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Journal articles on the topic 'Hypoglycemia – Epidemiology'

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Published: 4 June 2021
Last updated: 1 February 2022

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1

Kim, Hae Jin. "Epidemiology of Hypoglycemia in Diabetes." Korean Clinical Diabetes 9, no. 2 (2008): 91. http://dx.doi.org/10.4093/kcd.2008.9.2.91.

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2

Klimontov, Vadim V. "Impaired hypoglycemia awareness in diabetes: epidemiology, mechanisms and therapeutic approaches." Diabetes mellitus 21, no. 6 (February 18, 2019): 513–23. http://dx.doi.org/10.14341/dm9597.

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Impaired awareness of hypoglycemia (IAH) is a frequent complication of insulin therapy. Up to half insulin-treated individuals with type 1 and type 2 diabetes report the problems with hypoglycemia awareness, and 1525% of patients have a permanent IAH. A recurrent hypoglycemia is a cornerstone in IAH formation. The repeated episodes of hypoglycemia impair neurohumoral response to hypoglycemia, reduce its symptoms and induce inadequate brain adaptation to low glucose levels. In this regard, the IAH phenomenon can be considered as an example of "metabolic memory" in diabetes. The IAH is associated with episodes of severe hypoglycemia, fear of hypoglycemia and cognitive dysfunction. These associates can be combined into IAH syndrome. Development of IAH becomes a serious barrier in diabetes management. A growing body of evidence indicates that IAH is a reversible condition. If the syndrome is present, the hypoglycemia avoidance should be primary goal of the treatment. Structured training under specialized programs with psychological support is the most reasonable therapeutic approach to IAH amending. Technological approaches, including continuous subcutaneous insulin infusion, real-time continuous glucose monitoring, closed-loop insulin delivery systems ("artificial pancreas"), and islet transplantation also showed efficacy in hypoglycemia awareness improvement in some clinical studies. The diabetes management in patients with IAH is time-consuming and expensive. Therefore, step-by-step approach, from insulin personalization and therapeutic training to advanced medical technologies, should be recommended for these patients.
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3

Ahmad, Iram, Leila R. Zelnick, Zona Batacchi, Nicole Robinson, Ashveena Dighe, Jo-Anne E. Manski-Nankervis, John Furler, et al. "Hypoglycemia in People with Type 2 Diabetes and CKD." Clinical Journal of the American Society of Nephrology 14, no. 6 (April 17, 2019): 844–53. http://dx.doi.org/10.2215/cjn.11650918.

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Background and objectivesAmong people with diabetes mellitus, CKD may promote hypoglycemia through altered clearance of glucose-lowering medications, decreased kidney gluconeogenesis, and blunted counter-regulatory response. We conducted a prospective observational study of hypoglycemia among 105 individuals with type 2 diabetes treated with insulin or a sulfonylurea using continuous glucose monitors.Design, setting, participants & measurementsWe enrolled 81 participants with CKD, defined as eGFR<60 ml/min per 1.73 m2, and 24 control participants with eGFR≥60 ml/min per 1.73 m2 frequency-matched on age, duration of diabetes, hemoglobin A1c, and glucose-lowering medications. Each participant wore a continuous glucose monitor for two 6-day periods. We examined rates of sustained level 1 hypoglycemia (<70 mg/dl) and level 2 hypoglycemia (<54 mg/dl) among participants with CKD. We then tested differences compared with control participants as well as a second control population (n=73) using Poisson and linear regression, adjusting for age, sex, and race.ResultsOver 890 total days of continuous glucose monitoring, participants with CKD were observed to have 255 episodes of level 1 hypoglycemia, of which 68 episodes reached level 2 hypoglycemia. Median rate of hypoglycemic episodes was 5.3 (interquartile range, 0.0–11.7) per 30 days and mean time spent in hypoglycemia was 28 (SD 37) minutes per day. Hemoglobin A1c and the glucose management indicator were the main clinical correlates of time in hypoglycemia (adjusted differences 6 [95% confidence interval, 2 to 10] and 13 [95% confidence interval, 7 to 20] fewer minutes per day per 1% higher hemoglobin A1c or glucose management indicator, respectively). Compared with control populations, participants with CKD were not observed to have significant differences in time in hypoglycemia (adjusted differences 4 [95% confidence interval, −12 to 20] and −12 [95% confidence interval, −29 to 5] minutes per day).ConclusionsAmong people with type 2 diabetes and moderate to severe CKD, hypoglycemia was common, particularly with tighter glycemic control, but not significantly different from groups with similar clinical characteristics and preserved eGFR.
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4

Van Staa, Tjeerd, Lucien Abenhaim, and Johanne Monette. "Rates of hypoglycemia in users of sulfonylureas." Journal of Clinical Epidemiology 50, no. 6 (June 1997): 735–41. http://dx.doi.org/10.1016/s0895-4356(97)00024-3.

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5

Kumar, JuvvaGowtham, KPP Abhilash, RamaPrakasha Saya, Neeha Tadipaneni, and JMaheedhar Bose. "A retrospective study on epidemiology of hypoglycemia in Emergency Department." Indian Journal of Endocrinology and Metabolism 21, no. 1 (2017): 119. http://dx.doi.org/10.4103/2230-8210.195993.

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6

Awoniyi, Omodele, Rabia Rehman, and Samuel Dagogo-Jack. "Hypoglycemia in Patients with Type 1 Diabetes: Epidemiology, Pathogenesis, and Prevention." Current Diabetes Reports 13, no. 5 (August 4, 2013): 669–78. http://dx.doi.org/10.1007/s11892-013-0411-y.

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7

Ginde, A. A., R. M. Lieberman, D. J. Pallin, and C. A. Camargo. "169: Emergency Department Visits for Hypoglycemia: Epidemiology, Patient Education and Outcomes." Annals of Emergency Medicine 50, no. 3 (September 2007): S54. http://dx.doi.org/10.1016/j.annemergmed.2007.06.202.

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8

Min, Jea Young, Caroline A. Presley, Jennifer Wharton, Marie R. Griffin, Robert A. Greevy, Adriana M. Hung, Jonathan Chipman, Carlos G. Grijalva, Amber J. Hackstadt, and Christianne L. Roumie. "Accuracy of a composite event definition for hypoglycemia." Pharmacoepidemiology and Drug Safety 28, no. 5 (March 6, 2019): 625–31. http://dx.doi.org/10.1002/pds.4712.

