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https://www.readbyqxmd.com/read/28321786/adherence-to-pediatric-diabetic-ketoacidosis-guidelines-by-community-emergency-departments-providers
#1
Janine E Zee-Cheng, Emily C Webber, Samer Abu-Sultaneh
BACKGROUND: Diabetic ketoacidosis (DKA) is a common presentation of type I diabetes mellitus to the emergency departments. Most children with DKA are initially managed in community emergency departments where providers may not have easy access to educational resources or pediatric-specific guidelines and protocols that are readily available at pediatric academic medical centers. The aim of this study is to evaluate adherence of community emergency departments in the state of Indiana to the pediatric DKA guidelines...
December 2017: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28314598/design-and-synthesis-of-hybrids-of-diarylpyrimidines-and-diketo-acids-as-hiv-1-inhibitors
#2
Ping Xue, Huan-Huan Lu, Yuan-Yuan Zhu, Xiu-Lian Ju, Christophe Pannecouque, Xiao-Jiao Zheng, Gen-Yan Liu, Xiu-Lan Zhang, Shuang-Xi Gu
Based on the strategy of molecular hybridization, diketo acid fragment as a classical phamacophore of integrase inhibitors was introduced to reverse transcriptase inhibitors diarylpyrimidines to design a series of diarylpyrimidine-diketo acid hybrids (DAPY-DKAs). The target molecules 10b and 11b showed inhibitory activities against WT HIV-1 with EC50 values of 0.18μM and 0.14μM, respectively. And the results of molecular docking demonstrated the potential binding mode and revealed that the DKA moiety and its ester could both be tolerated in the nonnucleoside binding site (NNBS) of HIV-1 RT...
March 7, 2017: Bioorganic & Medicinal Chemistry Letters
https://www.readbyqxmd.com/read/28304323/diabetic-ketoacidosis-complicating-pregnancy
#3
S N Bryant, C L Herrera, D B Nelson, F G Cunningham
BACKGROUND: Although diabetic ketoacidosis (DKA) in pregnancy can result in significant adverse consequences for both mother and fetus, the response to treatment, time course of recovery, and perinatal outcomes have not been well studied in pregnancy. OBJECTIVE: We examined the precipitating factors, laboratory abnormalities, treatment strategies, and clinical recovery in pregnancies complicated by DKA. STUDY DESIGN: This is a retrospective cohort study of pregnancies complicated by DKA between October 1999 and June 2015...
March 16, 2017: Journal of Neonatal-perinatal Medicine
https://www.readbyqxmd.com/read/28288246/acute-kidney-injury-in-children-with-type-1-diabetes-hospitalized-for-diabetic-ketoacidosis
#4
Brenden E Hursh, Rebecca Ronsley, Nazrul Islam, Cherry Mammen, Constadina Panagiotopoulos
Importance: Acute kidney injury (AKI) in children is associated with poor short-term and long-term health outcomes; however, the frequency of AKI in children hospitalized for diabetic ketoacidosis (DKA) has not been previously examined. Objectives: To determine the proportion of children hospitalized for DKA who develop AKI and to identify the associated clinical and biochemical markers of AKI. Design, Setting, and Participants: This medical record review of all DKA admissions from September 1, 2008, through December 31, 2013, was conducted at British Columbia Children's Hospital, the tertiary pediatric hospital in British Columbia, Canada...
March 13, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28276776/brain-injury-with-diabetes-mellitus-evidence-mechanisms-and-treatment-implications
#5
Sherifa A Hamed
Diabetes mellitus is a risk for brain injury. Brain injury is associated with acute and chronic hyperglycaemia, insulin resistance, hyperinsulinemia, diabetic ketoacidosis (DKA) and hypoglycaemic events in diabetic patients. Hyperglycemia is a cause of cognitive deterioration, low intelligent quotient, neurodegeneration, brain aging, brain atrophy and dementia. Areas covered: The current review highlights the experimental, clinical, neuroimaging and neuropathological evidence of brain injury induced by diabetes and its associated metabolic derangements...
