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New Study of Chicago ER Patients Reveals Troubling Findings on Diabetes – NBC Chicago

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A new study published in the JAMA Network by UI Health staff found hundreds of unsuspecting patients had diabetes and prediabetes, that left untreated could lead to major complications down the road.

“What’s novel about this is that we’re conducting a preventative health screening within our emergency department. So most people that are coming to the emergency department are not coming in because they want to be screened. But we also know that diabetes is of high prevalence within our community,” Dr. Janet Lin said, an ER physician who helped implement the diabetes screenings.

For three months starting in February 2021, UI Health randomly screened more than 2,000 ER patients who met criteria for a diabetes screening.

Of the 2,074 screened, 52.3% had an abnormal A1C result. A stunning number, but that isn’t what shocked doctors the most.

“70% of the people that basically had an abnormal test, in aggregate, did not know that they were either prediabetic, or diabetic,” Dr. Lin said.

Of those 1,085 patients with abnormal results, 69.9% were prediabetic and 30.1% were diabetic. Among those patients, 62 had severe diabetes, which could be life-threatening.

“If it goes uncontrolled, it will lead to a lot of complications that include stroke, heart attacks, kidney failure, loss of limbs, loss of vision,” Dr. Lin said.

Dr. Lin and the study authors say this should be a wake up call that diabetes screenings are important, and often consist of a simple blood test.

The American Diabetes Association recommends anyone over the age of 45 be screened for diabetes every three years. People between the ages of 18-44, with a BMI greater than 25, which is an indication of obesity, should also be screened every three years as well.

UI Health has continued the diabetes screening beyond the pilot study that lasted three months and they’re seeing similar results. On average, they are diagnosing 300 people every month with prediabetes or diabetes, through the emergency room screenings.

When coordinators called one of the first patients who was found to have prediabetes, Dr. Janet Lin said he answered the phone right away and was very surprised by the results.

“He said, “What?” And he’s like, you know, I’m in line at the McDonald’s. I was just about to buy a Big Mac or some other thing. He’s like, I am not going to get a Big Mac, please tell me how I can actually help change my lifestyle,” Dr. Lin said.

Patients are referred for further care, a win for the medical community that is working hard to fight what is often called a silent disease.

“This is an opportunity for us to be able to screen for people that might not otherwise get screened,” Dr. Lin said.



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Study suggests COVID-19 can cause diabetes

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Study: New-Onset Diabetes and COVID-19: Evidence from a Global Clinical Registry. Image Credit: ADragan / Shutterstock


The authors of a new study under review at Nature Portfolio and currently posted to the Research Square preprint* server showed the clinical possibility that the coronavirus disease 2019 (COVID-19) heightens the risk of developing diabetes mellitus (DM), supporting diabetes screening in those infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 

Study: New-Onset Diabetes and COVID-19: Evidence from a Global Clinical Registry. Image Credit: ADragan / ShutterstockStudy: New-Onset Diabetes and COVID-19: Evidence from a Global Clinical Registry. Image Credit: ADragan / Shutterstock

Background

An increasing body of evidence suggests that COVID-19 is associated with new diabetes diagnoses. However, it is unclear whether COVID-19 detects pre-existing diabetes or induces new-onset diabetes.

Although previous research reported high blood-sugar levels and metabolic consequences resulting from pre-existing diabetes following COVID-19 hospitalization, studies correlating the disease to new-onset DM are scarce.

COVID-19 has been shown to exacerbate pre-existing diabetes. This likely occurs because COVID-19 is associated with low-grade inflammation, which may initiate or worsen insulin resistance. In addition, numerous studies have also demonstrated that SARS-CoV-2 can infest and multiply within insulin-producing pancreatic beta-cells, thus impairing insulin synthesis and secretion. 

However, whether SARS-CoV-2 can cause clinically meaningful changes in glucose metabolism remains unclear. Nevertheless, it may be possible to find an answer by characterizing the clinical symptoms of COVID-19-related diabetes and by determining the period between the onset of hyperglycemia and that of the infection.

It is imperative to establish a causal relationship between COVID-19 and diabetes since both diseases are prevalent throughout the world. Furthermore, establishing a causal relationship will have significant implications for diagnosis, management, public health, and scientific research. Despite this, it remains unclear whether the association between COVID-19 and diabetes results from indirect health consequences of the former, such as – a higher rate of detection of pre-existing diseases, or whether the causative virus (SARS-CoV-2) directly precipitates hyperglycemia. 

Owing to the higher rate of pre-existing disease detection in the COVID era, newly diagnosed diabetes may be explained both during and after an episode of infectious exposure.

The study

This study investigated the possibility that COVID-19 may trigger new-onset diabetes and its associated symptoms by examining average blood-glucose levels at the time of diabetes presentation against a global clinical registry.

A global COVID-19-related diabetes (CoviDIAB) registry was established to determine whether COVID-19 can acutely induce diabetes and its clinical symptoms. The CoviDIAB registry collects information regarding “newly diagnosed diabetes” and “severe metabolic complications associated with pre-existing diabetes” resulting from COVID-19. 

