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https://www.readbyqxmd.com/read/27913012/hyperglycemic-high-anion-gap-metabolic-acidosis-in-patients-receiving-sglt-2-inhibitors-for-diabetes-management
#1
Juliette Sandifer Kum-Nji, Aidar R Gosmanov, Helmut Steinberg, Samuel Dagogo-Jack
Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are a class of antidiabetic medications that improve glycemic control via inhibiting the reabsorption of filtered glucose and are approved for use in type 2 diabetes (T2DM). These drugs have recently been associated with euglycemic diabetic ketoacidosis (DKA). An increasing number of cases of SGLT-2i-associated DKA have occurred in patients with T2DM. Herein, we describe five episodes of hyperglycemic DKA in four type 2 diabetes patients receiving SGLT-2i therapy...
November 9, 2016: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/27896902/substantial-reduction-in-hospital-stay-of-children-and-adolescents-with-diabetic-ketoacidosis-after-implementation-of-clinical-practice-guidelines-in-a-university-hospital-in-saudi-arabia
#2
Abdulrahman Al Nemri, Yasser Sami Amer, Hala Gasim, Mohamed Elfaki Osman, Ayman Aleyadhy, Hessah Al Otaibi, Shaikh Mohammed Iqbal, Nasir Abdullah Aljurayyan, Asaad M Assiri, Amir Babiker, Sarar Mohamed
RATIONALE, AIMS AND OBJECTIVES: We aimed to determine the effect of Clinical Practice Guideline (CPG) implementation on length of hospital stay of children and adolescents with diabetic ketoacidosis (DKA). METHODS: This was a 6-year (2008-2014) case-control retrospective study conducted at King Khalid University Hospital, Riyadh, that compared patients with DKA managed using CPG with those treated before CPG implementation. RESULTS: There were 63 episodes of DKA in 41 patients managed using CPG compared with 40 episodes in 33 patients treated before implementation of CPG...
November 29, 2016: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/27896145/interprofessional-multiple-step-simulation-course-improves-pediatric-resident-and-nursing-staff-management-of-pediatric-patients-with-diabetic-ketoacidosis
#3
Linnea M Larson-Williams, Amber Q Youngblood, Dawn Taylor Peterson, J Lynn Zinkan, Marjorie L White, Hussein Abdul-Latif, Leen Matalka, Stephen N Epps, Nancy M Tofil
AIM: To investigate the use of a multidisciplinary, longitudinal simulation to educate pediatric residents and nurses on management of pediatric diabetic ketoacidosis. METHODS: A multidisciplinary, multiple step simulation course was developed by faculty and staff using a modified Delphi method from the Pediatric Simulation Center and pediatric endocrinology department. Effectiveness of the simulation for the residents was measured with a pre- and post-test and a reference group not exposed to simulation...
November 4, 2016: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27861474/-systematic-review-with-meta-analysis-subcutaneous-insulin-glargine-coadministration-for-diabetic-ketoacidosis
#4
Carlos Alberto Andrade-Castellanos, Luis Enrique Colunga-Lozano
BACKGROUND: The standard treatment of diabetic ketoacidosis involves intravenous infusion of regular insulin until recovery of the episode: this is associated with high costs. Coadministration of insulin glargine from the onset of management may prove beneficial, potentially avoiding rebound hyperglycemia, and hopefully improving the time to resolution of the disease. METHODS: We searched MEDLINE, EMBASE, and CENTRAL for randomized controlled trials comparing coadministration of insulin glargine versus standard treatment in patients with diabetic ketoacidosis...
November 2016: Gaceta Médica de México
https://www.readbyqxmd.com/read/27826544/a-prospective-multi-country-observational-trial-to-compare-the-incidences-of-diabetic-ketoacidosis-in-the-month-of-ramadan-the-preceding-month-and-the-following-month-dkar-international
#5
Elamin I E Abdelgadir, Mohamed M Hassanein, Alaaeldin M K Bashier, Sulaf Abdelaziz, Salwa Baki, Asma Chadli, Sara Askaoui, El Ansari Nawal, Ines S Slim, El Mghari Ghizlane, Khadija Hafidh, Fatheya Alawadi
BACKGROUND: 1.7 billion Muslims worldwide obey divine commands of fasting for a month. This may increase the probability of the acute complications of diabetes during the fasting period. DESIGN AND METHODS: We primarily aimed to compare the incidences and duration of Diabetic ketoacidosis (DKA) admissions during Ramadan compared to the month before (Shaaban) and the month after (Shawal) as well as the average pre-Ramadan six months' admissions. Our secondary objective was to assess the different incidence of DKA between Ramadan and the other months regarding precipitating factors, fasting practices in people admitted with DKA and gender differences...
