Diabetes Mellitus Hospitalization Research Articles

Disability-related disparities in health outcomes among newly diagnosed diabetic patients: A retrospective cohort

BackgroundA distinct gap in the literature persists regarding the health outcome of individuals with Type 2 diabetes who also have disabilities. This study aimed to investigate potential disparities in events occurrence among diabetes patients across various disability stages.MethodsWe conducted a retrospective cohort study on patients newly diagnosed with diabetes in 2013 and 2014, aged ≥ 18 years, and followed them until December 2021, using data from the Korean National Health Insurance database. All-cause mortality and hospitalization for diabetes mellitus and cardio-cerebrovascular diseases (CVD) was assessed.ResultsThe study included 26,085 patients, encompassing individuals without disabilities and those with physical, visual, hearing and speech, intellectual and developmental, and mental disabilities. After adjustment, individuals with disabilities had a higher risk of all-cause death (adjusted hazard ratio [aHR]: 1.25, 95% CI: 1.07–1.48) compared to those without disabilities. In particular, severe disabilities and hearing and speech disabilities showed significantly higher risks of all-cause death (aHR: 1.40, 95% CI: 1.06–1.85 and aHR: 1.58, 95% CI: 1.17–2.15, respectively), with marginal significance for mild disabilities (aHR: 1.20, 95% CI: 0.99–1.45) and mental disorders (aHR: 1.92, 95% CI: 0.98–3.73). Patients with disabilities also had significantly increased risks of CVD-related first admissions (aHR: 1.30, 95% CI: 1.07–1.56) and diabetes-related first admissions (aHR: 1.31, 95% CI: 1.20–1.43) compared to those without disabilities.ConclusionsThis study underscores the urgent need for public health policies to prioritize individuals with disabilities and diabetes, addressing the disparities in health outcome.

Emergency Visits or Hospitalizations for Cardiovascular Diagnoses in the Post-Acute Phase of COVID-19

BackgroundPrior studies of COVID-19 cardiovascular sequelae include diagnoses made within 4 weeks, but the World Health Organization definition for “postacute phase” is >3 months. ObjectivesThe purpose of this study was to determine which cardiovascular diagnoses in the postacute phase of COVID-19 are associated with SARS-CoV-2 infection. MethodsRetrospective cohort study of all adults in Alberta who had a positive SARS-CoV-2 reverse transcription polymerase chain reaction test between March 1, 2020 and June 30, 2021, matched (by age, sex, Charlson Comorbidity score, and test date) with controls who had a negative reverse transcription polymerase chain reaction test. ResultsThe 177,892 patients with laboratory confirmed SARS-CoV-2 infection (mean age 42.7 years, 49.7% female) were more likely to visit an emergency department (5.7% vs 3.3%), be hospitalized (3.4% vs 2.1%), or die (1.3% vs 0.4%) within 1 month than matched test-negative controls. After 3 months, cases were significantly more likely than controls to have an emergency department visit or hospitalization for diabetes mellitus (1.5% vs 0.7%), hypertension (0.6% vs 0.4%), heart failure (0.2% vs 0.1%), or kidney injury (0.3% vs 0.2%). In the 6,030 patients who had survived a hospitalization for COVID-19, postacute phase risks were substantially greater for diabetes mellitus (9.5% vs 3.0%, adjusted odds ratio [aOR]: 3.16 [95% CI: 2.43-4.12]), hypertension (3.5% vs 1.4%, aOR: 2.89 [95% CI: 1.97-4.23]), heart failure (2.1% vs 0.7%, aOR: 3.16 [95% CI: 1.88-5.29]), kidney injury (3.1% vs 0.8%, aOR: 2.70 [95% CI: 1.71-4.28]), bleeding (1.5% vs 0.5%, aOR: 3.40 [95% CI: 1.83-6.32]), and venous thromboembolism (0.8% vs 0.3%, aOR: 3.60 [95% CI: 1.59-8.13]). ConclusionsClinicians should screen COVID-19 survivors for diabetes mellitus, hypertension, heart failure, and kidney dysfunction in the postacute phase.