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9

Ratzki-Leewing, Alexandria, Stewart B. Harris, Selam Mequanint, Sonja M. Reichert, Judith Belle Brown, Jason Edward Black, and Bridget L. Ryan. "Real-world crude incidence of hypoglycemia in adults with diabetes: Results of the InHypo-DM Study, Canada." BMJ Open Diabetes Research & Care 6, no. 1 (April 2018): e000503. http://dx.doi.org/10.1136/bmjdrc-2017-000503.

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ObjectiveVery few real-world studies have been conducted to assess the incidence of diabetes-related hypoglycemia. Moreover, there is a paucity of studies that have investigated hypoglycemia among people taking secretagogues as a monotherapy or in combination with insulin. Accordingly, our research team developed and validated the InHypo-DM Person with Diabetes Mellitus Questionnaire (InHypo-DMPQ) with the aim of capturing the real-world incidence of self-reported, symptomatic hypoglycemia. The questionnaire was administered online to a national sample of Canadians (≥18 years old) with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) treated with insulin and/or insulin secretagogues.Research design and methodsSelf-report data obtained from the InHypo-DMPQ were descriptively analyzed to ascertain the crude incidence proportions and annualized incidence densities (rates) of 30-day retrospective non-severe and 1-year retrospective severe hypoglycemia, including daytime and nocturnal events.ResultsA total of 552 people (T2DM: 83%; T1DM: 17%) completed the questionnaire. Over half (65.2%) of the total respondents reported experiencing at least one event (non-severe or severe) at an annualized crude incidence density of 35.1 events per person-year. The incidence proportion and rate of non-severe events were higher among people with T1DM versus T2DM (77% and 55.7 events per person-year vs 54% and 28.0 events per person-year). Severe hypoglycemia was reported by 41.8% of all respondents, at an average rate of 2.5 events per person-year.ConclusionsThe results of the InHypo-DMPQ, the largest real-world investigation of hypoglycemia epidemiology in Canada, suggest that the incidence of hypoglycemia among adults with diabetes taking insulin and/or insulin secretagogues is higher than previously thought.
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10

Brož, Jan, and Jana Urbanová. "A general view of epidemiology of hypoglycemia in type 1 and type 2 diabetes mellitus." Vnitřní lékařství 65, no. 4 (April 1, 2019): 289–94. http://dx.doi.org/10.36290/vnl.2019.050.

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11

Nam, Young Hee, Colleen M. Brensinger, Warren B. Bilker, Charles E. Leonard, and Sean Hennessy. "Investigation of Concomitant Use of Alzheimer’s Disease Drugs with Sulfonylureas and Serious Hypoglycemia." Epidemiology 32, no. 1 (September 21, 2020): e3-e5. http://dx.doi.org/10.1097/ede.0000000000001263.

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12

Wickström, Ronny, Beatrice Skiöld, Gunnar Petersson, Olof Stephansson, and Maria Altman. "Moderate neonatal hypoglycemia and adverse neurological development at 2–6 years of age." European Journal of Epidemiology 33, no. 10 (July 20, 2018): 1011–20. http://dx.doi.org/10.1007/s10654-018-0425-5.

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13

Mathur, Arvind, Mohit Kackar, Indu Thanvi, and Harish Agarwal. "STUDY OF CLINICAL FEATURES AND EPIDEMIOLOGY OF COMPLICATED VIVAX MALARIA." International Journal of Research -GRANTHAALAYAH 7, no. 9 (September 30, 2019): 47–51. http://dx.doi.org/10.29121/granthaalayah.v7.i9.2019.556.

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Severe and complicated malaria is defined by the World Health Organization Malaria Action Programme in June 19851 as the presence of one or more of the following conditions in a slide confirmed diagnosed case of malaria cerebral malaria, severe anemia, renal failure, pulmonary edema or adult respiratory distress syndrome, hypoglycemia, circulatory collapse or shock, spontaneous bleeding, repeated generalized convulsions, acidemia or acidosis, macroscopic hemoglobinuria, impairment of consciousness less marked than unarousable coma,, hyperparasitemia, jaundice, hyperpyrexia, and the presence of complicating or associated infections. However, severe anemia and thrombocytopenia that causes bleeding diatesis is produced by hemolysis, reduced cell deformity of parasitized and non-parasitized erythrocytes, increased splenic clearance, reduction of platelet survival, decreased platelet production, and increased splenic uptake of platelets. Though these changes can be produced by P. vivax and P. falciparum infection yet the complicated malaria has commonly been associated with P. falciparum infections.
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14

Gorrell, Jennifer Justice, Jennifer Schoelles Williams, and Paula Powell. "Review and Update of Insulin Dependent Diabetes Mellitus." Journal of Pediatric Pharmacology and Therapeutics 8, no. 4 (October 1, 2003): 252–65. http://dx.doi.org/10.5863/1551-6776-8.4.252.

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The purpose of this article is to provide the health care practitioner with a comprehensive review of the pathophysiology and treatment of Type 1 Diabetes Mellitus. Traditionally, insulin has been administered via an insulin syringe. In the recent past, diabetes research has focused on developing more convenient insulin delivery devices and longer acting insulin's in hopes of increasing compliance with insulin therapy and improving the management of Type 1 diabetes in both children and adults. Rapidly developing approaches to insulin delivery for Type 1 diabetes continue to be developed at a rapid rate, including administration via continuous subcutaneous insulin infusion in addition to other new approaches. With these advances in therapy, pediatric patients with Type 1 diabetes have been able to achieve strict glycemic control, although the treatment of hypoglycemia remains a burden. The objectives of this article are to the following: to review the epidemiology, risk factors, pathophysiology, clinical manifestations, and diagnostic criteria of Type 1 diabetes mellitus in children,; to discuss the management of these patients, including, insulin therapy, monitoring, diet and exercise, carbohydrate counting and treatment of hypoglycemia,; and to review insulin administration devices, including insulin pens, insulin jet injectors, insulin pumps, and novel insulin delivery systems.
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15

Moen, Maureen F., Min Zhan, Van Doren Hsu, Lori D. Walker, Lisa M. Einhorn, Stephen L. Seliger, and Jeffrey C. Fink. "Frequency of Hypoglycemia and Its Significance in Chronic Kidney Disease." Clinical Journal of the American Society of Nephrology 4, no. 6 (May 7, 2009): 1121–27. http://dx.doi.org/10.2215/cjn.00800209.

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16

Han, Kyungdo, Jae-Seung Yun, Yong-Moon Park, Yu-Bae Ahn, Jae-Hyoung Cho, Seon-Ah Cha, and Seung-Hyun Ko. "Development and validation of a risk prediction model for severe hypoglycemia in adult patients with type 2 diabetes: a nationwide population-based cohort study." Clinical Epidemiology Volume 10 (October 2018): 1545–59. http://dx.doi.org/10.2147/clep.s169835.