2016: Journal of Diabetes and Metabolic Disorders
https://www.readbyqxmd.com/read/27822115/danish-registry-of-childhood-and-adolescent-diabetes
#6
REVIEW
Jannet Svensson, Charlotte Cerqueira, Per Kjærsgaard, Lene Lyngsøe, Niels Thomas Hertel, Mette Madsen, Henrik B Mortensen, Jesper Johannesen
AIM: The aims of the Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids) are to monitor and improve the quality of care for children and adolescents with diabetes in Denmark and to follow the incidence and prevalence of diabetes. STUDY POPULATION: The study population consists of all children diagnosed with diabetes before the age of 15 years since 1996. Since 2015, every child followed up at a pediatric center (<18 years of age) will be included...
2016: Clinical Epidemiology
https://www.readbyqxmd.com/read/27790975/unusual-case-of-pheochromocytoma-presenting-with-diabetic-ketoacidosis
#7
Yub Raj Sedhai, Kruthika Reddy, Dhruvan Patel, James A Lozada
Pheochromocytoma is a rare catecholamine-secreting tumour that arises from chromaffin cells in the adrenal medulla or extra-adrenal sympathetic ganglia. It classically presents with paroxysmal headaches, hypertension, palpitations and sweating related to catecholamine excess. Diabetes is reported to be present in approximately one-third of patients with pheochromocytoma; however, diabetic ketoacidosis is an extremely rare complication. We present a case of an African-American male aged 30 years who initially presented with diabetic ketoacidosis and hypertensive urgency whose blood pressure and glycaemic control improved remarkably following tumour excision...
October 19, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27761041/acute-post-operative-diabetic-ketoacidosis-atypical-harbinger-unmasking-latent-diabetes-mellitus
#8
Rudrashish Haldar, Ankur Khandelwal, Devendra Gupta, Shashi Srivastava, Prabhat K Singh
Hyperglycaemia following surgical and anaesthetic stress is a well-established entity which might have undesirable clinical consequences in known diabetics. We encountered a rare event where an undiagnosed diabetic patient developed ketoacidosis in the immediate post-operative period which was her initial presenting symptom of deranged glucoregulation. Presumably, the stress induced by surgery and anaesthesia lead to the genesis of this event. We discuss the management of this case. In addition, we highlight the importance of glycosylated haemoglobin as a subject of future research in identifying such "at risk" patients and for stratifying the risk of hyperglycaemic complications in perioperative settings...
October 2016: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/27752032/starvation-ketoacidosis-as-a-cause-of-unexplained-metabolic-acidosis-in-the-perioperative-period
#9
Monique Mostert, Anthony Bonavia
BACKGROUND Besides providing anesthesia for surgery, the anesthesiologist's role is to optimize the patient for surgery and for post-surgical recovery. This involves timely identification and treatment of medical comorbidities and abnormal laboratory values that could complicate the patient's perioperative course. There are several potential causes of anion and non-anion gap metabolic acidosis in surgical patients, most of which could profoundly affect a patient's surgical outcome. Thus, the presence of an acute acid-base disturbance requires a thorough workup, the results of which will influence the patient's anesthetic management...
October 18, 2016: American Journal of Case Reports
https://www.readbyqxmd.com/read/27749721/pediatric-type-1-diabetes-reducing-admission-rates-for-diabetes-ketoacidosis
#10
Jeniece Trast Ilkowitz, Steven Choi, Michael L Rinke, Kathy Vandervoot, Rubina A Heptulla
BACKGROUND: Diabetes ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM). Reducing DKA admissions in children with T1DM requires a coordinated, comprehensive management plan. We aimed to decrease DKA admissions, 30-day readmissions, and length of stay (LOS) for DKA admissions. METHODS: A multipronged intervention was designed in 2011 to reach all patients: (1) increase insulin pump use and basal-bolus regimen versus sliding scales, (2) transform educational program, (3) increased access to medical providers, and (4) support for patients and families...
