Hyperosmolar Hyperglycemic State Research Articles

The impact of diabetes pay-for-performance program on hyperglycemic hyperosmolar state (HHS)

Abstract Background To examine the effects of a diabetes pay-for-performance (P4P) program on the negative metabolic outcome: hyperglycemic hyperosmolar state (HHS) of patients in Taiwan. Methods Four years (2008∼2011) of data from the National Health Insurance Administration (NHIA) databases were examined. P4P patients included those who were newly enrolled in the P4P group in 2010, and consecutively included in 2011. Patients were never enrolled are defined as non-P4P group in these two years. The caliper matching method and a generalized estimating equation were used to estimate difference-in-differences models (baseline year 2009) and examine the effects of the P4P program on the count of the adverse outcome. Results The P4P program was associated with decreases in the incident of HHS (IRR 0.53, P = 0.02). Conclusions The disease management component of the diabetes P4P program can be beneficial for reducing the incidences of HHS. Key messages • The disease management component of the diabetes P4P program can be beneficial for reducing the incidences of HHS. • The disease management component of the diabetes P4P program is important.

Effectiveness of Dexamethasone for COVID-19 in Hospitalized Patients with Diabetes: A Retrospective Cohort Study.

Patients with diabetes have higher mortality from COVID-19 compared to the general population. Dexamethasone, a potent glucocorticoid used for moderate to severe COVID-19, can worsen hyperglycemia in patients with diabetes, potentially leading to worse outcomes. The efficacy and safety of use of dexamethasone for COVID-19 in patients with diabetes needs further evaluation. The study aimed to assess the efficacy and safety of dexamethasone in patients with diabetes hospitalized for COVID-19 infection. This retrospective study analyzed data from five hospitals in the Johns Hopkins Health System (JHHS) collected between March 3, 2020 and June 25, 2022. Propensity score matching was applied to a cohort of patients with diabetes who received dexamethasone and those who did not (controls), and outcomes were compared using Cox proportional hazards regression models. The primary outcome was time to death within 28 days. The secondary outcome was time to clinical improvement. Additional outcomes included the incidence of hyperglycemic emergencies and subgroup analysis of primary outcomes by clinical severity. Out of 10,329 patients admitted for COVID-19, 3,679 had diabetes, and 2,361 met the inclusion criteria. After propensity score matching, 529 patients were analyzed in each group. Survival rates between the dexamethasone and control groups during the 0-6 day and 7-28-day periods and time to clinical improvement at 28 days did not differ significantly. There was no difference in the incidence of diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) between the groups. Dexamethasone treatment did not significantly improve survival or time to clinical improvement in patients with diabetes and COVID-19 infection. Further prospective studies are needed to confirm these findings and determine potential mechanisms.

The role of ACPs in recognising and treating diabetic ketoacidosis and hyperosmolar hyperglycaemic state.

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) are both diabetic emergencies that require immediate identification and intervention. Advanced clinical practitioners (ACPs) play a crucial role in the early detection, management and co-ordination of care for patients with these conditions, although some may feel less confident in handling such complex cases. This clinical review explores the role of ACPs in managing DKA and HHS, focusing on their responsibilities in diagnosis, treatment initiation, and communication within multidisciplinary teams. It also examines the epidemiology, pathogenesis, risk factors, and causes of these conditions, alongside diagnostic criteria and management strategies. In addition, the review highlights the importance of minimising risks and preventing recurrence to ultimately enhance patient outcomes.

