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Introducción El objectivo fue evaluar la importancia de glucemia media (GM) y variabilidad glucémica (VG) durante la hospitalización sobre la mortalidad tras el alta.Material y métodosEstudio de cohortes retrospectivo longitudinal analítico. Se incluyeron pacientes dados de alta del Servicio de Medicina Interna con algún diagnóstico relacionado con la diabetes. El pronóstico evaluado fue la mortalidad. Se recogieron durante el ingreso variables clínicas, analíticas y relacionadas con el control glucémico hospitalario (GM, VG e hipoglucemias). La VG se midió con el coeficiente de variación (CV).Se calcularon las tasas de mortalidad por cada 1000 pacientes-año y se compararon con curvas de Kaplan-Meier. La determinación de los factores predictivos de mortalidad se realizó mediante regresión de Cox.ResultadosSe incluyeron 276 pacientes con edad media 77,6 (DE 10,2) años. La duración mediana del seguimiento extrahospitalario fue de 2,7 años.En análisis multivariante, una GM > 140 (HR=1,72; IC 95% 1,14-2,61; p=0,01) y un CV > 0,29 (HR=1,52; IC 95% 1,12-2,06; p=0,006), no así la presencia de hipoglucemias, se asociaron a incremento del riesgo de mortalidad de forma aditiva e independiente. Tener una GM > 140 simultáneamente con un CV > 0,29 incrementó las tasas de mortalidad (123 vs. 317 por 1.000 pacientes-año; p <0,001) y el riesgo ajustado de mortalidad (HR=2,70; IC 95% 1,71-4,27; p<0,001) respecto a tener una GM ≤ 140mg/dl.ConclusiónLa presencia simultánea de GM y VG elevadas constituye una potente herramienta de estratificación del riesgo de mortalidad tras el alta hospitalaria. (AU)
Introduction The aim of this study was to evaluate the impact of mean blood glucose (MBG) and glycaemic variability (GV) during hospitalisation on mortality after discharge.Material and methodsWe conducted a retrospective longitudinal analytical cohort study that included patients discharged form a department of internal medicine with a diabetes-related diagnosis The evaluated prognosis was mortality. During hospitalisation, the patients clinical, laboratory and glycaemic control-related variables were recorded (MBG, GV and hypoglycaemia). The GV was measured with the coefficient of variation (CV).We calculated the mortality rates for every 1000 patient-years and compared them with Kaplan-Meier curves. We determined the predictors of mortality by performing a Cox regression.ResultsThe study included 276 patients with a mean age of 77.6 (SD, 10.2) years. The median outpatient follow-up duration was 2.7 years.In the multivariate analysis, an MBG >140mg/dl (HR, 1.72; 95% CI 1.142.61; p=.01) and a CV >0.29 (HR, 1.52; 95% CI 1.122.06; p=.006) but not the presence of hypoglycaemia were additively and independently associated with an increased risk of mortality. An MBG >140mg/dl with a CV >0.29 increased the mortality rates (123 vs. 317 per 1000 patient-year; p <.001) and the adjusted mortality risk (HR, 2.70; 95% CI 1.714.27; p<.001) compared with having an MBG ≤140mg/dl.ConclusionThe simultaneous presence of a high MBG level and CV constitutes a powerful tool for stratifying mortality risk after hospital discharge. (AU)
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus/sangue , Diabetes Mellitus/mortalidade , Índice Glicêmico , Mortalidade Hospitalar , Estudos Longitudinais , Estudos RetrospectivosRESUMO