Diabetes mellitus hospitalization and mortality rate according to a national database in Brazil: a longitudinal study

BackgroundDiabetes mellitus (DM) is an important public health problem worldwide. In addition to the impairment in functionality, the large number of complications which lead to hospitalizations results in high treatment costs. The aim of this study was to analyze the incidence of hospitalizations, mortality rate and hospital costs, as well as to observe the temporal trend of hospitalizations and length of hospital stay due to DM between 2008 and 2019 in Brazil.MethodsThis is a longitudinal descriptive study in which all data regarding hospital admissions registered in the Brazilian system of Hospital Information of “Sistema Único de Saúde” (SIH/SUS; http://datasus.saude.gov.br) due to DM (ICD-10) were included. Comparisons among the groups were performed by an unpaired Student’s t-test, two-way ANOVA with a Tukey post hoc test (p < 0.05).ResultsAn increased hospitalization of 1.83% due to DM was observed between 2008 and 2019 in Brazil. The Southeastern region had the highest incidence (34.6%) and mortality rate when compared to the other regions (p < 0.05). We also found that females were more likely to be hospitalized in comparison to males, without a statistically significant difference. Finally, a progressive increase of hospitalizations and mortality rate were observed according to age groups, as well as increased spending due to DM hospitalizations over the years.ConclusionHospitalizations due to DM in Brazil showed an expressive increase over the last 12 years, and there is a need for primary healthcare interventions to help reduce this situation.

PMU27 ASSESSING RELATIONSHIPS AMONG HOSPITALIZATIONS FOR SPINE-RELATED INFECTIONS, DEMOGRAPHICS, COSTS, AND COMORBIDITY DIAGNOSES IN THE UNITED STATES

Spinal infection is associated with multiple medical conditions including diabetes mellitus (DM), illicit drug use, endocarditis, chronic kidney disease, human immunodeficiency virus, and cirrhosis. To better characterize the complexity of and payer costs associated with spine infection-related hospitalizations and comorbid conditions, we assessed a United States (U.S.) inpatient sample during a nine-year period. Patients hospitalized with spinal infection and associated medical conditions between 2006-2014 were identified with International Classification of Diseases-9 (ICD-9) diagnoses in the U.S. Healthcare Cost and Utilization Project (HCUPNet) publicly-available data tools. We assessed patient volumes and changes over time in hospital discharges, male/female ratio, age distribution, payer mix, and HCUP calculated aggregate payer costs. The number of U.S. patients discharged with a diagnosis of spine infection increased 5% (24,179-25,320) from 2006-2014. Associated Medicare and Medicaid beneficiary volumes increased 12% and 71%, respectively, while commercially-insured patients decreased 27%. Aggregate payer costs reflected similar patterns with Medicare costs increasing 25% ($193,254,675-$242,303,186), Medicaid costs increasing 74% ($75,486,525-$131,185,098), and private insurance costs decreasing 7% ($134,325,086-$125,069,130). Hospitalized spine-infection patients with a DM diagnosis increased 6%, while discharges with other associated comorbidities decreased. In the group of patients with spine infection and those with DM, the ratio of male/female patients, patient-age distribution, and payer mixes were similar. This was not present for the other comorbidity groups. The frequency of U.S. hospitalizations for spine infection increased between 2006 and 2014. The associated volume of Medicare and Medicaid patients increased and fewer patients were commercially insured, with consistent corresponding changes in aggregate HCUPnet calculated payer costs. The increase in spine infections appeared to parallel the increase in hospitalization for diabetes mellitus, a recognized comorbidity associated with infection. Assessing correlations between spine infection and comorbidities requires further study, along with estimating the economic burden of these patients.