October 2016: Quality Management in Health Care
https://www.readbyqxmd.com/read/27729426/operationalizing-and-examining-family-planning-vigilance-in-adult-women-with-type-1-diabetes
#11
Susan M Sereika, Dorothy Becker, Patricia Schmitt, A Blair Powell, Ana Maria Diaz, Andrea F R Fischl, Jennifer Thurheimer-Cacciotti, William H Herman, Denise Charron-Prochownik
OBJECTIVE: Because unplanned pregnancies could cause maternal-fetal complications for women with diabetes, family planning vigilance (FPV) is imperative. The aims of this article are to operationalize and describe FPV and examine the associations among FPV behaviors and diabetes self-care management (DSM) and health outcomes of women with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: Retrospective data were used from a follow-up study of adult women with T1D who participated as adolescents in a preconception counseling (PC) intervention trial and matched comparison women with T1D who did not receive the adolescent PC intervention...
October 11, 2016: Diabetes Care
https://www.readbyqxmd.com/read/27677911/induction-management-and-complications-of-streptozotocin-induced-diabetes-mellitus-in-rhesus-monkeys
#12
Jong-Min Kim, Jun-Seop Shin, Byoung-Hoon Min, Hyun-Je Kim, Jung-Sik Kim, Il-Hee Yoon, Won-Young Jeong, Ga-Eul Lee, Min-Sun Kim, Ju-Eun Kim, Sang-Man Jin, Chung-Gyu Park
BACKGROUND: Diabetes mellitus (DM) model using streptozotocin (STZ) which induces chemical ablation of β cell in the pancreas has been widely used for various research purposes in non-human primates. However, STZ has been known to have a variety of adverse effects such as nephrotoxicity, hepatotoxicity, and even mortality. The purpose of this study is to report DM induction by STZ, toxicity associated with STZ and procedure and complication of exogenous insulin treatment for DM management in rhesus monkeys (Macaca mulatta) that are expected to be transplanted with porcine islets within 2 months...
September 27, 2016: Xenotransplantation
https://www.readbyqxmd.com/read/27677576/euglycaemic-ketoacidosis-in-a-postoperative-whipple-patient-using-canaglifozin
#13
Trevor Wood, Allison J Pang, Julie Hallet, Paul Greig
SGLT2 inhibitors are a new class of oral antihyperglycaemic agents that have garnered much attention for their attractive efficacy profile in glycaemic control along with the added benefit of weight loss. There has been increasing concern for the risk of euglycaemic (serum glucose 4-8 mmol/L) ketoacidosis with these agents. In the setting of a postoperative patient, the use of these drugs may exacerbate the normal physiological stresses of the body and increase the risk of developing euglycaemic ketoacidosis (euKDA)...
September 27, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27642376/the-association-of-mindful-parenting-with-glycemic-control-and-quality-of-life-in-adolescents-with-type-1-diabetes-results-from-diabetes-miles-the-netherlands
#14
Inge J P Serkel-Schrama, Jolanda de Vries, Anke M Nieuwesteeg, Frans Pouwer, Ivan Nyklíček, Jane Speight, Esther I de Bruin, Susan M Bögels, Esther E Hartman
The objective of this study was to examine associations between the mindful parenting style of parents of adolescents (aged 12-18) with type 1 diabetes mellitus (T1DM), and the glycaemic control and quality of life (QoL) of the adolescents. Chronic health conditions, such as T1DM, that require demanding treatment regimens, can negatively impact adolescents' quality of life. Therefore, it is important to determine whether mindful parenting may have a positive impact in these adolescents. Age, sex and duration of T1DM were examined as potential moderators...
2016: Mindfulness
https://www.readbyqxmd.com/read/27636019/diabetic-ketoacidosis-without-diabetes
#15
Devina Willard, Jagriti Upadhyay, Chan Kim, Devin Steenkamp
CONTEXT: Type B insulin resistance syndrome is a rare disease which occurs due to the development of autoantibodies to the insulin receptor and can result in either severe insulin resistance and hyperglycemia or conversely hypoglycemia. Diabetes mellitus is often severe, usually transient and poorly responsive to exogenous insulin. Diabetic ketoacidosis is an unusual consequence of this most severe form of transient diabetes mellitus. CASE DESCRIPTION: A 39 year old Nigerian woman presented with significant weight loss, severe diabetic ketoacidosis and severe insulin resistance requiring massive doses of exogenous insulin...
