bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in Cardiovascular Risk in the United States 1999 - 2018
Authors: Li Hang Long , Cheung Bernard M Y 
Published: May 2021

Abstract
Introduction: As guidelines evolve, lifestyle changes and new drugs are introduced, the long-term trends in cardiovascular risk in the general population are of interest. We evaluated the AHA-ACC-ASCVD risk score (ASCVD-RS) in the US population in the last 20 years.
Methods: Participants in the National Health and Nutrition Examination Survey (NHANES) 1999–2018 aged 40–79 years were included. Pregnant participants and those with missing relevant laboratory/self-reported data were excluded. Temporal trends in ASCVD-RS and its components, and the proportions of participants at high risk (score ≥10%) were characterized using linear regression, adjusted for age, sex, and ethnicity. Data analysis was performed using the R statistical package “survey” (version 3.6.3).
Results: Altogether 12744 NHANES participants (mean age 56.4 years; 55.9% male) were analyzed. From 1999–2018, the proportion of people with diabetes and taking antihypertensives increased significantly (both p&lt;0.001), while total cholesterol level decreased significantly (p&lt;0.001). Levels of high-density lipoprotein-cholesterol (HDL), and the proportion of smokers and individuals with systolic blood pressure ≥120mmHg remained static. The mean ± standard error of ASCVD-RS significantly increased from 11.4±0.7% in 1999–2000 to 12.5±0.5% in 2017–2018 (p=0.014), and the proportion of high-risk participants increased from 39.1% to 44.1% (p=0.020).
Conclusions: Cardiovascular risk in the US population increased slightly in the past 20 years. Despite the increased treatment rate of hypertension and the decrease in total cholesterol, the prevalence of diabetes doubled. More effort should be directed at preventing diabetes through weight control and regular physical activity.
Diabetes Medication Reconciliation at Hospital Discharge
Authors: Shah Nandi , Kulasa Kristen 
Published: May 2021

Abstract
Background: During hospital discharge, patients are at high risk for medication discrepancies as they transition from hospital to home. This study aims to evaluate the prevalence of medication errors at hospital discharge for diabetes medications in patients who received an endocrinology consultation for diabetes and explore interventions to improve the accuracy of discharge medication reconciliation.
Methods: All patients (n=3018) who received an endocrinology consultation for diabetes at a tertiary care medical center from October 2017 to December 2019 were included. A retrospective chart review was performed to collect the following information on each patient: primary service from which the patient was discharged, hospital site, month and year of discharge date, and whether each patient’s medication reconciliation for diabetes medications at hospital discharge was in agreement with the inpatient diabetes team’s recommendations. Patients who were discharged on medications discordant from those recommended by the inpatient diabetes service were subcategorized into three groups: 1) one medication incorrect 2) more than one medication incorrect and 3) the primary service did not notify the consult team of patient’s discharge or request final recommendations for diabetes medications prior to discharge. Based on the findings of this study, an educational intervention was implemented in November 2019 to the Hospital Medicine services regarding diabetes discharge medication reconciliation.
Results: Of the 3018 patients who received an endocrinology consultation for diabetes at a tertiary university medical center, 2279 patients (76%) were discharged on correct medications, 165 patients (5%) were discharged with one incorrect medication, 443 patients (15%) were discharged with more than one incorrect medication, and 121 patients (4%) were discharged without final discharge recommendations from the diabetes service. There was no significant variation based on discharging service or month of the year. After an educational intervention was implemented in November 2019 to the Hospital Medicine service on the existence and use of a comprehensive diabetes discharge order set, the percentage of patients discharged on correct medications improved to 92% (11/12 patients) compared to prior 81% (44/54 patients).
Conclusion: Despite detailed discharge medication recommendations including patient education detailing the recommended regimen by the endocrinology diabetes service, a significant number of patients were discharged by providers across all services on diabetes medications discrepant with the diabetes service’s recommendations. Educational efforts improved the rate of correct medications at discharge on the Hospital Medicine service, and additional educational interventions with other services may be helpful in improving medication reconciliation accuracy.
