scholarly journals Sentinel visits in emergency department patients with diabetes mellitus as a warning sign for hyperglycemic emergencies

CJEM ◽  
2017 ◽  
Vol 20 (2) ◽  
pp. 230-237 ◽  
Author(s):  
Justin W. Yan ◽  
Katherine M. Gushulak ◽  
Melanie P. Columbus ◽  
Alexandra L. Hamelin ◽  
George A. Wells ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Blood Glucose ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Warning Sign ◽  
Diabetic Patients ◽  
Discharge Instructions ◽  
Patients With Diabetes ◽  
Hyperosmolar Hyperglycemic State

ABSTRACTObjectivesPatients with poorly controlled diabetes mellitus may have a sentinel emergency department (ED) visit for a precipitating condition prior to presenting for a hyperglycemic emergency, such as diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). This study’s objective was to describe the epidemiology and outcomes of patients with a sentinel ED visit prior to their hyperglycemic emergency visit.MethodsThis was a 1-year health records review of patients≥18 years old presenting to one of four tertiary care EDs with a discharge diagnosis of hyperglycemia, DKA, or HHS. Trained research personnel collected data on patient characteristics, management, disposition, and determined whether patients came to the ED within the 14 days prior to their hyperglycemia visit. Descriptive statistics were used to summarize the data.ResultsOf 833 visits for hyperglycemia, 142 (17.0%; 95% CI: 14.5% to 19.6%) had a sentinel ED presentation within the preceding 14 days. Mean (SD) age was 50.5 (19.0) years and 54.4% were male; 104 (73.2%) were discharged from this initial visit, and 98/104 (94.2%) were discharged either without their glucose checked or with an elevated blood glucose (>11.0 mmol/L). Of the sentinel visits, 93 (65.5%) were for hyperglycemia and 22 (15.5%) for infection. Upon returning to the ED, 61/142 (43.0%) were admitted for severe hyperglycemia, DKA, or HHS.ConclusionIn this unique ED-based study, diabetic patients with a sentinel ED visit often returned and required subsequent admission for hyperglycemia. Clinicians should be vigilant in checking blood glucose and provide clear discharge instructions for follow-up and glucose management to prevent further hyperglycemic emergencies from occurring.

scholarly journals P144: Sentinel visits in emergency department patients with diabetes mellitus as a warning sign for hyperglycemic emergencies

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S126-S126
Author(s):  
J. Yan ◽  
K. Gushulak ◽  
M. Columbus ◽  
A. Hamelin ◽  
I.G. Stiell
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Blood Glucose ◽  
Tertiary Care ◽  
Clinical History ◽  
Future Research ◽  
Warning Sign ◽  
Discharge Diagnosis ◽  
Discharge Instructions ◽  
Hyperosmolar Hyperglycemic State

Introduction: Patients with poorly controlled diabetes mellitus (DM) often visit the emergency department (ED) for management of hyperglycemia, diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Many of these patients have a “sentinel” ED visit for other medical conditions prior to their hyperglycemic visit, which may worsen their glucose control. The objective of this study was to describe the epidemiology and outcomes of patients presenting with a sentinel ED visit prior to their visit for a hyperglycemic emergency. Methods: This was a health records review of patients ≥18 years presenting to one of four tertiary care EDs (combined annual census 300,000) with a discharge diagnosis of DM, hyperglycemia, DKA or HHS in a one-year period. Visits for hypoglycemia were excluded. Trained research personnel collected data from medical records including demographics, clinical history and results of investigations. Electronic charts were reviewed to determine if the patient came to the ED within the prior 14 days of their index hyperglycemia visit, and the details and outcomes surrounding both visits. Descriptive statistics were used where appropriate to summarize the data. Results: From January-December 2014, 609 ED visits had a discharge diagnosis of hyperglycemia. Mean (SD) age was 50.4 (19.5) years, and 343 (56.3%) were male. 101/609 visitors (16.6%) had an ED presentation within the previous 14 days from their hyperglycemia visit. 71 (70.3%) of these were discharged from this initial visit and 49/71 (69.0%) were discharged either without their blood glucose checked or with an elevated blood glucose (>11.0 mmol/L). Of the sentinel visits, 58 (57.4%) were for hyperglycemia and 15 (14.9%) were for infection. Upon returning to the ED, 45/101 (44.6%) visitors were subsequently admitted for management of severe hyperglycemia, DKA or HHS. Conclusion: This unique ED-based study demonstrates that patients with DM presenting with hyperglycemia or infection often return and may ultimately require admission. Clinicians should be vigilant in checking blood glucose when these patients present to the ED and provide clear discharge instructions for follow-up and glucose management. Future research should focus on improving glycemic control in these patients in order to prevent further hyperglycemic emergencies from occurring.