September 16, 2016: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/27609719/thyroid-storm-presenting-as-psychosis-masked-by-diabetic-ketoacidosis
#16
Raafia Memon, WuQiang Fan, Richard Snyder, Mahesh Krishnamurthy
INTRODUCTION: While extremely uncommon, diabetic ketoacidosis (DKA) and thyroid storm (TS) are endocrine emergencies that can coexist. We describe a case with a confounding clinical presentation that identifies these two emergencies within the setting of sepsis and influenza. CASE: A 69-year-old diabetic female was found by the paramedic staff to be disoriented. She demonstrated tachycardia and had a foul-smelling abdominal wound. Laboratory evaluation revealed DKA, leukocytosis, influenza B, and urinary tract infection...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27599629/approach-to-the-treatment-of-diabetic-ketoacidosis
#17
Kamel S Kamel, Martin Schreiber, Ana P C P Carlotti, Mitchell L Halperin
Diabetic ketoacidosis (DKA), a common cause of severe metabolic acidosis, remains a life-threatening condition due to complications of both the disease and its treatment. This Acid-Base and Electrolyte Teaching Case discusses DKA management, emphasizing complications of treatment. Because cerebral edema is the most common cause of mortality and morbidity, especially in children with DKA, we emphasize its pathophysiology and implications for therapy. The risk for cerebral edema may be minimized by avoiding a bolus of insulin, excessive saline resuscitation, and a decrease in effective plasma osmolality early in treatment...
September 3, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27598833/sodium-glucose-co-transporter-2-inhibitors-in-addition-to-insulin-therapy-for-management-of-type-2-diabetes-mellitus-a-meta-analysis-of-randomized-controlled-trials
#18
Huilin Tang, Wei Cui, Dandan Li, Tiansheng Wang, Jingjing Zhang, Suodi Zhai, Yiqing Song
Given inconsistent trial results of sodium-glucose cotransporter 2 (SGLT2) inhibitors in addition to insulin therapy for treating type 2 diabetes mellitus (T2DM), a meta-analysis was performed to evaluate the efficacy and safety of this combination for T2DM by searching available randomized trials from PubMed, Embase, CENTRAL and ClinicalTrials.gov. Our meta-analysis included seven eligible placebo-controlled trials involving 4235 patients. Compared with placebo, SGLT2 inhibitor treatment was significantly associated with a mean reduction in HbA1c of -0...
September 6, 2016: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/27595573/hospitalization-of-elderly-diabetic-patients-characteristics-reasons-for-admission-and-gender-differences
#19
Wei Lin, Chan Chen, Huaqin Guan, Xiaohong Du, Junjian Li
BACKGROUND: Understanding the differences in characteristics, gender, and common causes for admission in hospitalized elderly diabetic patients provides a theoretical basis for their successful management. This study explored the reasons and gender differences in hospitalizations of elderly patients with diabetes mellitus. METHODS: Patients aged ≥60 years who had received a diagnosis of diabetes by the time of discharge, from 1 January 2011 to 1 January 2014, were retrospectively enrolled...
2016: BMC Geriatrics
https://www.readbyqxmd.com/read/27590952/maternal-complications-in-pregnancy-with-diabetes
#20
Vidushi Kulshrestha, Nutan Agarwal
Maternal complications of diabetes in pregnancy include obstetric complications such as pre-eclampsia, preterm labour, polyhydramnios, increased operative delivery and increased infective morbidity. These can be minimized with optimal glycaemic control. Additionally, pregnancies with overt/pregestational diabetes may have diabetes related complications such as hypoglycaemia, worsening of retinopathy, nephropathy and diabetic ketoacidosis. Women with pre-existing diabetic vasculopathy should be managed with multi-disciplinary approach with maternal and foetal surveillance to detect any deterioration...
September 2016: JPMA. the Journal of the Pakistan Medical Association
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