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Inpatient diabetes management

Richard A Hansen, Natalie Hohmann, Matthew L Maciejewski, Marisa E Domino, Neepa Ray, Nirosha Mahendraratnam, Joel F Farley
Objectives: Adults with schizophrenia and cardiometabolic conditions may be good candidates for co-management by primary care prescribers and specialists. Associated risks for discontinuity in medication management have not been well-studied. This study examines whether medication adherence, inpatient admissions, and emergency department (ED) visits vary by the number and types of prescribers seen by adults with schizophrenia and cardiometabolic conditions. Methods: This study used a retrospective cohort of 4,223 adult Medicaid enrollees with schizophrenia and hypertension, hyperlipidemia, and/or diabetes from three states in 2009-2010...
March 2018: Journal of Pharmaceutical Health Services Research
Colin J Crilly, Amy J Allen, Teresa M Amato, Allison Tiberio, Rifka C Schulman, Robert A Silverman
OBJECTIVE: To determine whether hyperglycemic patients can be successfully managed in the Emergency Department Observation Unit (EDOU), as determined by the frequency of inpatient admission following their EDOU stay. METHODS: This was a retrospective chart review of patients≥18years presenting to an academic tertiary care ED between May 1, 2014 and May 31, 2016, found to have a glucose≥300mg/dL, and selected for EDOU admission. Patient demographic information, lab results including an HbA1c, disposition, and hospital revisits within 30days of discharge were recorded...
February 27, 2018: American Journal of Emergency Medicine
Meda E Pavkov, Jessica L Harding, Nilka R Burrows
Acute kidney injury is a sudden decrease in kidney function with or without kidney damage, occurring over a few hours or days. Diabetes, hypertension, and advanced age are primary risk factors for acute kidney injury. It is increasingly recognized as an in-hospital complication of sepsis, heart conditions, and surgery (1,2). Its most severe stage requires treatment with dialysis. Acute kidney injury is also associated with higher likelihood of long-term care, incidence of chronic kidney disease and hospital mortality, and health care costs (1,2)...
March 16, 2018: MMWR. Morbidity and Mortality Weekly Report
Ahmed A Aljohaney
OBJECTIVES: To determine the mortality rates and predictors among patients hospitalized with active tuberculosis (TB) at King Abdulaziz University Hospital (KAUH) in Jeddah. METHODS: A retrospective study was performed on 291 active TB patients hospitalized in KAUH, Jeddah, Saudi Arabia from December 2011 to December 2016. Medical records were collected and evaluated using a dedicated data extraction sheet. The records included demographics, clinical, radiological, laboratory, and drug resistance data...
March 2018: Saudi Medical Journal
H K Akturk
Breuker et al. [1] highlighted that patients with Type 1 diabetes have an approximately twofold higher risk of medication errors at hospital admission compared with those with Type 2 diabetes. There are certain differences in the pathophysiology of the two types of diabetes that need to be considered during diabetes care at hospitals. Patients with Type 1 diabetes have higher glucose variability than those with Type 2 diabetes during the hospital stay [2]. Inpatient mortality is higher in patients with Type 1 diabetes [3]...
March 5, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
Christina R Whitehouse, Nancy C Sharts-Hopko, Suzanne C Smeltzer, David A Horowitz
The aim of the current study was to compare outcomes for older adults with type 2 diabetes mellitus and obesity following participation in a transitional care intervention that included diabetes self-management education (DSME) and homecare. The three groups analyzed comprised an inpatient DSME plus homecare group (n = 35); an inpatient DSME only group (n = 100); and a group who received usual care (n = 45). Outcomes of interest included rehospitalization rates and hemoglobin A1C (A1C) for up to 1-year post hospital discharge...
March 1, 2018: Research in Gerontological Nursing
Satya Surbhi, Ilana Graetz, Jim Y Wan, Justin Gatwood, James E Bailey
BACKGROUND: Nonadherence to essential chronic medications has been identified as a potential driver of high health care costs in superutilizers of inpatient services. Few studies, however, have documented the levels of nonadherence and factors associated with nonadherence in this high-cost, vulnerable population. OBJECTIVE: To examine the factors associated with nonadherence to essential chronic medications, with special emphasis on mental illness and use of opioid medications...