Individuals with a fasting blood glucose of 126 mg/dL or above or non-fasting blood glucose of 200 mg/dL or above, with no prior diabetes history, and those who had never been on glucose-lowering medications, and with their glycated hemoglobin (HbA1c) levels below the diabetic range (< 6.5%) at presentation were categorized as new-onset diabetes. Here, the researchers examined cases of newly diagnosed diabetes that occurred within four weeks of COVID-19 confirmation. In addition, the HbA1c data were evaluated at the time of diabetes detection to rule out pre-existing hyperglycemia and to confirm the association with SARS-CoV-2 infection.

The findings

Data on 537 eligible newly diagnosed diabetes cases was entered from 61 hospitals in 25 countries between 2020-2022. COVID-19 patients with newly diagnosed diabetes at presentation had HbA1c levels above the diagnostic range, suggesting pre-existing hyperglycemia.

In cases with new-onset hyperglycemia after the SARS-CoV-2 infection, individuals displayed glycemic levels above the diagnostic thresholds, although their HbA1c levels remained within the non-diabetic range. The results showed that 22% of newly diagnosed patients with documented HbA1c levels had recently acquired diabetes.

The most common diabetes subtype among adults was type 2 DM (59%), and the “not yet known” subtype (41%). Two newly diagnosed cases of type 1 DM were recorded among children. After COVID-19 resolution, hyperglycemia persisted in 39 of 89 patients (45%) with newly diagnosed diabetes.

For 28 of these individuals, follow-up data beyond three months was collected, demonstrating that five of them were in remission from diabetes, while 23 (82%) remained diabetic. 

The findings suggested that COVID-19 causes clinically significant changes in glucose metabolism. Although this study does not prove that SARS-CoV-2 causes diabetes, it strongly suggests that the virus may impose a diabetogenic aftermath. 

Further, type 2 DM was the predominant subtype among COVID-19 participants with newly diagnosed diabetes. Thus, type 2 DM likely accounts for most newly diagnosed diabetes cases associated with the post-acute phase of the SARS-CoV-2 infection.

This study confirms this phenomenon across diverse geographical locations and ethnicities by incorporating clinical observations from 25 countries. 

Numerous areas for improvement have been identified in this study, including inherent heterogeneity in clinical practice and the judgment of contributing physicians. 

Conclusion

The results of this study suggest that COVID-19 likely has a diabetogenic effect. Thus, individuals exposed to SARS-CoV-2 infection must be screened for diabetes. Further research is necessary to confirm the mechanisms through which the virus interferes with glucose metabolism.

*Important notice

Research Square publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.



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Diabetes indicators improve with use of health incentives, CDC study finds –

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Incentivizing patients to follow a lifestyle modification program helps them improve across a range of diabetes-related health measures, a new meta-analysis has found.

Investigators performed what they said is the first systematic review and meta-analysis to examine the effect of incentives on diabetes-related health indicators when patients participate in lifestyle modification programs. 

The researchers analyzed data from 19 randomized controlled trials. Relative to a control group, the incentive group had significant reductions in weight, and both systolic and diastolic blood pressure. One study found a significant reduction in hemoglobin A1c. A reduction in cholesterol level was also noted but was not significant. 

Six incentive-related domains were also studied. These included type of incentive, monetary value, recipient of the incentive (such as individuals, groups or a combination of both), frequency of incentives, certainty of incentive attainment and schedule (how the amount of the incentive was provided to recipients during the study period). 

Incentive effects

When incentives were provided, the meta-analysis showed patients experienced a nearly 2 kg greater weight loss and a significant reduction in BMI compared to no incentive, reported the authors, including researchers from the Centers for Disease Control and Prevention. 

“This finding has important health implications considering that a large study reported a 16% reduction in diabetes risk for every kilogram of weight lost, and others have shown that weight loss in conjunction with a lifestyle modification program can lower the risk for cardiovascular disease,” they wrote.

Incentives were also shown to be effective for reducing systolic and diastolic blood pressure. Those findings suggest a benefit for programs that seek to help participants achieve ideal blood pressure goals, such as less than 140/90 mm Hg, the authors said. This would be especially helpful for programs associated with chronic disease prevention and management, they added. 

Incentive type

Type of incentive did not appear to have an outsized effect on the positive results. “Therefore, it seems reasonable for lifestyle modification programs to use a variety of incentive domain subgroups,” the authors concluded.

Adults aged 65 years and older make up approximately 40% of the adult diabetic population, according to federal data from 2018. In nursing homes, the prevalence of diabetes is estimated to range from 25% to 34%. 

The current study was published in the CDC’s journal Preventing Chronic Diseases.

Related articles:

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Overtreated diabetes raises hypoglycemia risk in nursing homes, investigators say

Contested insulin therapy remains common in nursing homes: study



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