February 22, 2017: Expert Review of Clinical Pharmacology
https://www.readbyqxmd.com/read/28276512/the-efficacy-and-safety-of-sglt2-inhibitors-for-adjunctive-treatment-of-type-1-diabetes-a-systematic-review-and-meta-analysis
#6
Jiao Chen, Fang Fan, J Y Wang, Yang Long, C L Gao, R C Stanton, Yong Xu
To assess the efficacy and safety of the SGLT-2 inhibitors as adjunct therapy to insulin in T1DM, clinical trials indexed in PubMed, Cochrane Library, EMbase from inception through April 5, 2016. A meta-analysis was conducted on trials of SGLT-2 inhibitors in patients with T1DM on insulin therapy using RevMan 5.3 software. Of the 371 articles identified, ten met eligibility criteria. Seven clinical trials including four randomized controlled trials and 581 patients were included. Compared with the control group, SGLT-2 inhibitors group had significantly reduced fasting plasma glucose by 0...
March 9, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28265341/diabetic-ketoacidosis-treatment-in-the-intensive-care-unit-or-general-medical-surgical-ward
#7
EDITORIAL
Yamely Mendez, Salim Surani, Joseph Varon
Diabetic ketoacidosis (DKA) is defined as an acute metabolic disorder, which is characterized by an increased presence of circulating ketones, and the development of ketoacidosis in the presence of hyperglycemia. This syndrome occurs as a result of insulin deficiency. Patients can be dramatically ill, however, with aggressive treatment, most patients recover rapidly. Despite being a low-risk condition, the development of acidosis, is one of the admission criteria to the intensive care unit (ICU) for these patients, in order to provide close monitoring, and recognize complications that could result from the use of aggressive therapy, such as continuous infusions if insulin...
February 15, 2017: World Journal of Diabetes
https://www.readbyqxmd.com/read/28255480/multiple-electrolyte-and-metabolic-emergencies-in-a-single-patient
#8
Caprice Cadacio, Phuong-Thu Pham, Ruchika Bhasin, Anita Kamarzarian, Phuong-Chi Pham
While some electrolyte disturbances are immediately life-threatening and must be emergently treated, others may be delayed without immediate adverse consequences. We discuss a patient with alcoholism and diabetes mellitus type 2 who presented with volume depletion and multiple life-threatening electrolyte and metabolic derangements including severe hyponatremia (serum sodium concentration [SNa] 107 mEq/L), hypophosphatemia ("undetectable," <1.0 mg/dL), and hypokalemia (2.2 mEq/L), moderate diabetic ketoacidosis ([DKA], pH 7...
2017: Case Reports in Nephrology
https://www.readbyqxmd.com/read/28239611/pleotropic-acute-and-chronic-effects-of-leptin-to-reverse-type-1-diabetes
#9
Rachel J Perry
Recent studies have demonstrated that leptin can prolong life chronically in rats with poorly-controlled type 1 diabetes (T1D). Multiple explanations have been proposed to explain leptin's chronic antihyperglycemic effect, including suppression of glucagon release and/or signaling, reductions in hyperphagia and ectopic lipid content, and improvements in insulin sensitivity; it is leptin's ability to reduce plasma glucose relies on all of these effects. In addition, leptin reverses hyperglycemia and diabetic ketoacidosis (DKA) acutely, within 6 hours of leptin infusion, by suppressing hypothalamic-pituitary-adrenal (HPA) axis activity in insulinopenic rats...
January 2017: Postdoc Journal: a Journal of Postdoctoral Research and Postdoctoral Affairs
https://www.readbyqxmd.com/read/28211788/hemolytic-uremic-syndrome-complicated-by-clostridium-septicum-bacteremia-and-new-onset-type-1-diabetes-mellitus-report-of-a-case%C3%A2
#10
Anna C Iddings, Asha N Shenoi, Alba Morales Pozzo, Stefan G Kiessling
We report the unusual case of a 5-year-old male hospitalized for management of diabetic ketoacidosis (DKA) and new-onset type 1 diabetes mellitus (T1DM) who developed acute renal injury secondary to hemolytic uremic syndrome (HUS). He was diagnosed with Shiga toxin-producing entero-hemorrhagic <i>Escherichia coli</i> (EHEC) 0157:H7-positive HUS 48 hours after being diagnosed with new-onset T1DM/DKA. His hospital course was complicated by <i>Clostridium septicum</i> sepsis with colonic perforation...
