The Effects of a Comprehensive Multidisciplinary Outpatient Diabetes Program on Hospital Readmission Rates in Patients with Diabetes: A Randomized Controlled Prospective Study
OBJECTIVE:The diagnosis of diabetes mellitus is associated with an increased risk of hospital readmissions. The goal of this study was to determine whether there was a difference in the rates of 30-day and 365-day hospital readmissions between diabetic patients who, upon their discharge, received diabetes care in a standard primary care setting and those who received their care in a specialized multidisciplinary diabetes program. METHODS:This was a randomized controlled prospective study. RESULTS:One hundred and ninety two consecutive patients were recruited into the study, 95 (49%) into standard care (control group) and 97 (51%) into a multidisciplinary diabetes program (intervention group). The 30-day overall hospital readmission rates (including both emergency department and hospital readmissions) were 19% in the control group and 7% in the intervention group (P = .02). The 365-day overall hospital readmission rates were 38% in the control group and 14% in the intervention group (P = .0002). CONCLUSION/CONCLUSIONS:Patients with diabetes who are assigned to a specialized multidisciplinary diabetes program upon their discharge exhibit significantly reduced hospital readmission rates at 30 days and 365 days after discharge.
Parental migration for labour and health in children and adolescents left-behind children: A systematic review and meta-analysis [Meeting Abstract]
Background The number of people migrating for labour is growing around the world, particularly in low- and middleincome countries. Parents often move for work, leaving their children behind. In China alone there are 61 million leftbehind children and adolescents (LBCA). Methods We conducted a systematic review including studies on parental migration and LBCA aged 0-19 years in low- and middle-income countries. Our outcomes were the 10 main causes of disability-adjusted life years in the under-5, 5-9 and 10-19 year age groups. These included nutrition, mental health, unintentional injuries, infectious disease, substance use, unprotected sex, early pregnancy and abuse among. We searched databases including MEDLINE, EMBASE and CINAHL from inception to April 2017, with no language restrictions. We conducted meta-analyses, sensitivity analyses based on the quality of studies, subgroup analyses (internal and international migration and one or two parent absence), and meta-regression to investigate child gender and age. A revised version of the Newcastle-Ottawa tool was used to assess bias. The protocol was registered with PROSPERO (CRD42017064871). Results We identified 111 studies, including 2 64 967 children and adolescents. 91 studies were conducted in China, all of which focused on internal migration. The other 20 studies were largely related to international migration in Asia. LBCA had an increased risk of depression (risk ratio (RR) 1.52; 95% confidence interval (CI) 1.27,1.82) and higher depression scores (standardised mean difference (SMD) 0.16; 0.10,0.21), anxiety (RR 1.85;95% CI 1.36,2.53 and SMD 0.18; 95% CI 0.11,0.26), suicidal ideation (RR 1.70; 95% CI 1.28,2.26), conduct disorder (SMD 0.16; 95% CI 0.04,0.28) and substance use (RR 1.24; 95% CI 1.00,1.52). There was an increased risk of malnutrition: wasting (RR 1.13; 95% CI 1.02,1.24) and stunting (RR 1.12; 95% CI 1.00,1.26). We found no difference for other nutrition outcomes, unintentional injury, abuse or diarrhoea. Removing low quality studies made little difference to the outcomes, as did subgroup analyses. Meta-regression showed no significant effect of gender or mean age on any outcomes. Conclusions Parental labour migration is associated with morbidity in LBCA, with no evidence of any benefit. The strongest evidence exists in China, with more research required in the rest of the world
The role of advanced glycation end-products in the development of coronary artery disease in patients with and without diabetes mellitus: a review
BACKGROUND:Traditional risk factors are insufficient to explain all cases of coronary artery disease (CAD) in patients with diabetes mellitus (DM). Advanced glycation end-products (AGEs) and their receptors may play important roles in the development and progression of CAD. BODY: Hyperglycemia is the hallmark feature of DM. An increase in the incidence of both micro-and macrovascular complications of diabetes has been observed with increased duration of hyperglycemia. This association persists even after glycemic control has been achieved, suggesting an innate mechanism of "metabolic memory." AGEs are glycated proteins that may serve as mediators of metabolic memory due to their increased production in the setting of hyperglycemia and generally slow turnover. Elevated AGE levels can lead to abnormal cross linking of extracellular and intracellular proteins disrupting their normal structure and function. Furthermore, activation of AGE receptors can induce complex signaling pathways leading to increased inflammation, oxidative stress, enhanced calcium deposition, and increased vascular smooth muscle apoptosis, contributing to the development of atherosclerosis. Through these mechanisms, AGEs may be important mediators of the development of CAD. However, clinical studies regarding the role of AGEs and their receptors in advancing CAD are limited, with contradictory results. CONCLUSION:AGEs and their receptors may be useful biomarkers for the presence and severity of CAD. Further studies are needed to evaluate the utility of circulating and tissue AGE levels in identifying asymptomatic patients at risk for CAD or to identify patients who may benefit from invasive intervention.