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17

Chu, Yeh-Wen, Hsuan-Ming Lin, Jhi-Joung Wang, Shih-Feng Weng, Chih-Ching Lin, and Chih-Chiang Chien. "Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study." PLOS ONE 12, no. 3 (March 29, 2017): e0174601. http://dx.doi.org/10.1371/journal.pone.0174601.

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18

Tovar-Acero, Catalina, María Camila Velasco, Paula Andrea Avilés-Vergara, Dina Marcela Ricardo-Caldera, Erasmo Manuel Alvis, Javier Ramirez - Montoya, and Maria Fernanda Yasnot Acosta. "Liver and kidney dysfunction, hypoglycemia, and thrombocytopenia in Plasmodium vivax malaria patients at a Colombian Northwest region." Parasite Epidemiology and Control 13 (May 2021): e00203. http://dx.doi.org/10.1016/j.parepi.2021.e00203.

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19

Núñez, Mercedes, Silvia Díaz, Tatiana Dilla, Jesús Reviriego, and Antonio Pérez. "Epidemiology, Quality of Life, and Costs Associated with Hypoglycemia in Patients with Diabetes in Spain: A Systematic Literature Review." Diabetes Therapy 10, no. 2 (January 19, 2019): 375–92. http://dx.doi.org/10.1007/s13300-019-0563-0.

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20

Yaffe, Kristine, Cherie Falvey, Nathan Hamilton, Ann Schwartz, Tamara Harris, Andrea Metti, Ronald Shorr, Elsa Strotmeyer, and Eleanor Simonsick. "O2-10-03: Hypoglycemia and dementia: A reciprocal relationship?" Alzheimer's & Dementia 8, no. 4S_Part_7 (July 2012): P254—P255. http://dx.doi.org/10.1016/j.jalz.2012.05.680.

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21

Sokolov, Yury Y., Mariya A. Melikyan, Sergey A. Karpachev, Vladimir R. Druzhinin, Ekaterina A. Tashirova, Dmitry N. Brovin, and Oleg S. Danilenko. "Laparoscopic distal pancreatectomy in 16 years girl with insulinoma." Endocrine Surgery 10, no. 3 (March 9, 2017): 26–32. http://dx.doi.org/10.14341/serg2016326-32.

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We present a clinical case of insulinoma in 16 years-old girl. The patient complained about episodes of loss of consciousness, followed by retrograde amnesia and accompanied by weakness and dizziness. The patient was transferred to the Department of Endocrinology, where hypoglycemia was detected (2.0-2.5 mmol/l). Topical diagnosis of insulinoma was evidentiated with the help of radiological methods - multislice CT and contrast-enhanced MRI, which revealed an oval tumor 12x10 mm. The molecular genetic analysis of MEN1 gene was performed – no mutations were revealed. Prescribed Proglikem (diazoxide) therapy (100 mg / day) on pre-operative period was effective, patient`s glycemia values stabilized. Further the laparoscopic distal pancreatectomy with tumor removal was performed. After the surgery we achieved stable euglycemia. On microscopic and immunohistochemical studies pancreatic neuroendocrine tumor G1 was confirmed. The discussion presents data on the epidemiology, diagnosis and surgical treatment of insulinomas in children and adults.
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22

PAMBIANCO, GEORGIA, and TREVOR J. ORCHARD. "Severe Hypoglycemia (SH) and Diabetic Ketoacidosis (DKA) Hospitalization Rates—Twenty-Five Years in the Epidemiology of Diabetes Complications (EDC) Study." Diabetes 67, Supplement 1 (May 2018): 1263—P. http://dx.doi.org/10.2337/db18-1263-p.

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23

Van Staa, Tjeerd-Pieter, and Lucien Abenhaim. "The quality of information recorded on a UK database of primary care records: A study of hospitalizations due to hypoglycemia and other conditions." Pharmacoepidemiology & Drug Safety 3, no. 1 (January 1994): 15–21. http://dx.doi.org/10.1002/pds.2630030106.

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24

Iloh, GabrielUche Pascal, and AgwuNkwa Amadi. "Epidemiology of hypoglycemia among ambulatory Type 2 diabetic patients in a primary care clinic of a tertiary hospital in Southeastern Nigeria." Journal of Health Research and Reviews 5, no. 2 (2018): 57. http://dx.doi.org/10.4103/jhrr.jhrr_37_17.

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25

Klimontov, Vadim V., Mikhail M. Lazarev, Andrey Ju Letyagin, Dinara M. Bulumbaeva, and Natalia P. Bgatova. "Lipodystrophy at the insulin injection sites: current trends in epidemiology, diagnostics and prevention." Diabetes mellitus 23, no. 2 (June 26, 2020): 161–73. http://dx.doi.org/10.14341/dm12095.

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Lipodystrophy at the injection sites is most common local complication of insulin therapy. The history of its study started in 1926, when first cases of lipoatrophy at the sites of insulin injections were described. As we moved to human insulin and insulin analogues, immune mediated atrophic form of lipodystrophy has been replaced by hypertrophic one, which reflects anabolic and mitogenic effect of insulin. Lipohypertrophy at the injection sites is detected by physical examination in 40-70% of insulin-treated subjects. The detection efficiency depends on health care provider`s skills. Therefore, training of medical doctors and nurses in physical examination of injection sites seems to be reasonable. In recent years, ultrasound was introduced for diagnostics of insulin-induced lipohypertrophy. The method is more sensitive compared to palpation; ultrasound-verified lipohypertropthy was detected in more than 80% of cases. In patients with wide-spread lipohypertrophy ultrasound can be used to find suitable sites for injections (ultrasound injection map). Strain sonoelastography and 3D-power Doppler ultrasound can be used for quantitative estimation of rigidity and vascularization of lipohypertrophy. Both MRI and infrared images are considered as promising diagnostic tools. In a number of studies, it has been shown that the presence of lipohypertrophy is associated with high HbA1c levels, enhanced glycemic variability, unexplained hypoglycemia, and increased insulin doses. Thereby, lipohypertrophy aggravates the diabetes-related costs. The main risk factor for lipohypertrophy is inappropriate injection technique, including the lack of the site rotation, injections into lipodystrophic lesions, small injection area, reuse or excessive length of the needles. Accordingly, training patients in the injection technique is the basis for prevention of complication. The cessation of injections in lipohypertrophy areas and regular site rotation is essential for adequate titration of insulin dose and achievement of glycemic targets.
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26

Fährmann, Elke R., Laura Adkins, Cameron J. Loader, Hyoil Han, Kevin M. Rice, James Denvir, and Henry K. Driscoll. "Severe hypoglycemia and coronary artery calcification during the diabetes control and complications trial/epidemiology of diabetes interventions and complications (DCCT/EDIC) study." Diabetes Research and Clinical Practice 107, no. 2 (February 2015): 280–89. http://dx.doi.org/10.1016/j.diabres.2014.10.007.

