مقاله شماره ۲۵
#internalmedicine
#diabete
عنوان:
Racial and Ethnic Differences in 30-Day Hospital Readmissions Among Adults With Diabetes
نوع مطالعه:
Cohort study
مجله:
JAMA
تاریخ انتشار:
Oct, 2019
چکیده:
IMPORTANCE
Differences in readmission rates among racial and ethnic minorities have been reported, but data among people with diabetes are lacking despite the high burden of diabetes and its complications in these populations.
OBJECTIVES
To examine racial/ethnic differences in all-cause readmission among US adults with diabetes and categorize patient- and system-level factors associated with these differences.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study includes 272 758 adult patients with diabetes, discharged alive from the hospital between January 1, 2009, and December 31, 2014, and stratified by race/ethnicity. An administrative claims data set of commercially insured and Medicare Advantage beneficiaries across the United States was used. Data analysis took place between October 2016 and February 2019.
MAIN OUTCOMES AND MEASURES
Unplanned all-cause readmission within 30 days of discharge and individual-, clinical-, economic-, index hospitalization-, and hospital-level risk factors for readmission.
RESULTS
A total of 467 324 index hospitalizations among 272 758 adults with diabetes (mean [SD] age, 67.7 [12.7]; 143 498 [52.6%] women) were examined. The rates of 30-day all-cause readmission were 10.2% (33 683 of 329 264) among white individuals, 12.2% (11 014 of 89 989) among black individuals, 10.9% (4151 of 38 137) among Hispanic individuals, and 9.9% (980 of 9934) among Asian individuals (P < .001). After adjustment for all factors, only black patients had a higher risk of readmission compared with white patients (odds ratio, 1.05; 95% CI, 1.02-1.08). This increased readmission risk among black patients was sequentially attenuated, but not entirely explained, by other demographic factors, comorbidities, income, reason for index hospitalization, or place of hospitalization. Compared with white patients, both black and Hispanic patients had the highest observed-to-expected (OE) readmission rate ratio when their income was low (annual household income <$40 000 among black patients: OE ratio, 1.11; 95% CI, 1.09-1.14; among Hispanic patients: OE ratio, 1.11; 95% CI, 1.07-1.16) and when they were hospitalized in nonprofit hospitals (black patients: OE ratio, 1.10; 95% CI, 1.08-1.12; among Hispanic patients: OE ratio, 1.08; 95% CI, 1.05-1.12), academic hospitals (black patients: OE ratio, 1.16; 95% CI, 1.13-1.20; Hispanic patients: OE ratio, 1.12; 95% CI, 1.06-1.19), or large hospitals (ie, with ≥400 beds; black patients: OE ratio, 1.11; 95% CI, 1.09-1.14; Hispanic patients: OE ratio, 1.09; 95% CI, 1.04-1.14).
CONCLUSIONS AND RELEVANCE
In this study, black patients with diabetes had a significantly higher risk of readmission than members of other racial/ethnic groups. This increased risk was most pronounced among lower-income patients hospitalized in nonprofit, academic, or large hospitals. These findings reinforce the importance of identifying and addressing the many reasons for persistent racial/ethnic differences in health care quality and outcomes.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2752820
توضیحات مهم:
✅ در این مطالعه کوهورت گذشته نگر ۲۷۲۷۵۸ بیمار بزرگسال مبتلا به دیابت که از بیمارستان مرخص شده بودند ، برای ارزیابی تفاوت های نژادی و قومی ازنظر تمام علت های بستری مجدد مورد بررسی قرار گرفتند.
✔️ بیماران سیاه پوست ، اما نه Hispanic یا آسیایی ، در مقایسه با بیماران سفیدپوست خطر بیشتری برای بستری مجدد داشتند.
✔️ هر دو بیمار سیاه پوست و Hispanic نسبت به بیماران سفیدپوست که درامد خانوادگی آن ها پایین بود و در بیمارستان های خصوصی، بزرگ یا دانشگاهی بستری شده بودند؛ بستری مجدد بیشتری داشتند.