In-Hospital Outcomes in Patients With Hyperosmolar Hyperglycemic State With and Without Hypertriglyceridemia: Analysis of National Inpatient Sample
Authors: Velazquez Genaro , Shaka Hafeez , Murthi Mukunthan , Asemota Iriagbonse , Velagapudi Sujitha , Marcos-Abdala Hernan Gerardo , Akuna Emmanuel , Edigin Ehizogie 
Published: May 2021

Abstract
Background: In patients hospitalized with Hyperosmolar hyperglycemic state (HHS) the presence of comorbid conditions including hypertension, heart disease, stroke, and dementia have been variably reported to be associated with higher mortality. HTG is increasingly prevalent in patients with DM, especially those with poor glycemic control who are more likely to suffer from HHS. Elevated triglyceride levels have independently been associated with higher mortality in certain conditions like coronary artery disease and acute pancreatitis. However, data on the effect of Hypertriglyceridemia (HTG) on mortality and morbidity in hospitalized patients with HHS is sparse.
Objective: We wanted to compare the outcomes for HHS hospitalizations for patients with and without HTG.
Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 and 2017. About 42 740 hospitalizations who had HHS as primary diagnosis were enrolled and further stratified based on the presence or absence of HTG as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes included length of hospital stay, total Hospital charges, Sepsis, Septic Shock, Acute Kidney Injury (AKI), and Acute Respiratory Failure (ARF). Multivariate regression analysis was done to adjust for confounders.
Results: Out of the 42 740 hospitalizations with HHS, about 17 040 had HTG. The in-hospital mortality for patients with HHS was 305 overall, out of which 70 patients had HTG as secondary diagnosis. Compared with patients without HTG, patients with HTG had lower odds of in- hospital mortality (0.30, 95% CI 0.157–0.56, p&lt;0.005) when adjusted for patient and hospital characteristics. Patients with HHS and HTG had decreased length of hospital stay, less total Hospital charges, lower odds of Sepsis and Septic Shock, but similar odds of AKI and ARF in comparison to patients without HTG.
Conclusion: Our study shows that HTG is associated with lower odds of in-hospital mortality in patients with HHS, even though the odds of AKI and ARF was same in both groups. A similar inverse relationship has already been reported between TG levels and mortality in stroke patients. Though the mechanism of this effect is unclear, one possible explanation could be that patients with HTG are more likely to be treated with statins and fibrates which have known anti-inflammatory effects. Further studies are required to evaluate this possible positive prognostic effect of TG.
Inpatient Glycaemic Control is Poor in Patients Receiving Insulin Therapy
Authors: Reidy Niall , O’Donovan Marion C , Hannon Mark J 
Published: May 2021

Abstract
Patients with diabetes mellitus (DM) are admitted to hospital more frequently than the general population and have longer inpatient stays. Tight inpatient glycaemic control improves outcome but is difficult to achieve, especially in those on insulin. We prospectively reviewed the capillary blood glucose (CBG) control of hospital inpatients receiving insulin to determine their level of control and to examine healthcare providers’ responses to dysglycaemia. Between March and June 2020, all patients on insulin admitted to Bantry General Hospital for more than 24 hrs were reviewed. CBG recordings were individually categorised as either hypoglycaemic (CBG &lt; 4mmol/L), euglycaemic (CBG = 4–9.9mmol/L), mildly hyperglycaemic (CBG = 10-14mmol/L) or severely hyperglycaemic (CBG &gt;14mmol/L). Each patient’s individual insulin dose was reviewed and compared with their concurrent CBG level and categorised as either appropriate or inappropriate. Other factors that were reviewed included whether a HbA1C was performed, whether a referral to the diabetic clinical nurse specialist was made and whether the patient was on glucocorticoid therapy.16 patients were enrolled, average age 77. 497 CBG checks were recorded over 108 patient days. Average length of stay was 6.6 days. All patients had type 2 DM. 10 patients were on basal insulin therapy, 4 were on basal-bolus insulin, 2 were on mixed insulin. CBG was checked sub-optimally (i.e. fewer than 4 times per day) on 35/108 patient days. 355/497 CBG checks were in the euglycaemic range; but only 3 patients were entirely euglycaemic throughout admission.17 hypoglycaemic events occurred in 5 patients. These events were spread unevenly with 1 patient having 10 hypoglycaemic events while the other 7 events were spread between the remaining 4 patients.125 severely hyperglycaemic events occurred in 13 patients. Again, these events were spread unevenly with over half (67/125) events occurring in only 3 patients. Of these 13 patients, 5 were on glucocorticoid therapy. All 5 patients that had hypoglycaemic events also had severely hyperglycaemic events. Of the hypoglycaemic events recorded, only 12/17 were treated appropriately (i.e. with 15-20g of fast-acting carbohydrate and a reduction in subsequent insulin dose). Of the hyperglycaemic events recorded, 77/125 were managed appropriately (i.e. with either a stat dose of bolus insulin being administered or an increase in subsequent insulin doses being made or both). 6 prescribing errors were recorded in total. HbA1c was checked in 5 patients. An inpatient referral was made by the medical team to the diabetes clinical nurse specialist for only 4 patients. Inpatient glycaemic control was suboptimal in the majority of patients. Dysglycaemia, especially hyperglycaemia, remains problematic. Insulin doses were not adjusted often enough or dramatically enough. Further doctor and nurse education is required in this area.