National trends in diabetes mellitus hospitalization in Spain 1997–2010: Analysis of over 5.4 millions of admissions

AimsTo analyze national trends in the rates of hospitalizations (all-cause and by principal discharge diagnosis) in total diabetic population of Spain. MethodsWe carried out a nation-wide population-based study of all diabetic patients hospitalized between 1997 and 2010. All-cause hospitalizations, hospitalizations by principal discharge diagnosis, mean age, Charlson Comorbidity Index, readmission rates and length of hospital stay were examined. Annual rates adjusted for age and sex were analyzed and trends were calculated. ResultsOver 14-years-period, all-cause hospitalizations of diabetic patients increased significantly, with an average annual percentage change of 2.5 (95%CI: 1.5–3.5; Ptrend < 0.01). The greatest increase was observed in heart failure (5.4; 95%CI: 4.8–6.0; Ptrend < 0.001), followed by neoplasms (4.9; 95%CI: 3.6–5.8; Ptrend < 0.001), pneumonia (2.7; 95%CI: 2.0–4.0; Ptrend < 0.001), stroke (2.4; 95%CI: 1.6–3.4; Ptrend < 0.001), chronic obstructive pulmonary disease (2.0; 95%CI: 1.4–3.4; Ptrend < 0.001) and coronary artery disease (1.6; 95%CI: 1.1–2.3; Ptrend < 0.01). The adjusted number of all-cause hospitalizations of patients with diabetes per 100,000 inhabitants increased 2.6-fold. The increase in hospitalizations was significantly higher among patients ≥75 years old. Males experienced a greater increase in all-cause, neoplasm, heart failure, chronic obstructive pulmonary disease, and pneumonia hospitalizations (p < 0.01 for all). Hospitalized diabetic patients were progressively older and had more comorbidities, higher readmission rates and shorter hospital stays (p < 0.05 for all). ConclusionsHospitalizations of diabetic patients more than doubled in Spain during the study period. Heart failure and neoplasms experienced the greatest annual increases and remained the principal causes of hospitalization, probably associated with advanced age and comorbidities of hospitalized diabetics. Coronary and cerebrovascular diseases experienced a lower annual increase, suggesting an improvement in cardiovascular care in diabetes in Spain.

Ethylenediaminetetraacetate-dependent pseudothrombocytopenia accompanied by morphological changes

A 65-year-old female patient was referred to our hospital for diabetes mellitus, diabetic nephropathy, pulmonary infection, and hypertension on November 6, 2012. Following admission, findings from laboratory tests were as follows: white blood cell count, 14.76 9 10/L; hemoglobin, 123 g/L; platelet count, 28 9 10/L; creatinine, 272 lmol/L; fasting glucose, 14.26 mmol/L; prothrombin time, 14.6 s; D-dimer, 4800 lg/L. Tests for antinuclear and antineutrophil cytoplasmic antibodies were negative, but were positive for platelet-associated IgG. Dipotassium EDTA, sodium citrate, and heparin sodium were selected as the anticoagulants for blood cell counts, to exclude the influence of EDTA salt. We performed whole-blood cell counts measured by a Sysmex XE-2100 complete blood count analyzer, followed by blood smears and staining with a Sysmex sp1000i automated hematology slide preparation unit. The platelet and white blood cell counts were 12 9 10 and 6.9 9 10/L for EDTA-2K anticoagulants, 242 9 10 and 4.3 9 10/L for sodium citrate anticoagulants, 250 9 10 and 4.6 9 10/L for heparin sodium anticoagulants, respectively. The blood smear results are shown in Figs. 1 and 2. The International Committee for Standardization in Hematology recommends dipotassium EDTA for anticoagulation of peripheral blood cells for analysis [1]. Blood specimens that met the review criteria after detection by the blood cell analyzer were smeared, stained, and observed under a microscope. When the platelet aggregation occurred, a cluster of platelets with uneven sizes was observed. However, the aggregated platelets retained their individual morphologies (Fig. 3). Microscopic examination of the blood smear revealed clumps of violescent material