INTRODUCTION: The aim of this study was to evaluate the impact of mean blood glucose (MBG) and glycaemic variability (GV) during hospitalisation on mortality after discharge. MATERIAL AND METHODS: We conducted a retrospective longitudinal analytical cohort study that included patients discharged form a department of internal medicine with a diabetes-related diagnosis. The evaluated prognosis was mortality. During hospitalisation, the patients' clinical, laboratory and glycaemic control-related variables were recorded (MBG, GV and hypoglycaemia). The GV was measured with the coefficient of variation (CV). We calculated the mortality rates for every 1000 patient-years and compared them with Kaplan-Meier curves. We determined the predictors of mortality by performing a Cox regression. RESULTS: The study included 276 patients with a mean age of 77.6 (SD, 10.2) years. The median outpatient follow-up duration was 2.7 years. In the multivariate analysis, an MBGâ¯>â¯140â¯mg/dL (HRâ¯=â¯1.72; 95% CI 1.14-2.61; pâ¯=â¯.01) and a CVâ¯>â¯0.29 (HRâ¯=â¯1.52; 95% CI 1.12-2.06; pâ¯=â¯.006), but not the presence of hypoglycaemia, were additively and independently associated with an increased risk of mortality. An MGâ¯>â¯140â¯mg/dL with a CVâ¯>â¯0.29 increased the mortality rates (123 vs. 317 per 1000 patient-year; pâ¯<â¯.001) and the adjusted mortality risk (HRâ¯=â¯2.70; 95% CI 1.71-4.27; pâ¯<â¯.001) compared with having an MBGâ¯≤â¯140 mg/dL. CONCLUSION: The simultaneous presence of a high MBG level and CV constitutes a powerful tool for stratifying mortality risk after hospital discharge.
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Glicemia , Diabetes Mellitus , Idoso , Estudos de Coortes , Diabetes Mellitus/epidemiologia , Hospitais , Humanos , Estudos RetrospectivosRESUMO
INTRODUCTION: The aim of this study was to evaluate the impact of mean blood glucose (MBG) and glycaemic variability (GV) during hospitalisation on mortality after discharge. MATERIAL AND METHODS: We conducted a retrospective longitudinal analytical cohort study that included patients discharged form a department of internal medicine with a diabetes-related diagnosis The evaluated prognosis was mortality. During hospitalisation, the patients' clinical, laboratory and glycaemic control-related variables were recorded (MBG, GV and hypoglycaemia). The GV was measured with the coefficient of variation (CV). We calculated the mortality rates for every 1000 patient-years and compared them with Kaplan-Meier curves. We determined the predictors of mortality by performing a Cox regression. RESULTS: The study included 276 patients with a mean age of 77.6 (SD, 10.2) years. The median outpatient follow-up duration was 2.7 years. In the multivariate analysis, an MBG >140mg/dl (HR, 1.72; 95% CI 1.14-2.61; p=.01) and a CV >0.29 (HR, 1.52; 95% CI 1.12-2.06; p=.006) but not the presence of hypoglycaemia were additively and independently associated with an increased risk of mortality. An MBG >140mg/dl with a CV >0.29 increased the mortality rates (123 vs. 317 per 1000 patient-year; p <.001) and the adjusted mortality risk (HR, 2.70; 95% CI 1.71-4.27; p<.001) compared with having an MBG ≤140mg/dl. CONCLUSION: The simultaneous presence of a high MBG level and CV constitutes a powerful tool for stratifying mortality risk after hospital discharge.