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27

Zherdоva, N., and B. Mankovsky. "Characteristics of cognitive function in patients with diabetes mellitus type 1 younger depending transferred hypoglycemic conditions." East European Journal of Neurology, no. 1(13) (March 20, 2017): 17–21. http://dx.doi.org/10.33444/2411-5797.2017.1(13).17-21.

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Many studies focus on the effect of compensation of diabetes, glucose-lowering therapy of choice, the influence of cardio - vascular diseases in the state of cognition. At the same time, not enough attention is paid to cognitive impairment in patients with type 1 diabetes mellitus, especially young people. The aim of our study was to investigate the prognostic factors of dementia in patients with type 1 diabetes mellitus are younger. 33 patients were examined with type 1 diabetes and 10 people in the control group. Of the 33 patients with diabetes, 21 people had hypoglycemia in the last 3 months and 12 without hypoglycemic states. To identify depression used two questionnaires: Centre for Epidemiologic Studies Depression Scale (CES-D) and the Hospital Anxiety and Depression Scale (HAD). Evaluation of cognitive impairment was conducted using the following methods: The test "5 words", sample Schulte, the scale of assessment of mental status ( MMSE), test battery on the frontal dysfunction (BLD), evaluation of test o’clock. To reveal the 10-year risk of dementia patients used the scale which was developed by a team of researchers at Utrecht University Medical Rudolf Magnus. In patients with type 1 diabetes with hypoglycemia marked deterioration in cognitive function, according to the neuropsychological tests, namely the BLD and MMSE compared with patient without hypoglycemia. The risk of developing dementia over 10 years in patients with diabetes mellitus type 1 young up 2.2 times compared with patients without hypoglycemia. Hypoglycemic state is the main risk factor that leads to the development of cognitive impairment, and this is a factor which can be influenced by insulin properly selected.
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28

Yarrington, Michael E., Deverick J. Anderson, Elizabeth Dodds Ashley, Travis Jones, Angelina Davis, Melissa Johnson, Yuliya Lokhnygina, Daniel J. Sexton, and Rebekah W. Moehring. "Impact of FDA black box warning on fluoroquinolone and alternative antibiotic use in southeastern US hospitals." Infection Control & Hospital Epidemiology 40, no. 11 (September 2, 2019): 1297–300. http://dx.doi.org/10.1017/ice.2019.247.

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AbstractWe analyzed antibiotic use data from 29 southeastern US hospitals over a 5-year period to determine changes in antibiotic use after the fluoroquinolone US Food and Drug Administration (FDA) advisory update in 2016. Fluoroquinolone use declined both before and after the FDA announcement, and the use of select, alternative antibiotics increased after the announcement.Fluoroquinolones are among the 4 most commonly prescribed antibiotic classes.1,2 Postmarketing reports of serious adverse events linked to fluoroquinolones include tendonitis, neuropathy, hypoglycemia, psychiatric side effects, and possible aortic vessel rupture, leading to safety label changes in July 2008 and August 2013.3 In July 2016, the US Food and Drug Administration (FDA) strengthened the “black box” warning following an initial safety announcement in May 2016, recommending avoidance of fluoroquinolones for uncomplicated infections such as acute exacerbation of chronic bronchitis, uncomplicated urinary tract infections, and acute bacterial sinusitis.4 Concerns over safety and the association with Clostridiodes difficile infection have led inpatient antimicrobial stewardship programs (ASPs) to develop initiatives to promote avoidance of quinolones. The objective of this study was to quantify the effect of the 2016 FDA “black box” update on inpatient antibiotic use among a cohort of southeastern US hospitals.
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29

Scheld, Michael W., Brian Wispelwey, and Richard D. Pearson. "Pentamidine: A Review." Infection Control & Hospital Epidemiology 12, no. 6 (June 1991): 375–82. http://dx.doi.org/10.1086/646360.

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With the advent of the acquired immunodeficiency syndrome (AIDS), the therapeutic importance of pentamidine isethionate has increased greatly. This review summarizes the pharmacology, clinical experience in the treatment of Pneumocystis carinii pneumonia, and toxicity of pentamidine. Data are conflicting as to whether pentamidine is more or less effective than trimethoprim-sulfamethoxazole (TMP-SX) for the treatment of P carinii pneumonia in individuals with AIDS, but due to its toxicity and expense, it is considered as second-line therapy for P carinii pneumonia by many authorities. Hypoglycemia has been encountered in up to 27%, and nephrotoxicity in 25%, of treatment courses with pentamidine. In an attempt to circumvent the toxicities associated with parenteral administration, aerosolized delivery has been evaluated for both therapy and prevention of P carinii pneumonia. Aerosolized pentamidine, on the basis of early clinical results, convenience, and low toxicity, is being used extensively to prevent P carinii pneumonia in individuals at high risk. Relapses occur, however, and pneumothorax may be more common in those using this form of prophylaxis. Aerosolized pentamidine should not be used as sole therapy for acute P carinii pneumonia.
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Ross, Jennifer A., John W. Downs, Lindsay A. Bazydlo, Paige H. Bordwine, Catherine E. Gineste, Marissa C. Kopatic, Saumitra V. Rege, et al. "Outbreak of Severe Hypoglycemia After Ingestion of a Male Enhancement Supplement — Virginia, August–November 2019." MMWR. Morbidity and Mortality Weekly Report 69, no. 24 (June 19, 2020): 740–43. http://dx.doi.org/10.15585/mmwr.mm6924a3.

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31

Cozza, Justin, Tuong Vi Cassandra Do, Shyam Ganti, and Jayaramakrishna Depa. "The Ugly Side of Colchicine." Journal of Investigative Medicine High Impact Case Reports 9 (January 2021): 232470962110297. http://dx.doi.org/10.1177/23247096211029744.

