XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

COVID-19 Dashboard

argument is often, if not acrimonious, at least heated. It gives an impression of the fluidity of opinion on many fundamental ideas under discussion and of the urgency with which cardiac cyanosis in the newborn is regarded. When Dr. William Muscott says that the earliest he has operated for pulmonary stenosis is on an infant 3 days old, and Sir Russell Brock agrees that the earlier in the first month that operation is undertaken the better, and when Dr. Varco asks Dr. Senning 'so far as I know they have never yet catheterized any child intrauterine in Sweden, but they have done it through the delivery canal sometimes-would you tell us the indications of the Scandinavian group for catheterization in the immediate newborn period?', one is indeed being kept up with the times. But that was two years ago and already some of the questions then debated have since been answered. This beautifully printed and well-illustrated stiff paperbacked volume is, and will for a few years yet remain, an invaluable companion to a full-scale textbook on congenital heart disease.

Growth at Adolescence.

Background Metformin is an oral anti-hyperglycemic agent that has been shown to reduce total mortality compared to other anti-hyperglycemic agents, in the treatment of type 2 diabetes mellitus. Metformin, however, is thought to increase the risk of lactic acidosis, and has been considered to be contraindicated in many chronic hypoxemic conditions that may be associated with lactic acidosis, such as cardiovascular, renal, hepatic and pulmonary disease, and advancing age. Objectives To assess the incidence of fatal and nonfatal lactic acidosis, and to evaluate blood lactate levels, for those on metformin treatment compared to placebo or non-metformin therapies. Search strategy A comprehensive search was performed of electronic databases to identify studies of metformin treatment. The search was augmented by scanning references of identified articles, and by contacting principal investigators. Selection criteria Prospective trials and observational cohort studies in patients with type 2 diabetes of least one month duration were included if they evaluated metformin, alone or in combination with other treatments, compared to placebo or any other glucose-lowering therapy. Data collection and analysis The incidence of fatal and nonfatal lactic acidosis was recorded as cases per patient-years, for metformin treatment and for non-metformin treatments. The upper limit for the true incidence of cases was calculated using Poisson statistics. In a second analysis lactate levels were measured as a net change from baseline or as mean treatment values (basal and stimulated by food or exercise) for treatment and comparison groups. The pooled results were recorded as a weighted mean difference (WMD) in mmol/L, using the fixed-effect model for continuous data. Main results Pooled data from 347 comparative trials and cohort studies revealed no cases of fatal or nonfatal lactic acidosis in 70,490 patient-years of metformin use or in 55,451 patients-years in the non-metformin group. Using Poisson statistics the upper limit for the true incidence of lactic acidosis per 100,000 patient-years was 4.3 cases in the metformin group and 5.4 cases in the non-metformin group. There was no difference in lactate levels, either as mean treatment levels or as a net change from baseline, for metformin compared to non-metformin therapies. Authors' conclusions There is no evidence from prospective comparative trials or from observational cohort studies that metformin is associated with an increased risk of lactic acidosis, or with increased levels of lactate, compared to other anti-hyperglycemic treatments.

/pdf/risk-of-fatal-and-nonfatal-lactic-acidosis-with-metformin-4ujte07kg8.pdf

Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus

Abstract To which extent the pre-existing hypothyroidism or hyperthyroidism has an impact on coronavirus infection 2019 (COVID-19) outcomes remains unclear. The objective of this study was to evaluate COVID-19 morbidity and mortality in patients with pre-existing thyroid dysfunction. A retrospective cohort of patients with a polymerase chain reaction (PCR)-conﬁrmed COVID-19 infection (n=14 966) from March 11 to May 30, 2020, was established using the database of the Turkish Ministry of Health. We compared the morbidity and mortality rates of COVID-19 patients with pre-existing hypothyroidism (n=8813) and hyperthyroidism (n=1822) to those patients with normal thyroid function (n=4331). Univariate and multivariate regression analyses were performed to identify the factors associated with mortality. Mortality rates were higher in patients with hyperthyroidism (7.7%) and hypothyroidism (4.4%) than those with normal thyroid function (3.4%) (p<0.001 and p=0.008, respectively). Pre-existing hyperthyroidism was significantly associated with an increased risk of mortality (OR 1.54; 95% CI, 1.02–2.33; p=0.042) along with advanced age, male gender, lymphopenia and chronic kidney disease (p<0.001 for all). Although a potential trend was noted, the association between pre-existing hypothyroidism and mortality was not significant (OR 1.36; 95% CI, 0.99–1.86; p=0.055). In conclusion, this study showed an association between pre-existing hyperthyroidism with higher COVID-19 mortality. A potential trend towards increased mortality was also observed for hypothyroidism. The risk was more pronounced in patients with hyperthyroidism.

http://www.thieme-connect.de/products/ejournals/pdf/10.1055/a-1971-8781.pdf

The Clinical Characteristics and Outcomes of COVID-19 Patients with Pre-Existing Thyroid Dysfunction: A Nationwide Study

Cirrhosis, hepatocellular carcinoma, and sarcopenia.