scholarly journals Psycho-sexual Disorders in Clinic Diabetes mellitus Patients of a Teaching Hospital of Eastern Nepal

2020 ◽  
Vol 4 (2) ◽  
pp. 19-23
Author(s):  
Dhana Ratna Shakya ◽  
R Maskey ◽  
P Karki ◽  
SK Sharma
Keyword(s):  
Diabetes Mellitus ◽  
Erectile Dysfunction ◽  
Sexual Dysfunction ◽  
Teaching Hospital ◽  
Sexual Experience ◽  
Tertiary Care ◽  
Sexual Disorders ◽  
Diabetic Patients ◽  
Diabetes Clinic ◽  
Patients With Diabetes

Background: Diabetes mellitus, a chronic disease, is frequently associated with sexual dysfunctions. Identification and management of these dysfunctions are important for overall wellbeing of the patient, though usually neglected. We lack data on this regard from Nepal. Objective: To estimate prevalence of psycho-sexual disorders (with emphasis on erectile dysfunction) in the patients with diabetes mellitus visiting ‘Diabetes clinic’ of a tertiary care teaching hospital in eastern Nepal. Method: It is a hospital-clinic based prevalence study. This study analyzed consecutive diabetes mellitus clinic patients’ response to self response questionnaires ‘Arizona Sexual Experience Scale’ (ASEX) for over all sexual dysfunction and ‘5- Item Version of the International Index of Erectile Dysfunction’ (IIEF-5) for erectile dysfunction. ‘Diabetes mellitus’ diagnosis was made based on the ADA guidelines 2010. Results: Among 100 male clinic diabetes patients, majorities were married, above age 50 years and all diagnosed as type 2 diabetes mellitus. Out of total, 48% had sexual dysfunction by the ASEX and many subjects had erectile dysfunction by the IIEF-5. Conclusion: Psychosexual dysfunctions, mainly erectile dysfunction are common among diabetic patients. Hence, assessment should include attention to sexual problems as well during management of diabetes mellitus.

scholarly journals Biochemical markers in saliva of patients with diabetes mellitus

2012 ◽  
Vol 59 (4) ◽  
pp. 198-204 ◽  
Author(s):  
Biljana Andjelski-Radicevic ◽  
Radica Dozic ◽  
Tatjana Todorovic ◽  
Ivan Dozic
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Diabetic Patients ◽  
Non Invasive ◽  
Stress Markers ◽  
Frequent Monitoring ◽  
Patients With Diabetes ◽  
Protein Components

Diabetes mellitus is metabolic syndrome characterized by disorder in metabolism of carbon hydrates, lipids and proteins. The diagnosis of diabetes is established by measuring the blood glucose level using standardized methods. Frequent monitoring of blood glucose level could be inconvenient for patients because of possible pain during blood sample taking. In the last few years biological materials with non invasive sampling, like saliva, have been analyzed. Research has confirmed that some organic and inorganic components of saliva are modified in diabetic patients (glucose, lipid and protein components, oxidative stress markers, electrolytes). Beside other markers, the analysis of glucose in saliva is an attempt to find a non-invasive and painless way for frequent monitoring of glucose concentration in diabetic patients. Collecting saliva is simple and economical, it neither requires expensive equipment nor specially trained staff. Saliva can be taken many times and in unlimited quantity. In regards to the data about the possibilities for using saliva as biological sample in monitoring diabetes mellitus, which could be alternative to blood serum or plasma, the conclusion is that saliva becomes more important in this context.

scholarly journals The risk factors of developing diabetic foot ulcers incidence with diabetic patients in Mukalla/Yemen

