Inpatient Mortality in People With Type 2 Diabetes: A Cross-sectional Study

Objective: This study aimed to estimate inpatient mortality rate for diabetes and identify its associated factors. Materials and methods: This is a cross-sectional study. The population was comprised between January 1 and December 31, 2019 in 32 public hospitals in Portugal, using summary hospital discharge data. We used both the Disease-Related Diagnosis Groups and the Disease Staging. Patients were grouped into survivors and non-survivors, and inpatient mortality was compared using competing event regression. Results: A total of 7980 patients were admitted with type 2 diabetes mellitus, there were 747 (10.3%) non-survivors. The advanced age (OR = 1.772; 95% CI 1.625–1.932), the stage (3) severity of type 2 diabetes mellitus (OR = 4.301; 95% CI 2.564–7.215), comorbid lung, bronchial or mediastinal malignant neoplasm (OR = 5.118; 95% CI 2.222–11.788), comorbid bacterial pneumonia (OR = 3.214; 95% CI 2.539–4.070), other respiratory system disorders (OR = 2.187; 95% CI 1.645–2.909), comorbid rhino-, adeno- and coronavirus infections (OR = 1.680; 95% CI 1.135–2.488) were determinants for inpatient mortality. Conclusions: Elderly patients with diabetes with micro- and macrovascular complications of the disease, who have bacterial pneumonia and who enter the emergency department are those who have a lower survival rate

Beyond Apnea-Hypopnea Index: how clinical and comorbidity are important in obstructive sleep apnea

Introduction: The classification of the severity of obstructive sleep apnea (OSA) based on the Apnea/Hypopnea Index (AHI) does not reflect the heterogeneity and prognosis of the disease. The Baveno classification proposes a new assessment system that includes symptoms and comorbidities. The aim of our study was to evaluate the application of the Baveno classification in clinical practice and to explore its association with sleep indices, adherence to therapy and symptoms over a 6-months period. Material and methods: Prospective study including patients diagnosed with OSA between January and July 2021 was conducted. Patients were divided into 4 groups (A–D) according to the Baveno classification. The adherence to PAP treatment and Epworth Sleepiness Scale (ESS) values were obtained 6 months after initiation of therapy. Results: A total of 91 patients (84% male, 58 ± 13 years) were included in the study. The median ESS score was 10 (6–15), mean AHI was 28.4 ± 22.2 events/hour and the time with SpO2 < 90% (T90) was 9.7 ± 14.9%. At diagnosis, patients were classified into Baveno groups: A: 30%; B: 35%; C: 17%, D: 19%. There were no statistical differences in AHI between the different groups. On the other hand, T90 had higher values in patients with comorbidities (C, D). Regarding the treatment, the prescription of PAP was higher in patients with comorbidities (C, D), and adherence to this treatment at 6 months was higher in group D. Among patients under PAP therapy, there was a statistically significant decrease in daytime sleepiness at 6 months in groups B and D. Conclusions: The Baveno classification distributes patients with OSA evenly across the different phenotypes, regardless of the AHI value. The treatment decision was linked to the comorbidities (C, D) were the ones who had the greatest adherence to treatment at 6 months were in group D. ESS improved with greater emphasis in the most symptomatic (B, D), while the AHI is essential for the diagnosis of OSA, the Baveno classification may guide physicians better in their treatment decision

Activation of the hypothalamic-pituitary-adrenal axis by exogenous and endogenous GDF15.

An acute increase in the circulating concentration of glucocorticoid hormones is essential for the survival of severe somatic stresses. Circulating concentrations of GDF15, a hormone that acts in the brain to reduce food intake, are frequently elevated in stressful states. We now report that GDF15 potently activates the hypothalamic-pituitary-adrenal (HPA) axis in mice and rats. A blocking antibody to the GDNF-family receptor α-like receptor completely prevented the corticosterone response to GDF15 administration. In wild-type mice exposed to a range of stressful stimuli, circulating levels of both corticosterone and GDF15 rose acutely. In the case of Escherichia coli or lipopolysaccharide injections, the vigorous proinflammatory cytokine response elicited was sufficient to produce a near-maximal HPA response, regardless of the presence or absence of GDF15. In contrast, the activation of the HPA axis seen in wild-type mice in response to the administration of genotoxic or endoplasmic reticulum toxins, which do not provoke a marked rise in cytokines, was absent in Gdf15 -/- mice. In conclusion, consistent with its proposed role as a sentinel hormone, endogenous GDF15 is required for the activation of the protective HPA response to toxins that do not induce a substantial cytokine response. In the context of efforts to develop GDF15 as an antiobesity therapeutic, these findings identify a biomarker of target engagement and a previously unrecognized pharmacodynamic effect, which will require monitoring in human studies