Fever of unknown origin (FUO) is a challenging condition in the practice of internal medicine. It frequently requires use of complicated tests and applications in the diagnostic workup. We here report a patient presented with FUO who was diagnosed with osteomyelitis by biopsy after a positive Fludeoxyglicose Positron Emission tomography (FDG-PET) scan.

/pdf/successful-but-cautious-use-of-fdg-pet-scan-in-the-393yzhlrds.pdf

Successful but Cautious Use of FDG-PET Scan in the Evaluation of Fever of Unknown Origin: A Case Report

To the Editor: R ivastigmine is a centrally acting pseudoirreversible inhibitor of acetylcholinesterase (AChE) and butyrylcholinesterase used widely for symptomatic treatment of mild to moderate Alzheimer disease (AD) and Parkinson disease dementia. Long-term tolerability and safety are essential challenges in treatment with rivastigmine because of gastrointestinal (GI) adverse effects, including nausea, vomiting, anorexia, and abdominal pain. However, the rivastigmine patch form seems to help reduce those adverse effects, making it more favorable in the treatment of dementia. Massive weight loss associated with the rivastigmine patch is an uncommon and life-threatening adverse effect. Here, we report a case of an older woman with a history of AD who lost weight unintentionally because of the rivastigmine patch. “MsG”was a 75-year-old womanwho presented to the outpatient service of geriatrics clinic in September 2018 with a history of loss of appetite, fatigue, a feeling of hopelessness, and loss of interest in daily activities. She experienced feeling sick and discomfort for almost 6 months. In addition to these complaints, abdominal pain occurred for 2 months. She lost 42-lb (19 kg) gradually during this period. She started the rivastigmine patch prescribed by her neurologist for AD sinceNovember2017, and thedosage increased to 13.3mg/d (15 cm) inMarch 2018. In addition, her relatives reported that she was brought to an emergency department for nausea and fatigue a couple of times after the dosage raise of rivastigmine patch to 13.3 mg/d (15 cm). Another present medication was low-dose quetiapine (12.5 mg twice daily) for agitation associated with dementia, which was concomitantly started with rivastigmine patch and continued at the same dose since the beginning of treatment. She was not taking any other medications. Her baseline weight and body mass index obtained from medical records were 137 lb (62 kg) and 27.9 kg/cm. There was no history of smoking, alcohol, any substance abuse. Her relatives shared information on emesis and anorexia occurred at 1 month of donepezil use. The written informed consent was obtained from her primary guardian for publication of this case report.

Massive Weight Loss From Rivastigmine Patch in an Older Patient: A Rare Case.

European Journal of NeurologyVolume 30, Issue 2 p. 558-559 LETTER TO THE EDITOR Comment on “Association between depression and motoric cognitive risk syndrome among community-dwelling older adults in China: A 4-year prospective cohort study” Mehmet Ilkin Naharci, Corresponding Author Mehmet Ilkin Naharci drnaharci@yahoo.com orcid.org/0000-0003-2730-7144 Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Division of Geriatrics, University of Health Sciences, Ankara, Turkey Correspondence Mehmet Ilkin Naharci, University of Health Sciences, Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Division of Geriatrics, Ankara, Turkey. Email: drnaharci@yahoo.comSearch for more papers by this authorIlker Tasci, Ilker Tasci Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Division of Geriatrics, University of Health Sciences, Ankara, Turkey Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Department of Internal Medicine, University of Health Sciences, Ankara, TurkeySearch for more papers by this author Mehmet Ilkin Naharci, Corresponding Author Mehmet Ilkin Naharci drnaharci@yahoo.com orcid.org/0000-0003-2730-7144 Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Division of Geriatrics, University of Health Sciences, Ankara, Turkey Correspondence Mehmet Ilkin Naharci, University of Health Sciences, Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Division of Geriatrics, Ankara, Turkey. Email: drnaharci@yahoo.comSearch for more papers by this authorIlker Tasci, Ilker Tasci Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Division of Geriatrics, University of Health Sciences, Ankara, Turkey Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Department of Internal Medicine, University of Health Sciences, Ankara, TurkeySearch for more papers by this author First published: 09 October 2022 https://doi.org/10.1111/ene.15595Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume30, Issue2February 2023Pages 558-559 RelatedInformation 

Letter to the Editor about a recent article titled "Association between depression and motoric cognitive risk syndrome among community-dwelling older adults in China: A 4-year prospective cohort study (Eur J Neurol 2022 May;29(5):1377-1384.)".

Ilker Tasci

Papers

The Clinical Characteristics and Outcomes of COVID-19 Patients with Pre-Existing Thyroid Dysfunction: A Nationwide Study

Cirrhosis, hepatocellular carcinoma, and sarcopenia.

Successful but Cautious Use of FDG-PET Scan in the Evaluation of Fever of Unknown Origin: A Case Report

Massive Weight Loss From Rivastigmine Patch in an Older Patient: A Rare Case.

Letter to the Editor about a recent article titled "Association between depression and motoric cognitive risk syndrome among community-dwelling older adults in China: A 4-year prospective cohort study (Eur J Neurol 2022 May;29(5):1377-1384.)".