Weakness and hypotension: case study A case of weakness and hypotension that led to a diagnosis of Addison's disease.
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- Diabetes-related comorbidities/complications.
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Case study: Type 1 diabetes in a child An apparently minor illness had a serious cause. Follow Us: Twitter Facebook. Status of discharge. Home medications. ACE inhibitor. Table 2: Distribution of comorbidities among cases and controls.
Presence of comorbidities. Diabetes a. Congestive heart failure. Myocardial infarction. Chronic renal failure. Gastrointestinal tract disease.
Metastatic cancer. Non-metastatic cancer. Cerebrovascular accident. Predictably, and as shown in Table 2, the patients with diabetes had higher prevalence of neuropathy Comorbidity a. Comorbidity number. Comorbidity numbers — noDM. Table 3 shows the comparison of comorbidities between diabetic and non-diabetic patients. Concerning the number of comorbidities, the diabetic patients scored a higher number of comorbidities relative to that of non-diabetics 6.
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It did not significantly differ between cases and controls p-value: 0. Predictors a. All variables were retained: DM variable HR: 2. Table 5: Main predictors that increase mortality rate in the studied population detected by Cox hazard proportional model. Three variables show a significant association with the dependent variable and they are as follow: neuropathy OR: 8. We mainly found that comorbidities rather than diabetes by itself affected LOS, while both diabetes and comorbidity increased mortality rate of hospitalized patients.
Regarding LOS, our study showed that diabetic patients spend one day longer than non-diabetic patients, but the difference was not significant, which support the results of a previous study cases LOS: 48 days vs Our results demonstrate that non-diabetic patients were three times more prone to die compared with diabetic patients. This result was in accordance with the study of Zekry et al. This may be due to the fact that diabetes associated mortality have been diluted by the inclusion of patients with recent onset of diabetes.
Also, maybe one of the main reasons was the high prevalence of COPD in non-diabetic patients The COPD represents an increasing burden worldwide, reported to be the sixth leading cause of death in , and the fourth in .
Discouragingly, it is projected to jump to third place by the year . But, those results contradict previous studies on younger adults, Rao Kondapally Seshasai et al. A multivariable analysis showed that DM was associated with a modestly lower risk-adjusted survival to hospital discharge adjusted OR [aOR]: 0. Zekry et al. It emphasizes our results in this aspect, where CCI score was significantly different between both cases and controls. But there were no available studies that use a modified CCI in diabetic patients. The major strength of this study was that the filling of the scores and the questionnaire for each individual was managed by only one person, which decreases the inter variability and it ensures the same quotation and calculation of scores in all patients by the same way.
The usage of two scores in this study is beneficial and of high quality, and the quotations of the level of the scores were validated by the investigator to ensure quality. In Lebanon, there is no published data that studies the effect of comorbidities on diabetic patients; it is the first study of kind. Nevertheless, our study also had limitations. First, this analysis was conducted using medical records from the hospital database; it does not contain information on the duration of DM of all patients, so we could not control for disease severity.
Diabetes duration and severity may be an important determinant of comorbidities.
Second, the choice of the hospital may be the reason. Surprisingly, the turnover of patients during six months was low it may be due to private hospital problems. Third, a coding or miscoding of certain type of comorbidity may affect the prevalence of comorbidity; however it is unclear what the overall impact is. Fourth, selection of the control with chronic disease may be the cause behind obscuring the significant difference between the two groups studied.
So, that cases and controls seem to be of same weight when comparing them using the modified scores. Fifth, survival bias is possible in very old patients, whereby patients with long standing diabetes die before reaching the age of elderly. So, it would be of great interest to stratify the mortality risk associated with diabetes according to diabetes duration in a larger study.
Future research should also include the evaluation of long term mortality, e. The patient is a year-old man who has had type 1 diabetes for 15 years. The patient reports that he is currently homeless and has lost his supply of insulin, syringes, glucose meter, and related glucose testing supplies. He reports that he has been on insulin since the time of his diagnosis, and he has never been prescribed oral agents for diabetes management. GAD antibodies were positive, and C-peptide value was low, helping to confirm the diagnosis of type 1 diabetes.
Most recently, he has been using insulin glargine 55 units once daily, and insulin aspart per correction doses 3 times daily. There was an imbalance when comparing his basal and bolus insulin doses.