Management of Diabetes During a Dual Pandemic.

The dual pandemics of coronavirus disease-19 (COVID-19) and diabetes among patients are associated with 2- to 3-times higher intensive care admissions and higher mortality rates. Whether sheltering at home, quarantined with a positive COVID-19 test, or hospitalized, the person living with diabetes needs special considerations for successful management. Having diabetes and being COVID-19-positive increases the risk of poor outcomes and death. Providers need to give anticipatory pharmacologic guidance to patients with diabetes during COVID-19 lockdown. Patients with diabetes need to be more observant than others and to use self-protective actions. This review (1) discusses the clinical observations of COVID-19, diabetes and underlying mechanisms, (2) describes special considerations in caring for patients with diabetes in a COVID-19 environment, and (3) reviews clinical implications for the health care provider. This review highlights current evidenced-based knowledge. Additional research regarding clinical management is warranted.

Evaluation Of Two Thromboembolism (TE) Risk Methods And Oral Anticoagulation Use Among Cardiac Device Patients With Atrial Tachyarrhythmias (AT).

BACKGROUND: In the implantable cardiac device (CD) population, not only can clinically silent atrial tachyarrythmias (AT) be detected, but an associated AT burden can be documented. There are two methods of determining stroke risk: CHADS2 and CHA2DS2-VASc. Recommendations for initiating anticoagulation based on stroke risk profiles and/or AT burden remain unclear for device-detected AT. OBJECTIVE: Aims of this study were to reveal the AT burden among CD patients, determine CHADS2 and CHA2DS2-VASc scores among patients with an AT burden, and evaluate current practices for anticoagulation. METHODS: Records were reviewed from patients undergoing a new CD implant within the last three years from two device clinics. Continuous variables were expressed as mean with standard deviation (SD) and categorical variables were stated as numbers and percentages. The categorical variables were compared using the Chi2 Square test and the continuous variables were compared using the independent 2-sided t-test. RESULTS: There were 275 CD patients enrolled. Eighty-seven had an AT burden and 188 patients did not have an AT burden. CD patients with AT burden were older than those without AT burden [69 (11), p=0.007]. Patients with AT burden had more hypertension and previous history of stroke (p=0.038, p=0.005) compared to those without AT burden. Both the CHADS2 and CHA2DS2-VASc mean scores were higher in patients with an AT burden (p=0.018 and p=0.041). Thirty patients with a previous history of AT were on anticoagulation (p=<0.001) prior to implant. Forty-eight patients had a new diagnosis of AT (NDAT) and 46% (n=22) were started on anticoagulation. CONCLUSIONS: An AT burden was detected in 32% of patients with at least 75% falling within a high-risk category using both scores. However, less than half of NDAT patients were started on anticoagulation. The use of oral anticoagulation in practice remains inconsistent and further randomized trials are recommended.

Emerging inflammatory biomarkers with acute stroke.

Despite newer neuroimaging techniques, timely and accurate diagnosis of acute stroke remains a significant challenge. The ability to identify stroke patients rapidly using a biologic biomarker would be highly beneficial. Inflammation following stroke is one physiologic mechanism that has been studied extensively in biomarker research. Several emerging inflammatory biomarkers have been identified and may be useful to diagnosis stroke, to predict the evolution of stroke, and to predict hemorrhagic transformation, particularly with the administration of thrombolytic therapy. Many challenges must be overcome before application to clinical practice can be recommended. Nevertheless, emerging inflammatory biomarkers demonstrate considerable promise, particularly as part of a multiple biomarker strategy, and significant improvement in stroke diagnosis, clinical management, and outcomes may be realized.

Latent autoimmune diabetes of adulthood (LADA): an often misdiagnosed type of diabetes mellitus.

PURPOSE: The purpose of this article is to raise awareness about a frequently misdiagnosed form of diabetes, latent autoimmune diabetes of adulthood (LADA), to describe its clinical and epidemiological characteristics, and to compare them to those of the more common and widely known types of diabetes, type 1 diabetes mellitus (DM) and type 2 DM. DATA SOURCES: A review of the pertinent literature describing the features of LADA from 2000-2007 is summarized. CONCLUSIONS: LADA is a rather common and often underrecognized form of diabetes whose clinical presentation falls somewhere between that of type 1 DM and type 2 DM. From a pathophysiological perspective, it is more closely related to type 1 DM, and some have even used the term type 1.5 diabetes to refer to it; however, it is most often misdiagnosed and treated as type 2 DM. IMPLICATIONS FOR PRACTICE: Nurse practitioners (NPs) should always consider alternate diagnoses when patients with newly or previously identified adult-onset diabetes mellitus do not fit the traditional stereotype of type 2 DM (i.e., overweight with signs of insulin resistance and a significant family history of diabetes). Statistically, strong consideration must be given to the diagnosis of LADA, especially in those who are of normal weight, show little evidence of insulin resistance, and have hardly any family history of diabetes. Knowing the patient's exact diabetes type can give the NP a much greater understanding of the natural history of the patient's disease, the changes that may occur as the patient ages, and how to optimally manage their diabetes to minimize complications. Likewise, when a patient is correctly diagnosed, they can be empowered to manage their diabetes with the appropriate therapies.