7313 Impact of Day of Admission on Hyperosmolar Hyperglycemic State Outcomes- a National Inpatient Sample Study

Abstract Disclosure: B. Neupane: None. S. Karki: None. A. Bhandari: None. K. Rajamani: None. Introduction: Hospital mortality and results are significantly influenced by the day of admission (weekend vs. weekday). Studies have shown there is an increase in rates of adjusted hospital mortality in various diseases. Hyperosmolar hyperglycemic state (HHS), or Hyperosmotic hyperglycemic nonketotic state (HHNK), is a serious complication associated with type 2 diabetes mellitus. There have been limited studies on how the day of admission impacts outcomes in HHS. Objective:To investigate if there are differences in weekend vs. weekday admission with the diagnosis of HHS on hospital outcomes. Methods: Retrospective data on adult patients (age >18) with a primary diagnosis of HHS was taken between 2017 and 2020 using the National Inpatient Sample (NIS). The data analysis tool utilized was STATA. Diseases and outcome codes were selected using the International Classification of Diseases (ICD-10). Multivariate regression analysis was used to adjust for potential variables and determine the adjusted odds ratio (aOR). The Fisher exact test was used to compare proportions, while the student t-test was used to compare continuous variables. The study's primary outcome was mortality; additional secondary outcomes included length of stay (LOS), total hospitalization costs, acute coronary syndrome (ACS), septic shock, pulmonary edema, acute respiratory failure (ARF), mechanical ventilation, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and cerebrovascular accidents (CVA). Between 2017 and 2020, the mortality rates, LOS, and total hospitalization charges of weekend and weekday admissions were analyzed. Results:181,720 patients were diagnosed with HHS; 46,100(25.36%) were admitted on the weekend. Weekend admission had increased rates of ARF (aOR =1.2, 11.15% vs. 9.57%, p<0.01) and mechanical ventilation (aOR =1.24, 7.04% vs. 5.79%, p<0.01) compared to the weekday admission. There was no difference in the outcomes of the two groups in the mortality rate, mean LOS, total hospital charges, ACS, septic shock, pulmonary edema, AKI, CVA, and ARDS. In weekend admission, there was an increase in trends of LOS and total hospitalization charges, but there were no significant outcomes in the mortality rates over the years. In weekday admission, there was an increase in mortality rate trends, LOS, and total hospitalization charges. Conclusion: There was an increase in ARF and mechanical ventilation rates on weekends compared to weekday admission. When the two groups were compared, there were no significant outcomes in mortality rate, LOS, hospital charges, and other hospital outcomes. In both weekend and weekday admissions, there was an increase in trends of LOS and total hospitalization charges; however, only admissions during the weekday showed a significant increase in mortality rate trends. Presentation: 6/1/2024

8197 A Captivating Case Report of Teprotumumab Induced Hyperglycemic Hyperosmolar State

Abstract Disclosure: K.M. Tuna: None. J.P. Perdomo Rodriguez: None. Introduction: Teprotumumab, a monoclonal antibody targeting the IGF-1 receptor, is increasingly utilized for moderate to severe thyroid eye disease. Initial trials noted mild hyperglycemia in patients with diabetes, while recent trials revealed a significant elevation in Hemoglobin A1c (HbA1c) among those with diabetes or pre-diabetes post-infusion. Here, we discuss a case of a patient with diet-controlled diabetes who developed hyperglycemic hyperosmolar state (HHS) two months after Teprotumumab infusion. Case Presentation: A 43-year-old male, with class III obesity, obstructive sleep apnea, dyslipidemia, coronary artery disease, and diet-controlled diabetes (HbA1c 6.5%) presented with worsening proptosis, decreased color vision, severe visual field depression. Laboratory evaluation revealed elevated TSH (6.3 mIU/ml), normal free T4 (0.67 ng/dl, ref: 0.60-1.2 ng/dl), and undetectable Thyroid Stimulating Immunoglobulin (<0.1 IU/L). Blood cell count, renal and liver function tests were normal. Due to high clinical suspicion of thyroid eye disease, he was treated with timolol, dorzolamide, brimonidine, and methylprednisolone 1g daily for 3 days. Glycemic control was achieved with 30 units of daily insulin while on pulse steroids. On outpatient ophthalmology follow-up, Teprotumumab was initiated and he received 2 doses. Eight weeks later, the patient was hospitalized with altered mental status caused by HHS (glucose 617 mg/dl, serum osmolality 316 osm). HbA1c was found to be significantly increased to 12% and the patient required 150 units total daily insulin and metformin upon discharge. Of note, the patient did not have significant weight changes during this time. GAD, IA2, and Zinc Transporter-8 antibodies were obtained prior to discharge and results are pending. Discussion: The IGF-1 receptor, a partial homologue of the insulin receptor, plays a pivotal role in glucose homeostasis. Inhibiting this receptor can lead to hyperglycemia. Initial randomized controlled trials (RCTs) reported a 10% incidence of mild hyperglycemia. A recent RCT from a cohort of 42 patients demonstrated a 50% incidence of hyperglycemia, in which two-thirds of the patients remained in a dysglycemic state with one patient with pre-existing prediabetes developing diabetic ketoacidosis (DKA). Our patient mirrored this scenario with no identifiable confounding factors. Conclusion: Teprotumumab-induced hyperglycemia, though rare, can lead to life-threatening complications. Baseline glycemic assessment, identification of high-risk patients, and comprehensive discussions on risks and benefits are crucial before initiating therapy. Close monitoring, especially in those with prediabetes, is recommended. Patient education plays a pivotal role in early symptom recognition, averting delayed diagnoses, and subsequent hospitalization. Presentation: 6/3/2024