The Weight of Words: A Mixed Methods Study to Understand Indian Doctors’ Perspectives and Experiences of Patient Communication
Authors: Selvan Chitra , Lathia Tejal , Chawak Shweta , Akula Niveditha , Chittam Mahati 
Published: May 2021

Abstract
Background: Effective doctor communication can lead to increased treatment adherence and improved self-management among individuals living with diabetes. Yet, there is limited research in India which examines how doctors communicate, especially in terms of verbal and nonverbal communication. Aims: (1) To examine communication in clinic (verbal, nonverbal and basic content) among Indian doctors specialized in diabetes and endocrine care, and (2) to explore doctors’ styles of verbal and nonverbal communication. Methods: Using a mixed methods design, a survey containing quantitative (n=834) and qualitative (n=648) elements was filled out by doctors specialized in the fields of diabetes and endocrinology in India. Questions in the quantitative section included questions such as addressing patients’ illness-related concerns, acknowledging challenges of using insulin, and non-verbal behaviours. The qualitative section focussed on elaborating some responses made to the quantitative section, such as questions about explaining the cause of illness, listing words and phrases that may potentially impact patients, and explaining why the patients need to be initiated on insulin. The data was analysed using descriptive statistics and qualitative content analysis, respectively. Results: The findings of the quantitative study showed that the majority of the doctors (i) always greeted their patient as they entered the room (43.2%), (ii) addressed the risk of developing diabetes with patients’ siblings/children (87.9%), (iii) always acknowledged the challenges of using insulin (42.8%), and (iv) never asked patients’ experiences at the end of the consultation (31.9%). All common communication cues were rated as extremely important; eye contact (48.7%), tone of voice (41.5%), body language (39.6%), and words and phrases (41.8%). The qualitative findings revealed that doctors preferred to use verbal communication such as using authoritative language, educating patients using facts, analogies and behavioural information, employing empathetic language on occasion. Doctors also reported using negative words that portrayed fear, blame and disengagement in order to promote adherence. Discussion and Conclusion: The findings suggest that doctors rely on verbal rather than nonverbal communication when interacting with patients, with fear messages being a favoured means of ensuring adherence. It is possible that this may be because, while recognizing the value of nonverbal methods, doctors lack training in using these techniques in communication. Therefore, developing a communication skill training program for Indian doctors focussed on empathic and nonverbal communication can help to improve consultation and patient outcomes (e.g., adherence, patient satisfaction).