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Humanos , Equinococose/complicações , Equinococose/epidemiologia , Atenção Primária à Saúde/métodos , Diagnóstico PrecoceRESUMO
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Humanos , Masculino , Adulto , Dermatite Alérgica de Contato/diagnóstico , Plantas/efeitos adversos , Radiação Solar/efeitos adversos , Diagnóstico Diferencial , Herpes Zoster/diagnósticoRESUMO
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Humanos , Masculino , Pessoa de Meia-Idade , Urticária/terapia , Urticária , Exantema/complicações , Exantema/diagnóstico , Dor Abdominal/etiologia , Prurido/etiologia , Gastroscopia/métodos , Mucosa Gástrica/parasitologia , Mucosa Gástrica , Eosinofilia/complicações , Eosinofilia/diagnóstico , Albendazol/uso terapêuticoRESUMO
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Humanos , Masculino , Feminino , Glicemia/análise , Automonitorização da Glicemia/tendências , Hiperglicemia/epidemiologia , Hiperglicemia/prevenção & controle , Corticosteroides/uso terapêutico , Protocolos Clínicos/normas , Avaliação de Eficácia-Efetividade de Intervenções , Planejamento de Assistência ao Paciente/normasRESUMO
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Humanos , Masculino , Feminino , Índice Glicêmico , Índice Glicêmico/fisiologia , Glicemia/análise , PrognósticoRESUMO
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Humanos , Masculino , Pessoa de Meia-Idade , Infecções dos Tecidos Moles/complicações , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/tratamento farmacológico , Diagnóstico Precoce , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Reação em Cadeia da Polimerase/métodos , Reação em Cadeia da Polimerase , Diarreia/complicações , Diarreia/diagnóstico , Incontinência Fecal/complicações , Frequência Cardíaca , Amicacina/uso terapêutico , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/complicações , Infecções Pneumocócicas/diagnóstico , Celulite/complicações , Celulite/diagnósticoRESUMO
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Humanos , Feminino , Pessoa de Meia-Idade , Hepatite/complicações , Hepatite/diagnóstico , Icterícia/complicações , Plantas Medicinais/efeitos adversos , Plantas Medicinais/toxicidade , Diagnóstico Precoce , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Atenção Primária à SaúdeAssuntos
Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Icterícia/diagnóstico , Extratos Vegetais/efeitos adversos , Dor Abdominal/etiologia , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Feminino , Humanos , Icterícia/etiologia , Pessoa de Meia-Idade , Extratos Vegetais/administração & dosagemRESUMO
Objetivos: Los objetivos del presente trabajo fueron evaluar si la difusión de un protocolo de manejo de la hiperglucemia sería capaz de incrementar el uso de insulina programada y mejorar el control glucémico durante la estancia hospitalaria. Pacientes y métodos: Estudio observacional de cohortes retrospectivo analítico. Se comparan 2 grupos de pacientes dados de alta con un diagnóstico relacionado con diabetes (DM) en servicios de Medicina Interna, antes (grupoPRE) y después (grupoPOS) de la implantación de un protocolo de actuación. Las respuestas analizadas fueron indicadores de proceso (probabilidad de permanecer sin insulina programada, evaluada mediante curvas de Kaplan-Meier), y de resultados (diferencias ajustadas (grupoPOS - grupoPRE) de control glucémico, evaluadas mediante regresión lineal múltiple). Resultados: Hubo 228 pacientes en el grupoPRE y 127 en el grupoPOS. La mediana del tiempo hasta el inicio de insulina programada fue de un día (IC 95%: 0-2,5) en el grupoPOS y de cuatro días (IC 95%: 2-6) en el grupoPRE (p=0,056). La glucemia en las primeras 48 horas de ingreso entre los pacientes que no recibieron insulina programada fue inferior en el grupoPOS respecto al grupoPRE (163,9 vs 186,7 mg/dl; p=0,025). La glucemia media las primeras 24 horas fue inferior en el grupoPOS (diferencia: -24,8 mg/dl (IC 95%: -40,5-(-9); p=0,002)). En análisis estratificado, la diferencia en glucemia media durante el ingreso fue significativa en los pacientes en ayunas (-29,8 mg/dl; IC 95%: -58,9-(-0,6); p=0,045) pero no en aquellos con ingesta conservada. Conclusión: Un protocolo específico puede mejorar la calidad en la asistencia hospitalaria al paciente con DM (AU)
