Risk factors for hypoglycemia in patients with type 2 diabetes, hospitalized in internal medicine wards: Findings from the FADOI-DIAMOND study.

AIMS: Hypoglycemia is a potential risk in the management of patients suffering from type 2 diabetes (T2DM) and hospitalized in internal medicine units (IMUs). The aim of this analysis was to evaluate incidence of hypoglycemia and related risk factors in a group of patients admitted to IMUs. METHODS: We used the FADOI-DIAMOND study carried out in 53 Italian IMUs. The DIAMOND design included two cross-sectional surveys interspersed with an educational program. In both phases each center reviewed the charts of the last 30 hospitalized patients with known T2DM (n=3167), including information about hypoglycemia during hospital stay. The association between occurrence of hypoglycemia and potential predictors was evaluated by means of a multivariable logistic regression analysis. RESULTS: A total of 385 symptomatic hypoglycemic events were observed (rate=12%). Advanced age, cognitive dysfunction, and nephropathy were associated with hypoglycemia. Hypoglycemia occurred in 19.4% of patients treated according to the insulin sliding-scale method versus 11.4% of patients treated with basal bolus (p<0.01). More patients with hypoglycemia received sulfonylureas versus the no-hypoglycemia group (28.3% versus 20.6%, p<0.001). Significantly longer length of hospital stay and increased in-hospital mortality were found in the group with hypoglycemia compared with the no-hypoglycemia group (12.7±10.9 versus 9.6±6.5 days; 8.8% versus 4.8%, p<0.01). CONCLUSIONS: Hypoglycemia in hospitalized patients with diabetes is associated with increased length of hospitalization and in-hospital mortality. Identification of patients at increased risk of hypoglycemia may be important for optimally adapting treatment and patient management.

Evaluation of the effects of noniodinized and iodinized ionic contrast media and gadoteric acid in acute necrotizing pancreatitis: experimental study in rabbits.

OBJECTIVE: To evaluate the effects of iodine contrast media and gadoteric acid in acute necrotizing pancreatitis. METHODS: Fifty rabbits were distributed in 5 groups: 10 rabbits were assigned in the control group (group 5) and 40 rabbits were assigned in the pancreatitis group, wherein acute necrotizing pancreatitis was induced through retrograde injection of 5% sodium taurocholate (1 mL/kg weight) in the main pancreatic duct. After 3 hours, they were randomized to receive endovenous iodinized nonionic contrast medium (group 1), iodinized ionic contrast medium (group 2), gadoteric acid (group 3), and physiological serum at 0.9% (group 4). Six hours after induction of pancreatitis, these animals were reoperated. During surgery, pancreatic tissue flow through laser Doppler, hematometric values, biochemistry, and histopathology analysis by hematoxylin and eosin were done. Statistical analysis using Kruskal-Wallis, Fisher-Freeman-Halton, and parametric t tests was performed. RESULTS: There was statistical significance when comparing tissue flow before and after induction of pancreatitis (P < 0.0001). Ionic and nonionic contrast media and gadoteric acid did not increase the grade of pancreatic necrosis (P > 0.05). CONCLUSIONS: Ionic and nonionic contrast media and gadoteric acid did not produce adverse effects in the present model of acute necrotizing pancreatitis.

A funçäo renal de ratos espontaneamente hipertensos submetidos ao pneumoperitônio / Renal function of spontaneously hypertensive rats submitted to pneumoperitoneum

Objetivo: Estudar a funçäo renal de ratos espontaneamente hipertensos submetidos ao pneu-moperitônio com CO 2. Métodos: Foram utilizados 60 ratos, sendo 30 Wistar SHR e 30 EPM-1 Wistar, com idade ao redor de quatro meses, com peso médio de 341g. A amostra foi distribuída em dois grupos, experi-mento (ratos hipertensos) e controle (ratos normotensos), de acordo com a linhagem, SHR e EPtv1-1 Wistar, respectivamente. Cada grupo foi redistribuído em dois subgrupos, com 15 animais cada, de acordo com a pressäo de pneumoperitônio, 10 e 4mmHg. Os animais foram anestesiados e posicionados, dando início ao procedimento de cateterizaçäo da artéria femoral esquerda, que permitiu aferiçäo da pressäo arterial média e a coleta sanguínea durante todo o experimento. Após a anti-sepsia, procedeu-se à realizaçäo de incisäo transversa de 5mm de comprimento na regiäo central do abdome para introduçäo de trocarte de 2mm, por onde foi introduzida a agulha de Veress, permitindo a insuflaçäo de COZ até atingir a pressäo estabelecida para cada grupo (4mmHg ou l0mmHg), que foi mantida durante uma hora, seguida por uma hora de desinsuflaçäo. Ao término do período de desinsuflaçäo todos os animais de todos os grupos, ainda sob efeito anestésico, foram submetidos à eutanásia por exanguinaçäo, através do cateter arterial. As amostras de sangue foram coletadas em três fases: 1) após a cateterizaçäo, 2) após uma hora de pneumoperitônio, e 3) após uma hora de desinsuflaçäo, sendo conduzidas ao laboratório para dosagens de uréia e creatinina. Resultados: Houve aumento da creatinina para o rato SHR durante pneumoperitônio com pressäo de l0mmHg; já a uréia mostrou-se aumentada tanto para o SHR quanto para o Wistar, durante o pneumoperitônio com pressäo de l0mmHg. Durante o pneumoperitônio com pressäo de 4mmHg, a creatinina e a uréia mantiveram-se nos níveis basais. Conclusäo: A funçäo renal do SHR se altera de forma transitória, semelhante ao rato näo-hipertenso quando submetido ao pneumoperitônio.