Control glucémico y desenlaces hospitalarios adversos en pacientes con antecedente de diabetes mellitus hospitalizados en sala general en un hospital de tercer nivel en Colombia 2022.

dc.contributorMora Garzón, Edwind Ronald
dc.creatorGonzález Montoya, Alexandra
dc.date2023-03-15T17:54:28Z
dc.date2027-04-01
dc.date2023-03-15T17:54:28Z
dc.date2023-03-15
dc.date.accessioned2023-09-06T18:27:14Z
dc.date.available2023-09-06T18:27:14Z
dc.identifierhttps://repositorio.ucaldas.edu.co/handle/ucaldas/18825
dc.identifierUniversidad de Caldas
dc.identifierRepositorio Institucional Universidad de Caldas
dc.identifierhttps://repositorio.ucaldas.edu.co/
dc.identifier.urihttps://repositorioslatinoamericanos.uchile.cl/handle/2250/8697602
dc.descriptionIlustraciones
dc.descriptionspa:introducción: La diabetes mellitus genera alta morbilidad y mortalidad. Colombia es uno de los países de Sur América con mayor prevalencia. Aunque la literatura actual soporta la necesidad de establecer metas de control glucémico a nivel hospitalario, este continúa siendo deficiente. El objetivo de este estudio es evaluar el control glucémico de los pacientes diabéticos hospitalizados en salas generales, conocer la epidemiologia local y determinar los desenlaces adversos hospitalarios asociados al mal control glucémico. Metodología: Estudio observacional, transversal, analítico en un hospital de tercer nivel de la ciudad de Manizales, Colombia. Se evaluaron las historias clínicas de los pacientes mayores de 18 años con diabetes mellitus hospitalizados en salas generales entre enero y Julio del 2022. Se describieron las características basales, el manejo intrahospitalario, la ocurrencia de desenlaces adversos hospitalarios y su asociación con el mal control glucémico. Resultados: Se incluyeron 330 pacientes. La edad promedio fue de 69.9 años, el 95.2% tenían diabetes mellitus tipo 2. El principal motivo de ingreso fue la infección. El esquema correctivo fue el más usado. El promedio de glucometrías fue de 156 mg/dL. La hipoglucemia se presentó en el 28.8%. El mal control glucémico definido por tiempo en rango terapéutico menor del 70% se asoció con traslado a unidad de cuidados intensivos y mortalidad; el promedio de glucometrías fuera de metas se asoció con mortalidad e injuria renal. La alta variabilidad glucémica se asoció con delirium. La hipoglucemia se asoció con infección, delirium, estancia hospitalaria y traslado a unidad de cuidados intensivos. Conclusión: En pacientes diabéticos hospitalizados en sala general el mal control medido por diferentes métricas se asoció con desenlaces adversos en salud.
dc.descriptioneng:Introduction: Diabetes mellitus generates high morbidity and mortality. Colombia is one of the South American countries with the highest prevalence. Although the current literature supports the need to establish glycemic control goals at the hospital level, this continues to be deficient. The objective of this study is to evaluate the glycemic control of diabetic patients hospitalized in general wards, to know the local epidemiology and to determine the hospital adverse outcomes associated with poor glycemic control. Methodology: Observational, cross-sectional, analytical study in a third level hospital in the city of Manizales, Colombia. The clinical histories of patients older than 18 years with diabetes mellitus hospitalized in general wards between January and July 2022 were evaluated. Baseline characteristics, in-hospital management, the occurrence of in-hospital adverse outcomes and their association with poor glycemic control were described. Results: 330 patients were included. The average age was 69.9 years, 95.2% had type 2 diabetes mellitus. The main reason for admission was infection. The corrective scheme was the most used. The average blood glucose measurement was 156 mg/dL. Hypoglycemia occurred in 28.8%. Poor glycemic control defined by time in the therapeutic range of less than 70% was associated with transfer to the intensive care unit and mortality; the average number of glucose measurements outside the goals was associated with mortality and renal injury. High glycemic variability was associated with delirium. Hypoglycemia was associated with infection, delirium, hospital length, and transfer to the intensive care unit. Conclusion: In diabetic patients hospitalized in the general ward, poor control measured by different metrics was associated with adverse health outcomes.
