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Adult vaccination is an accepted part of health care and diabetes care. In spite of evidence regarding the efficacy and utility of vaccination in preventing disease, we continue to encounter vaccine hesitancy and vaccine skepticism. As physicians, it is our duty to encourage the public to get vaccinated. In this article, we create a simple framework which helps assess the barriers to vaccine acceptance, and create bridges to overcome vaccine hesitancy and skepticism. We use an interesting mnemonic, NARCO, to remind ourselves, and our readers, of the appropriate hierarchy of interviewing related to vaccine acceptance.
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Physicians , Vaccination Hesitancy , Adult , Humans , Health Facilities , Memory , Vaccination , Primary Health CareABSTRACT
Background: In Mexico, diabetes mellitus (DM) and diseases cardiovascular, register an upward trend. Objective: To estimate the number of complications due to cardiovascular events (CVD) and complications derived from DM (CDM) accumulated in beneficiaries of the Mexican Institute of Social Security (IMSS) from 2019 to 2028, as well as the expense for medical and economic benefits in a scenario baseline and one of change in metabolic profile due to lack of medical follow-up during the COVID-19 pandemic. Material and methods: The number of CVD and CDM was estimated from 2019, with a 10-year risk projection using the ESC CVD Risk Calculator and United Kingdom Prospective Diabetes Study, considering risk factors registered in the institutional databases. Results: From 2019 to 2028, cumulative CVD cases were estimated at 2 million and those of CDM in 960 thousand, with an impact on medical spending of 439,523 million pesos and on the economic benefits of 174,085 millions. When considering the COVID-19 pandemic, CVD events and CDM increased by 589 thousand, with an increase in spending of 93,787 million pesos for medical care and 41,159 million for economic benefits. Conclusions: Without a comprehensive intervention in the management of CVD and CDM, the cost by both diseases will continue to increase, with financial pressures getting older. Copyright © 2023 Revista Medica del Instituto Mexicano del Seguro Social.
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Hyperglycemia has become an urgent problem in new coronavirus infection as it is a predictor of a severe course and poor outcomes in both diabetic and non-diabetic patients. This article describes possible mechanisms of hyperglycemia development in new coronavirus infection COVID-19 taking into account peculiarities of pathogenesis and course of the disease, reproduction of SARS-CoV-2, and the ways for hyperglycemia correction by administering different insulin therapy regimens based on the review of national and foreign literature. © 2022 Tomsk State University. All rights reserved.
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Vaccine hesitancy is a common issue in many countries and is likely to hamper the fight against the COVID-19 pandemic. This reluctance is alarming in diabetic patients who are more prone to severe forms of the disease. The aim of this study was to determine the COVID-19 vaccination rate in a population of diabetics followed for their diabetes and to analyze the factors associated with vaccine hesitancy. This cross-sectional, multicenter study, was carried out over 3 months (January 1st-March 31, 2022) in five consultation centers in Abidjan, Ivory Coast. All 254 patients with diabetes who had a consultation were included. There were more women than men (56.3%) and more with under high school diploma (72.8%). Among them, 2% had COVID-19 once and 14% had relatives affected with COVID-19;63.8% knew the symptoms of COVID-19 and the media (TV and social networks) were the main source of information (81.9%). Among the patients included, 51.9% were not vaccinated against COVID-19;25.9% refused vaccination while 12.0% were hesitant due to their diabetes. The reasons for refusal were: fear of side effects, questionable effectiveness of the vaccine and fear of injections.Copyright © 2022 Elsevier Masson SAS
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Patients with COVID-19 are more susceptible to coinfections with fungi.The invasive fungal infection is commonly seen in immunocomprised and diabetics. Mucormycosis is a fatal disease with high mortality and morbidity. Hence, early diagnosis and management helps to prevent mortality.Our study is a Retrospective study. The main aim is to determine the epidemiology, risk factors, clinical presentation and diagnosis & management of fungal sinusitis and to determine the various microbiological species associated with post covid and non-covid patients. The study includes 70 suspected patients of mucormycosis.Out of which 52 were Post covid and 18 were Non covid persons. 64.2 % received steroids and 45.7 % received oxygen during COVID-19 management. Diabetes mellitus was the most common co-morbidity with 94% followed by hypertension. Sinonasal involvement were the most common site followed by orbit and facial pain(91.4%) was the most common presentation.Nasal and oral specimens were sent for KOH mount, fungal culture and sensitivity.The surgical procedure was carried out based on the clinical and radiological extent of the patient. The results concludes with culture positive Mucormycosis was found in 30(42.85%).Out of which Rhizopus was the predominant species in 22(31.42%) followed by Aspergillus 14(20%).The patients who underwent surgery were on routine follow-up for 6 monthsCopyright © 2023, Research Journal of Pharmaceutical, Biological and Chemical Sciences.All Rights Reserved.
