Predictors of mortality in hospitalized diabetic patients: A 7-year prospective study.

UNLABELLED: This study was conducted to investigate the mortality rate, causes of death, and standardized mortality ratio (SMR), and to identify the significant predictive factors of mortality in diabetic patients at a medical center in Taiwan. Clinical data were obtained from 1792 diabetic inpatients discharged from the metabolism department of a medical center during the years 1996-2002. Underlying causes of death were determined from death certificates. Predictors of mortality were assessed by uni- and multivariate Cox survival analyses. Of 1792 patients studied, 410 (22.9%) patients died. The crude mortality rate was 93.2/1000 person-years, and the overall SMR was 2.98 (2.71-3.28). The percentages of causes of death ascribed to diabetes, cancer, cardiopulmonary disease, infection, stroke, digestive diseases, nephropathy, accidents, suicide, and disease of arteries, arterioles, and capillaries were 38.0, 13.2, 9.5, 7.8, 7.6, 6.8, 5.1, 2.0, 0.5, and 0.2%, respectively. The independent predictors of mortality were age greater than 65, duration of hypertension more than 5 years, 24h proteinuria greater than 0.3g, and estimated creatinine clearance less than 60mL/min. CONCLUSION: The mortality of diabetic inpatients was about threefold that of the general population. The predictors of mortality included older age, longer duration of hypertension, increased 24h proteinuria, and decreased creatinine clearance.

Relationship between several surrogate estimates of insulin sensitivity in non-diabetic patients with coronary artery disease.

BACKGROUND AND PURPOSE: Insulin resistance plays an important role in the pathogenesis of coronary artery disease (CAD). Thus, there is a need for accurate and accessible tools for measurement of insulin sensitivity in patients with this disease. This study explored the relationship between several surrogate estimates of insulin sensitivity in non-diabetic patients with angiographic evidence of CAD. METHODS: The study population consisted of 1363 non-diabetic subjects with angiography results which revealed evidence of CAD in 660 and no evidence of CAD in 703 subjects. After overnight fasting, blood samples were drawn for determination of glucose and insulin concentrations in order to determine the homeostasis model assessment for insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI). In addition, steady-state plasma glucose (SSPG) concentrations obtained from insulin suppression tests were carried out in 54 subjects with and 194 subjects without CAD. The correlation of QUICKI with other surrogate estimates of insulin sensitivity in obese and non-obese subjects was also evaluated. RESULTS: The QUICKI correlated significantly with other methods for estimating insulin sensitivity in the CAD and non-CAD groups. The QUICKI also had a closer correlation with SSPG and log fasting plasma insulin (log FPI) in subjects with CAD (r = -0.573 and -0.869, respectively) than HOMA-IR (r = 0.508 and 0.777, respectively). QUICKI had a closer correlation with SSPG in the obese subjects than in the non-obese subjects, irrespective of the presence of CAD. CONCLUSIONS: The QUICKI was more closely related with SSPG, insulin area, and log FPI than other measurements of insulin sensitivity. These findings suggest that the QUICKI may provide a convenient, efficient method to measure insulin sensitivity in non-diabetic patients with CAD.

Severe hypophosphatemia in a patient with diabetic ketoacidosis and acute respiratory failure.

Although hypophosphatemia is a common complication during therapy of diabetic ketoacidosis, it is seldom severe and rarely causes clinical manifestations. We report a 39-year-old woman with diabetic ketoacidosis who developed acute respiratory failure after therapy. Although hyperglycemia and acidosis were corrected after treatment, respiratory distress and weakness still persisted. The chest radiograph showed no active lung lesion. Brain CT revealed no significant abnormality. Echocardiographic study revealed normal LV systolic wall motion. Blood biochemistry demonstrated severe hypophosphatemia of 0.3 mg/dL (normal value: 2.5 to 4.5 mg/dL). Phosphate replacement therapy with potassium phosphate was given. The patient's clinical condition improved steadily over the next few days, and after 4 weeks of hospitalization, she was discharged home without obvious long-term sequelae. In a critically ill patient, the symptoms of hypophosphatemia are not apparent and may mimic the symptoms of other underlying disease. Although phosphate replacement is not recommended routinely in diabetic ketoacidosis, if the patient develops cardiopulmonary distress, anemia or severe hypophosphatemia, phosphate therapy under close surveillance is indicated.

The efficacy of a home-based nursing program in diabetic control of elderly people with diabetes mellitus living alone.

The purpose of this study was to evaluate the efficacy of a home-based nursing program in the diabetic control of elderly people with diabetes mellitus living alone. Patients meeting the sampling criteria were recruited from a medical center and 10 health centers in Taipei for this quasi-experimental study. By matching the effects of age, sex, education, and history of diabetes, subjects were assigned semirandomly to two groups based on the intensity of home-based nursing care visitations. Group I was defined as daily visits to supervise diet, exercise, medication, and self-monitoring blood sugar (n = 15) and Group II as weekly visits to supervise diet, exercise, medication education, and self-monitoring blood sugar (n = 15). Patients who agreed only to receive blood examination were assigned to the control group (n = 14). The results of the study showed that reductions in fasting blood sugar, postmeal blood sugar, and hemoglobin A1c (HbA1c) in Groups I and II were significantly greater than those in the control group. The reduction in the total cholesterol and low-density lipoprotein in Groups I and II was significantly greater than that in the control group. There were no significant differences among the three groups in the improvement of high-density lipoprotein (HDL) and triglycerides (TGs). Group I revealed a significantly greater weight reduction compared to Group II. There was no significant difference between Groups I and II in the improvements of diabetes knowledge, depression level, or quality of life. From the research findings, based on cost-effectiveness, it is recommend that Program II be implemented.