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We report a rare case of a 32-year-old male who ingested 32.4 to 54 mg of colchicine and presented after 44 hours. He developed progressive multiple organ failure with shock, acute kidney failure, troponemia, pancytopenia, absolute neutropenia, disseminated intravascular coagulation, acute liver failure, rhabdomyolysis, and lactic acidosis. He also developed electrolyte abnormalities and refractory hypoglycemia. Initial treatment consisted of activated charcoal, fluids, and broad-spectrum antibiotics with supportive treatment of mechanical ventilation, hemodialysis, vasopressors, N-acetylcysteine, colony-stimulating factors, and blood products. Literature shows potential benefit of colchicine-specific Fab fragments for acute toxicity with limited studies and is not currently available in the United States. Further research for N-acetylcysteine protocol for acute liver failure in colchicine toxicity and potential use of colchicine-specific Fab fragments is needed. Our case demonstrates the importance of early use of activated charcoal for ingestion overdose with the incorporation of poison control into multidisciplinary team for coordinated patient care.
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32

Finn, Erin, Kimberly Kripps, Christina Chambers, Michele Rapp, Naomi J. L. Meeks, Fang Xu, Wuyan Chen, Austin A. Larson, and Natalie J. Nokoff. "A Novel Intronic Pathogenic Variant in STAR With a Dominant Negative Mechanism Causes Attenuated Lipoid Congenital Adrenal Hyperplasia." Journal of Investigative Medicine High Impact Case Reports 9 (January 2021): 232470962110146. http://dx.doi.org/10.1177/23247096211014685.

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Lipoid congenital adrenal hyperplasia (LCAH) is typically inherited as an autosomal recessive condition. There are 3 reports of individuals with a dominantly acting heterozygous variant leading to a clinically significant phenotype. We report a 46,XY child with a novel heterozygous intronic variant in STAR resulting in LCAH with an attenuated genital phenotype. The patient presented with neonatal hypoglycemia and had descended testes with a fused scrotum and small phallus. Evaluation revealed primary adrenal insufficiency with deficiencies of cortisol, aldosterone, and androgens. He was found to have a de novo heterozygous novel variant in STAR: c.65-2A>C. We report a case of a novel variant and review of other dominant mutations at the same position in the literature. Clinicians should be aware of the possibility of attenuated genital phenotypes of LCAH and the contribution of de novo variants in STAR at c.65-2 to the pathogenesis of that phenotype.
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33

Muanda, Flory T., Matthew A. Weir, Lavanya Bathini, Kristin K. Clemens, Vlado Perkovic, Manish M. Sood, Eric McArthur, Jessica M. Sontrop, Richard B. Kim, and Amit X. Garg. "Higher-Dose Sitagliptin and the Risk of Congestive Heart Failure in Older Adults with CKD." Clinical Journal of the American Society of Nephrology 15, no. 12 (November 25, 2020): 1728–39. http://dx.doi.org/10.2215/cjn.08310520.

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Background and objectivesSitagliptin, a dipeptidyl peptidase-4 inhibitor, is commonly prescribed to patients with type 2 diabetes. As this drug is primarily eliminated by the kidney, a reduced dose is recommended for patients with CKD. Some evidence suggests that sitagliptin is associated with a higher risk of congestive heart failure, particularly at higher doses. We compare the 1-year risk of death or hospitalization with congestive heart failure in patients with CKD newly prescribed sitagliptin at >50 versus ≤50 mg/d.Design, setting, participants, & measurementsThis population-based cohort study included older adults (>66 years) with type 2 diabetes and an eGFR<45 ml/min per 1.73 m2 (but not receiving dialysis) who were newly prescribed sitagliptin between 2010 and 2017 in Ontario, Canada. We used inverse probability of treatment weighting on the basis of propensity scores to balance baseline characteristics. The primary composite outcome was death or hospitalization with congestive heart failure. Secondary outcomes included hospitalization with pancreatitis or hypoglycemia, all-cause hospitalization, and glycemic control. Weighted hazard ratios were obtained using Cox proportional hazards regression, and 95% confidence intervals were obtained using bootstrap variance estimators.ResultsOf 9215 patients, 6518 started sitagliptin at >50 mg/d, and 2697 started sitagliptin at ≤50 mg/d. The 1-year risk of death or hospitalization with congestive heart failure did not differ significantly between groups (79 versus 126 events per 1000 person-years; weighted hazard ratio, 0.88; 95% confidence interval, 0.67 to 1.14); hospitalization with pancreatitis (weighted hazard ratio, 0.98; 95% confidence interval, 0.32 to 3.03) and hypoglycemia (weighted hazard ratio, 1.10; 95% confidence interval, 0.64 to 1.90) also did not differ significantly between groups. Patients starting sitagliptin at >50 mg/d had lower mean glycated hemoglobin concentrations (weighted between-group difference, −0.12%; 95% confidence interval, −0.19 to −0.06) and a lower risk of all-cause hospitalization (weighted hazard ratio, 0.81; 95% confidence interval, 0.66 to 0.98).ConclusionsThe risk of death or congestive heart failure was not higher in older adults with CKD starting sitagliptin at >50 versus ≤50 mg/d.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_11_25_CJN08310520_final.mp3
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Punnath, Kishore, Kiran K. Dayanand, Valleesha N. Chandrashekar, Rajeshwara N. Achur, Srinivas B. Kakkilaya, Susanta K. Ghosh, Suchetha N. Kumari, and D. Channe Gowda. "Association between Inflammatory Cytokine Levels and Thrombocytopenia during Plasmodium falciparum and P. vivax Infections in South-Western Coastal Region of India." Malaria Research and Treatment 2019 (April 11, 2019): 1–10. http://dx.doi.org/10.1155/2019/4296523.

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Background. Thrombocytopenia is a most commonly observed complication during malaria infections. Inflammatory cytokines such as IL-1, IL-6, and IL-10 have been documented in malaria induced thrombocytopaenia. This study was aimed to understand the possible relationship between inflammatory cytokines across varying degrees of thrombocytopenia during P. vivax, P. falciparum, and mixed infections. Methods. A hospital-based cross sectional study was conducted at District Wenlock Hospital in Mangaluru, a city situated along the south-western coastal region of Arabian Sea in India. In this study, blood samples from 627 malaria patients were analyzed for infected parasite species, clinical conditions, platelet levels, and key cytokines that are produced in response to infection; samples from 176 uninfected healthy individuals were used as controls. Results. The results of our study showed a high prevalence of malarial thrombocytopenia (platelets <150 ×103/μl) in this endemic settings. About 62.7% patients had mild-to-moderate levels of thrombocytopenia and 16% patients had severe thrombocytopenia (platelets <50 × 103/μl). Upon comparison of cytokines across varying degrees of thrombocytopenia, irrespective of infecting species, the levels of TNF-α and IL-10 were significantly higher during thrombocytopenia, whereas IL-6 levels were considerably lower in severe thrombocytopenia patients suffering from P. vivax or P. falciparum infections. The severe clinical complications observed in patients with malarial thrombocytopenia included severe anemia (17.5%), acute renal failure (12.7%), jaundice (27.0%), metabolic acidosis (36.5%), spontaneous bleeding (3.2%), hypoglycemia (25.4%), hyperparasitemia (4.8%), acute respiratory distress syndrome (1.6%), pulmonary edema (19.0%), and cerebral malaria (1.6%) in various combinations. Conclusion. Overall, the results of our study suggest that inflammatory cytokines influence the transformation of mild forms of thrombocytopenia into severe forms during malarial infections. Further studies are needed to understand the association of inflammatory cytokine responses with severe malaria complications and thrombocytopenia.
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Kuo, Yu-Min, and Chu-Wan Lee. "P1-336: Hypoglycemia induces tau hyperphosphorylation and learning and memory deficit in Wistar rats." Alzheimer's & Dementia 6 (July 2010): S271. http://dx.doi.org/10.1016/j.jalz.2010.05.889.

