Objective To explore the situation and causes of misdiagnosed hypoglycemia in China so as to develop some strategies for reducing misdiagnosis.Methods We searched CBMdisc, CMCC, CJFD and VIP (Jan. 1994-Dec. 2003). All the publisled studies about the misdiagnosis of hypoglycemia were collected to analyse their classifications and causes.Results A total of 172 studies involving 1 478 patients met the inclusion criteria. The studies were either case reports or clinical reviews. The 1 478 cases were misdiagnosed as 31 sorts of diseases, mainly including stroke (71.18%), transient ischemia attack (4.87%), epilepsy (4.13%) and hepatic coma (2.64%) . The causes of misdiagnosis could be classified into 14 categories, including complex manifestations of hypoglycemia (29.07%), lack of knowledge of hypoglycemic encephalopathy (16.44%), insufficient medical history collection (10.21%) and interference of compound diseases (9.86%) etc..Conclusions The misdiagnosis of hypoglycemia is mainly caused by the poor professional skills of doctors or their lack of responsibility, and poor patient management, especially when hypoglycemia are manifested by brain disability.
Objective To observe the feature of post-operative hyperglycemia after coronary artery bypass grafting(CABG) surgery in department of intensive care unit（ICU） patients.Methods Patients who had CABG surgery in Zhongshan Hospital from January 2005 to December 2005 were enrolled.Data were collected including the history of diabetes，pre-operative and post-operative blood glucose(BG) levels，and the time that post-operative hyperglycemia and peak BG occurred.The patients were divided into diabetic and non-diabetic groups according to the diabetic history.The data were compared and analyzed between the two groups.Results 200 patients were enrolled in this study.The incidence of post-operative hyperglycemia was 77%，and about 99.4% occurred in the first 24 hours admitted to ICU，which was independent on diabetic history (χ2=2.58，P=0.108)，but was related to the BG level above 6.1 mmol/L (χ2=12.31，P=0.000).In 80% of the patients，peak BG occurred in the first 24 hours admitted to ICU，which was significantly earlier in the non-diabetic group compared with the diabetic group (8.5 h vs 18.5 h，P=0.02 ).In the patients who had post-operative hyperglycemia，the median time of the BG peak is 10 hours，and 75.3% of the BG peak occurred in the first 24 hours admitted to ICU.Conclusion There is a high incidence of post-operative hyperglycemia in post-CABG patients which always occur within 24 hours after operation and relate to pre-operative high BG.
Objective To investigate the effects of tight blood glucose control on the shortterm prognosis of the patients after heart valve replacement, in order to improve treatment effectiveness and lower postoperative complications. Methods A total of 240 patients including 150 males and 90 females underwent mitral valve replacement or mitral and aortic valve replacement were enrolled in this study from January 2007 to December 2008 at the cardiac surgery department of Renmin hospital of Wuhan university. The age of these patients ranged from 19 to 65 years old with an average age of 53.33 years. According to insulin administration time and blood glucose control level, they were randomly separated into two groups. In the experimental group, there were 121 patients who received continuous insulin infusion to maintain postoperative glucose level between 4.4 and 6.1 mmol/L, while 119 patients in the control group received insulin infusion when their glucose level went higher than 11.1 mmol/L to control the level between 6.1 and 11.1 mmol/L. Then the postoperative wound infection, malignant arrhythmia rate, the assisted ventilation time, intensive care unit(ICU) stay time and count of neutrophils were compared and analyzed. Results There was no hospitalized death in both groups. The rate of wound infection（3.31% vs.10.08%, χ2=4.430,P=0.035）, the assisted ventilation time（9.02±2.73 h vs. 10.01±3.58 h, t=2.280,P=0.024）, time for count of leukocytes to decrease to the normal level（11.04±3.16 d vs. 12.05±3.76 d, t=2.168,P=0.031）, average hospitalization time（13.49±3.81 d vs. 14.51±4.02 d,t=2.017,P=0.045）, and count of neutrophils on the third day（0.82±0.04 vs. 0.84±0.05, t=2.644,P=0.009） in the experimental group were significantly lower or shorter than those in the control group. But there was no significant difference between both groups in ICU stay time and the rate of malignant arrhythmia. Conclusion Tight blood glucose control can lower the rate of postoperative wound infection, shorten the assisted ventilation time and hospitalization time, and reduce the usage of antibiotics in patients after heart valve replacement. Accordingly, it can enhance the curative effect, reduce overall medical expenses, and improve prognosis.
