ABSTRACT
AIM: Hypoglycaemia is considered a factor contributing to morbidity and mortality in patients with diabetes. The aim of the present study was to examine the frequency, clinical characteristics, predisposing factors and outcomes of iatrogenic hypoglycaemia requiring medical assistance. METHODS: Eight hospitals participated in this prospective survey of documented iatrogenic hypoglycaemia at their emergency departments. Cases with type 2 diabetes (T2D) were compared with a control group, consisting of patients visiting the outpatients' diabetes clinics of the same hospitals during the same time period. RESULTS: Median survey duration was 16.5 months, and 295 episodes of iatrogenic hypoglycaemia were recorded. Frequency varied across centres from 0.25 to 0.78 cases per 100 presenting patients. Most cases (90.8%) were observed in patients with T2D (mean age: 76.7±10.1 years), while 8.1% of events were recorded in patients with type 1 diabetes (mean age: 42.7±18.3 years). Total in-hospital mortality was 3.4%, and all involved patients with T2D. In T2D patients, advanced age (OR: 1.3 [1.20-1.45] for 5-year increase), use of sulphonylureas (OR: 4.0 [2.5-6.36]), use of insulin (OR: 2.35 [1.42-3.95]), lower estimated GFR (OR: 1.15 [1.07-1.23] at 10mL/min) and number of comorbidities (OR: 1.74 [1.34-2.27]) were each independently associated with hypoglycaemia requiring medical assistance. CONCLUSION: Hypoglycaemia requiring medical assistance in patients with diabetes is a moderately common condition seen in emergency departments and has a mortality rate of 3.4%. The majority of cases involve elderly individuals with T2D who are suffering from serious comorbidities and treated with insulin and/or sulphonylureas.
Subject(s)
Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemia/chemically induced , Hypoglycemic Agents/adverse effects , Insulin/adverse effects , Sulfonylurea Compounds/adverse effects , Adult , Aged , Aged, 80 and over , Female , Hospitalization , Humans , Hypoglycemia/epidemiology , Hypoglycemia/therapy , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Male , Middle Aged , Prevalence , Prospective Studies , Sulfonylurea Compounds/therapeutic use , Tertiary Care Centers , Young AdultSubject(s)
Cardiovascular Diseases/prevention & control , Diabetic Angiopathies/therapy , Preventive Health Services , Aged , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/etiology , Diabetic Angiopathies/complications , Diabetic Angiopathies/diagnosis , Female , Guideline Adherence , Humans , Male , Middle Aged , Patient Compliance , Practice Guidelines as Topic , Retrospective Studies , Risk Assessment , Risk FactorsABSTRACT
Although data from literature suggest that diabetic women are frequently under screened for gynaecological cancers little is known about screening implementation for other cancers for both genders. This study investigates comprehensive cancer screening practices of diabetics as compared with non-diabetics; analyses screening patterns both by gender and level of evidence and reveals target subgroups that should be paid more attention for screening implementation. 675 diabetics vs. 5772 non-diabetic Greek individuals entered the PACMeR 02 cancer screening study. Diabetic women reported significantly lower performance for the sex-specific evidence-based cancer screening tests and digital rectal examination (DRE) as compared with non-diabetics (P < 0.05). Diabetic women older than 60 years old, of elementary education, housewives and farmers showed the lowest performance rates (P < 0.01). Prostate cancer screening was higher among diabetic men with ultrasound and DRE reaching statistical significance (P < 0.05). Subgroups analysis did not reveal a hidden relationship. Both genders of diabetics reported never performing skin examination at higher rates (P < 0.001), although screening intent is extremely low in both diabetics and non-diabetics (<1%). Evidence-based screening coverage was inconsistent in both genders independently by the diabetic status. Primary care efforts should be provided to implement presymptomatic cancer control.
Subject(s)
Diabetes Complications/diagnosis , Early Detection of Cancer , Mass Screening , Neoplasms/diagnosis , Adult , Age Factors , Aged , Aged, 80 and over , Case-Control Studies , Female , Greece , Health Services Accessibility , Humans , Male , Mass Screening/statistics & numerical data , Middle Aged , Risk Factors , Sex Factors , Socioeconomic Factors , Young AdultABSTRACT
BACKGROUND: Colorectal cancer is the second leading cause of cancer death in European countries. Differences in screening implementation may explain USA vs. European survival differences. The proportion of European primary care physicians advising colorectal screening has been reported to be inconsistent. We therefore hypothesised the presence of a belief-related bias among European physicians regarding who is responsible for cancer screening delivery. OBJECTIVES: To index beliefs in cancer screening implementation among a wide sample of Greek physicians. Study design Cross-sectional survey. METHODS: Three hundred and sixty-six physicians involved in primary care activities in 15 provinces answered a questionnaire about responsibility in cancer screening delivery. Results 22.4% and 7.6% of physicians declared that the health system and the patients, respectively, have the main responsibility for cancer screening implementation, while 70 % advocated patient-health system co-responsibility. Beliefs were statistically correlated to age (p=0.039) and specialisation category (p=0.002). Patients' will was mainly indicated by internists, trainee internists and physicians older than 30, while GPs, trainee GPs and house officers were mainly health system-oriented. Worryingly, when physicians were asked about which specialty should inform the population, 81% indicated family doctor (for-fee-service) while the involvement of free-from-fee specialities was inconsistent. CONCLUSION: A considerable disorientation about responsibilities in cancer screening delivery was observed in our study sample. Continual medical education and clear redefinition of primary care physicians' activities are required (AU)
No disponible
Subject(s)
Humans , Male , Female , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/prevention & control , Physicians/statistics & numerical data , Mass Screening , Practice Patterns, Physicians'/standards , Practice Patterns, Physicians' , Health Knowledge, Attitudes, Practice , Greece/epidemiology , Data Collection/methods , Data CollectionABSTRACT
Tumour markers are neither sensitive nor specific enough for cancer screening. Despite established guidelines, tumour marker 'screening myth' may be alive among physicians, but no study has analysed the phenomenon. This study aims to investigate tumour marker recommendation for screening purposes in primary care setting. A total of 209 Hellenic physicians were surveyed for screening activities by a multiple-choice questionnaire. Data were abstracted for the following tumour marker recommendations: carcinoembryonic antigen (CEA); cancer antigens 19.9, 125 and 15.3; alpha-fetoprotein and beta-human chorionic gonadotropin (beta-HCG). A high rate of physicians advocate that tumour markers in cancer screening (range from 24% for beta-HCG to 46% for CEA). This phenomenon is not related to age, sex, type and level of physicians' specialization. In conclusion, many physicians recommend tumour markers for screening purposes. This may be harmful, since their prescriptions unnecessarily burden health economics, and further evaluation of false-positive findings might be associated with increased costs and risk from additional diagnostic/therapeutic interventions.