dc.description1. Introducción / 2. Metodología / 2.1 Diseño del estudio / 2.2 Participantes / 2.3 Variables / 2.4 Recolección de la información / 3. Análisis estadístico / 4. Resultados / 4.1 Características de los pacientes / 4.2 Descriptivo a nivel hospitalario / 4.3 Control glucémico hospitalario / 4.4 Hipoglucemias / 4.5 Desenlaces adversos hospitalarios / 4.6 Mal control glucémico y desenlaces adversos hospitalarios / 4.6.1 Desenlaces médicos / 4.6.2 Desenlaces administrativos / 5. Discusión / 6. Conclusiones y recomendaciones / 6.1 Conclusiones / 6.2 Recomendaciones / 7. Bibliografía
dc.descriptionEspecialización médico - quirúrgica
dc.descriptionNo se autoriza la publicación de este trabajo de investigación debido a que se publicará en una revista cientifica A1.
dc.descriptionEspecialista Medicina Interna
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dc.languageeng
dc.languagespa
dc.publisherFacultad de Ciencias para la Salud
dc.publisherManizales
dc.publisherEspecialización Medicina Interna
dc.relationElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2023. Diabetes Care [Internet]. 2022 Dec 12;46(Supplement_1):S267–78. Available from: https://doi.org/10.2337/dc23-S016
dc.relationCho N, Kirigia J, Ogurstova K, Reja A. IDF Diabetes Atlas (Internet) [Internet]. 2017. 1–150 p. Available from: www.diabetesatlas.org
dc.relationVargas-Uricoechea H, Casas-Figueroa LÁ. An Epidemiologic Analysis of Diabetes in Colombia. Ann Glob Heal [Internet]. 2015;81(6):742–53. Available from: http://dx.doi.org/10.1016/j.aogh.2015.11.001
dc.relationPasquel FJ, Lansang MC, Dhatariya K, Umpierrez GE. Management of diabetes and hyperglycaemia in the hospital. Lancet Diabetes Endocrinol [Internet]. 2021;9(3):174–88. Available from: http://dx.doi.org/10.1016/S2213-8587(20)30381- 8
dc.relationUmpierrez G, Isaacs S, Bazargan N et al. Hyperglycemia: An independent marker of in-hospital mortality in patients with undiagnosed diabetes [1] (multiple letters). J Clin Endocrinol Metab. 2002;88(3):1402.
dc.relationUmpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(1):16–38.
dc.relationCare D, Suppl SS. Diabetes care in the hospital: Standards of medical care in diabetes-2021. Diabetes Care. 2021;44(January):S211–20.
dc.relationMendez CE, Mok K-T, Ata A, Tanenberg RJ, Calles-Escandon J, Umpierrez GE. Increased glycemic variability is independently associated with length of stay and mortality in noncritically ill hospitalized patients. Diabetes Care. 2013 Dec;36(12):4091–7
dc.relationMalcolm J, Halperin I, Miller DB, Moore S, Nerenberg KA, Woo V, et al. In-Hospital Management of Diabetes. Can J Diabetes [Internet]. 2018;42:S115–23. Available from: https://doi.org/10.1016/j.jcjd.2017.10.014
dc.relationChowdhury TA, Cheston H, Claydon A. Managing adults with diabetes in hospital during an acute illness. BMJ. 2017;357:1–5.
dc.relationDhatariya K, Mustafa OG, Rayman G. Safe care for people with diabetes in hospital. Clin Med J R Coll Physicians London. 2020;20(1):21–7.
dc.relationRoman SH, Chassin MR. Windows of opportunity to improve diabetes care when patients with diabetes are hospitalized for other conditions. Diabetes Care. 2001;24(8):1371–6.
dc.relationOng KY, Kwan YH, Tay HC, Tan DS-Y, Chang JY. Prevalence of dysglycaemic events among inpatients with diabetes mellitus: a Singaporean perspective. Singapore Med J. 2015 Jul;56(7):393–400.
dc.relationKorytkowski MT, Muniyappa R, Antinori-Lent K, Donihi AC, Drincic AT, Hirsch IB, et al. Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab [Internet]. 2022 Aug 1;107(8):2101–28. Available from: https://doi.org/10.1210/clinem/dgac278
dc.relationGomez AM, Umpierrez GE. Continuous glucose monitoring in insulin-treated patients in non-ICU settings. J Diabetes Sci Technol. 2014 Sep;8(5):930–6.
dc.relationBurt MG, Roberts GW, Aguilar-Loza NR, Stranks SN. Brief report: Comparison of continuous glucose monitoring and finger-prick blood glucose levels in hospitalized patients administered basal-bolus insulin. Diabetes Technol Ther. 2013 Mar;15(3):241–5.
dc.relationSpanakis EK, Levitt DL, Siddiqui T, Singh LG, Pinault L, Sorkin J, et al. The Effect of Continuous Glucose Monitoring in Preventing Inpatient Hypoglycemia in General Wards: The Glucose Telemetry System. J Diabetes Sci Technol. 2018 Jan;12(1):20–5.