April 2017: Clinical Nephrology
https://www.readbyqxmd.com/read/28207721/clinical-anatomy-e-cases-a-five-year-follow-up-of-learning-analytics
#11
Geoffrey Braatvedt, Amelia Tekiteki, Holly Britton, John Wallace, Manish Khanolkar
AIMS: To examine the length of stay and need for intensive care of people admitted with diabetic ketoacidosis (DKA) to a single centre between 1988 and 2011. METHODS: Patients aged ≥15 years admitted for the first time with DKA (plasma glucose ≥ 10mmol/L and a bicarbonate concentration ≤15mmol/L and a pH <7.35, and raised plasma or urine ketones or anion gap) to Auckland City Hospital from 1988-2011 were identified retrospectively. The patients were divided into four cohorts (1988-1996; 1997-2001; 2002-2006; 2007-2011)...
February 17, 2017: New Zealand Medical Journal
https://www.readbyqxmd.com/read/28203360/blood-versus-urine-ketone-monitoring-in-a-pediatric-cohort-of-patients-with-type-1-diabetes-a-crossover-study
#12
Line Goffinet, Thierry Barrea, Véronique Beauloye, Philippe A Lysy
BACKGROUND: The aim of our study was to determine the influence of routine ketone monitoring on hyperglycemic events (HE) and ketosis in youngsters with type 1 diabetes (T1D). METHODS: Our single-site, controlled and randomized study was conducted on children and adolescents with T1D outside of remission phase. During two crossover periods of 6 months, patients (n = 22) experiencing HE tested ketones alternatively with a blood ketone meter or urine ketone test strips and gave their opinion on screening methods after completion of clinical trial...
January 2017: Therapeutic Advances in Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28154987/striving-for-control-lessons-learned-from-a-successful-international-type-1-diabetes-youth-challenge
#13
Olga Kordonouri, Andriani Vazeou, Mauro Scharf, Martina Würsig, Tadej Battelino
AIMS: To demonstrate whether young people with T1D using modern insulin treatment and CGM could successfully participate in extreme sport activity while maintaining good glycemic control. METHODS: The challenge took place in Crete/Greece over 4 days combining a long-distance trek of different levels of severity with final destination the summit of the White Mountains at 2080 m. Eleven participants (5/6 female/male, age 18.2 ± 1.3 years, T1D duration 7.9 ± 3...
February 2, 2017: Acta Diabetologica
https://www.readbyqxmd.com/read/28146595/pediatric-diabetes-outpatient-center-at-rhode-island-hospital-the-impact-of-changing-initial-diabetes-education-from-inpatient-to-outpatient
#14
Mia M Pingul, Erin M Mulvihill, Steven E Reinert, Geetha Gopalakrishnan, Wendy A Plante, Charlotte M Boney, Shara R Bialo, Jose Bernardo Quintos
BACKGROUND: This study compared outcomes and costs for new-onset Type 1 diabetes mellitus (T1DM) patients educated at the outpatient versus inpatient settings. METHODS/DESIGN: Retrospective study examining the following variables: 1) hemoglobin A1c (HbA1c), 2) severe hypoglycemia, 3) admissions for diabetic ketoacidosis (DKA) or ER visits, and 4) healthcare cost. RESULTS: 152 patients with new-onset T1DM from September 2007-August 2009. There were no differences between outpatient group (OG) and inpatient group (IG) in mean HbA1c levels at 1, 2 and 3 years post-diagnosis (OG 8%, 8...
February 1, 2017: Rhode Island Medical Journal
https://www.readbyqxmd.com/read/28145127/cortisol-levels-in-children-with-diabetic-ketoacidosis-associated-with-new-onset-type-1-diabetes-mellitus
#15
Kristen M Williams, Pamela Fazzio, Sharon E Oberfield, Mary P Gallagher, Gaya S Aranoff
There is little data documenting cortisol levels in children with diabetic ketoacidosis (DKA), despite the fact that untreated adrenal insufficiency (AI) could worsen the outcome of DKA. In this cross-sectional study, we assessed serum cortisol levels in 28 children with DKA and new onset type 1 diabetes mellitus evaluated at our center over a 5-year period. Average duration of diabetes-related symptoms was positively associated with age ( P = .002), and significantly lower hemoglobin A1c levels were observed in the youngest children...