Śmiertelność szpitalna u osób z cukrzycą typu 2 — badanie przekrojowe

Wstęp: Celem tego badania było oszacowanie śmiertelności szpitalnej z powodu cukrzycy i zidentyfikowanie związanych z nią czynników. Materiał i metody: Było to badanie przekrojowe, obejmujące populację pacjentów hospitalizowanych w okresie od 1 stycznia do 31 grudnia 2019 roku w 32 szpitalach publicznych w Portugalii, oparte na danych zamieszczonych w karcie wypisowej. Ustalono zarówno grupy diagnostyczne według klasyfikacji DRGs (diagnosis-related groups), jak i ocenę stopnia zaawansowania choroby. Pacjentów podzielono na tych, którzy przeżyli i tych, którzy zmarli, a śmiertelność szpitalną porównano za pomocą regresji zdarzeń konkurencyjnych. Wyniki: W analizowanym okresie hospitalizowano 7980 pacjentów z cukrzycą typu 2, z czego 747 (10,3%) nie przeżyło. Zaawansowany wiek (OR = 1,772; 95% CI 1,625–1,932), stadium 3. ciężkości cukrzycy typu 2 (OR = 4,301; 95% CI 2,564–7,215), współistniejący rak płuca, oskrzeli lub śródpiersia (OR = 5,118; 95% CI 2,222–11,788), współistniejące bakteryjne zapalenie płuc (OR = 3,214; 95% CI 2,539–4,070), inne choroby układu oddechowego (OR = 2,187; 95% CI 1,645–2,909), współistniejące zakażenie rino-, adenolub koronawirusem (OR = 1,680; 95% CI 1,135–2,488) były determinantami śmiertelności szpitalnej. Wnioski: U pacjentów w podeszłym wieku, z cukrzycą, powikłaniami mikro- i makronaczyniowymi oraz bakteryjnym zapaleniem płuc, którzy trafiają na oddział ratunkowy, obserwuje się niższy wskaźnik przeżycia

Beyond Apnea-Hypopnea Index: How Clinical and Comorbidity Are Important in Obstructive Sleep Apnea

Introduction: The classification of the severity of obstructive sleep apnea (OSA) based on the Apnea/Hypopnea Index (AHI) does not reflect the heterogeneity and prognosis of the disease. The Baveno classification proposes a new assessment system that includes symptoms and comor-bidities. The aim of our study was to evaluate the application of the Baveno classification in clinical practice and to explore its association with sleep indices, adherence to therapy and symptoms over a 6-months period. Material and methods: Prospective study including patients diagnosed with OSA between January and July 2021 was conducted. Patients were divided into 4 groups (A–D) according to the Baveno classification. The adherence to PAP treatment and Epworth Sleepiness Scale (ESS) values were obtained 6 months after initiation of therapy. Results: A total of 91 patients (84% male, 58 ± 13 years) were included in the study. The median ESS score was 10 (6–15), mean AHI was 28.4 ± 22.2 events/hour and the time with SpO2 < 90% (T90) was 9.7 ± 14.9%. At diagnosis, patients were classified into Baveno groups: A: 30%; B: 35%; C: 17%, D: 19%. There were no statisti-cal differences in AHI between the different groups. On the other hand, T90 had higher values in patients with comorbidities (C, D). Regarding the treatment, the prescription of PAP was higher in patients with comorbidities (C, D), and adherence to this treatment at 6 months was higher in group D. Among patients under PAP therapy, there was a statistically significant decrease in daytime sleepiness at 6 months in groups B and D. Conclusions: The Baveno classification distributes pa-tients with OSA evenly across the different phenotypes, regardless of the AHI value. The treatment decision was linked to the comorbidities (C, D) were the ones who had the greatest adherence to treatment at 6 months were in group D. ESS improved with greater emphasis in the most sympto-matic (B, D), while the AHI is essential for the diagnosis of OSA, the Baveno classification may guide physicians better in their treatment decision