Background: Our aims were to assess the effectiveness of a diabetes (DM) management protocol to increase scheduled insulin therapy and to improve glycemic inpatient control. Patients and methods: We designed an analytical retrospective cohort study comparing 2 groups of medical services hospitalized patients with a primary or secondary discharge diagnosis of DM, before (group PRE) and after (group POS) the delivery of a DM management protocol. We analyzed the quality of attention by process indicators (cumulative probability of receive scheduled insulin therapy, evaluated with Kaplan-Meier analysis) and result indicators (adjusted glucose differences (group POS - group PRE), evaluated with multivariate regression models). Results: A number of patients (355) were included (228 group PRE and 127 group POS). The median time to scheduled insulin regimen beginning was 1 (CI 95%: 0-2.5) day in group POS and 4 (CI 95%: 2-6) days in group PRE (p=0.056). First 48 hours mean glucose in patients without scheduled insulin therapy was lower in group POS than in group PRE (163.9 versus 186.7 mg/dl; p=0.025). The first 24 hours mean glucose was significantly lower in patients of group POS, with a difference between both groups of -24.8 mg/dl (CI 95%: -40.5-(-9); p=0.002). Stratified analysis showed statistically significant mean in-hospital glucose difference only in the nothing by mouth situation (-29.8 mg/dl; CI 95%: -58.9-(-0.6); p=0.045). Conclusion: The delivery of an institutional protocol can improve hospitalized DM patients management quality (AU)
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Humanos , Masculino , Feminino , Protocolos Clínicos/classificação , Glicemia/análise , Glicemia/biossíntese , Pacientes Internados/educação , Serviço Hospitalar de Enfermagem/classificação , Serviço Hospitalar de Enfermagem , Diabetes Mellitus/sangue , Estudo Observacional , Protocolos Clínicos/normas , Glicemia/genética , Glicemia/metabolismo , Pacientes Internados/classificação , Serviço Hospitalar de Enfermagem/normas , Serviço Hospitalar de Enfermagem , Diabetes Mellitus/patologia , Estudos RetrospectivosRESUMO
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Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Adenocarcinoma/cirurgia , Quimioterapia Adjuvante/métodos , Biomarcadores Tumorais/análise , Atenção Primária à Saúde/métodos , Estudos de Casos e Controles , Tomografia Computadorizada de Emissão/métodos , Radiografia Torácica/métodosRESUMO
INTRODUCTION: The objective was to assess the prognostic importance of various glycaemic control measures on hospital mortality. MATERIAL AND METHODS: Retrospective, analytical cohort study that included patients hospitalised in internal medicine departments with a diagnosis related to diabetes mellitus (DM), excluding acute decompensations. The clinical endpoint was hospital mortality. We recorded clinical, analytical and glycaemic control-related variables (scheduled insulin administration, plasma glycaemia at admission, HbA1c, mean glycaemia (MG) and in-hospital glycaemic variability and hypoglycaemia). The measurement of hospital mortality predictors was performed using univariate and multivariate logistic regression. RESULTS: A total of 384 patients (50.3% men) were included. The mean age was 78.5 (SD, 10.3) years. The DM-related diagnoses were type 2 diabetes (83.6%) and stress hyperglycaemia (6.8%). Thirty-one (8.1%) patients died while in hospital. In the multivariate analysis, the best model for predicting mortality (R(2)=0.326; P<.0001) consisted, in order of importance, of age (χ(2)=8.19; OR=1.094; 95% CI 1.020-1.174; P=.004), Charlson index (χ(2)=7.28; OR=1.48; 95% CI 1.11-1.99; P=.007), initial glycaemia (χ(2)=6.05; OR=1.007; 95% CI 1.001-1.014; P=.014), HbA1c (χ(2)=5.76; OR=0.59; 95% CI 0.33-1; P=.016), glycaemic variability (χ(2)=4.41; OR=1.031; 95% CI 1-1.062; P=.036), need for corticosteroid treatment (χ(2)=4.03; OR=3.1; 95% CI 1-9.64; P=.045), administration of scheduled insulin (χ(2)=3.98; OR=0.26; 95% CI 0.066-1; P=.046) and systolic blood pressure (χ(2)=2.92; OR=0.985; 95% CI 0.97-1.003; P=.088). CONCLUSION: An increase in initial glycaemia and in-hospital glycaemic variability predict the risk of mortality for hospitalised patients with DM.