Deceptive Late Maternal Euglycaemia
Authors: Irene Arockia Silviya , Lata Anthikat Sankaranarayanan 
Published: May 2021

Abstract
Background: Strict glycemic control is the most critical factor determining outcome in Gestational Diabetes mellitus. But having capillary blood glucose readings within the target levels, in the late trimester may be deceptive. If fetal hyperinsulinaemia and fetopathy have already set in, maternal glucose may be spuriously normal. We support this hypothesis based on our experience with 4 GDM patients who apparently reported normal blood glucose in late trimester, yet ended up with neonatal complications. Materials and Methods: Records of mothers of four neonates (Infant of diabetic mother) admitted in neonatal ICU with GDM associated complications were retrospectively analyzed. Diagnosis of GDM was made as per the ADA guidelines. The blood glucose values of the 9-point readings (Fasting, pre-lunch, pre-dinner, 1hr and 2hr post breakfast, lunch and dinner) every 3 to 5 days, which the patients shared online were plotted and studied. Mode of delivery and neonatal outcome were noted. Results: All patients (mean age 28.5years, range 24–31) presented to us only in third trimester though two of them had deranged OGTT during first trimester screening elsewhere. The average HbA1c at the time of presentation was 5.425 (Range 4.8 to6.3). Only one of them was on insulin for a short term, which she stopped on her own as the readings continued to be in range even after stopping insulin. Of the 529 last trimester readings shared by the patients, 91.3% were within the target range of FBS&lt; 92mg/dl, 1and 2 post meals &lt;140 and 120 respectively, and pre meals &lt; 95mg/dl. Three of them were induced (Two at 40 weeks and one at 38.4 weeks) for labour. The obstetrical outcomes were as follows: one had LSCS due to non-descent of head, second had vacuum assisted delivery, third had shoulder dystocia and fourth had normal delivery. The neonatal outcomes in respective cases were large for date baby with hypocalcaemia, transient HOCM with hypocalcaemia, shoulder dystocia with perinatal depression, PDA with respiratory distress. Conclusion: GDM should be intervened before the establishment of diabetic fetopathy. Missing the initial spikes in maternal glucose and the consequent surreptitious transfer of glucose to fetus can initiate such fetopathy. There is rerouting or detour of the maternal glucose, to the fetal system, for its disposal. Hence low or normal blood glucose readings in a known GDM patient should alert the clinician about the possibility of fetal glucose steal.1 Highly suspicious cases can be monitored for polyhydramnios and fetal and maternal weight gain. The best ways to prevent this are pre-conceptional screening for IGT and universal screening for GDM with OGTT in each trimester.
Reference: 1.
Desoye, Gernot & Nolan, Christopher. (2016). The fetal glucose steal: an underappreciated phenomenon in diabetic pregnancy. Diabetologia. 59. 10.1007/s00125-016-3931-6.aq`
Maternal Chronotype and Pregnancy Outcomes in Gestational Diabetes
Authors: Sampaio Facanha Cristina F , De Bruin Veralice Sales , Alencar Victoria S , Machado Paula S , Rocha Thaine M , Lopes Fernando Henrique A , Macedo Rejane B , Viana Antonio B , De Bruin Pedro Felipe 
Published: May 2021

Abstract
Introduction: Gestational diabetes mellitus (GDM) is an increasingly frequent complication of pregnancy and its presence is related to the development of adverse maternal and fetal outcomes. Pregnancy is deeply influenced by the circadian rhythm and the misalignment of the maternal rhythm can lead to disturbances in the temporal organization of physiological and metabolic functions. Previously, the association between circadian rhythm disorders and diabetes has been well described in pregnancy. Objective: To investigate the influence of chronotype on the development of maternal and fetal complications during pregnancy in GDM. Methodology: Prospective cohort study of patients with GDM. Clinical data and behavior questionnaires were collected by face- to- face interview. Questionnaires evaluated the chronotype (Morning-Eveningness-Questionnaire- MEQ), sleep quality (Pittsburgh Sleep Quality Index- PSQI), daytime sleepiness (Epworth Sleepiness Scale -ESS), depressive symptoms (Edinburgh Postnatal Depression Scale-EDPS) and insomnia (Insomnia Severity Index- ISI). Sleep diaries (14 days) and actigraphic record (5 to 7 days) were obtained. Results: Overall, 305 2nd to 3rd trimester GDM patients were evaluated. Eighty-nine GDM patients completed the sleep diary and 53 performed a valid actigraphic registry. Amongst these, 49.5% were identified as morning chronotypes (MEQ≥59), 43.6% intermediate types (MEQ from 42 to 58) and 6.9% had evening type preference (MEQ&lt;41). Evening preference patients were younger (p&lt; 0.005), had more unstable marital status (P = 0.04), had worse sleep quality (p = 0.02); latter sleep midpoint (p= 0.01), higher prevalence of insomnia (p&lt; 0.005) and depression (p= 0.004) before and during pregnancy. No differences were found in total sleep duration as recorded by sleep diary (p=0.4) or actigraphic measurements (p=0.83). Evening type preference in GDM was associated with pre-eclampsia (p= 0.02) and neonatal ICU admission (p= 0.03). Conclusion: This study suggests that the presence of the evening-type chronotype in pregnant women with GDM is associated with adverse pregnancy outcomes such as the development of hypertensive syndromes, insomnia and depressive symptoms. In addition, a higher prevalence of newborns admitted to the neonatal ICU was found in the offspring of GDM patients with evening preference.