6608 Racial Disparities In Outcomes of Hyperosmolar Hyperglycemic State- A National Inpatient Sample Analysis

Abstract Disclosure: S. Karki: None. S. Neupane: None. B. Neupane: None. L.F. Chavez: None. Introduction: Numerous studies have explored variations in access to healthcare among racial and ethnic groups, revealing disparate challenges in insurance coverage and other healthcare services. Hyperosmolar Hyperglycemic State (HHS) or Hyperosmotic Hyperglycemic Nonketotic State (HHNK) represents a severe complication associated with type 2 diabetes mellitus. Objective of the study:To investigate if there are any racial disparities between white and black populations with the diagnosis of HHS, focusing on outcomes such as mortality rates, length of stay (LOS), hospital costs, and other outcomes. Methods: Retrospective data encompassing adult patients (age >18) with HHS between 2017 and 2020 were extracted from the National Inpatient Sample (NIS). Employing STATA as the data analysis tool, the International Classification of Diseases (ICD-10) was utilized to select disease and outcome codes. Multivariate regression analysis adjusted for relevant variables determining the adjusted odds ratio (aOR). Proportions were compared using the Fisher exact test, while continuous variables were assessed via the student t-test. The study's primary outcome was mortality, with secondary outcomes including LOS, total hospitalization costs, Acute Coronary Syndrome (ACS), septic shock, pulmonary edema, Acute Respiratory Failure (ARF), mechanical ventilation, Acute Respiratory Distress Syndrome (ARDS), Acute Kidney Injury (AKI), and Cerebrovascular Accident (CVA). Results: Among 181,720 HHS-diagnosed patients, 84,140 were white, and 58,645 were black. White patients exhibited a $2,741 higher total hospital expenses compared to their black counterparts. Rates of septic shock (aOR=0.78, 5.26% vs. 4.1%, p<0.001) and ARF (aOR=0.83%, 10.54 vs. 9%, p<0.001) were elevated in whites compared to blacks. Conversely, rates of AKI were higher in blacks (aOR=1.48, 58.29% vs. 50.58%, p<0.001) compared to whites. No statistically significant differences in mortality rates, mean LOS, ACS, pulmonary edema, mechanical ventilation, ARDS, and CVA were observed. Conclusion: Whites demonstrated increased rates of total hospital expenses, septic shock, and ARF compared to blacks, while blacks exhibited higher rates of AKI. No significant differences were observed in mortality rates, LOS, ACS, pulmonary edema, mechanical ventilation, ARDS, and CVA. Presentation: 6/2/2024

6769 Rhabdomyolysis In Diabetic Emergencies Highlighting The Necessity Of Prompt Creatine Kinase Monitoring

Abstract Disclosure: A. Tiwari: None. M. Corsten: None. W. salari: None. N. Malik: None. A. Dabaja: None. C. Saad: None. Rhabdomyolysis results from skeletal muscle necrosis, causing the release of intracellular contents into the bloodstream. While its association with life-threatening diabetic emergencies is rare, it remains a significant complication. We detail the case of a 37-year-old male admitted with acute pancreatitis who subsequently developed a hyperosmolar hyperglycemic state accompanied by significant electrolyte imbalances. Upon arrival at our emergency department, he displayed severe dehydration, stupor, a blood glucose level surpassing 2,000 mg/dl, and high anion gap metabolic acidosis. His condition worsened when his creatine kinase levels surged from 210 U/L to 39,000 U/L, leading to oliguric renal failure and the need for hemodialysis. His thyroid profile was unremarkable and was not on any medication. Comprehensive treatment included crystalloids, parenteral insulin, and rigorous ICU monitoring with mechanical ventilation. Following this, the patient showed rapid improvement and was discharged without requiring further dialysis. A thorough history and observation established a rare but strong link between rhabdomyolysis and hyperosmolar hyperglycemic states. These situations can intensify nephrotoxic events, especially in patients already facing severe dehydration and prerenal factors. This case emphasizes the critical need for consistent monitoring of creatine kinase levels in diabetic emergencies. Such monitoring ensures early detection and facilitates effective management of rhabdomyolysis-induced acute kidney injury, reducing potential complications and improving patient outcomes. Presentation: 6/3/2024

Beyond Infection: Unmasking the Impact of COVID-19 on Diabetes Emergency Trends.