March 2018: Journal of Managed Care & Specialty Pharmacy
Andjela T Drincic, Padmaja Akkireddy, Jon T Knezevich
PURPOSE OF REVIEW: Diabetes affects about a third of all hospitalized patients and up to 50% of inpatients go on to experience hyperglycemia. Despite strong evidence supporting the importance of adequate glycemic control, as well detailed guidelines from major national organizations, many patients continue to have hypo- and hyperglycemia during their hospital stay. While this may be partially related to provider and patient-specific factors, system-based barriers continue to pose a major obstacle...
February 14, 2018: Current Diabetes Reports
Julia Kopanz, Katharina M Lichtenegger, Gerald Sendlhofer, Barbara Semlitsch, Gerald Cuder, Andreas Pak, Thomas R Pieber, Christa Tax, Gernot Brunner, Johannes Plank
OBJECTIVES: Insulin charts represent a key component in the inpatient glycemic management process. The aim was to evaluate the quality of structure, documentation, and treatment of diabetic inpatient care to design a new standardized insulin chart for a large university hospital setting. METHODS: Historically grown blank insulin charts in use at 39 general wards were collected and evaluated for quality structure features. Documentation and treatment quality were evaluated in a consecutive snapshot audit of filled-in charts...
February 9, 2018: Journal of Patient Safety
Charles Kodner, Laurie Anderson, Katherine Pohlgeers
Glucose management in hospitalized patients poses challenges to physicians, including identifying blood glucose targets, judicious use of oral diabetes mellitus medications, and implementing appropriate insulin regimens. Uncontrolled blood glucose levels can lead to deleterious effects on wound healing, increased risk of infection, and delays in surgical procedures or discharge from the hospital. Previously recommended strict blood glucose targets for hospitalized patients result in more cases of hypoglycemia without improvement in patient outcomes...
November 15, 2017: American Family Physician
Nicole Nigro, Bettina Winzeler, Isabelle Suter-Widmer, Philipp Schuetz, Birsen Arici, Martina Bally, Julie Refardt, Matthias Betz, Gani Gashi, Sandrine A Urwyler, Lukas Burget, Claudine A Blum, Andreas Bock, Andreas Huber, Beat Müller, Mirjam Christ-Crain
BACKGROUND: Hypernatraemia is common in inpatients and is associated with substantial morbidity. Its differential diagnosis is challenging, and delayed treatment may have devastating consequences. The most important hormone for the regulation of water homeostasis is arginine vasopressin, and copeptin, the C-terminal portion of the precursor peptide of arginine vasopressin, might be a reliable new parameter with which to assess the underlying cause of hypernatraemia. METHODS: In this prospective, multicentre, observational study conducted in two tertiary referral centres in Switzerland, 92 patients with severe hyperosmolar hypernatraemia (Na+  > 155 mmol/L) were included...
February 9, 2018: Critical Care: the Official Journal of the Critical Care Forum
Shiv Shankar Singh, Swapan Kumar Paul, Ranabir Pal, Pandurang Vithal Thatkar
Background: India has a growing trend of acute myocardial infarction (AMI) due to shifting lifestyle. Objective: To study the profile of patients died due to AMI and to find its risk correlates. Methods: A study was conducted on consecutive AMI cases admitted in the teaching hospital at Port Blair from April 2011 to March 2016. During inpatients management, outcomes were followed up from admission till discharge or expiry. Results: Of the total 491 cases, majority (75...
July 2017: Journal of Family Medicine and Primary Care
Jeffrey R Curtis, Shuo Yang, Jasvinder A Singh, Fenglong Xie, Lang Chen, Huifeng Yun, Paul Muntner, Shia T Kent, Emily B Levitan, Monika M Safford, Kenneth G Saag, Jie Zhang
BACKGROUND/PURPOSE: The 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol treatment guidelines recommend statins for patients with diabetes aged 40-75 years due to their elevated cardiovascular disease (CVD) risk. We compared the incidence of hospitalized acute myocardial infarction (MI), stroke, and coronary revascularization according to whether patients had diabetes, rheumatoid arthritis (RA), both or neither. METHODS: Using 2006 to 2010 private and public health plan claims, we identified 4 mutually exclusive retrospective cohorts age>40: patients with 1) RA and diabetes; 2) RA only; 3) diabetes only; 4) neither condition...