The influence of family health strategy on health indicators in the municipalities of Rio de Janeiro, Brazil

ABSTRACT: This study examines the behavior of health indicators deployment of Family Health in the cities of Rio de Janeiro, Nova Iguacu and Duque de Caxias. This is ecological study of time series of selected variables in the period 1998 to 2010. Data were collected at the websites of DATASUS and Department of Primary Care and later exported into a spreadsheet, tabulated and analyzed using inferential statistics with calculation of Pearson coefficient (r) and t test at a significance level of 5% (α = 0.05). There was a strong negative correlation with statistical significance between the evolution of family health and: number of deaths from infectious and parasitic diseases in Rio de Janeiro and Duque de Caxias; frequency of hospitalized children with diarrhea in Rio de Janeiro and Nova Iguacu; and frequency of hospitalization for diabetes mellitus in Rio de Janeiro. It is concluded that the strategy of family health influence the behavior of health indicators for the cities studied, however, further research will be needed to investigate further the impact of family health in cities with high population density.

Primary Care and Avoidable Hospitalizations

This article provides evidence of the effectiveness of family-based, community-oriented primary healthcare programs on the reduction of ambulatory care sensitive hospitalizations in Brazil. Between 1998 and 2002, expansions of the Family Health Program were associated with reductions in hospitalizations for diabetes mellitus and respiratory problems and Community Health Agents Program expansions were associated with reductions in circulatory conditions hospitalizations. Results were significant for only the female population only, suggesting that these programs were more effective in reaching women than men. Program coverage may have contributed to an estimated 126 000 fewer hospitalizations between 1999 and 2002, corresponding to potential savings of 63 million US dollars.

微小膵癌の1例

A 72-year-old male, who visited our hospital for diabetes mellitus, was pointed out abnormality on pancreas and admitted to our hospital for further examination. Abdominal US, CT, MRI and EUS showed a cyst 7mm in diameter in the pancreatic body and dilatation of the main pancreatic duct (MPD) in the pancreatic body and tail. ERP showed severe localized stenosis of the MPD in the pancreatic body, with proximal duct dilatation. The result of cytologic examination of the pancreatic juice was class IIIa. Under the diagnosis of pancreatic cancer, distal pancreatectomy was performed. Histopathological study showed inflammatory cells and marked fibrosis but no tumor tissues around the stenotic part of the MPD. And it showed carcinoma in situ approximately 5mm in size mainly presented in the branch of the pancreatic duct and partially in the MPD in the distal portion. p53 staining showed diffusely positive pattern in the carcinoma.

A Case of Recurrence of Graves Disease and Adenomatous Goiter Accompanied by Diabetes Mellitus

A 58-year-old woman visited our hospital for diabetes mellitus and thyroid nodule therapy. At the age of 45, she suffered from Graves disease. We had given her anti-thyroid drugs for three years. The euthyroid state continued for more than 3 years after discontinuing the drug. At 56, glycosuria and hyperglycemia led a practitioner to suspect diabetes mellitus. A practitioner administered an oral hypoglycemic drug. However, she frequently suffered hypoglycemia, resulting from poor diet therapy. At 58, she palpated two cervical tumors in the right thyroid. We diagnosed the recurrence of Graves disease and the occurrence of nodular goiter. The fasting immunoreactive insulin (IRI) level was 22μU/ml, urine C-peptide reactivity level was 142μg/day and the peak IRI level after oral glucose ingestion was 105μU/ml in the hyperthyroid state. The percentage of TSH receptor antibody present was 71%. The blood glucose control improved after proper diet therapy alone. The histological examination revealed adenomatous goiter accompanied by Graves disease after subtotal thyroidectomy. The adenomatous goiter may have occurred because of the presence of the TSH receptor antibody and high concentration of insulin levels, either of which facilitates thyroid follicular cells proliferation.