✔✔ این مطالعه کوهورت که به صورت گذشته نگر انجام شد ، نشان داد که از بین نزدیک به 273،000 بزرگسال بستری مبتلا به دیابت، بیماران سیاهپوست در 30 روز پس از ترخیص از بیمارستان ، نسبت به سایر گروه های نژادی / قومی خطر قابل توجهی برای بستری مجدد داشتند.
#internalmedicine
#diabete
عنوان:
Racial and Ethnic Differences in 30-Day Hospital Readmissions Among Adults With Diabetes
نوع مطالعه:
Cohort study
مجله:
JAMA
تاریخ انتشار:
Oct, 2019
چکیده:
IMPORTANCE
Differences in readmission rates among racial and ethnic minorities have been reported, but data among people with diabetes are lacking despite the high burden of diabetes and its complications in these populations.
OBJECTIVES
To examine racial/ethnic differences in all-cause readmission among US adults with diabetes and categorize patient- and system-level factors associated with these differences.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study includes 272 758 adult patients with diabetes, discharged alive from the hospital between January 1, 2009, and December 31, 2014, and stratified by race/ethnicity. An administrative claims data set of commercially insured and Medicare Advantage beneficiaries across the United States was used. Data analysis took place between October 2016 and February 2019.
MAIN OUTCOMES AND MEASURES
Unplanned all-cause readmission within 30 days of discharge and individual-, clinical-, economic-, index hospitalization-, and hospital-level risk factors for readmission.
RESULTS
A total of 467 324 index hospitalizations among 272 758 adults with diabetes (mean [SD] age, 67.7 [12.7]; 143 498 [52.6%] women) were examined. The rates of 30-day all-cause readmission were 10.2% (33 683 of 329 264) among white individuals, 12.2% (11 014 of 89 989) among black individuals, 10.9% (4151 of 38 137) among Hispanic individuals, and 9.9% (980 of 9934) among Asian individuals (P < .001). After adjustment for all factors, only black patients had a higher risk of readmission compared with white patients (odds ratio, 1.05; 95% CI, 1.02-1.08). This increased readmission risk among black patients was sequentially attenuated, but not entirely explained, by other demographic factors, comorbidities, income, reason for index hospitalization, or place of hospitalization. Compared with white patients, both black and Hispanic patients had the highest observed-to-expected (OE) readmission rate ratio when their income was low (annual household income <$40 000 among black patients: OE ratio, 1.11; 95% CI, 1.09-1.14; among Hispanic patients: OE ratio, 1.11; 95% CI, 1.07-1.16) and when they were hospitalized in nonprofit hospitals (black patients: OE ratio, 1.10; 95% CI, 1.08-1.12; among Hispanic patients: OE ratio, 1.08; 95% CI, 1.05-1.12), academic hospitals (black patients: OE ratio, 1.16; 95% CI, 1.13-1.20; Hispanic patients: OE ratio, 1.12; 95% CI, 1.06-1.19), or large hospitals (ie, with ≥400 beds; black patients: OE ratio, 1.11; 95% CI, 1.09-1.14; Hispanic patients: OE ratio, 1.09; 95% CI, 1.04-1.14).
CONCLUSIONS AND RELEVANCE
In this study, black patients with diabetes had a significantly higher risk of readmission than members of other racial/ethnic groups. This increased risk was most pronounced among lower-income patients hospitalized in nonprofit, academic, or large hospitals. These findings reinforce the importance of identifying and addressing the many reasons for persistent racial/ethnic differences in health care quality and outcomes.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2752820
توضیحات مهم:
✅ در این مطالعه کوهورت گذشته نگر ۲۷۲۷۵۸ بیمار بزرگسال مبتلا به دیابت که از بیمارستان مرخص شده بودند ، برای ارزیابی تفاوت های نژادی و قومی ازنظر تمام علت های بستری مجدد مورد بررسی قرار گرفتند.