Introduction The relationship between COVID-19 and diabetes has been demonstrated in many studies. However, it is thought that the psycho-socioeconomic effects of the pandemic led to a worsening of glycemic control and an increase in diabetes-associated clinical emergencies in diabetic patients without a diagnosis of COVID-19. Objectives We aimed to reveal the change in the frequency of diabetes-related clinical emergencies before and during the COVID-19 pandemic. Patients and methods The data of the patients requiring endocrinology consultations in Manisa Celal Bayar University Faculty of Medicine Emergency Service between March 2018 and March 2022 were included. In total, 269 consultations were analyzed. The March 2018 - March 2020 period was considered as pre-COVID, and March 2020 - March 2022 as the COVID-19 period. The frequency of diabetes-related conditions between these two periods was compared. Results Compared to the pre-COVID period, there was a significant increase in the frequency of admissions with diabetic ketosis, hyperglycemic hyperosmolar state, hypoglycemia, and hyperglycemia in the COVID-19 period (p=0.022, p=0.037, p=0.044, and p=0.004 respectively). Although an increase was observed in the frequency of diabetic ketoacidosis (DKA) cases, no statistical significance was found. When the mortality data of the patients was evaluated, the total number of deaths was seen to increase significantly in the COVID-19 period (p=0.01). It was observed that the ratio of type 2 diabetes mellitus (DM)/type 1 DM among DKA patients increased significantly in the COVID-19 period (p=0.001). Conclusions It can be concluded that the increasing trend in diabetic emergencies that started even before the pandemic is exacerbated by COVID-19, especially in patients with poor glycemic control.

Tacrolimus related diabetic ketoacidosis and hyperglycaemic hyperosmolar nonketotic syndrome: an observational, retrospective, pharmacovigilance study

ABSTRACT Background Information on the incidence and risk factors for diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS) caused by tacrolimus has rarely been reported. This study aims to assess the spectrum of DKA/HHNS associated with tacrolimus. Methods We conducted an observational, retrospective pharmacovigilance study using the Food and Drug Administration adverse event reporting system (FAERS) database. We employed the information component (IC) and reporting odds ratio (ROR) to evaluate the association between tacrolimus and DKA/HHNS. Results A total of 232 events were identified as tacrolimus-related DKA/HHNS, 186 cases from DKA and 54 cases from HHNS. The frequency of tacrolimus-associated DKA and HHNS was found to be significantly higher compared to all other drugs. Specifically, HHNS was significantly associated with tacrolimus based on its ROR and IC. There were no significant differences in death and non-death cases in gender, age group, year of reporting and region of reporting. Conclusion Our study showed that DKA and HHNS were associated with tacrolimus use. Healthcare professionals should be aware of the possibility of DKA/HHNS following tacrolimus administration, as they were associated with an increased risk of mortality in transplant recipients.

Exploring Uncommon Neurologic Complication in Young Diabetics with Osmotic Demyelination Syndrome: A Case Series and Literature Review.

Osmotic demyelination syndrome (ODS) is well known to be associated with the rapid correction of hyponatremia. However, there is limited literature on its link to persistent or corrected hyperglycemic states in diabetic patients. We report two young patients with ODS and hyperglycemia. Neuroimaging and blood tests indicated central pontine and extrapontine myelinolysis with a hyperglycemic hyperosmolar state (HHS). These unusual cases provide insight into the neurologic complications of hyperglycemia.

