Obesity, diabetes, and related manifestations are associated with an enhanced, but poorly understood, risk for mucosal infection and systemic inflammation. Here, we show in mouse models of obesity and diabetes that hyperglycemia drives intestinal barrier permeability, through GLUT2-dependent transcriptional reprogramming of intestinal epithelial cells and alteration of tight and adherence junction integrity. Consequently, hyperglycemia-mediated barrier disruption leads to systemic influx of microbial products and enhanced dissemination of enteric infection. Treatment of hyperglycemia, intestinal epithelial-specific GLUT2 deletion, or inhibition of glucose metabolism restores barrier function and bacterial containment. In humans, systemic influx of intestinal microbiome products correlates with individualized glycemic control, indicated by glycated hemoglobin levels. Together, our results mechanistically link hyperglycemia and intestinal barrier function with systemic infectious and inflammatory consequences of obesity and diabetes.

Hyperglycemia drives intestinal barrier dysfunction and risk for enteric infection.

(2012). The 2012 SEMDSA Guideline for the Management of Type 2 Diabetes. Journal of Endocrinology, Metabolism and Diabetes of South Africa: Vol. 17, No. 1, pp. 61-62.

https://www.tandfonline.com/doi/pdf/10.1080/22201009.2012.10872276

The 2012 SEMDSA Guideline for the Management of Type 2 Diabetes

Hospital admissions, emergency department utilisation and patient activation for self-management among people with diabetes

This study aimed to investigate relationships between dysglycaemia and length of hospital stay, short-term mortality and readmission in an unselected population in an acute medical unit (AMU). The rate of follow up in non-diabetic individuals with hyperglycaemia was also measured. We analysed data from all 1,502 patients admitted through our AMU in February 2010 to assess blood glucose levels on admission, length of stay, 28-day readmissions and mortality, and to determine whether blood glucose > or = 11.1 mmol/l on admission in non-diabetic individuals was followed up. In total, blood glucose was measured on admission for 893 patients. Mean length of stay was 8.8 (standard deviation 11.9) days, for patients with blood glucose 20.1 mmol/l. Length of stay for patients with blood glucose > 6.5 mmol/l on admission was significantly longer (p = 0.002). The 28-day readmission rates were 6.4%, 6%, 9.7%, 12.5%, 10% and 15%, respectively, and 28-day death rates were 4.8%, 6%, 5.8%, 17.2%, 17.1% and 6.1%, respectively. Overall, 51.4% of non-diabetic individuals with blood glucose > 11.1 mmol/l on admission were followed up. The study showed that blood glucose > 6.5 mmol/l on admission is associated with significantly longer length of stay. Hyperglycaemia was associated with increased 28-day mortality and readmissions, and is frequently underinvestigated.

https://www.rcpjournals.org/content/clinmedicine/12/2/137.full.pdf

Assessing the relationship between admission glucose levels, subsequent length of hospital stay, readmission and mortality

Objective: To analyse the relationship between the
presence of malnutrition (MN), as measured by the NRS-
2002 nutritional evaluation, and the rate of morbidity and
mortality.
Design: Cross-sectional study.
Setting: Patients admitted to Mateu Orfila Hospital,
the regional hospital for the island of Menorca, Spain.
Subjects: 1,075 patients who were admitted to Mateu
Orfila Hospital (Menorca) who had laboratory studies
and a nutritional risk (NR) evaluation available were
studied. Those who had a clinical suspicion of MN or
those at risk were studied.
Intervention: Demographic (age, gender) and clinical
(current weight, normal weight, body mass index, weight
loss, oral intake, presence of intestinal failure, fistula,
renal failure, respiratory infection, urinary infection,
hyperglycaemia, admission to the ICU, hospital stay, days
of parenteral nutrition treatment and reason for admission)
were collected during hospitalisation, as well as
hospital mortality and mortality at 6 months following
discharge. All underwent the NRS-2002 test.
Results: The mean patient age was 67.9 years and
58.3% were men. 62% of patients met the criteria for
manutrition according to the NRS-2002 test. A statistically
significant association was seen between malnutrition
according to the NRS-2002 and intestinal failure,
fistula, renal failure, respiratory infection, hyperglycaemia,
hospital mortality and mortality at 6 months.
Conclusion: Malnutrition affects more than half of the
patients who are admitted to a medium-long admission
hospital and it is associated with increased morbidity and
mortality. The results underscore the need to establish an
update plan and preventative and therapeutic nutritional
follow-up. These measures reduce the rate of avoidable
complications and save the costs associated with them.

/pdf/association-between-nutritional-risk-based-on-the-nrs-2002-36isyj88vg.pdf

Association between nutritional risk based on the NRS-2002 test and hospital morbidity and mortality.

Background
Hyperglycemia in hospitalized patients is known to be related to a higher incidence of clinical and surgical complications and poorer outcomes. Adequate glycemic control and earlier diagnosis of type 2 diabetes during hospitalization are cost-effective measures.

/pdf/impact-of-hyperglycemia-on-morbidity-and-mortality-length-of-1svw8igj42.pdf

Sabrina P Niece

Papers

Impact of hyperglycemia on morbidity and mortality, length of hospitalization and rates of re-hospitalization in a general hospital setting in Brazil.