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Burne, Rebecca M., and Michal Abrahamowicz. "Adjustment for time-dependent unmeasured confounders in marginal structural Cox models using validation sample data." Statistical Methods in Medical Research 28, no. 2 (August 24, 2017): 357–71. http://dx.doi.org/10.1177/0962280217726800.

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Large databases used in observational studies of drug safety often lack information on important confounders. The resulting unmeasured confounding bias may be avoided by using additional confounder information, frequently available in smaller clinical “validation samples”. Yet, no existing method that uses such validation samples is able to deal with unmeasured time-varying variables acting as both confounders and possible mediators of the treatment effect. We propose and compare alternative methods which control for confounders measured only in a validation sample within marginal structural Cox models. Each method corrects the time-varying inverse probability of treatment weights for all subject-by-time observations using either regression calibration of the propensity score, or multiple imputation of unmeasured confounders. Two proposed methods rely on martingale residuals from a Cox model that includes only confounders fully measured in the large database, to correct inverse probability of treatment weight for imputed values of unmeasured confounders. Simulation demonstrates that martingale residual-based methods systematically reduce confounding bias over naïve methods, with multiple imputation including the martingale residual yielding, on average, the best overall accuracy. We apply martingale residual-based imputation to re-assess the potential risk of drug-induced hypoglycemia in diabetic patients, where an important laboratory test is repeatedly measured only in a small sub-cohort.
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McNay, Ewan, Pattie S. Green, and Suzanne Craft. "P1-132: Type 2 diabetes and recurrent hypoglycemia both elevate hippocampal amyloid, but by different mechanisms." Alzheimer's & Dementia 6 (July 2010): S212. http://dx.doi.org/10.1016/j.jalz.2010.05.681.

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Kennedy, Kaitlin E., Chengwen Teng, Taylor M. Patek, and Christopher R. Frei. "2296. Hypoglycemia Risk with Antibiotics: An Epidemiologic Surveillance Study of the FDA Adverse Event Reporting System (FAERS)." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S787. http://dx.doi.org/10.1093/ofid/ofz360.1974.

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Abstract Background In July of 2018, the FDA published a drug safety warning for the potential risk of developing hypoglycemia with fluoroquinolones. Some studies have evaluated the potential risk of developing hypoglycemia with linezolid and tigecycline. A few case reports have also been published that report hypoglycemia from cefditoren, doxycycline, and trimethoprim-sulfamethoxazole use. Since data comparing various antibiotics and the risk of developing hypoglycemia is limited, the objective of this study was to evaluate the association between hypoglycemia and antibiotics using the FDA Adverse Event Reporting Systems (FAERS). Methods FAERS reports from January 1, 2004 to December 31, 2017 were included in the study. The Medical Dictionary for Regulatory Activities (MedDRA) was used to identify cases of hypoglycemia. Reporting odds ratios (RORs) and corresponding 95% confidence intervals (95% CI) for the association between antibiotics and hypoglycemia were calculated. An association was considered to be statistically significant when the lower limit of the 95% CI was greater than 1.0. Results A total of 2,334,959 reports (including 18,466 hypoglycemia reports) were considered, after inclusion criteria were applied. Cefditoren had the greatest proportion of hypoglycemia reports, representing 10% of all cefditoren reports. Statistically significant hypoglycemia RORs (95% CI) for antibiotics were: cefditoren 14.03 (8.93–22.03), tigecycline 3.32 (1.95–5.65), clarithromycin 2.41 (1.89–3.08), ertapenem 2.07 (1.14–3.75), moxifloxacin 2.06 (1.59–2.65), levofloxacin 1.66 (1.37–2.01), linezolid 1.54 (1.07–2.20). Conclusion Cefditoren, tigecycline, clarithromycin, ertapenem, moxifloxacin, levofloxacin, and linezolid were all significantly associated with hypoglycemia. The ertapenem association had not been reported in prior literature. Levofloxacin and moxifloxacin were the only fluoroquinolones significantly associated with hypoglycemia, even though the FDA drug safety warning was issued for all fluoroquinolones. Doxycycline and trimethoprim-sulfamethoxazole were not significantly associated with hypoglycemia, even though case reports have reported hypoglycemia with doxycycline and trimethoprim-sulfamethoxazole. Disclosures All authors: No reported disclosures.
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Pöhlmann, Johannes, Beth D. Mitchell, Sanjay Bajpai, Beatrice Osumili, and William J. Valentine. "Nasal Glucagon Versus Injectable Glucagon for Severe Hypoglycemia: A Cost-Offset and Budget Impact Analysis." Journal of Diabetes Science and Technology 13, no. 5 (January 30, 2019): 910–18. http://dx.doi.org/10.1177/1932296819826577.

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Background: Severe hypoglycemic events (SHEs) in patients with diabetes are associated with substantial health care costs in the United States (US). Injectable glucagon (IG) is currently available for treatment of severe hypoglycemia but is associated with frequent handling errors. Nasal glucagon (NG) is a novel, easier-to-use treatment that is more often administered successfully. The economic impact of this usability advantage was explored in cost-offset and budget impact analyses for the US setting. Methods: A health economic model was developed to estimate mean costs per SHE for which treatment was attempted using NG or IG, which differed only in the probability of treatment success, based on a published usability study. The budget impact of NG was projected over 2 years for patients with type 1 diabetes (T1D) and type 2 diabetes treated with basal-bolus insulin (T2D-BB). Epidemiologic and cost data were sourced from the literature and/or fee schedules. Results: Mean costs were $992 lower if NG was used compared with IG per SHE for which a user attempted treatment. NG was estimated to reduce SHE-related spending by $1.1 million and $230 000 over 2 years in 10 000 patients each with T1D and T2D-BB, respectively. Reduced spending resulted from reduced professional emergency services utilization as successful treatment was more likely with NG. Conclusions: The usability advantage of NG over IG was projected to reduce SHE-related treatment costs in the US setting. NG has the potential to improve hypoglycemia emergency care and reduce SHE-related treatment costs.
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Lacy, Mary E., Paola Gilsanz, Michal Schnaider Beeri, Andrew J. Karter, Charles P. Quesenberry, and Rachel A. Whitmer. "P3-496: SEVERE HYPOGLYCEMIA AND COGNITIVE FUNCTIONING IN OLDER ADULTS WITH TYPE 1 DIABETES: THE STUDY OF LONGEVITY IN DIABETES (SOLID)." Alzheimer's & Dementia 14, no. 7S_Part_24 (July 1, 2006): P1312. http://dx.doi.org/10.1016/j.jalz.2018.06.1860.

