RESUMO
AIMS: To evaluate the external validity of Finnish diabetes risk score (FINDRISC) and Latin American FINDRISC (LAFINDRISC) for undiagnosed dysglycemia in hospital health care workers. METHODS: We carried out a cross-sectional study on health workers without a prior history of diabetes mellitus (DM). Undiagnosed dysglycemia (prediabetes or diabetes mellitus) was defined using fasting glucose and two-hour oral glucose tolerance test. LAFINDRISC is an adapted version of FINDRISC with different waist circumference cut-off points. We calculated the area under the receptor operational characteristic curve (AUROC) and explored the best cut-off point. RESULTS: We included 549 participants in the analysis. The frequency of undiagnosed dysglycemia was 17.8%. The AUROC of LAFINDRISC and FINDRISC were 71.5% and 69.2%; p = 0.007, respectively. The optimal cut-off for undiagnosed dysglycemiaaccording to Index Youden was ≥ 11 in LAFINDRISC (Sensitivity: 78.6%; Specificity: 51.7%) and ≥12 in FINDRISC (Sensitivity: 70.4%; Specificity: 53.9%). CONCLUSION: The discriminative capacity of both questionnaires is good for the diagnosis of dysglycemia in the healthcare personnel of the María Auxiliadora hospital. The LAFINDRISC presented a small statistical difference, nontheless clinically similar, since there was no difference by age or sex. Further studies in the general population are required to validate these results.
Assuntos
Diabetes Mellitus , Programas de Rastreamento , Humanos , Feminino , Masculino , Adulto , Peru/epidemiologia , Pessoa de Meia-Idade , Estudos Transversais , Programas de Rastreamento/métodos , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/sangue , Pessoal de Saúde , Teste de Tolerância a Glucose , Glicemia/análise , Fatores de Risco , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/sangue , Estado Pré-Diabético/epidemiologiaRESUMO
OBJECTIVE: To evaluate the association between hyperglycemia treatment and mortality in patients with diabetes and COVID-19 in a Peruvian hospital. METHODS: A retrospective cohort study was conducted between March and July 2020. Individual-level data were extracted from an implemented virtual platform. We included patients with type 2 diabetes hospitalized with COVID-19. The assessed outcome was in-hospital mortality. The Independent variable of interest was hyperglycemic treatment. We used Poisson regressions with robust variance to obtain crude and adjusted relative risks (RR) and their 95% confidence intervals (95% CI). RESULTS: Out of 1635 patients hospitalized for COVID-19 during the study period, 248 patients with diabetes mellitus were included. The majority were men (66.9%), the median age was 62 years. Ninety-seven patients died in the hospital (39.1%). The median glycemia on admission was 222.5 mg/dL. At 48 h after hospital admission, 125 patients (50.4%) received sliding scale insulin alone (SSI), 46 (18.5%) received a fixed-dose insulin regimen. In the adjusted analysis, the group with SSI at 48 h of hospitalization had higher mortality than those with fixed-dose insulin (adjusted RR: 1.69; 95% CI: 1.01 - 2.83), and those and who continued with SSI in the following days had higher mortality compared to the group that switched to fixed-dose insulin (adjusted RR: 1.64; 95% CI: 1.17 - 2.32). CONCLUSION: Among assessed patients with diabetes and COVID-19, more than a third died during hospitalization. Early and continuous use of the sliding scale was associated with higher mortality compared to fixed-dose insulin regimens.
RESUMO
AIM: The pandemic has generated the need for COVID-19 patients to be treated as best as possible; however, the effect of these treatments on glycemic control has not yet been taken into account. This article aims to determine whether the daily variation of glucose is influenced by the use of corticosteroids in COVID-19 patients treated in Lima-Peru. METHODOLOGY: A prospective cohort study was undertook, in which glucose was measured four times a day in 53 patients hospitalized due to COVID-19. These values were associated with the use of corticosteroids and adjusted for other socio-educational variables, all by means of PA-GEE models. RESULTS: Nested multivariate analysis of daily glucose variation found that those using corticosteroids increased the daily average glucose as well as the first and last glucose measurements, this is, at 6am and 10pm, respectively (all p-values <0.026). An increase in glucose levels was also observed in those with diabetes (all p-values <0.001). In contrast, we found that there was a decrease in the last glucose measurement of the day in obese patients (p-value = 0.044). CONCLUSIONS: The patients who used corticosteroids for the treatment of COVID-19 increased the average glucose per day, especially in the first and last measurement.