Effectiveness of the Educational Program on Nurses’ Knowledge concerning Hyperosmolar Hyperglycemic State

Hyperosmolar Hyperglycemic State (HHS) is one of the acute diabetic complications that commonly seen with type 2 diabetes mellitus (T2DM). This represents a critical case necessitating prompt and efficient intervention to prevent potential severe complications. Nursing plays a crucial role in the care of these patients at the critical care settings. Specifically, the project aims to investigate whether nurses' HHS knowledge can be enhanced by educational programs. Quasi-experimental design was used to investigate the effect of the educational program on nurses’ knowledge about HHS at Al-Diwaniyah Teaching Hospital in three unites: Cardiac Care Unites (CCU), respiratory care unit (RCU) and emergency room (ER). A non-probability (purposive) sample was chosen from nurses who works in these three unites, the study group consisted of 35 nurses, while the control group comprised 41 nurses. A statistical package for social science (SPSS) program, version 26 was used for descriptive and inferential statistics. By comparing the nurses’ knowledge about HHS between the test before (6.4286± 1.35659) and after the program (8.2000± 1.10613), there is a significant difference in nurses’ knowledge after the program in the study group, but as for the control group, there is no difference. By comparing the nurses' knowledge regarding nursing care of HHS between the test before (14.0286± 2.05062) and after the program (16.6286± 1.41600), there is a significant increase in nurses' knowledge about nursing care of HHS after the program in the study group. The finding of study show that the educational program was effective to enhance nurses’ knowledge about HHS.

Trends in diabetic ketoacidosis- and hyperosmolar hyperglycemic state-related mortality during the COVID-19 pandemic in the United States: A population-based study.

During the pandemic, a notable increase in diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), conditions that warrant emergent management, was reported. We aimed to investigate the trend of DKA- and HHS-related mortality and excess deaths during the pandemic. Annual age-standardized mortality rates related to DKA and HHS between 2006 and 2021 were estimated using a nationwide database. Forecast analyses based on prepandemic data were conducted to predict the mortality rates during the pandemic. Excess mortality rates were calculated by comparing the observed versus predicted mortality rates. Subgroup analyses of demographic factors were performed. There were 71 575 DKA-related deaths and 8618 HHS-related deaths documented during 2006-2021. DKA, which showed a steady increase before the pandemic, demonstrated a pronounced excess mortality during the pandemic (36.91% in 2020 and 46.58% in 2021) with an annual percentage change (APC) of 29.4% (95% CI: 16.0%-44.0%). Although HHS incurred a downward trend during 2006-2019, the excess deaths in 2020 (40.60%) and 2021 (56.64%) were profound. Pediatric decedents exhibited the highest excess mortality. More than half of the excess deaths due to DKA were coronavirus disease 2019 (COVID-19) related (51.3% in 2020 and 63.4% in 2021), whereas only less than a quarter of excess deaths due to HHS were COVID-19 related. A widened racial/ethnic disparity was observed, and females exhibited higher excess mortality than males. The DKA- and HHS-related excess mortality during the pandemic and relevant disparities emphasize the urgent need for targeted strategies to mitigate the escalated risk in these populations during public health crises.

Risk factors for adverse outcomes in children with diabetic ketoacidosis.

Develop a multivariable model to identify children with diabetic ketoacidosis (DKA) and/or hyperglycemic hyperosmolar state (HHS) at increased risk of adverse outcomes, and apply it to analyze adverse outcomes during and after the COVID-19 pandemic. Retrospective review of clinical data from 4565 admissions (4284 with DKA alone, 31 [0.7%] only HHS, 250 [5.4%] hyperosmolar DKA) to a large academic children's hospital from January 2010-June 2023. 2010-2019 data (N=3004) were used as a training dataset, and 2020-2021 (N=903) and 2022-2023 (N=658) data for validation. Death or intensive care unit stays >48 hours comprised a composite "Adverse Outcome" group. Risks for this composite outcome were assessed using generalized estimating equations. There were 47 admissions with Adverse Outcomes (1.5%) in 2010-2019, 46 (5.0%) in 2020-2021, and 16 (2.4%) in 2022-2023. Eight patients died (0.18%). Maximum serum glucose, initial pH and diagnosis of type 2 diabetes most strongly predicted Adverse Outcomes. The proportion of patients with type 2 diabetes was highest in 2020-2021. A multivariable model incorporating these factors had excellent discrimination (area under receiver operator characteristic curve [AUC] of 0.948) for the composite outcome in the training dataset, and similar predictive power (AUC 0.960 and 0.873) in the 2020-2021 and 2022-2023 validation datasets, respectively. In the full dataset, AUC for death was 0.984. Type 2 diabetes and severity of initial hyperglycemia and acidosis are independent risk factors for Adverse Outcomes, and explain the higher frequency of Adverse Outcomes during the COVID-19 pandemic. Risks decreased in January 2022-June 2023.