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BACKGROUND: The coronavirus pandemic has had an extremely negative impact on the patients with diabetes mellitus (DM both in terms of a more severe course of COVID -19 and an increased risk of death. AIM: Analysis of risk factors for death due to COVID -19 in patients with DM type 1 and type 2 (DM1 and DM2). MATERIALS AND METHODS: Retrospective analysis of the database of the national diabetes register (NDR), which included DM patients with COVID-19 and reported virus infection outcome (recovery/or death) in 15 712 DM1 and 322 279 DM2 patients during a 2-year follow-up period (01/02/2020 to 03/04/2022) (discharge date)). RESULT(S): Case fatality rate in patients with DM, who underwent COVID -19 was 17.1% (DM1-8.8%;DM2-17.5%). As a result of multivariate regression analysis of seven significant factors in DM1 and thirteen in DM2 (evaluated by univariate anlisys), a number of the most important predictors of risk for fatal outcome were identified: in DM1 these were age >=65 years (OR =4.01, 95% CI: 1.42-11.36), presence of arterial hypertension (AH) (OR =2.72, 95% CI: 1.03 -7.16) and diabetic foot syndrome (DFS) (OR = 7.22, 95% CI: 1.98-26.29);for T2DM: age >= 65 years (OR =2.53, 95% CI: 1.96-3.27), male (OR =1.51, 95% CI: 1.23-1.84), duration DM >=10 years (OR =2.01, 95% CI: 1.61-2.51), BMI >= 30 kg/m2 (OR =1.26, 95% CI: 1.02-1.55), ASCVD/CKD (OR =1.49, 95% CI: 1.01-2.04), history of diabetic coma (OR =12.97, 95% CI: 1.89-88.99) and presence of disability (OR =1.40, 95% CI: 1.14-1.73). In T2DM, the type of antidiabetic therapy (ADT) prior to COVID -19 (last visit before the development of infection) had a significant impact: Insulin therapy (OR = 1.64, 95% CI: 1.30-2.07), sulfonylureas (SU) (OR =1.51, 95% CI: 1.23-1.84));dipeptidyl peptidase-4 inhibitor (iDPP-4) therapy (OR =0.57, 95% CI: 0.39-0.83) and sodium-glucose cotransporter-2 inhibitor (iSGLT2) therapy (OR =0.64, 95% CI: 0.46-0.88). Vaccination was the most important protective factor in both types of DM: DM1 OR =0.19, 95% CI: 0.06-0.59;SD2 OR =0.20, 95% CI: 0.16-0.26. CONCLUSION(S): The common risk factor for fatal outcome in both DM1 and DM2 was age >=65 years;in DM1 - history of hypertension and DFS, in DM2 - male sex, diabetes duration >=10 years, BMI >=30 kg/m2, history of ASCVD/CKD and diabetic coma, disability. In T2DM, significant differences in risk were observed depending on the type of ADT: insulin and SU therapy were factors that increased the risk of death, whereas therapy with iDPP-4 and iSGLT2 reduced the risk of death. Vaccination reduced the risk of death in DM1 and DM2 by 5.2 and 5-fold, respectively.Copyright © Endocrinology Research Centre, 2022.