✔️ بیماران سیاه پوست ، اما نه Hispanic یا آسیایی ، در مقایسه با بیماران سفیدپوست خطر بیشتری برای بستری مجدد داشتند.
✔️ هر دو بیمار سیاه پوست و Hispanic نسبت به بیماران سفیدپوست که درامد خانوادگی آن ها پایین بود و در بیمارستان های خصوصی، بزرگ یا دانشگاهی بستری شده بودند؛ بستری مجدد بیشتری داشتند.
✔✔ این مطالعه کوهورت که به صورت گذشته نگر انجام شد ، نشان داد که از بین نزدیک به 273،000 بزرگسال بستری مبتلا به دیابت، بیماران سیاهپوست در 30 روز پس از ترخیص از بیمارستان ، نسبت به سایر گروه های نژادی / قومی خطر قابل توجهی برای بستری مجدد داشتند.
مقاله شماره ۳۳
#Internal_medicine
#Diabete
عنوان:
Preventing Foot Ulceration in Diabetes
مجله:
Diabetologia
نوع مطالعه:
systematic review and meta-analyses of RCT data
تاریخ انتشار:
27 November 2019
سایتیشن:
Crawford et al.
چکیده:
AIMS/HYPOTHESIS
Foot ulceration is a serious complication for people with diabetes that results in high levels of morbidity for individuals and significant costs for health and social care systems. Nineteen systematic reviews of preventative interventions have been published, but none provides a reliable numerical summary of treatment effects. The aim of this study was to systematically review the evidence from RCTs and, where possible, conduct meta-analyses to make the best possible use of the currently available data.
METHODS
We conducted a systematic review and meta-analysis of RCTs of preventative interventions for foot ulceration. OVID MEDLINE and EMBASE were searched to February 2019 and the Cochrane Central Register of Controlled Trials to October 2018. RCTs of interventions to prevent foot ulcers in people with diabetes who were free from foot ulceration at trial entry were included. Two independent reviewers read the full-text articles and extracted data. The quality of trial reporting was assessed using the Cochrane Risk of Bias tool. The primary outcome of foot ulceration was summarised using pooled relative risks in meta-analyses.
RESULTS
Twenty-two RCTs of eight interventions were eligible for analysis. One trial of digital silicone devices (RR 0.07 [95% CI 0.01, 0.55]) and meta-analyses of dermal infrared thermometry (RR 0.41 [95% CI 0.19, 0.86]), complex interventions (RR 0.59 [95% CI 0.38, 0.90], and custom-made footwear and offloading insoles (RR 0.53 [95% CI 0.33, 0.85]) showed beneficial effects for these interventions.
CONCLUSIONS/INTERPRETATION
Four interventions were identified as being effective in preventing foot ulcers in people with diabetes, but uncertainty remains about what works and who is most likely to benefit.
https://link.springer.com/article/10.1007%2Fs00125-019-05020-7
توضیحات مهم:
✅ نویسندگان این مرور ساختارمند و متاآنالیز، اثربخشی مداخلات طراحی شده برای جلوگیری از زخم پای دیابتی را در بین مبتلایان به دیابت ارزیابی کردند.
✔️ در میان 22 مطالعه RCT که 8 مداخله را ارزیابی می کند ، مداخلات نشان داده دماسنج dermal infrared، مداخلات پیچیده و کفش custom-made و offloading insole موثر بوده است.
✔️ یک آزمایش واحد از دستگاه های دیجیتالی سیلیکون نیز از مزیت متوسطی برخوردار بود.
✔✔ اگرچه 4 مداخله در پیشگیری از زخم پای دیابتی در بین مبتلایان به دیابت مؤثر شناخته شده است ، اما مطالعات آینده لازم است تا مشخص شود که کدام مداخلات مؤثرتر هستند و استفاده از این راهکارها در کدام جمعیت هدف پیشگیرانه بیشتر است.
