Admission analysis of diabetic patients at the emergency room of the UHC Sisters of charity internal medicine department

Šećerna bolest, s prevalencijom od 7,9%, predstavlja veliki zdravstveni i socioekonomski problem u Republici Hrvatskoj. Prema podacima Hrvatskog zavoda za javno zdravstvo u periodu od 2009. do 2014. prevalencija bolesti je porasla sa 6,7% na 7,9%, te pokazuje daljnji trend rasta. Tip 2 šećerne bolesti, od kojeg boluje 92% šećernih bolesnika u Republici Hrvatskoj, je gotovo u potpunosti preventabilna bolest. Glavni problem je što mjere prevencije zahtijevaju promjenu životnog stila. Cilj ove studije je analizirati glavne karakteristike dijabetičkih bolesnika primljenih u Objedinjeni hitni bolnički prijem Kliničkog bolničkog centra Sestre milosrdnice u periodu od 24 sata, dobiti uvid u reguliranost glikemije oboljelih i dobivene podatke usporediti s ostalim studijama. Važno je naglasiti da su na tržištu Republike Hrvatske dostupni svi lijekovi za liječenje šećerne bolesti kao i u ostalim zemljama sa znatno većim bruto društvenim dohotkom. Većina tih lijekova se nalazi na A listi Hrvatskog zavoda za zdravstveno osiguranje. Rezultati pokazuju da je reguliranost glikemije u naših bolesnika znatno lošija, da imaju značajno više razvijenih komplikacija i prisutnih rizičnih čimbenika. Glavni razlog je vjerojatno loša edukacija oboljelih i nedovoljno dobra suradljivost pri uzimanju terapije.Diabetes mellitus, with a national prevalence 7.9%, poses a huge health care and socioeconomic threat to the Republic of Croatia. According to national data, the prevalence rose from 6.7% to 7.90% in the period between 2009 and 2014 and is still growing. Type 2 diabetes mellitus, found in 92% of our diabetic patients, is a completely preventable disease. The problem is that this prevention necessarily requires changes in people’s lifestyles. The main aim of this survey is to analyze biological and medical features in diabetic patients admitted to the emergency room of the UHC Sisters of Charity Internal Medicine Department during a 24-hour period and compare them with trends in other countries. It is important to emphasize that currently all antidiabetic agents, as well as other treatments included in diabetes management used in more developed countries, are available in the Republic of Croatia. Moreover, most of those are on the A list of the Croatian Health Insurance Fund. The results show that our diabetic patients have a much poorer regulation of glycemia, and thus more complications and poorer outcomes. The main reason is probably the low level of education about the disease, as well as low compliance

Admission analysis of diabetic patients at the emergency room of the UHC Sisters of charity internal medicine department

Šećerna bolest, s prevalencijom od 7,9%, predstavlja veliki zdravstveni i socioekonomski problem u Republici Hrvatskoj. Prema podacima Hrvatskog zavoda za javno zdravstvo u periodu od 2009. do 2014. prevalencija bolesti je porasla sa 6,7% na 7,9%, te pokazuje daljnji trend rasta. Tip 2 šećerne bolesti, od kojeg boluje 92% šećernih bolesnika u Republici Hrvatskoj, je gotovo u potpunosti preventabilna bolest. Glavni problem je što mjere prevencije zahtijevaju promjenu životnog stila. Cilj ove studije je analizirati glavne karakteristike dijabetičkih bolesnika primljenih u Objedinjeni hitni bolnički prijem Kliničkog bolničkog centra Sestre milosrdnice u periodu od 24 sata, dobiti uvid u reguliranost glikemije oboljelih i dobivene podatke usporediti s ostalim studijama. Važno je naglasiti da su na tržištu Republike Hrvatske dostupni svi lijekovi za liječenje šećerne bolesti kao i u ostalim zemljama sa znatno većim bruto društvenim dohotkom. Većina tih lijekova se nalazi na A listi Hrvatskog zavoda za zdravstveno osiguranje. Rezultati pokazuju da je reguliranost glikemije u naših bolesnika znatno lošija, da imaju značajno više razvijenih komplikacija i prisutnih rizičnih čimbenika. Glavni razlog je vjerojatno loša edukacija oboljelih i nedovoljno dobra suradljivost pri uzimanju terapije.Diabetes mellitus, with a national prevalence 7.9%, poses a huge health care and socioeconomic threat to the Republic of Croatia. According to national data, the prevalence rose from 6.7% to 7.90% in the period between 2009 and 2014 and is still growing. Type 2 diabetes mellitus, found in 92% of our diabetic patients, is a completely preventable disease. The problem is that this prevention necessarily requires changes in people’s lifestyles. The main aim of this survey is to analyze biological and medical features in diabetic patients admitted to the emergency room of the UHC Sisters of Charity Internal Medicine Department during a 24-hour period and compare them with trends in other countries. It is important to emphasize that currently all antidiabetic agents, as well as other treatments included in diabetes management used in more developed countries, are available in the Republic of Croatia. Moreover, most of those are on the A list of the Croatian Health Insurance Fund. The results show that our diabetic patients have a much poorer regulation of glycemia, and thus more complications and poorer outcomes. The main reason is probably the low level of education about the disease, as well as low compliance

