Diabetes research and clinical practice
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Diabetes Res. Clin. Pract. · Jul 2007
Undertreatment of cardiovascular risk factors among persons with diabetes in the United States.
We examined the extent of control of cardiovascular risk factors and distance from goal for those with uncontrolled levels in a recent sample of U.S. adults with diabetes. ⋯ Many U.S. adults with diabetes have sub-optimal control of cardiovascular risk factors and remain far from target goals for BP, lipids and A1C, even if on treatment.
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We have investigated predictive value of HbA1c for hospital mortality and length of stay (LOS) in patients with type 2 diabetes admitted because of sepsis. A prospective observational study was implemented in a university hospital, 286 patients with type 2 diabetes admitted with sepsis were included. Leukocyte count, CRP, admission plasma glucose, APACHE II and SOFA score were noted at admission, HbA1c was measured on the first day following admission. ⋯ Logistic regression showed that HbA1c is an independent predictor of hospital mortality (odds ratio 1.36), together with female sex (OR 2.24), APACHE II score (OR 1.08) and SOFA score (OR 1.28). Multiple regression showed that HbA1c and APACHE II score are independently related to hospital LOS. According to our results, HbA1c is an independent predictive factor for hospital mortality and hospital LOS of diabetic patients with sepsis.
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Diabetes Res. Clin. Pract. · Jul 2007
Total and excess bed occupancy by age, specialty and insulin use for nearly one million diabetes patients discharged from all English Acute Hospitals.
To investigate total diabetes bed occupancy and prolonged inpatient length of stay (LOS) in all English Acute Hospitals, we analysed hospital episode statistics (HES) discharge data for all English Acute Hospitals over 4 years for ICD10 discharge codes of E10 ('insulin-dependent diabetes') or E11 ('non-insulin dependent diabetes') by age-band (18-60, 61-75 and >75 years) and specialties. We matched these data to control discharges without these codes. There were 943,613 diabetes discharges (6,508,668 bed days) and 10,724,414 matched controls. ⋯ Excess diabetes LOS is concentrated in younger age groups. Excess bed occupancy due to prolonged LOS in medical and surgical inpatients is three times greater than bed occupancy due to diabetic ketoacidosis. Strategies to reduce excess diabetes bed occupancy should emphasize reducing inpatient LOS in younger inpatients.
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Diabetes Res. Clin. Pract. · Jul 2007
Treatment of diabetic ketoacidosis in adults in Denmark: a national survey.
The aims of this study were to investigate management routines of diabetic ketoacidosis (DKA) in adult patients in departments of internal medicine in Denmark and to relate current routines of treatment to available evidence. A questionnaire requesting information on management routines of DKA was sent to all departments of internal medicine in Denmark responsible of managing DKA. Fifty-nine departments (88%) returned the questionnaire and/or a copy of their management protocol. ⋯ This study shows significant variations in management routines of DKA in Denmark. In many cases, the treatment routines employed are not supported by evidence from clinical trials. We recommend implementation of national and/or European guidelines for management of DKA in adult patients.