Assuntos
Corticosteroides/efeitos adversos , Glicemia/análise , Tratamento Farmacológico da COVID-19 , Hiperglicemia/patologia , SARS-CoV-2/isolamento & purificação , Idoso , Automonitorização da Glicemia/métodos , COVID-19/epidemiologia , COVID-19/virologia , Feminino , Humanos , Hiperglicemia/induzido quimicamente , Hiperglicemia/metabolismo , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Estudos ProspectivosRESUMO
Describir la frecuencia de pacientes con diabetes mellitus tipo 2 (DM2) hospitalizados en Piura.Material y Métodos: realizamos un estudio transversal en los dos hospitales de mayor nivel de atención de Essalud en Piura: Hospital III José Cayetano Heredia y Hospital II Jorge Reátegui Delgado. Obtuvimos las características clínico-demográficas de las historias clínicas (HC) de los participantes durante el Día Internacional de la Diabetes 2014.Resultados: De los 183 pacientes hospitalizados en ambos centros, 39 pacientes (21%) padecían DM2, la media de edad fue 67.8± 11.8 años. No reportan la glucemia de ingreso y glucemia diaria 17 y 24 participantes, respectivamente. En 31 participantes no se reportó el peso del paciente. El pie diabético fue la principal causa de hospitalización.Conclusión: La DM2 es muy frecuente en los pacientes hospitalizados de EsSalud Piura, no hay un adecuado registro en las HC de parámetros como peso y control glucémico...
Objective: To describe the frequency of patients with diabetes mellitus type 2 hospitalized in Piura. Material and Methods: we ronrinctpri a cross-sectional study in two hospitals of greater complexity ran. of EsSalmi in Piura: Hospital III Jose Cayetano Heredia and Hospital II Jorge Reategui Delgado. Results: We obtained the clinical-demographic characteristics of the participants during the International Diabetes Day 2014. Of the 183 in patients in both centers, 39 patients (21%) had diabetes mellitus type 2; the mean age was 67.8 ± 11.8. The medical records do not report hospital admission blood glucose and blood glucose during hospitalization in 17 and 24 participants, respectively. The medical records do not report weight of 31 participants. Diabetic foot was the primary cause of hospitalization. Conclusion: We conclude that diabetes mellitus type 2 is common in hospitalized patients of Essalud Piura, there is no proper record in the medical records of parameters such as weight and glycemic control...
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Humanos , Masculino , Feminino , Hospitalização , Pacientes , Pé Diabético , Estudos TransversaisRESUMO
La obesidad aumenta el riesgo de desarrollar o agravar múltiples afecciones particularmente la diabetes tipo 2, una enfermedad crónica de difícil control cuyo tratamiento con distintos fármacos y aún con insulina, frecuentemente no alcanza los objetivos terapéuticos ni reduce el riesgo cardiovascular. Cuando se asocia a obesidad severa, su terapéutica se torna más compleja. Se analiza la utilización de cirugía bariátrica y metabólica en pacientes con obesidad severa y diabetes, se revisan las técnicas quirúrgicas, las hipótesis sobre su mecanismo de acción, la selección de pacientes y los resultados. La cirugíabariátrica ha probado ser efectiva en el tratamiento de la obesidad severa y de la DM2 en pacientes con IMC >35 kg/m2. Es una cirugía de aceptable tolerancia en personas preparadas, de bajo riesgo y con complicaciones subsanables y manejables en la actualidad. La cirugía bariátrica dispone de suficiente respaldo científico. En cambio, en las evidencias disponibles de la cirugía metabólica en pacientes con IMC <35 kg/m2 y más aún con IMC <30 kg/m2 existen resultados promisorios en el corto y mediano plazo, pero no se dispone aún de evidencia suficiente que avale su indicación. Se requieren más investigaciones para establecer la eficacia y seguridad de estas técnicas quirúrgicas en el largo plazo.
Assuntos
Cirurgia Bariátrica , Obesidade MórbidaRESUMO
La obesidad aumenta el riesgo de desarrollar o agravar múltiples afecciones particularmente la diabetes tipo 2, una enfermedad crónica de difícil control cuyo tratamiento con distintos fármacos y aún con insulina, frecuentemente no alcanza los objetivos terapéuticos ni reduce el riesgo cardiovascular. Cuando se asocia a obesidad severa, su terapéutica se torna más compleja. Se analiza la utilización de cirugía bariátrica y metabólica en pacientes con obesidad severa y diabetes, se revisan las técnicas quirúrgicas, las hipótesis sobre su mecanismo de acción, la selección de pacientes y los resultados. La cirugíabariátrica ha probado ser efectiva en el tratamiento de la obesidad severa y de la DM2 en pacientes con IMC >35 kg/m2. Es una cirugía de aceptable tolerancia en personas preparadas, de bajo riesgo y con complicaciones subsanables y manejables en la actualidad. La cirugía bariátrica dispone de suficiente respaldo científico. En cambio, en las evidencias disponibles de la cirugía metabólica en pacientes con IMC <35 kg/m2 y más aún con IMC <30 kg/m2 existen resultados promisorios en el corto y mediano plazo, pero no se dispone aún de evidencia suficiente que avale su indicación. Se requieren más investigaciones para establecer la eficacia y seguridad de estas técnicas quirúrgicas en el largo plazo. (AU)