Addressing challenges when applying GRADE to public health guidelines: a scoping review protocol and pilot analysis

This is a protocol for a scoping review that aims to determine how guideline authors using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach have addressed previously identified challenges related to public health. The Joanna Briggs Institute (JBI) methodology for scoping reviews will be followed. We will search and screen titles of guidelines for all languages published in 2013−2021 in: the GIN library, BIGG database, Epistemonikos GRADE guidelines repository, GRADEpro Database, MAGICapp, NICE and WHO websites. Two reviewers will independently screen full texts of the documents identified. The following information will be extracted: methods used for identifying different stakeholders and incorporating their perspectives; methods for identification and prioritization of non-health outcomes; methods for determining thresholds for decision-making; methods for incorporating and grading evidence from non-randomized studies; methods for addressing concerns with conditional recommendations in public health; methods for reaching consensus; additional methodological concerns; and any modifications made to GRADE. A combination of directed content analysis and descriptive statistics will be used for data analysis, and the findings presented narratively in a tabular and graphical form. In this protocol, we present the pilot results from 13 identified eligible guidelines issued between January and August 2021. We will publish the full review results when they become available

Admission analysis of diabetic patients at the emergency room of the UHC Sisters of charity internal medicine department

Šećerna bolest, s prevalencijom od 7,9%, predstavlja veliki zdravstveni i socioekonomski problem u Republici Hrvatskoj. Prema podacima Hrvatskog zavoda za javno zdravstvo u periodu od 2009. do 2014. prevalencija bolesti je porasla sa 6,7% na 7,9%, te pokazuje daljnji trend rasta. Tip 2 šećerne bolesti, od kojeg boluje 92% šećernih bolesnika u Republici Hrvatskoj, je gotovo u potpunosti preventabilna bolest. Glavni problem je što mjere prevencije zahtijevaju promjenu životnog stila. Cilj ove studije je analizirati glavne karakteristike dijabetičkih bolesnika primljenih u Objedinjeni hitni bolnički prijem Kliničkog bolničkog centra Sestre milosrdnice u periodu od 24 sata, dobiti uvid u reguliranost glikemije oboljelih i dobivene podatke usporediti s ostalim studijama. Važno je naglasiti da su na tržištu Republike Hrvatske dostupni svi lijekovi za liječenje šećerne bolesti kao i u ostalim zemljama sa znatno većim bruto društvenim dohotkom. Većina tih lijekova se nalazi na A listi Hrvatskog zavoda za zdravstveno osiguranje. Rezultati pokazuju da je reguliranost glikemije u naših bolesnika znatno lošija, da imaju značajno više razvijenih komplikacija i prisutnih rizičnih čimbenika. Glavni razlog je vjerojatno loša edukacija oboljelih i nedovoljno dobra suradljivost pri uzimanju terapije.Diabetes mellitus, with a national prevalence 7.9%, poses a huge health care and socioeconomic threat to the Republic of Croatia. According to national data, the prevalence rose from 6.7% to 7.90% in the period between 2009 and 2014 and is still growing. Type 2 diabetes mellitus, found in 92% of our diabetic patients, is a completely preventable disease. The problem is that this prevention necessarily requires changes in people’s lifestyles. The main aim of this survey is to analyze biological and medical features in diabetic patients admitted to the emergency room of the UHC Sisters of Charity Internal Medicine Department during a 24-hour period and compare them with trends in other countries. It is important to emphasize that currently all antidiabetic agents, as well as other treatments included in diabetes management used in more developed countries, are available in the Republic of Croatia. Moreover, most of those are on the A list of the Croatian Health Insurance Fund. The results show that our diabetic patients have a much poorer regulation of glycemia, and thus more complications and poorer outcomes. The main reason is probably the low level of education about the disease, as well as low compliance