2020 ◽  
Author(s):  
مريم باراس ◽  
Eidha A. Bin Hameed
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Blood Glucose ◽  
Bacterial Infection ◽  
Diabetic Foot ◽  
Age Groups ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Diabetic Patients ◽  
Patients With Diabetes

Background: Diabetes is on the rise worldwide and is already considered as an epidemic by some experts. So, there is a need to raise awareness on the important factors that can help prevent bacterial infection in wounds of patients with diabetes. Objective: To study the risk factors of developing diabetic foot ulcer (DFU) in patients with diabetes. The study is the first in Yemen to investigate the prevalence of bacterial infection in wounds of diabetic patients. Materials and Methods: This is a case-control study carried out from November 2018 to May 2019. Twenty diabetic patients with foot ulcer and twenty without foot ulcer were examined. Risk factors and clinical profile of patients were studied by using a standardized questionnaire that included gender, age groups, past history of diabetes, duration of the disease, type of diabetes, DFU, type of ulcer, smoking, glucose level, and control of blood glucose level. Results: The risk factors that affected significantly the occurrence of DFU were gender (0.038), age groups (0.010), and duration of diabetes mellitus (DM) while hyperglycemic control, smoking, and family history were not. There was no significant difference (0.977) in mean fasting blood glucose (MBG) between the DM and DFU patients. Conclusions: Male diabetic patients aged more than 55 years and suffering from DM for more than 10 years were most likely to have DFU. Key words: diabetic foot ulcer, diabetes mellitus, risk factors, Yemen 

scholarly journals Perioperative anesthetic management of patients with diabetes mellitus: focused on blood glucose control

2020 ◽  
Vol 63 (9) ◽  
pp. 526-531
Author(s):  
Hyungseok Seo
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Postoperative Complications ◽  
Surgical Stress ◽  
Anesthetic Management ◽  
Blood Glucose Control ◽  
Perioperative Period ◽  
Physiological Status ◽  
Diabetic Patients ◽  
Patients With Diabetes

Diabetes mellitus is the most common metabolic disease characterized by elevated blood glucose, which results in damage to the heart, blood vessels, eyes, kidney, and nervous system. The incidence of diabetes mellitus has increased in Korea due to longer life expectancy or lifestyle improvement. Since diabetes affects multiple organs including the cardiovascular, neuroendocrine, and autonomic nervous systems, the risk of postoperative complications such as wound infection and cardiovascular events might be increased in patients with diabetes. In addition to postoperative complications, hypoglycemia or hyperglycemia in diabetes may also cause serious problems during surgery. Preoperative fasting and surgical stress may contribute to the derangement of the patient’s physiological status. For appropriate management of diabetic patients in the perioperative period, patients should be evaluated in detail preoperatively and their blood glucose levels should be checked repeatedly during the surgery and even after surgery. The present paper reviews preoperative, intraoperative, and postoperative management of patients with diabetes.

scholarly journals Prevalence of Different Types of Barriers to the Use of Glucometer in Diabetic Patients

2021 ◽  
Vol 11 (9) ◽  
pp. 181-186
Author(s):  
Abhishek Pradha ◽  
Charutha Reji ◽  
A. R. Shabaraya
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Health Care Professionals ◽  
Diabetic Patients ◽  
Self Monitoring ◽  
Different Types ◽  
Patients With Diabetes ◽  
Complexity Cost ◽  
The Cost ◽  
Lack Of Knowledge

Self-monitoring of blood glucose (SMBG) is a very useful method for patients with diabetes to maintain glycaemic control. Different types of barriers in glucometer use of diabetic patients include the high cost of strips, pain, lack of knowledge and motivation, need of assistance and lack of inventory supplies of glucometer. The purpose of the study was to access the prevalence of different types of barriers to the use of glucometer in diabetic patients. A prospective observational study involving 150 diabetic patients was conducted at a Dakshina Kannada from January 2021 to June 2021. The study was conducted among patients of both gender having Type 1 and Type 2 Diabetes mellitus. A total of 150 patients participated in our study qualifying the inclusion criteria. The main factors influencing the glucometer use was related to its cost, pain, lack of knowledge and supply. The barriers found were mainly the cost of the strips, fear for needles, pain, lack of knowledge and motivation, need of assistance and lack of inventory supplies of glucometer. Participants insight to the purpose of glucometer use, complexity, cost, pain related to glucometer as well as educating, catering knowledge and motivation were the key factors taken care by the health care professionals while advising the patients having diabetes mellitus with SMBG. Key words: Self-monitoring blood glucose level (SMBG), Diabetes mellitus (DM).