Objective To identify the best therapy regimen for a patient with rare hypoglycemia due to insulin autoantibody (IAA). Methods We searched The Cochrane Library (Issue 3, 2008), PubMed (1966-July 2009), EMbase (1974-July 2009) and CBM (1978-July 2009) to identify relevant evidence. The quality of the retrieved studies was critically assessed. Results A total of 291 records were retrieved. No clinical guidelines, systematic reviews or clinical randomized studies were identified. Thirty treatment-related studies involving 6 interventions showed that insulin combined with Prednisone was relatively more effective and safer than conventional therapies. Conclusion The steroid treatment might be useful for the improvement of glycamic control in patients with high IAA levels and severe hypoglycemia and hyperglycemia due to insulin antibodies raised against subcutaneously-injected human insulin.
ObjectiveTo investigate the knowledge of hypoglycemia in patients with type 2 diabetes mellitus, analyze its influential factors, and explore the measure of hypoglycemia education. MethodsA questionnaire survey was conducted with a sample of 5 961 patients with type 2 diabetes mellitus from 144 hospitals in China between April and July 2010. The investigation contents included patients' demographic data and the knowledge of hypoglycemia. ResultsThe score of the knowledge of hypoglycemia was 62.71±10.34 and the status was medium. Multiple stepwise regression analysis showed that degree of education, duration of diabetes mellitus, periodic inspection, education about diabetic complications, times of hypoglycemia were influencing factors for the knowledge of hypoglycemia (P<0.05). ConclusionThe status of the knowledge of hypoglycemia is not optimistic. Educators should pay attention to the characteristics of patients and provide a safe regiment for controlling blood sugar with a comprehensive introduction of hypoglycemia.
ObjectiveTo investigate the clinical symptom and risk factors of diabetic seizures. MethodsThe clinical data of 44 patients with diabetes related seizures were analyzed with the clinical classification, blood glucose, Na+, Plasma Osmotic Pressure, HbA1c, EEG, brain MR, and the antiepileptic drugs. Results① Diabetic hyperglycemia (DH) related seizures: among the 28 patients, 17 cases were male patients, 11 cases were female patients. The mean age was 51.3 years old. Simple partial seizure without secondary generalized seizures (12/28, 42.8%) was the most common, 8 patients (8/28, 28.6%) showed complex partial seizure, 8 patients (8/28, 28.6%) showed no obvious focal origin generalized tonic-closure seizures. Patients with poor glycemic control (HbA1c > 9%) had significantly higher risk of generalized seizures (46.7% vs. 7.7 %, P < 0.05) (P < 0.05). ② Diabetic ketoa-cidosis or hypertonic state associated seizures: among the 7 patients, 6 cases were male patients, 1case was female patients. The mean age was 45.7 years old, 2 patients (2/7, 28.6%) had generalized tonic-clonic seizure, 2 patients (2/7, 28.6%) showed status epilepticus, 2 patients (2/7, 28.6%) showed local motor seizure, 1 patient (1/7, 14.2%) showed Jackson seizure. ③ Diabetic hypoglycemia related seizures: among the 9 patients, 7 cases were male patients, 2 cases were female patients. The mean age was 45.3 years old.5 patients showed generalized tonic-clonic seizure (5/9, 55.6%), 3 patients had complex partial seizure (3/9, 33.3%), 1 patients had generalized tonic-closure seizures (1/9, 11.1%). ConclusionSimple partial seizure is the most common in patients with diabetic hyperglycemia related seizures; so as to diabetic hypoglycemia and keto-acidosis, generalized seizures are relatively common. HbA1c can be an important risk factor of seizures for patients with hyperglycemia.
ObjectiveTo investigate the impact of elevated fasting blood glucose (FBG) level after open radical hepatectomy on the early recurrence of hepatocellular carcinoma (HCC).MethodsThe clinical data of 112 patients with HCC who underwent the open radical hepatecomy from January 2013 to December 2014 in the Affiliated Hospital of Qingdao University were retrospectively analyzed. After the radical resection of HCC, 86 patients with level of FBG 3.9–6.1 mmol/L and 26 patients with level of FBG≥6.1 mmol/L were design into a normal FBG group and an elevated FBG group, respectively. The recurrence rates of HCC were compared between the two groups at 1- and 2-year after the opreation.ResultsThere were no significant differences between the 2 groups in the gender, age, history of alcohol drinking, hepatitis B history, preoperative ALT, AST, AFP and Child-Pugh classification, scope of hepatectomy, intraoperative hemorrhage, hepatic blood flow occlusion, diameter of maximal tumor, histopathological differentiation, tumor number, cirrhosis, satellite lesion, postoperative adjuvant TACE treatment or not (P>0.05). The postoperative 1- and 2-year recurrence rates of HCC were 19.8% (17/86) and 33.7% (29/86) in the normal FBG group and 42.3% (11/26) and 61.5% (16/26) in the elevated FBG group, respectively, showing significant differences between the 2 groups (P<0.05). The results of multivariate analysis showed that the level of FBG≥6.1 mmol/L, low histopathological differentiation, and no postoperative TACE treatment were the independent risk factors affecting tumor-free survival rate after the open radical resection of HCC (P<0.05). ConclusionsElevated FBG level after open radical resection has a stimulative effect on early recurrence of HCC. As a result, monitoring and controlling of FBG level after operation is helpful in decreasing early recurrence rate of patients with HCC.