February 6, 2018: Arthritis Care & Research
Mikhail Kosiborod
Numerous studies have documented that hyperglycemia is frequent in patients hospitalized with acute coronary syndromes, affects patients with and without established diabetes, and is associated with adverse outcomes, with incremental increase in risk of mortality and complications observed across the spectrum of glucose elevations. This article reviews present knowledge about the association between glucose levels and outcomes of patients hospitalized with acute coronary syndromes; describes available data regarding inpatient glucose management in this patient group, and comparative data across the spectrum of critically ill hospitalized patients; addresses some controversies in this field; and offers practical recommendations for patient management based on existing data...
March 2018: Endocrinology and Metabolism Clinics of North America
Karmon E Helmle, Alun L Edwards, Andre W Kushniruk, Elizabeth M Borycki
OBJECTIVES: A qualitative evaluation of the perceived impact of a new evidence-informed electronic basal bolus insulin therapy order set on clinical workflow and practice, and exploration of potential barriers and facilitators to electronic basal bolus insulin order set uptake and use in acute care facilities for various acute care team members. METHODS: We conducted 9 semistructured focus groups with multidisciplinary nursing staff (n=22), resident trainees (n=24) and attending physicians (n=23) involved in the delivery of inpatient diabetes care at 3 adult acute care facilities...
January 29, 2018: Canadian Journal of Diabetes
Ghada El Khoury, Hanine Mansour, Wissam Kabbara, Nibal Chamoun, Nadim Attalah, Pascale Salameh
BACKGROUND: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to, decrease length of hospital stay and to reduce complications and readmissions. OBJECTIVE: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients...
January 19, 2018: Current Diabetes Reviews
(no author information available yet)
It is the position of American Association of Diabetes Educators (AADE) that all inpatient interdisciplinary teams include a diabetes educator to lead or support improvement efforts that affect patients hospitalized with diabetes or hyperglycemia. This not only encompasses patient and family education but education of interdisciplinary team members and achievement of diabetes-related organizational quality metrics and performance outcomes.
February 2018: Diabetes Educator
Cristiana M Toscano, Tatiana H Sugita, Michelle Q M Rosa, Hermelinda C Pedrosa, Roger Dos S Rosa, Luciana R Bahia
The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1) peripheral neuropathy without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients...
January 8, 2018: International Journal of Environmental Research and Public Health
Scott L Zuckerman, Nikita Lakomkin, Blaine P Stannard, Constantinos G Hadjipanayis, Christopher I Shaffrey, Justin S Smith, Joseph S Cheng
BACKGROUND: Surgery for adult spinal deformity (ASD) improves quality of life, yet morbidity is high. Sepsis is a challenging postoperative complication that can result in death and drive inpatient resources. OBJECTIVE: To identify the incidence and risk factors for development of sepsis within 30 days following ASD surgery. METHODS: Adult patients who underwent thoracolumbar spinal deformity correction between 2008 and 2014 were identified in the National Surgical Quality Improvement Program database...
December 21, 2017: Neurosurgery
Susan Feng Lu, Lauren Xiaoyuan Lu, Sidney C Smith, Xuming Dai
BACKGROUND: Cardiovascular disease has become a leading cause of death for patients with paraplegia. Acute myocardial infarction in patients with paraplegia has not been described in literature. Evidence gathered from studies of acute myocardial infarction in ambulating individuals may not be directly applicable to paraplegic patients. This study investigates clinical features, management strategies, and outcomes of acute myocardial infarction in patients with paraplegia. METHODS: Acute myocardial infarction in patients with or without paraplegia was identified in the New York State Inpatient Database between 2007 and 2013...
December 21, 2017: American Journal of Medicine
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