scholarly journals Prevalence of complications of diabetes among patients with diabetes mellitus attending a tertiary care centre in Tamil Nadu

2019 ◽  
Vol 6 (4) ◽  
pp. 1452
Author(s):  
M. S. Praythiesh Bruce ◽  
M. C. Vasantha Mallika
Keyword(s):  
Diabetes Mellitus ◽  
Tamil Nadu ◽  
Tertiary Care ◽  
High Rate ◽  
World Health ◽  
Diabetic Patients ◽  
Tertiary Care Centre ◽  
Type 2 Diabetic Patients ◽  
Complications Of Diabetes ◽  
Patients With Diabetes

Background: Diabetes will be the 7th leading cause of death by the year 2030 as per the World Health Organization. In adults the prevalence of diabetes globally has risen from 4.7% in 1980 to 8.5% in 2014. Level of awareness depends on socioeconomic class, literacy of the patients, training received by them, source of information on diabetes. Knowledge, attitude, and practices about diabetes mellitus and its complications are important to reduce the prevalence and morbidity associated with diabetes mellitus and its complications.Methods: The cross sectional study was conducted among 201 patients with diabetes visiting. Outpatient department of Sree Mookambika Institute of Medical Sciences, Kulasekharam, Tamil Nadu during a period from January 2017 to June 2018 using a pre-tested, semi structured questionnaire.Results: Among 201 patients with diabetes included in the study, 69.0% had one or more of the complications of diabetes. Factors significantly associated with high rate of complications were the female gender (p<0.001), obesity, rural residential area, high blood pressure (p<0.001), familial history of diabetes (p<0.001), duration of the disease above 5 years (p< 0.001) and high HbA1c level (p<0.001).Conclusions: This study revealed that type 2 diabetic patients followed up in the OPD of SMIMS showed a high rate of chronic complications which often occurred in age more than 50 years. Socio-demographic and biological factors were significantly associated with the high rate of complications of diabetes. 

scholarly journals STATUS OF HbA1c;

2012 ◽  
Vol 20 (01) ◽  
pp. 054-059
Author(s):  
NUDRAT ANWAR ZUBERI ◽  
NAVEED AHSAN ◽  
ALIYA JAFRI ◽  
Tehseen Iqbal ◽  
Tahira Parveen
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Serum Iron ◽  
Iron Status ◽  
Tertiary Care ◽  
Deficiency Anemia ◽  
Diabetic Patients ◽  
Iron Deficient

Background: Glycated hemoglobin [HbA1c] is a marker to identify the average plasma glucose level over past threemonths but it is also influenced by the iron deficiency status of an individual. Objective: Research is designed to assess the relationshipbetween HbA1c concentration and iron status among diabetic and non diabetic subjects. Design: Cross sectional comparative study.Setting: Tertiary Care Unit of Karachi, Pakistan. Period: Dec 2010 till June 2011. Material and methods: A total of 75 subjects of bothsexes were taken and divided into three groups. Fasting and random glucose levels, serum iron and TIBC were performed by enzymaticmethod while HbA1c was estimated by fast iron resin separation method and Complete blood count (CBC ) was done by Coulter.Statistical analysis: The data feeding and analysis was on computer package SPSS (Statistical Packages of Social Sciences) version16.0. the results were given in the mean and Standard Deviation (SD) and correlation ( r ) for quantitative data i.e. age, FBS, RBS, HbA1c,Serum Iron , Hb HCT, and TIBC. Using Analysis of Variance (ANOVA) with tukey test for comparison (Controls, Iron deficiency anemia withand without diabetes mellitus). In all statistical analysis only p < 0.01 will be considered significant. Results: HbA1c is a non-specificmarker of Diabetes mellitus in iron deficieny anemia patients. Thus it is reccomended that iron status of diabetic patients must beconsidered while interpreting results. This study showed significantly raised levels of Fasting blood glucose (FBS), random blood glucose(RBS) and HbA1c in diabetic anemic patients when compared to control and nondiabetic anemic subjects (p < 0.01) while total ironbinding capacity (TIBC) and HbA1c in nondiabetic anemic subjects were also significantly raised when compared to control (p < 0.01).Hemoglobin (Hb) , Hematocrit (HCT) and Serum Iron levels were significantly decreased in diabetic and nondiabetic anemic subjectswhen compared to control (p < 0.01). Conclusions: Our study depicted that while diagnosing Diabetes mellitus in iron deficient patientsone should be carefull as HbA1c is not a very reliable parameter to assess glycemic control in iron deficiency anemia patients.