Patients with hypercortisolism may experience cutaneous atrophy, weakened cutaneous barrier function, decreased immunity, opportunistic bacteria or fungal infections, which hinder the healing of cutaneous wounds, and even the ulcers will not heal for a long time, and may progress to chronic ulcers, which are difficult and expensive to treat. It affects the quality of life of patients, and can lead to the spread of infection and life-threatening in severe cases. The pathological mechanism of cutaneous ulcers and delayed healing caused by hypercortisolism is complicated, which is a clinical problem that needs to be solved urgently. This article explains the possible mechanism of hypercortisolism hindering the healing of cutaneous ulcers from the aspects of leading to cutaneous atrophy, pathophysiological abnormalities affecting wound healing, hyperglycemia inhibiting wound healing, and infection and hypercoagulable state, and discusses the possible mechanisms of hypercortisolism hindering the healing of cutaneous ulcers, and its treatment methods, aiming to provide a basis for more in-depth mechanism research and clinical prevention and treatment.
Objective To evaluate the feasibility of hyperinsulinemic normoglycemia strategy in critically ill patients. Methods Between January 2020 and October 2021, the critically ill patients with stress hyperglycemia in the Emergency Intensive Care Unit of the Fourth People’s Hospital of Langfang were randomly assigned into a trial group or a control group. The trial group adopted hyperinsulinemic normoglycemia therapy, while the control group adopted conventional glucose control therapy. The mean and variability (standard deviation) of blood glucose, incidences of severe hypoglycemia and abnormal hyperglycemia, as well as the percentage of blood glucose values within the target range were compared between the two groups, to evaluate the feasibility of hyperinsulinemic normoglycemia strategy in critically ill patients from the perspective of safety and effectiveness. The non-normally distributed measurement data were presented as median (lower quartile, upper quartile). Results A total of eighty patients were included, with forty cases in each group. The mean blood glucose level [6.00 (5.74, 6.70) vs. 9.51 (8.74, 10.01) mmol/L, P<0.001], the standard deviation of glucose level [1.58 (1.11, 2.15) vs. 2.20 (1.21, 2.76) mmol/L, P=0.028], and the glycemic lability index [175.52 (100.51, 346.69) vs. 408.51 (205.56, 651.91) mmol2/(L2·h·d), P<0.001] were all smaller in the trial group than those in the control group. The percentage of blood glucose values within the target range was 77.34% in the trial group and 5.33% in the control group, respectively, and the difference was statistically significant (P<0.001). No patients experienced severe hypoglycemia. There was a significant difference in the incidence of abnormal hyperglycemia between the two groups (5.08% vs. 36.16%, P<0.001). Conclusions Hyperinsulinemic normoglycemia strategy can effectively and safely provide normoglycemia, reduce glycemic variability, and achieve good glycemic control in critically ill patients. Hyperinsulinemic normoglycemia strategy may be a new approach to glycemic control in critically ill patients.
ObjectiveTo systematically review the effectiveness of breastfeeding duration and intensity in reducing the risk of overweight or obesity among offspring exposed to intrauterine hyperglycemia. MethodsThe PubMed, EMbase, Web of Science, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect observational studies on the associations of breastfeeding with the risk of overweight or obesity among offspring exposed to intrauterine hyperglycemia from inception to September 25th, 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Stata 16.0 software was used for the meta-analysis. ResultsA total of 12 657 participants from 13 observational studies were included. The results of meta-analysis showed that breastfeeding could reduce the risk of overweight or obesity among offspring exposed to intrauterine hyperglycemia (OR=0.67, 95%CI 0.53 to 0.84, P=0.001). Subgroup analysis revealed a protective effect of breastfeeding for both 1-6 months (OR=0.53, 95%CI 0.37 to 0.75, P<0.001) and ≥6 months (OR=0.56, 95%CI 0.46 to 0.69, P<0.001); however, breastfeeding shorter than one month was suggested to increase the risk of overweight or obesity (OR=2.15, 95%CI 1.41 to 3.27, P<0.001). ConclusionAvailable evidence suggests that breastfeeding for more than one month is effective in reducing the risk of overweight or obesity in offspring exposed to intrauterine hyperglycemia, and women with hyperglycemia should be encouraged to breastfeed their offspring for at least 1 month to achieve the effect. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.