Recurrent Abortion in Multigravid Type 1 Diabetes Mellitus Woman With Subclinical Hypothyroidism Hashimoto’s Thyroiditis and Antiphospholipid Syndrome as a Manifestation of Type III Autoimmune Polyglandular Syndrome: A Case Report
Authors: Kamila Tasya , Pranandi Muhammad , Putra Robby Pratomo , Nasarudin Jerry , Mokoagow Muhammad Ikhsan , Epriliawati Marina , Kshanti Ida Ayu 
Published: May 2021

Abstract
Recurrent Abortion in Multigravid Type 1 Diabetes Mellitus Woman With Subclinical Hypothyroidism Hashimoto’s Thyroiditis and Antiphospholipid Syndrome as a Manifestation of Type III Autoimmune Polyglandular Syndrome: A Case Report
Background: Type 1 Diabetes Mellitus, Antiphospholipid Syndrome, and autoimmune thyroid disease such as Hashimoto’s Thyroiditis had been reported for increasing risk of miscarriages. Meanwhile, the type III Autoimmune Polyglandular Syndrome comprises of autoimmune hypothyroidism and immune mediated diabetes mellitus. Here we report a manifestation of the syndrome presented as a recurrent pregnancy loss in newly diagnosed subclinical hypothyroidism phase of Hashimoto’s Thyroiditis and Antiphospholipid Syndrome, in multigravid woman with long standing Type 1 Diabetes Mellitus.
Clinical Case: A 31 years old woman, 20 weeks pregnant, with previously known Type 1 Diabetes Mellitus since the age of 11 years old, came to the Emergency Room with diabetic ketoacidosis. She complained of having nausea, vomiting, and diarrhea two days before hospital admission. She also had history of six spontaneous abortions which all occurred at below 20 weeks of gestation, but no further examination was done to find the cause. The patient was examined with fetal ultrasound and showed good fetal condition, fetal heart rate 143 bpm, estimated fetal weight 562 grams, polyhidramnion, and single umbilical artery. The patient denied any symptoms regarding hair loss, cold intolerence, slow movement, slow speech, or constipation. From physical examination, we found normal vital signs, no abnormalities in thyroid physical examination, but dry hyperpigmented skin in both legs. The patient was examined for thyroid function and found elevated TSH (5.625 IU/mL, n = 0,48 - 4,17 mIU/L) and normal free T4 (1,3 ng/dL, n = 0,89 - 1,76 ng/dL). The TPO antibody was 549,59 IU/mL (n&lt;5.61 IU/mL) and lupus anticoagulant was weakly positive (1.2 - 2.5, n&lt;1.2). The patient was finally diagnosed as Hashimoto’s Thyroiditis and Antiphospholipid Syndrome, which was unrecognized at previous medical care, and in addition to previously known Diabetes Mellitus Type 1 could be manifested as Type III Autoimmune Polyglandular Syndrome. The likely cause of recurrent pregnancy loss in this case could be the Hashimoto’s Thyroiditis and Antiphospholipid Syndrome.
Conclusion: Type III Autoimmune Polyglandular Syndrome could be manifested as recurrent pregnancy loss in patient with Type 1 Diabetes Mellitus, therefore the examination of thyroid function and other autoimmune disease such as Antiphospholipid Syndrome should be conducted.