对照组,差异具有统计学意义(P0.05)。结论采用护理干预的护理模式能够有效提高护理效果,促进护患关系,对改善患者焦虑抑郁,改善血糖水平具有积极作用,值得临床推广使用。     

Assessing Cardiovascular Risk in Patients with Diabetes: An Update

The globalization of the Western lifestyle has resulted in increase of diabetes mellitus, a complex, multifactorial disease. Diabetes mellitus is a condition often related to the disorders of the cardiovascular system. It is well established that three quarters of diabetics, aged over 40, will die from cardiovascular disease and are more likely than non-diabetics to die from their first cardiovascular event. Therefore, it is of paramount importance to individualize treatment via risk stratification. Conditions that increase cardiovascular risk in people with diabetes include age more than 40 years, male gender, history of relative suffering from premature CHD, blood pressure and high LDL levels, presence of microalbuminuria, obstructive sleepapnea, erectile dysfunction and other conditions.Several models have been developed in order to assess cardiovascular risk in people with and without diabetes. Some of them have been proven to be inadequate while others are widely used for years. An emerging way of risk assessment in patients with diabetes mellitus is the use of biomarkers but a lot of research needs to be done in this field in order to have solid conclusions.     

Relationship Between Primary Care Physician Visits and Hospital/Emergency Use for Uncomplicated Hypertension,an Ambulatory Care-Sensitive Condition

BackgroundHospitalizations for ambulatory care-sensitive conditions (ACSCs) represent an indirect measure of access and quality of community care. The purpose of this study was to examine the association between one ACSC, uncomplicated hypertension, and previous primary care physician (PCP) utilization.MethodsA cohort of patients with hypertension was identified using administrative databases in Alberta between fiscal years 1994 and 2008. We applied the Canadian Institute for Health Information's case definition to detect patients with uncomplicated hypertension as the most responsible reason for hospitalization and/or Emergency Department (ED) visit. We assessed hypertension-related and all-cause PCP visits.ResultsThe overall adjusted rate of ACSC hospitalizations and ED visits for uncomplicated hypertension was 7.1 and 13.9 per 10,000 hypertensive patients, respectively. The likelihood of ACSC hospitalization for uncomplicated hypertension was associated with age, household income quintile, region of residence, and Charlson comorbidity status (all P < 0.0001). The adjusted rate of ACSC hospitalizations for uncomplicated hypertension increased from 4.8 per 10,000 hypertensive patients for those without hypertension-related PCP visits before diagnosis to 10.5 per 10,000 hypertensive patients for those with 5 or more hypertension-related PCP visits. The rate of ACSC hospitalizations and/or ED visits for uncomplicated hypertension increased as the number of hypertension-related PCP visits increased even after stratifying according to demographic and clinical characteristics.ConclusionsAs the frequency of hypertension-related PCP visits increased, the rate of ACSC hospitalizations and/or ED visits for uncomplicated hypertension increased. This suggests that ACSC hospitalization for uncomplicated hypertension might not be a particularly good indicator for access to primary care.     

优质护理服务在住院抑郁症合并糖尿病患者护理中的应用

目的 分析优质护理服务在住院抑郁症合并糖尿病患者护理中的应用及效果.方法 将2019年1月—2020年3月纳入该院治疗的64例抑郁症合并糖尿病患者作为研究对象,采取随机方法分组为对照组(32例)、研究组(32例),给予对照组临床常规护理干预,给予研究组优质护理服务,对比两组护理应用及效果.结果 接受护理后,研究组患者的...     

Dual Medicare and Veteran Health Administration Use and Ambulatory Care Sensitive Hospitalizations

OBJECTIVE

The objective of the study is to examine the association between ambulatory care sensitive hospitalizations (ACSH) and dual Medicare/Veteran Health Administration use.

PARTICIPANTS

A nationally representative sample of Medicare beneficiaries, who participated in the Medicare Current Beneficiary Survey (MCBS).