scholarly journals The Diet Patterns of Diabetes Mellitus Patients in Lhokseumawe, Aceh Province, Indonesia

2020 ◽  
Vol 2 (1) ◽  
pp. 23-36
Author(s):  
Zulfan Haris ◽  
Siti Zahara Nasution ◽  
Cholina Trisa Siregar
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Research Result ◽  
Food Composition ◽  
Diabetic Patients ◽  
Diet Patterns ◽  
Glucose Levels ◽  
Daily Food ◽  
Patients With Diabetes ◽  
Aceh Province

Diabetes Mellitus/DM is an increase in blood glucose levels or hyperglycemia which causes various complications in some important organs such as eyes, kidneys, nerves, and blood vessels. A proper diet of diabetes mellitus patients is determined based on the amount of food intake, scheduled meal, and daily food composition. This study is a descriptive research, and aim to identify the diets of diabetic patients in Pusong, Lhokseumawe with 108 in population. The number of research samples were 52 respondents using purposive sampling techniques.  The sample criteria applied with several conditions, such as had been suffering from type 2 DM for more than 5 years and able to read and write in Indonesian. Data were collected using a validated and reliable questionnaire with a Cronbach alpha test value of 0.841. The results showed that 78.8% of respondents were not able to control the type of daily food consumption, 73.1% were not able to control the amount of daily food, 67.3% were not able to obey the scheduled meal and 72.2% of the respondents were adhere to a daily diet. According to this research result, it is important to identify the factors that contribute to the diet of patients with diabetes mellitus in the future. Keywords: diabetes mellitus diet, blood glucose, hyperglycemia

scholarly journals Study of effect of normal occlusion and malocclusion on periodontal condition of diabetes mellitus patients in dental OPD (Orthodontics) at tertiary care centre, Patna, Bihar, India: A case-control study

2021 ◽  
Vol 7 (2) ◽  
pp. 128-136
Author(s):  
Sanjay Kumar ◽  
Ved Prakash ◽  
Vibha Rani ◽  
Arshad Ahmad ◽  
AK Sharma
Keyword(s):  
Diabetes Mellitus ◽  
Prevalence Rate ◽  
Periodontal Diseases ◽  
Tertiary Care ◽  
Case Control ◽  
Diabetic Patients ◽  
Tertiary Care Centre ◽  
Normal Occlusion ◽  
Patients With Diabetes ◽  
Microsoft Office

: Diabetes mellitus is a metabolic disorder in which there is an abnormal elevation of blood glucose level. The periodontitis is recognized as the sixth complication of diabetes. The role of malocclusion in accelerating plague deposition is well known however in normal occlusion with well aligned teeth is less documented. So, the objectives of the study are to study the prevalence of periodontitis in diabetic patients with malocclusion and in normal occlusion and to study the effect of various determinants of diabetes mellitus if at all exists. : It is case-control observational study. Two hundred (200) patients were included in the study from the dental OPD (Orthodontics) of Dept. of Dentistry, and from the Dept. of Endocrinology, Indira Gandhi institute of medical sciences, Patna, Bihar, India. The statistical analysis was done Microsoft office excel. The results were analysed in frequencies and percentages to estimate the prevalence of malocclusion and occlusion in patients with diabetes mellitus and their effects on periodontium of the teeth. The prevalence rate of severe destructive periodontal diseases (SDPD) in malocclusion group was 81.72% than in normal occlusion group with less prevalence rate of 55.21%. The prevalence of severe destructive periodontal diseases in the uncontrolled diabetes mellitus in malocclusion group was more than in normal occlusion group, with maximum periodontium destruction observed during first between 1-5 years of detection of diabetes.

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