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Family support in the treatment of diabetes has a substantial impact on the benefit of the health and quality of life of the patient, in this sense the article aims to determine the relationship between family support and quality of life perceived by the patient with Diabetes Mellitus type 2, in times of Covid-19, from the Chicama-Peru Level-I Primary Care Center. The study used the hypothetical-deductive method, a quantitative approach, with a non-experimental, descriptive-correlational cross-sectional design. It included 106 patients diagnosed with Type 2 Diabetes Mellitus of both sexes from the Chronic Noncommunicable Disease program. Two questionnaires were applied, one on family support and the other on quality of life and its dimensions. The results allowed us to demonstrate that family support (59.76%), physical dimension (53.66%) and social dimension (52.44%) were regularly perceived;Likewise, it is evident that the quality of life (62.20%), satisfaction dimension (74.39%), impact dimension (52.44%) and concern dimension (46.34%) are classified as good. It is concluded that although the relationship between family support and quality of life perceived by the patient with diabetes mellitus-2 was low, the emotional and social dimensions were significantly related to quality of life © 2023, Revista de Ciencias Sociales.All Rights Reserved.
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European cities should address the climate change challenges, improving quality of life and reducing costs. They need potential smart and digital approaches. Public health (PH) has recognized climate change as a major challenge. The development of urban policies should be guided by evidence-based PH practices. The environmental health determinants and the climate crisis now represent a clear PH threat. The core of the Smart City is sustainability, and its basic condition is active PH. The inclusion of public health into the pillars of the Smart City concept to contribute toward mitigating PH crises, such as the COVID-19 pandemic, is a framework for action. Design Science Research Methodology (DSRM) is used to elicit a Smart Public Health City (SPHEC) framework. A set of PH and smart city experts participated in the DSRM process, using diabetes as a case study. The European Green Deal served as a blueprint for this transformational change toward a healthier and more sustainable city. The SPHEC framework was defined by elucidating clearly the several dimensions of the PH functions within a digital city, via the identification of a set of digital PH services that are required to support the SPHEC framework. This allows for an assessment of the actual benefits that are obtained with the digital health services, and provides evidence for guiding decision-making. The role of digital PH services emerges from the analysis of the SPHEC framework, through the development of proper digital health services within the smart city, strengthening capacity and resilience in future climate emergencies, and motivating policy makers to take this challenge more seriously. © 2023 by the authors.
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Importance: The COVID-19 pandemic has led to increased utilization of telemedicine. Patients with diabetes are a vulnerable population that require regular treatment and monitoring. Little is known about the impact visit modality on diabetes outcomes in an ambulatory setting. Objective: Compare proportions of patients with diabetes with uncontrolled diabetes among those with telemedicine versus in-person only ambulatory visits and examine differences by age, race, gender, ethnicity, and insurance. Design: A retrospective cohort study. Setting : The largest academic healthcare system in the state of Georgia with ambulatory clinics in urban, suburban and rural settings. Participants : Adults with diabetes scheduled for an ambulatory primary or specialty clinic visit between May 2020 and May 2021 were included. Patients were compared among three visit groups: those with all in-person visits, those with one telemedicine visit, and those with 2+ telemedicine visits. Demographics including age, race, ethnicity, gender, insurance status, and comorbidities were extracted from the electronic medical record. Main Outcomes and Measures: The primary clinical outcome was uncontrolled diabetes, defined as HbAlc >= 9.0%. Chi-square test was used to determine crude differences in uncontrolled diabetes between visit groups. Multivariable logistic regression was used to assess differences in uncontrolled diabetes between visit groups following risk adjustment. Results: A total of 18,148 ambulatory clinic visits for patients with diabetes were scheduled during the study period, and 11.6% had uncontrolled diabetes. There was no difference in proportion of patients with uncontrolled diabetes between all in-person visits (834 (11.6%)), one telemedicine visit (558 (11.8%)), or 2+ telemedicine visits (709 (11.4%)) (p = 0.80). Patients with 2+ telemedicine visits had significantly lower odds of uncontrolled diabetes compared to all in-person visits after adjusting for age, gender, race, ethnicity, insurance status, and comorbidities (OR: 0.88;95% CI: 0.79 - 0.99, p = 0.03). Conclusions and Relevance: Telemedicine visits were associated with a lower odds of uncontrolled diabetes. Further work is warranted to explore the relationship between telemedicine visits, equitable access to care, and diabetes outcomes. Copyright © 2023 Annals of Family Medicine, Inc.