🔎 @Meditorha
#Internal_medicine
#Diabete
عنوان:
Preventing Foot Ulceration in Diabetes
مجله:
Diabetologia
نوع مطالعه:
systematic review and meta-analyses of RCT data
تاریخ انتشار:
27 November 2019
سایتیشن:
Crawford et al.
چکیده:
AIMS/HYPOTHESIS
Foot ulceration is a serious complication for people with diabetes that results in high levels of morbidity for individuals and significant costs for health and social care systems. Nineteen systematic reviews of preventative interventions have been published, but none provides a reliable numerical summary of treatment effects. The aim of this study was to systematically review the evidence from RCTs and, where possible, conduct meta-analyses to make the best possible use of the currently available data.
METHODS
We conducted a systematic review and meta-analysis of RCTs of preventative interventions for foot ulceration. OVID MEDLINE and EMBASE were searched to February 2019 and the Cochrane Central Register of Controlled Trials to October 2018. RCTs of interventions to prevent foot ulcers in people with diabetes who were free from foot ulceration at trial entry were included. Two independent reviewers read the full-text articles and extracted data. The quality of trial reporting was assessed using the Cochrane Risk of Bias tool. The primary outcome of foot ulceration was summarised using pooled relative risks in meta-analyses.
RESULTS
Twenty-two RCTs of eight interventions were eligible for analysis. One trial of digital silicone devices (RR 0.07 [95% CI 0.01, 0.55]) and meta-analyses of dermal infrared thermometry (RR 0.41 [95% CI 0.19, 0.86]), complex interventions (RR 0.59 [95% CI 0.38, 0.90], and custom-made footwear and offloading insoles (RR 0.53 [95% CI 0.33, 0.85]) showed beneficial effects for these interventions.
CONCLUSIONS/INTERPRETATION
Four interventions were identified as being effective in preventing foot ulcers in people with diabetes, but uncertainty remains about what works and who is most likely to benefit.
https://link.springer.com/article/10.1007%2Fs00125-019-05020-7
توضیحات مهم:
✅ نویسندگان این مرور ساختارمند و متاآنالیز، اثربخشی مداخلات طراحی شده برای جلوگیری از زخم پای دیابتی را در بین مبتلایان به دیابت ارزیابی کردند.
✔️ در میان 22 مطالعه RCT که 8 مداخله را ارزیابی می کند ، مداخلات نشان داده دماسنج dermal infrared، مداخلات پیچیده و کفش custom-made و offloading insole موثر بوده است.
✔️ یک آزمایش واحد از دستگاه های دیجیتالی سیلیکون نیز از مزیت متوسطی برخوردار بود.
✔✔ اگرچه 4 مداخله در پیشگیری از زخم پای دیابتی در بین مبتلایان به دیابت مؤثر شناخته شده است ، اما مطالعات آینده لازم است تا مشخص شود که کدام مداخلات مؤثرتر هستند و استفاده از این راهکارها در کدام جمعیت هدف پیشگیرانه بیشتر است.
🔎 @Meditorha
Diabetologia
Preventing foot ulceration in diabetes: systematic review and meta-ana
Foot ulceration is a serious complication for people with diabetes that results in high levels of morbidity for individuals and significant costs for health and social care systems. Nineteen systematic reviews of preventative interventions have been published…
مقاله شماره ۳۴
#Internal_medicine
#Diabete
#Cardiology
عنوان:
2019 ADA and EASD Guidelines for the Management of Hyperglycemia in Type 2 Diabetes
مجله:
Diabetes Care
نوع مطالعه:
Original Research
تاریخ انتشار:
October 15, 2019
سایتیشن:
Buse et al.