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Wang, Jianjun, and Fiammetta Cosci. "Neonatal Withdrawal Syndrome following Late in utero Exposure to Selective Serotonin Reuptake Inhibitors: A Systematic Review and Meta-Analysis of Observational Studies." Psychotherapy and Psychosomatics 90, no. 5 (2021): 299–307. http://dx.doi.org/10.1159/000516031.

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<b><i>Introduction:</i></b> A clear picture of neonatal withdrawal signs due to in utero selective serotonin reuptake inhibitor (SSRI) exposure and its consequences is still missing. <b><i>Objective:</i></b> A systematic review and a meta-analysis were performed to provide an overview of neonatal withdrawal signs following late in utero exposure to SSRIs and to quantify the corresponding risks. <b><i>Methods:</i></b> MEDLINE, Web of Science, and Embase were searched from inception to January 2021. The Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed. English-language observational studies reporting on acute postpartum outcomes following late in utero exposure to SSRIs or SSRIs/venlafaxine were evaluated. <b><i>Results:</i></b> Of 2,269 citations reviewed, 79 studies were assessed for eligibility; 13 were included in the qualitative analysis of the literature, which allowed us to identify 26 signs. A meta-analysis was run separately for studies on SSRI exposure (<i>n</i> = 3) and those on SSRI/venlafaxine exposure (<i>n</i> = 6). Hypoglycemia was identified as a withdrawal sign based on the SSRI studies. Tremors, hypotonia, tachycardia, rapid breathing, respiratory distress, and hypertonia were identified as withdrawal signs based on the SSRI/venlafaxine studies. <b><i>Conclusions:</i></b> The present work provides a framework for the identification of neonatal SSRI withdrawal syndrome. Tapering and discontinuation of antidepressant drugs before and during the early phase of pregnancy are worth attempting to prevent the occurrence of this syndrome.
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Mann, Johannes F. E., Vivian A. Fonseca, Neil R. Poulter, Itamar Raz, Thomas Idorn, Søren Rasmussen, Bernt Johan von Scholten, and Ofri Mosenzon. "Safety of Liraglutide in Type 2 Diabetes and Chronic Kidney Disease." Clinical Journal of the American Society of Nephrology 15, no. 4 (March 4, 2020): 465–73. http://dx.doi.org/10.2215/cjn.11881019.

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Background and objectivesThe glucagon-like peptide-1 receptor agonist liraglutide demonstrated cardiovascular and kidney benefits in the LEADER trial, particularly in participants with CKD.Design, setting, participants, & measurementsThis post hoc analysis evaluated the safety of liraglutide treatment in patients with CKD in LEADER. Overall, 9340 patients were randomized to liraglutide or placebo, both in addition to standard of care. Of those, 2158 patients had CKD versus 7182 without CKD (defined as eGFR <60 versus ≥60 ml/min per 1.73 m2, respectively); 966 patients had macroalbuminuria and 2456 had microalbuminuria (urine albumin-creatinine ratio >300 mg/g and ≥30 to ≤300 mg/g, respectively). At baseline, the mean eGFR in patients with CKD was 46±11 ml/min per 1.73 m2 versus 91±22 ml/min per 1.73 m2 in those without CKD. Time to first event within event groups was analyzed using Cox regression with treatment group, baseline eGFR group, or baseline albuminuria group as fixed factors.ResultsOverall, serious adverse events were more frequently recorded in patients with CKD compared with those without CKD (59% versus 50%; interaction P=0.11); however, they occurred to the same extent in those on liraglutide versus placebo. Similarly, no interaction of adverse events with randomized therapy was observed in patients with micro- or macro- versus normoalbuminuria (interaction P=0.11). Risk of severe hypoglycemia was significantly reduced with liraglutide versus placebo in patients with CKD or with micro- or macroalbuminuria (hazard ratio, 0.63 [95% CI, 0.43 to 0.91] and 0.57 [95% CI, 0.40 to 0.82], respectively).ConclusionsIn LEADER, the use of liraglutide in those with CKD was safe, with no difference between patients with and without CKD.Clinical Trial registry name and registration numberClinicalTrials.gov; NCT01179048 (https://clinicaltrials.gov/ct2/show/NCT01179048).
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Yan, J., K. Gushulak, M. Columbus, A. Hamelin, and I. G. Stiell. "P144: Sentinel visits in emergency department patients with diabetes mellitus as a warning sign for hyperglycemic emergencies." CJEM 18, S1 (May 2016): S126. http://dx.doi.org/10.1017/cem.2016.318.

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Introduction: Patients with poorly controlled diabetes mellitus (DM) often visit the emergency department (ED) for management of hyperglycemia, diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Many of these patients have a “sentinel” ED visit for other medical conditions prior to their hyperglycemic visit, which may worsen their glucose control. The objective of this study was to describe the epidemiology and outcomes of patients presenting with a sentinel ED visit prior to their visit for a hyperglycemic emergency. Methods: This was a health records review of patients ≥18 years presenting to one of four tertiary care EDs (combined annual census 300,000) with a discharge diagnosis of DM, hyperglycemia, DKA or HHS in a one-year period. Visits for hypoglycemia were excluded. Trained research personnel collected data from medical records including demographics, clinical history and results of investigations. Electronic charts were reviewed to determine if the patient came to the ED within the prior 14 days of their index hyperglycemia visit, and the details and outcomes surrounding both visits. Descriptive statistics were used where appropriate to summarize the data. Results: From January-December 2014, 609 ED visits had a discharge diagnosis of hyperglycemia. Mean (SD) age was 50.4 (19.5) years, and 343 (56.3%) were male. 101/609 visitors (16.6%) had an ED presentation within the previous 14 days from their hyperglycemia visit. 71 (70.3%) of these were discharged from this initial visit and 49/71 (69.0%) were discharged either without their blood glucose checked or with an elevated blood glucose (>11.0 mmol/L). Of the sentinel visits, 58 (57.4%) were for hyperglycemia and 15 (14.9%) were for infection. Upon returning to the ED, 45/101 (44.6%) visitors were subsequently admitted for management of severe hyperglycemia, DKA or HHS. Conclusion: This unique ED-based study demonstrates that patients with DM presenting with hyperglycemia or infection often return and may ultimately require admission. Clinicians should be vigilant in checking blood glucose when these patients present to the ED and provide clear discharge instructions for follow-up and glucose management. Future research should focus on improving glycemic control in these patients in order to prevent further hyperglycemic emergencies from occurring.
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McClintock, H. F., and H. R. Bogner. "An Intervention Addressing Social Determinants and Oral Hypoglycemic Medication Adherence." Annals of Epidemiology 49 (September 2020): 77. http://dx.doi.org/10.1016/j.annepidem.2020.05.026.