Diabetic ketosis during hyperglycemic crisis is associated with decreased all-cause mortality in patients with type 2 diabetes mellitus

Patients with type 2 diabetes mellitus have impaired ketogenesis due to high serum insulin and low growth hormone levels. Evidence exists that ketone bodies might improve kidney and cardiac function. In theory, improved ketogenesis in diabetics may have positive effects. We aimed to assess the impact of diabetic ketosis on all-cause mortality in patients with type 2 diabetes mellitus presenting with hyperglycemic crisis. We analyzed 486 patients with diabetic ketosis and 486 age and sex-matched patients with non-ketotic hyperglycemia presenting to the emergency department. Cox proportional hazard models were used to analyze the link between patient characteristics and mortality. During an observation time of 33.4 months, death of any cause occurred in 40.9 % of the non-ketotic hyperglycemia group and 30.2 % of the DK group (hazard ratio in the diabetic ketosis group, 0.63; 95 % confidence interval 0.48-0.82; P = 0.0005). Patients with diabetic ketosis had a lower incidence of symptomatic heart failure and had improved renal function. They used less furosemide and antihypertensive drugs, more metformin and lower insulin doses, all of which was independently associated with decreased mortality. Plasma glucose and glycated hemoglobin levels were similar in both groups. Patients with hyperglycemic crisis and diabetic ketosis have decreased all-cause mortality when compared to those with non-ketotic hyperglycemia. diabetic ketosis might be a compensatory mechanism rather than a complication in patients with hyperglycemic crises, but further prospective studies are warranted

Ketosis in type 2 diabetes mellitus: complication or compensatory mechanism?

The exact clinical role of diabetic ketosis in patients presenting to emergency departments with hyperglycemic crises is largely unknown. The aim of this brief review is to provide insights into possible mechanisms and clinical impact of diabetic ketosis in patients with hyperglycemic crises and clinical features of type 2 diabetes mellitus (T2DM). Patients with T2DM have impaired ketogenesis and lower blood ketone levels. High insulin, low glucagon, IGF-I, ghrelin and adiponectin levels are associated with suppressed ketogenesis. Adenosine 5’-monophosphate-activated protein kinase is an enzyme expressed in skeletal muscle and seems to have pivotal role in impaired ketogenesis. An increase in ketogenesis is associated with weight loss, increase in insulin sensitivity and serum IGF-I levels, which have beneficial effects on glycemia but also on cardiovascular morbidity and mortality. Ketone bodies are far more efficient fuel sources than glucose, especially in diabetics with heart failure and kidney disease. In theory, ketogenesis in patients with T2DM can be improved by low- carbohydrate and low-calorie diet, physical activity, moderate alcohol use, metformin, dipeptidyl peptidase 4 inhibitors, glucagon-like peptide-1 agonists and sodium/glucose cotransporter 2 (SGLT-2) inhibitors. SGLT-2 inhibitors are the most potent inducers of ketogenesis. They induce profound glycosuria with a consequent shift to fatty acid metabolism and increased ketogenesis. This could potentially explain how SGLT-2 inhibitor empagliflozin lowers cardiovascular mortality and slowers progression of kidney disease. Therefore, we believe that diabetic ketosis in patients with hyperglycemic crisis may be a compensatory mechanism, rather than a complication itself. Further prospective studies are needed to test this hypothesis