Risk of chronic kidney disease in patients with a hyperglycemic crisis as the initial presentation of type 2 diabetes

Limited data exist on long-term renal outcomes in patients with hyperglycemic crisis (HC) as initial type 2 diabetes presentation. We evaluated the risk of chronic kidney disease (CKD) development in those with concurrent HC at diagnosis. Utilizing Taiwan’s insurance claims from adults newly diagnosed with type 2 diabetes during 2006–2015, we created HC and matched non-HC cohorts. We assessed incident CKD/diabetic kidney disease (DKD) by 2018’s end, calculating the hazard ratio (HR) with the Cox model. Each cohort comprised 13,242 patients. The combined CKD and DKD incidence was two-fold higher in the HC cohort than in the non-HC cohort (56.47 versus 28.49 per 1000 person-years) with an adjusted HR (aHR) of 2.00 (95% confidence interval [CI] 1.91–2.10]). Risk increased from diabetic ketoacidosis (DKA) (aHR:1.69 [95% CI 1.59–1.79]) to hyperglycemic hyperosmolar state (HHS) (aHR:2.47 [95% CI 2.33–2.63]) and further to combined DKA-HHS (aHR:2.60 [95% CI 2.29–2.95]). Subgroup analysis in individuals aged ≥ 40 years revealed a similar trend with slightly reduced incidences and HRs. Patients with HC as their initial type 2 diabetes presentation face a higher CKD risk than do those without HC. Enhanced medical attention and customized interventions are crucial to reduce this risk.

Management of diabetes-related hyperglycaemic emergencies in advanced chronic kidney disease: Review of the literature and recommendations.

Despite the substantial progress in the management of diabetes mellitus (DM), chronic kidney disease (CKD) remains one of the most common complications. Although uncommon, diabetic emergencies [diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state (HHS)] can still occur in stage 4 and 5 CKD, at times with less typical clinical manifestations due to the altered pathophysiology, presence of chronic metabolic acidosis and effect of haemodialysis on glycaemic control and metabolic parameters. The purpose of this article is to review the current literature and provide recommendations for the diagnosis and treatment of DKA, euglycaemic DKA and HHS in people with advanced CKD. Guidance on the management of diabetes-related emergencies mainly focuses on individuals with preserved renal function or early-stage CKD. Existing literature is limited, and recommendations are based on expert opinions and case reports. Given the clinical need for amended guidelines for this population, we are proposing a management algorithm for DKA and HHS based on clinical and metabolic parameters. In this review article, we propose treatment algorithms for diabetes-related hyperglycaemic emergencies in people with advanced CKD. Further research is needed to validate our proposed algorithms.

The Implication of Elevated Serum Myoglobin Level in Acute Diabetic Complications of Ketoacidosis and Hyperglycemic Hyperosmolar State: A Real-World Study.

To investigate the implications of elevated myoglobin (MYO) in acute diabetic conditions of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). This study integrates in-patient data from Shanghai Pudong Hospital from 2019 to 2023. Laboratory data were compared between stable T2D patients (without acute diabetic complications), DKA, and HHS patients. The multilinear regression explored variables relevant to the elevated MYO in DKA and HHS. The dynamics of MYO, the survival rate, and associated risk factors in HHS were determined. Except for triglyceride, procalcitonin, low-density lipoprotein, islet cell autoimmune antibodies, N-terminal Pro-brain natriuretic peptide (NT-ProBNP), and brain natriuretic peptide (BNP), there were significant differences in age, gender distribution, duration of diabetes, type of diabetes, and other referred laboratory data (p<0.05). The age, gender, creatine kinase (CK), estimated glomerular filtration rate (eGFR), and free triiodothyronine (FT3) in DKA, whereas osmolar, uric acid (UA), and cardiac troponin I (cTNI) in the HHS, were significant determinants of elevated MYO, respectively (p<0.05). The dynamic of MYO in HHS was in line with the survival trend, where the percentage of death was 29.73%, and aging with higher procalcitonin levels was a key risk factor. Besides, the cumulative survival rates between patients with or without bone fracture or muscle injury were substantially different. This real-world study demonstrated DKA and HHS potentially have unique causes for increased MYO. By utilizing the appropriate regression parameters, we could forecast the progression of increased MYO in groups of DKA and HHS, while based on risk factors of aging, severity of infection, and different MYO sources, we could predict the prognosis of HHS.