چکیده:
The American Diabetes Association and the European Association for the Study of Diabetes have briefly updated their 2018 recommendations on management of hyperglycemia, based on important research findings from large cardiovascular outcomes trials published in 2019. Important changes include: 1) the decision to treat high-risk individuals with a glucagon-like peptide 1 (GLP-1) receptor agonist or sodium–glucose cotransporter 2 (SGLT2) inhibitor to reduce major adverse cardiovascular events (MACE), hospitalization for heart failure (hHF), cardiovascular death, or chronic kidney disease (CKD) progression should be considered independently of baseline HbA1c or individualized HbA1c target; 2) GLP-1 receptor agonists can also be considered in patients with type 2 diabetes without established cardiovascular disease (CVD) but with the presence of specific indicators of high risk; and 3) SGLT2 inhibitors are recommended in patients with type 2 diabetes and heart failure, particularly those with heart failure with reduced ejection fraction, to reduce hHF, MACE, and CVD death, as well as in patients with type 2 diabetes with CKD (estimated glomerular filtration rate 30 to ≤60 mL min–1 [1.73 m]–2 or urinary albumin-to-creatinine ratio >30 mg/g, particularly >300 mg/g) to prevent the progression of CKD, hHF, MACE, and cardiovascular death.
https://doi.org/10.2337/dci19-0066
توضیحات مهم:
✔ The ADA and EASD have updated their guidelines for the management of hyperglycemia in type 2 diabetes to include the use of GLP-1 receptor agonists or SGLT2 inhibitors in high-risk patients.
✔ The update also includes the consideration of GLP-1 receptor agonist use in those diabetic patients without cardiovascular disease and the use of SGLT2 inhibitors in type 2 diabetes patients with heart failure and chronic kidney disease.
🔎 @Meditorha
#Internal_medicine
#Diabete
#Cardiology
عنوان:
2019 ADA and EASD Guidelines for the Management of Hyperglycemia in Type 2 Diabetes
مجله:
Diabetes Care
نوع مطالعه:
Original Research
تاریخ انتشار:
October 15, 2019
سایتیشن:
Buse et al.
چکیده:
The American Diabetes Association and the European Association for the Study of Diabetes have briefly updated their 2018 recommendations on management of hyperglycemia, based on important research findings from large cardiovascular outcomes trials published in 2019. Important changes include: 1) the decision to treat high-risk individuals with a glucagon-like peptide 1 (GLP-1) receptor agonist or sodium–glucose cotransporter 2 (SGLT2) inhibitor to reduce major adverse cardiovascular events (MACE), hospitalization for heart failure (hHF), cardiovascular death, or chronic kidney disease (CKD) progression should be considered independently of baseline HbA1c or individualized HbA1c target; 2) GLP-1 receptor agonists can also be considered in patients with type 2 diabetes without established cardiovascular disease (CVD) but with the presence of specific indicators of high risk; and 3) SGLT2 inhibitors are recommended in patients with type 2 diabetes and heart failure, particularly those with heart failure with reduced ejection fraction, to reduce hHF, MACE, and CVD death, as well as in patients with type 2 diabetes with CKD (estimated glomerular filtration rate 30 to ≤60 mL min–1 [1.73 m]–2 or urinary albumin-to-creatinine ratio >30 mg/g, particularly >300 mg/g) to prevent the progression of CKD, hHF, MACE, and cardiovascular death.
https://doi.org/10.2337/dci19-0066
توضیحات مهم:
✔ The ADA and EASD have updated their guidelines for the management of hyperglycemia in type 2 diabetes to include the use of GLP-1 receptor agonists or SGLT2 inhibitors in high-risk patients.
✔ The update also includes the consideration of GLP-1 receptor agonist use in those diabetic patients without cardiovascular disease and the use of SGLT2 inhibitors in type 2 diabetes patients with heart failure and chronic kidney disease.
🔎 @Meditorha
American Diabetes Association
2019 Update to: Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA)…
The American Diabetes Association and the European Association for the Study of Diabetes have briefly updated their 2018 recommendations on management of hyperg