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The risk of severe type I diabetes mellitus in children with new coronavirus infection (COVID-19) is extremely high, which is associated, with a high risk of intracranial hypertension, cerebral edema and multiple organ dysfunction, syndrome. On the example of a clinical case, the features of the course of diabetic ketoacidosis and. intensive care measures in children with COVID-19 were considered. The main data of the history and clinical and laboratory examination are reflected, specialattention is paid to the applied aspects of therapy, it was noted that with a severe course of a new coronavirus infection and diabetic ketoacidosis, the risk of developing cerebral injury, acute kidney injury and. thromboembolic complications is quite high, which, may require artificial lung ventilation, for the purpose of cerebral protection, renal replacement therapy and. the use of anticoagulants. The new coronavirus infection is a risk factor for the severe course of diabetic ketoacidosis in children with type I diabetes, regardless of the age of the child, which is the basis for clinicalalertness in order to timely identify and treat potential life-threatening complications.Copyright © 2022 Authors. All rights reserved.
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The risk of severe type I diabetes mellitus in children with new coronavirus infection (COVID-19) is extremely high, which is associated, with a high risk of intracranial hypertension, cerebral edema and multiple organ dysfunction, syndrome. On the example of a clinical case, the features of the course of diabetic ketoacidosis and. intensive care measures in children with COVID-19 were considered. The main data of the history and clinical and laboratory examination are reflected, specialattention is paid to the applied aspects of therapy, it was noted that with a severe course of a new coronavirus infection and diabetic ketoacidosis, the risk of developing cerebral injury, acute kidney injury and. thromboembolic complications is quite high, which, may require artificial lung ventilation, for the purpose of cerebral protection, renal replacement therapy and. the use of anticoagulants. The new coronavirus infection is a risk factor for the severe course of diabetic ketoacidosis in children with type I diabetes, regardless of the age of the child, which is the basis for clinicalalertness in order to timely identify and treat potential life-threatening complications.Copyright © 2022 Authors. All rights reserved.
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Aim: To describe Brazilian web survey methods termed DIABETESvid by assessing the diabetic individuals' self-care practices and their resilience in the COVID-19 pandemic. Method(s): This is a cross-sectional study on data collected from web surveys in the period between 1st September and 19th October 2020, in which socio-demographic, clinical, self-care and resilience variables were investigated. A questionnaire was elaborated and implemented by using the Research Electronic Data Capture platform. Result(s): A total of 1,633 participants were eligible for this study, with a higher frequency of females, 46.5% being aged between 18 and 39 years old, 40.9% being diagnosed with diabetes within 1 to 10 years and all having high level of education. Most of the participants was living in south-eastern Brazil, self-reported type 1 diabetes mellitus and had access to the survey link on WhatsApp. In this 7-week study, it was evidenced that the survey response rate was higher in the first week (38.5%) and number of accesses were increased on Thursdays (20.2%) and in the night (40.2%). Conclusion(s): The method used here can be useful as a baseline for future web surveys involving diabetic individuals so that several analyses can be conducted in the clinical care and academic contexts.Copyright © 2021 The Authors
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Euglycaemic diabetic ketoacidosis (EDK) is a complication of diabetes mellitus (DM) that is associated with high morbidity and mortality if it is not treated early and vigorously. Pregnancy is a risk factor for developing EDK, with a higher incidence than the general population, and is associated with high maternal-foetal mortality and morbidity (till 35%). In the absence of marked hyperglycaemia, delays in the diagnosis and treatment of this entity may occur. SARS-CoV-2 infection has also been associated with the development of EDK, so in a pregnant COVID+ patient with a history of DM, EDK should be suspected if metabolic acidosis with a high anion gap develops. We present the case of a 36-year-old woman, 32 weeks pregnant, with a history of DM, who developed EDK in the context of SARS-CoV-2 infection. © 2022 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo
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BACKGROUND: A decrease in the frequency of amputations due to diabetic foot syndrome (DFS) is one of the parameters that determine the quality of medical care for patients with diabetes mellitus. AIM: Our aim was to study the indicators characterizing medical care for patients with lower limb pathology in diabetes mellitus in St. Petersburg from 2010 to 2021. MATERIALS AND METHODS: Annual reports on the treatment of patients with DFS in city hospitals specializing in the surgical treatment of DFS and in outpatient offices <<Diabetic foot>> (DFO) from 2010 to 2021 were analyzed. RESULT(S): The average number of patients per year admitted to the DFO was 18,527 (34,440 visits). Proportion of patients with foot ulcers - 8,9%, with Charcot's arthropathy - less than 1%. Before 2020, the frequency of above the foot amputations decreased from 48.3% to 8.6%, hospital mortality - from 11.7 to 5.7%, the number of revascularizations increased from 37 to 642 per year. The increase in operational activity was not accompanied by a decrease in the frequency of amputations (59.3% in 2019). Of all amputations, 11.3% were patients referred from DFO. During the epidemic, the number of visits and patients admitted to the DFO decreased by 27,3% and 31%, respectively. The proportion of foot ulcers and the frequency of amputations have not changed. Inpatient care was characterized by a decrease in operational activity, a decrease in the availability of revascularization, a 2-fold increase in the proportion of high amputations and an increase in hospital mortality from 5.7% in 2019 to 14.9% in 2021. CONCLUSION(S): An analysis of the statistics of specialized care for patients with DFS over 12 years showed the reduction of the frequency of high amputations, but revealed an increase in the frequency of surgical interventions in DFS against the background of an almost unchanged proportion of amputations in the structure of all operations. Despite significant quantitative indicators, the outpatient service seems to be insufficiently effective in reaching the target population. The negative impact of the epidemic has led to a significant increase in the frequency of high amputations and mortality.Copyright © Endocrinology Research Centre, 2022.
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Background: COVID-19 pneumonia is newly recognized illness has spread rapidly around the world. It causes much morbidity and mortality. Diabetes in COVID-19 patients is individual risk factor and documented in worldwide studies to contribute to severity of the disease, increased length of stay and higher mortality. Aggressive management of blood sugars and acute diabetic complications reduce the length of stay and mortality. Method(s): The improvement project carried over for four months in King Fahd Armed Forces hospital. Randomly selected 200 patients admitted to the hospital with diabetes and COVID-19 studied. The unified treatment protocol applied for all patients and blood sugars monitored closely and optimized. Data collected on bimonthly basis and analyzed. The patient characteristics taken from data extraction tool (Oasis) of hospital. Median values for length of stay and post discharge FBS and RBS were calculated Microsoft Excel tool. Mortality rates calculated by percentages. Result(s): 200 patients studied in the 4 months study period. The median length of stay was 3 days. The mortality rate was 2.5%. The median FBS and RBS in the patient group monitored in the post discharge clinic was 130 mg/dl and 170 mg/dl respectively. The results compared with the standard international studies and improvements in primary and secondary outcomes documented. Discussion(s): The length of stay in the study population in the project was 3 days as compared to 13 days in a major international study helping rapid turnover of beds and financial savings. The mortality was 2.5% compared to 7.3% in a major published study, reflecting the implications of aggressive management of diabetes by teamwork. The median values of FBS 130 mg/dl and RBS of 170mg/dl achieved by regular follow-up and support to the patient by running postdischarged clinic definitely help reducing readmissions and acute complications of uncontrolled diabetes. Conclusion(s): COVID-19 patients with diabetes are more prone to have more severe disease, and tend to stay longer in hospital and have higher mortality compared to non-diabetics. An aggressive preemptive strategy with unified treatment protocols and readily available service of endocrinologist and effective control of diabetes and acute complications of diabetes significantly reduces the length of and mortality in COVID-19 patients with diabetes.