The readmission rates in patients with versus those without diabetes mellitus at an urban teaching hospital
OBJECTIVE:We examined the 30-day hospital readmission rates and their association with the admission diagnosis and the length of stay (LOS) in patients with diabetes versus those without diabetes mellitus (DM) in an urban teaching hospital. METHODS:In this retrospective study, we compared the 30-day readmission rates in patients with DM (n=16,266) versus those without DM (n=86,428) at an urban teaching hospital between January 1, 2013, and September 30, 2015. In individuals with a secondary diagnosis of DM, we analyzed the relationship between readmission rates and the ten most common Medicare Severity Diagnosis Related Groups (MS-DRGs). Additionally, we examined the relationship between the LOS and readmission rates in patients with diabetes and those without DM. RESULTS:The 30-day readmission rates adjusted for age and gender were higher in patients with DM compared to those without DM (15.3% vs. 8.4%, respectively, <0.001). The increased risk of readmissions was present both in patients with a primary or a secondary diagnosis of DM. For the secondary diagnosis of DM, statistically significant difference was present for two out of the ten most common DRGs (DRG # 313 [chest pain], and # 392 [esophagitis, gastroenteritis, and miscellaneous digestive disorders], p=0.045 and 0.009, respectively). There was a direct correlation between LOS and readmission rates in both patients with diabetes and those without DM (p<0.001 for both). CONCLUSIONS:The 30-day readmission rates are higher in patients with DM compared to patients without DM. DM is an independent risk factor for hospital readmissions. The readmission rates correlate directly with LOS in both patients with diabetes and those without DM.
REDUCING HOSPITAL RE-ADMISSIONS IN PATIENTS WITH DIABETES: DEVELOPING BETTER STRATEGIES
Is there a role for vitamin D in human reproduction?
Vitamin D is a steroid hormone with canonical roles in calcium metabolism and bone modeling. However, in recent years there has been a growing body of literature presenting associations between vitamin D levels and a variety of disease processes, including metabolic disorders such as diabetes and prediabetes and autoimmune conditions such as thyroid disease. This review focuses on the potential role of vitamin D in both male and female reproductive function. The vitamin D receptor (VDR) is expressed throughout central and peripheral organs of reproduction. VDR is often co-localized with its metabolizing enzymes, suggesting the importance of tissue specific modulation of active vitamin D levels. Both animal and human studies in males links vitamin D deficiency with hypogonadism and decreased fertility. In females, there is evidence for its role in polycystic ovary syndrome (PCOS), endometriosis, leiomyomas, in-vitro fertilization, and pregnancy outcomes. Studies evaluating the effects of replacing vitamin D have shown variable results. There remains some concern that the effects of vitamin D on reproduction are not direct, but rather secondary to the accompanying hypocalcemia or estrogen dysregulation.