DESIGN/MEASUREMENTS

Cross-sectional analyses (

RESULTS

Among inpatient users, 10.1% had ACSH events for acute conditions and 15.8% for chronic conditions. Among all survey respondents, 5% had any ACSH event. Among predominant-VHA users the rate was 4.9% and among veterans with some VHA use it was 3.7%. In bivariate and multivariate analyses, dual Medicare/VHA use was not significantly associated with any ACSH.

CONCLUSION

In a representative sample of Medicare beneficiaries, despite low income and health status, veterans with dual Medicare/VHA use were as likely as veterans without dual use to have any ACSH, perhaps due to expanded healthcare access and emphasis on primary care in the VHA system.

     

Risk Factors for Hypoxemia During Ambulatory Gastrointestinal Endoscopy in ASA I–II Patients

Background Most studies identify the American Society of Anesthesiology (ASA) classification as the most significant risk factor for hypoxemia. The risk factors operative within ASA I and II patients are not well defined. Therefore, we analyzed prospectively collected data to identify the risk factors of hypoxemia in such patients. Methods A combination of a narcotic and benzodiazepine was used for sedation and oxygen was supplemented if hypoxemia (oxygen saturation ≤90%) developed. Univariate and multivariate analyses were performed and correlations estimated for predetermined clinical variables. Results 40 of 79 patients (51%) developed hypoxemia, which occurred more frequently in the obese (71%; 10/14) than the nonobese (46%; 30/65) group (P = 0.08). On multivariate analysis, the odds ratios (OR) and 95% confidence intervals (CI) for developing hypoxemia were age ≥ 60 years 4.5 (1.4–14.3) P = 0.01, and incremental 25-mg doses of meperidine 2.6 (1.02–6.6) P = 0.04. Body mass index (BMI) significantly correlated with the number of hypoxemic episodes (rho 0.26, 95% CI 0.04–0.48, P = 0.02). Conclusion In ASA I and II patients, BMI significantly correlated with the number of hypoxemic episodes, whereas age ≥ 60 years and meperidine dose were significant risk factors for hypoxemia.     

血糖控制不佳的2型糖尿病患者心血管病风险分析

目的评估比较血糖控制良好和控制不佳的2型糖尿病患者未来10年心血管病风险及相关危险因素。方法收集本院内分泌科住院的2型糖尿病患者549例,根据其入院次日空腹糖化血红蛋白(HbA1c)测定结果,分为血糖控制不佳组(HbA1c>7%) 408例和血糖控制良好组(HbA1c≤7.0%) 141例,监测两组年龄、性别、现居地、吸烟史、饮酒史、个人疾病史、体重指数、腰围、收缩压、舒张压、血糖、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白和纤维蛋白原等指标,并应用Framingham风险评估模型和China-PAR模型预测患者未来10年的心血管病发病风险。结果血糖控制不佳组收缩压、舒张压、空腹血糖、总胆固醇和低密度脂蛋白胆固醇平均值差异有统计学意义(P<0.05)。Framingham风险评估模型和China-PAR模型结果提示:血糖控制良好的2型糖尿病患者大多属于心血管病低、中风险,血糖控制不佳的2型糖尿病患者大多属于心血管病高风险。结论血糖控制不佳的糖尿病患者应更加注意心血管病危险因素的监测与控制,以降低其心血管病风险。     

Diabetes and Depression

Diabetes and depression occur together approximately twice as frequently as would be predicted by chance alone. Comorbid diabetes and depression are a major clinical challenge as the outcomes of both conditions are worsened by the other. Although the psychological burden of diabetes may contribute to depression, this explanation does not fully explain the relationship between these 2 conditions. Both conditions may be driven by shared underlying biological and behavioral mechanisms, such as hypothalamic-pituitary-adrenal axis activation, inflammation, sleep disturbance, inactive lifestyle, poor dietary habits, and environmental and cultural risk factors. Depression is frequently missed in people with diabetes despite effective screening tools being available. Both psychological interventions and antidepressants are effective in treating depressive symptoms in people with diabetes but have mixed effects on glycemic control. Clear care pathways involving a multidisciplinary team are needed to obtain optimal medical and psychiatric outcomes for people with comorbid diabetes and depression.