February 2017: Clinical Pediatrics
https://www.readbyqxmd.com/read/28145026/self-reported-regular-alcohol-consumption-in-adolescents-and-emerging-adults-with-type-1-diabetes-a-neglected-risk-factor-for-diabetic-ketoacidosis-multicenter-analysis-of-29-630-patients-from-the-dpv-registry
#16
Julia M Hermann, Michael Meusers, Rainer Bachran, Ursula Kuhnle-Krahl, Norbert Jorch, Sabine E Hofer, Reinhard W Holl
BACKGROUND: The risk of hypoglycemia increases after alcohol consumption in patients with type 1 diabetes. This study aimed to investigate the association between metabolic control and self-reported alcohol consumption in young patients with type 1 diabetes. MATERIALS AND METHODS: N = 29 630 patients with type 1 diabetes aged 12 to <30 years (median age 17.0 [14.9, 18.3] years, duration of diabetes 6.8 [3.3, 10.9] years, 53% male) from the German/Austrian DPV registry were analyzed...
February 1, 2017: Pediatric Diabetes
https://www.readbyqxmd.com/read/28135278/clinical-characteristics-of-diabetic-ketoacidosis-in-children-with-newly-diagnosed-type-1-diabetes-in-addis-ababa-ethiopia-a-cross-sectional-study
#17
Helen Siyoum Atkilt, Muluken Gizaw Turago, Balewgizie Sileshi Tegegne
BACKGROUND: Diabetic ketoacidosis (DKA) is one of the most serious acute complications of type 1 diabetes (T1D) and the leading cause of morbidity and mortality in children with T1D. This study was aimed at assessing the prevalence and associated factors of DKA in children with newly diagnosed T1D in Addis Ababa. METHODS: A hospital based cross-sectional study was conducted in selected hospitals in Addis Ababa. Children below the age of 12 years with DKA who were admitted to the pediatric ward in the selected hospitals between January 2009 and December 2014 and the residence of Addis Ababa were included...
2017: PloS One
https://www.readbyqxmd.com/read/28129999/long-term-risk-of-stroke-in-type-2-diabetes-patients-with-diabetic-ketoacidosis-a-population-based-propensity-score-matched-longitudinal-follow-up-study
#18
Y-L Chen, S-F Weng, C-Y Yang, J-J Wang, K-J Tien
AIM: To investigate the long-term risk of stroke in type 2 diabetes (T2D) patients with previous episodes of diabetic ketoacidosis (DKA). METHODS: This retrospective nationwide population-based cohort study was conducted using Taiwan's National Health Insurance database. Claims data from 2000 to 2002 were extracted for 3572 T2D patients with DKA and 7144 controls matched for age, gender, diabetes complications severity index, frequency of clinical visits and baseline comorbidities...
January 24, 2017: Diabetes & Metabolism
https://www.readbyqxmd.com/read/28127835/residual-beta-cell-function-in-diabetes-children-followed-and-diagnosed-in-the-teddy-study-compared-to-community-controls
#19
Andrea K Steck, Helena Elding Larsson, Xiang Liu, Riitta Veijola, Jorma Toppari, William A Hagopian, Michael J Haller, Simi Ahmed, Beena Akolkar, Åke Lernmark, Marian J Rewers, Jeffrey P Krischer
OBJECTIVE: To explore whether children diagnosed with type 1 diabetes during islet autoantibody surveillance through The Environmental Determinants of Diabetes in the Young (TEDDY) study retain greater islet function than children diagnosed through the community. METHODS: TEDDY children identified at birth with high-risk human leukocyte antigen and followed every 3 months until diabetes diagnosis were compared to age-matched children diagnosed with diabetes in the community...
January 27, 2017: Pediatric Diabetes
https://www.readbyqxmd.com/read/28112679/mechanism-for-leptin-s-acute-insulin-independent-effect-to-reverse-diabetic-ketoacidosis
#20
Rachel J Perry, Liang Peng, Abudukadier Abulizi, Lynn Kennedy, Gary W Cline, Gerald I Shulman
The mechanism by which leptin reverses diabetic ketoacidosis (DKA) is unknown. We examined the acute insulin-independent effects of leptin replacement therapy in a streptozotocin-induced rat model of DKA. Leptin infusion reduced rates of lipolysis, hepatic glucose production (HGP), and hepatic ketogenesis by 50% within 6 hours and were independent of any changes in plasma glucagon concentrations; these effects were abrogated by coinfusion of corticosterone. Treating leptin- and corticosterone-infused rats with an adipose triglyceride lipase inhibitor blocked corticosterone-induced increases in plasma glucose concentrations and rates of HGP and ketogenesis...
February 1, 2017: Journal of Clinical Investigation
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