Holistic and Personalized Strategies for Managing in Elderly Type 2 Diabetes Patients.

Due to increased life expectancy and lifestyle changes, the prevalence of diabetes among the elderly in Korea is continuously rising, as is the associated public health burden. Diabetes management in elderly patients is complicated by age-related physiological changes, sarcopenia characterized by loss of muscle mass and function, comorbidities, and varying levels of functional, cognitive, and mobility abilities that lead to frailty. Moreover, elderly patients with diabetes frequently face multiple chronic conditions that elevate their risk of cardiovascular diseases, cancer, and mortality; they are also prone to complications such as hyperglycemic hyperosmolar state, diabetic ketoacidosis, and severe hypoglycemia. This review examines the characteristics of and management approaches for diabetes in the elderly, and advocates for a comprehensive yet personalized strategy.

Hyperglycaemic crises in adults with diabetes: a consensus report

The American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), Joint British Diabetes Societies for Inpatient Care (JBDS), American Association of Clinical Endocrinology (AACE) and Diabetes Technology Society (DTS) convened a panel of internists and diabetologists to update the ADA consensus statement on hyperglycaemic crises in adults with diabetes, published in 2001 and last updated in 2009. The objective of this consensus report is to provide up-to-date knowledge about the epidemiology, pathophysiology, clinical presentation, and recommendations for the diagnosis, treatment and prevention of diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar state (HHS) in adults. A systematic examination of publications since 2009 informed new recommendations. The target audience is the full spectrum of diabetes healthcare professionals and individuals with diabetes.

Hyperglycemic Crises in Adults With Diabetes: A Consensus Report.

The American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), Joint British Diabetes Societies for Inpatient Care (JBDS), American Association of Clinical Endocrinology (AACE), and Diabetes Technology Society (DTS) convened a panel of internists and diabetologists to update the ADA consensus statement on hyperglycemic crises in adults with diabetes, published in 2001 and last updated in 2009. The objective of this consensus report is to provide up-to-date knowledge about the epidemiology, pathophysiology, clinical presentation, and recommendations for the diagnosis, treatment, and prevention of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) in adults. A systematic examination of publications since 2009 informed new recommendations. The target audience is the full spectrum of diabetes health care professionals and individuals with diabetes.

Post-marketing Safety Concerns of Teprotumumab: A Real-World Pharmacovigilance Assessment.

Teprotumumab is the only drug approval by The US Food and Drug Administration (FDA) for the treatment of thyroid eye disease (TED), which targets the insulin-like growth factor-1 receptor. This study aimed to identify potential safety signals of teprotumumab by analyzing post-marketing safety data from the FDA Adverse Event Reporting System (FAERS) database in 2023. The case/non-case approach was used to estimate the reporting odds ratio (ROR) and information component (IC) with relevant confidence intervals (95% CI) for adverse events (AEs) that numbered three or more. Total of 2158 cases were included in the analysis. Main safety signals identified were ear and labyrinth disorders, reproductive system and breast disorders, metabolism and nutrition disorders and gastrointestinal disorders. Specifically, autophony (ROR [95% CI] = 4188.34 [1403.29-12500.8]), eyelid retraction (ROR [95% CI] = 2094.17 [850.69-5155.29]), deafness permanent (ROR [95% CI] = 1552.35 [789.07-3053.98]), deafness bilateral (ROR [95% CI] = 73.12 [41.14-129.97]), inflammatory bowel disease (ROR [95% CI] = 23.26 [13.46-40.19]), hyperglycaemic hyperosmolar nonketotic syndrome (ROR [95% CI] = 17.75 [5.70-55.28]) and amenorrhoea (ROR [95% CI] = 47.98 [36.22-63.54]) showed significant safety signals of teprotumumab. This study identified ear and labyrinth disorders, reproductive system and breast disorders, as specific safety signals of teprotumumab. Clinicians and pharmacists should be vigilant regarding these AEs. However, available data are currently insufficient, and further pharmacovigilance and surveillance are needed to fully understand this issue.