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Gomes, Tara, David N. Juurlink, Lorraine L. Lipscombe, and Muhammad M. Mamdani. "Clinical and demographic characteristics of patients receiving different oral hypoglycemic agents." Pharmacoepidemiology and Drug Safety 18, no. 8 (August 2009): 756–60. http://dx.doi.org/10.1002/pds.1750.

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46

Cohen, M. Michael. "Beckwith-Wiedemann Syndrome: Historical, Clinicopathological, and Etiopathogenetic Perspectives." Pediatric and Developmental Pathology 8, no. 3 (May 2005): 287–304. http://dx.doi.org/10.1007/s10024-005-1154-9.

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Macroglossia, prenatal or postnatal overgrowth, and abdominal wall defects (omphalocele, umbilical hernia, or diastasis recti) permit early recognition of Beckwith-Wiedemann syndrome. Complications include neonatal hypoglycemia and an increased risk for Wilms tumor, adrenal cortical carcinoma, hepatoblastoma, rhabdomyosarcoma, and neuroblastoma, among others. Perinatal mortality can result from complications of prematurity, pronounced macroglossia, and rarely cardiomyopathy. The molecular basis of Beckwith-Wiedemann syndrome is complex, involving deregulation of imprinted genes found in 2 domains within the 11p15 region: telomeric Domain 1 ( IGF2 and H19) and centromeric Domain 2 ( KCNQ1, KCNQ1OT1, and CDKN1C). Topics discussed in this article are organized as a series of perspectives: general, historical, epidemiologic, clinical, pathologic, genetic/molecular, diagnostic, and differential diagnostic.
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Klein, B. E. K., R. Klein, and S. E. Moss. "Risk of Hypoglycemia in Users of Human Insulin: The Wisconsin Epidemiologic Study of Diabetic Retinopathy." Diabetes Care 20, no. 3 (March 1, 1997): 336–39. http://dx.doi.org/10.2337/diacare.20.3.336.

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48

Hadler, Nortin M. "Oral Hypoglycemics and Diabetic Nephropathy." Clinical Journal of the American Society of Nephrology 3, no. 1 (January 2008): 159–62. http://dx.doi.org/10.2215/cjn.03730907.

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49

Amin, Sunil, Grace Mhango, Jenny J. Lin, Anne Aronson, Paolo Boffetta, Juan P. Wisnivesky, and Aimee Lucas. "Effect of metformin on survival in pancreatic ductal adenocarcinoma." Journal of Clinical Oncology 34, no. 4_suppl (February 1, 2016): 383. http://dx.doi.org/10.1200/jco.2016.34.4_suppl.383.

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383 Background: Pancreatic ductal adenocarcinoma (PDAC) remains highly lethal. Diabetes mellitus (DM) is both a risk factor for and a sequela of PDAC. Metformin, a commonly prescribed biguanide oral hypoglycemic used for the treatment of type II DM, has been found to have a chemo-protective role in PDAC in some in-vitro and human-based studies; conflicting literature exists regarding its potential role as a therapeutic agent. We investigated whether metformin use prior to PDAC diagnosis is associated with improved survival of patients with DM. Methods: We used the Surveillance, Epidemiology, and End-Results (SEER) linked Medicare database to identify diabetic patients with PDAC diagnosed between 2007-2011. Information regarding use of anti-hyperglycemic drugs prior to cancer diagnosis was extracted from Part D claims. The diabetic severity comorbidity index (DCSI) was used to control for DM severity. Logistic regression was used to calculate propensity scores for metformin use based on each patient’s sociodemographic characteristics, diabetic severity, and co-morbidity status. Inverse propensity weighted Cox Proportional-Hazard Models were subsequently used to assess the association between metformin use and overall survival adjusting for measured confounders. Results: We identified 1916 patients with PDAC and a diagnosis of DM on hypoglycemic medications at least one year prior to cancer diagnosis. Of these, 1098 (57.3%) were treated with metformin and 818 (42.7%) with other DM medications. Mean survival for those on metformin was 5.5 months compared with 4.2 months for those not on metformin (p < 0.01). After adjusting for confounders, patients on metformin had a 12% decreased risk of mortality compared to patients on other medications (hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.81-0.96, P <.01). In stratified analysis, differences persisted for those with Charlson score 0-1 vs > 2, DCSI 0-1 vs > 2, and for those treated with insulin vs other hypoglycemic medications (p < 0.01 for all). Conclusions: Metformin is associated with increased survival among diabetics with PDAC. If confirmed in prospective study, these results suggest a possible role for metformin use in diabetics with PDAC.
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Limanova, O. A., L. E. Fedotova, and O. A. Gromova. "Combined oral contraceptives and treatment of new coronavirus infection (COVID-19): aspects of drug interactions." Infekcionnye bolezni 19, no. 1 (2021): 149–58. http://dx.doi.org/10.20953/1729-9225-2021-1-149-158.

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This article discusses the problem of drug interactions between combined oral contraceptives on the example of Belara® (30 μg of ethinyl estradiol + 2 mg of chlormadinone acetate; Gedeon Richter, Hungary) and medications recommended for the treatment of new coronavirus infection (COVID-19) and concomitant disorders at the pharmacodynamic and pharmacokinetic levels with an assessment of the efficacy and safety of therapy for females. We described safe, potentially dangerous, and dangerous combinations of these drugs. Key words: new coronavirus infection (CAVID-19), combined oral contraceptives, antiviral drugs, antibacterial drugs, antiinflammatory drugs, anticoagulants, migraine drugs, antihypertensive drugs, oral hypoglycemic drugs, essential micronutrients, pharmacodynamic and pharmacokinetic interactions
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