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Background: Vaccines are highly effective in preventing severe disease and death from COVID-19, and new medications that can reduce disease severity have been approved. However, many countries are facing limited supply of vaccine doses and medications. Research question: A model estimating the probabilities for hospitalisation and mortality according to individual risk factors and vaccine doses received could help prioritise vaccination and yet scarce medications to maximise lives saved and reduce the burden on hospitalisation facilities. Method(s): Electronic health records from 101,034 individuals infected with SARS-CoV-2, since the beginning of the pandemic and until 30 November 2021, were extracted from a national healthcare organization in Israel. Logistic regression models were built to estimate the risk for subsequent hospitalization and death based on the number of BNT162b2 mRNA vaccine doses received and few major risk factors (age, sex, body mass index, hemoglobin A1C, kidney function, and presence of hypertension, pulmonary disease or malignancy). Result(s): The models built predicts the outcome of newly infected individuals with remarkable accuracy: area under the curve was 0.889 for predicting hospitalisation, and 0.967 for predicting mortality. Even when a breakthrough infection occurs, receiving three vaccination doses significantly reduces the risk of hospitalization by 66% (OR = 0.336) and death by 78% (OR = 0.220). Conclusion(s): The models enable rapid identification of individuals at high risk for hospitalisation and death when infected. These patients can be prioritised to receive booster vaccination and the yet scarce medications. A calculator based on these models is made public: http://covidest.web.app.
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Since the outbreak of the COVID-19 pandemic, it has been suspected that its causative agent, the SARS-CoV-2 coronavirus, may cause transient or permanent hyperglycemia. This fact has resulted in a new focus of research interest related to the study of potential mechanisms leading to damage of pancreatic insulin-producing cells, as well as the possible impact of the virus on insulin sensitivity, which may manifest as metabolic disturbances in patients with COVID-19 and cause diabetes mellitus. Evidence from the literature suggests that Corona viruses can damage pancreatic (beta-cells by direct or indirect mechanisms and cause changes in insulin secretion and sensitivity. To what extent all these changes are valid claims that SARS-CoV-2 can trigger diabetes mellitus is still not fully proven.Copyright © 2022 Medical Information Center. All rights reserved.
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Since the outbreak of the COVID-19 pandemic, it has been suspected that its causative agent, the SARS-CoV-2 coronavirus, may cause transient or permanent hyperglycemia. This fact has resulted in a new focus of research interest related to the study of potential mechanisms leading to damage of pancreatic insulin-producing cells, as well as the possible impact of the virus on insulin sensitivity, which may manifest as metabolic disturbances in patients with COVID-19 and cause diabetes mellitus. Evidence from the literature suggests that Corona viruses can damage pancreatic (beta-cells by direct or indirect mechanisms and cause changes in insulin secretion and sensitivity. To what extent all these changes are valid claims that SARS-CoV-2 can trigger diabetes mellitus is still not fully proven.Copyright © 2022 Medical Information Center. All rights reserved.
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Background: It is well established that diabetic patients infected with COVID-19- are at higher risk of developing severe symptoms that may lead to death. Such observation argues for the possibility that SARS-CoV-2 may target and infect pancreatic islets. SARSCoV- 2 is thought to enter the cells through the binding of viral spike S1 protein to ACE2. The cellular entry process includes priming of the S protein by TMPRSS2 and ADAM17, which facilitate the binding and promote ACE2 shedding. To date, no conclusive evidence has emerged to address the expression of TMPRSS2 and ADMA17 or the interaction between SARS-CoV-2 and human pancreatic islets. Method(s): Microarray and RNA-sequencing (RNA-seq) expression data from human islets were used to profile the expression pattern of ACE2, ADAM17, and TMPRSS2 in diabetic and non-diabetic subjects. Result(s): Pancreatic islets express all three receptors regardless of diabetes status. ACE2 expression was significantly elevated in diabetic islets than non-diabetic. Female donors showed to have higher ACE2 expression compared to males, whereas ADAM17 and TMPRSS2 were not affected by gender. No difference in the expression of the three receptors in young (<=40 years old) compared to old (>=60 years old) islets. Obese donors (BMI>30) showed significantly higher expression levels of ADAM17 and TMPRSS2 as compared to non-obese (BMI<25). Expression of TMPRSS2 was associated positively with HbA1c and inversely with age, while ADAM17 and TMPRSS2 were associated positively with BMI. Muscle and subcutaneous adipose tissues showed similar expression of the three receptors in diabetic and nondiabetic donors. Conclusion(s): ACE2 expression is increased in diabetic human islets. More studies are warranted to understand the permissiveness of human pancreatic beta-cells to SARS-Cov-2 and whether variations of ACE2 expression could explain the severity of COVID-19 infection between diabetics and non-diabetic patients.