dc.relationCook CB, Kongable GL, Potter DJ, Abad VJ, Leija DE, Anderson M. Inpatient glucose control: A glycemic survey of 126 U.S. hospitals. J Hosp Med. 2009;4(9):7– 14.
dc.relationCook CB, Kongable GL, Potter DJ, Abad VJ, Leija DE, Anderson M. Inpatient glucose control: a glycemic survey of 126 U.S. hospitals. J Hosp Med. 2009 Nov;4(9):E7–14.
dc.relationCheng S, Hou G, Liu Z, Lu Y, Liang S, Cang L, et al. Risk prediction of in-hospital mortality among patients with type 2 diabetes mellitus and concomitant communityacquired pneumonia. Ann Cardiothorac Surg. 2020;9(5):3313–25.
dc.relationEvans NR, Dhatariya KK. Assessing the relationship between admission glucose levels, subsequent length of hospital stay, readmission and mortality. Clin Med. 2012 Apr;12(2):137–9.
dc.relationMcAlister FA, Majumdar SR, Blitz S, Rowe BH, Romney J, Marrie TJ. The relation between hyperglycemia and outcomes in 2,471 patients admitted to the hospital with community-acquired pneumonia. Diabetes Care. 2005 Apr;28(4):810–5.
dc.relationDeng L, Aibibula W, Talat Z, Filion KB, Eintracht S, Dasgupta K, et al. The association between glycaemic control during hospitalization and risk of adverse events: A retrospective cohort study. Endocrinol diabetes Metab. 2021 Jul;4(3):e00268.
dc.relationOmar AS, Salama A, Allam M, Elgohary Y, Mohammed S, Tuli AK, et al. Association of time in blood glucose range with outcomes following cardiac surgery. BMC Anesthesiol. 2015;15(1):14.
dc.relationGabbay MAL, Rodacki M, Calliari LE, Vianna AGD, Krakauer M, Pinto MS, et al. Time in range: a new parameter to evaluate blood glucose control in patients with diabetes. Diabetol Metab Syndr [Internet]. 2020;12(1):22. Available from: https://doi.org/10.1186/s13098-020-00529-z
dc.relationLu J, Wang C, Shen Y, Chen L, Zhang L, Cai J, et al. Time in Range in Relation to All-Cause and Cardiovascular Mortality in Patients With Type 2 Diabetes: A Prospective Cohort Study. Diabetes Care. 2021 Feb;44(2):549–55.
dc.relationRains JL, Jain SK. Oxidative stress, insulin signaling, and diabetes. Free Radic Biol Med. 2011 Mar;50(5):567–75.
dc.relationDossett LA, Cao H, Mowery NT, Dortch MJ, Morris JMJ, May AK. Blood glucose variability is associated with mortality in the surgical intensive care unit. Am Surg. 2008 Aug;74(8):679–85; discussion 685.
dc.relationChoi H, Park CS, Huh J, Koo J, Jeon J, Kim E, et al. Intraoperative Glycemic Variability and Mean Glucose are Predictors for Postoperative Delirium After Cardiac Surgery: A Retrospective Cohort Study. Clin Interv Aging. 2022;17:79–95.
dc.relationFinfer S, Chittock DR, Su SY-S, Blair D, Foster D, Dhingra V, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009 Mar;360(13):1283–97.
dc.relationAdler GK, Bonyhay I, Failing H, Waring E, Dotson S, Freeman R. Antecedent Hypoglycemia Impairs Autonomic Cardiovascular Function: Implications for Rigorous Glycemic Control. Diabetes [Internet]. 2009 Feb 1;58(2):360–6. Available from: https://doi.org/10.2337/db08-1153
dc.relationStrain WD, Paldánius PM. Diabetes, cardiovascular disease and the microcirculation. Cardiovasc Diabetol [Internet]. 2018;17(1):1–10. Available from: https://doi.org/10.1186/s12933-018-0703-2
dc.relationOsuna M, Rivera MC, Bocanegra C de J, Lancheros A, Tovar H, Hernández JI, et al. Caracterización de la diabetes mellitus tipo 2 y el control metabólico en el paciente hospitalizado . Vol. 39, Acta Medica Colombiana . scieloco ; 2014. p. 344– 51.
dc.relationOstling S, Wyckoff J, Ciarkowski SL, Pai C-W, Choe HM, Bahl V, et al. The relationship between diabetes mellitus and 30-day readmission rates. Clin Diabetes Endocrinol. 2017;3(1):1–8.
dc.relationKim H, Ross JS, Melkus GD, Zhao Z, Boockvar K. Scheduled and unscheduled hospital readmissions among patients with diabetes. Am J Manag Care. 2010 Oct;16(10):760–7.
dc.relationJiang HJ, Stryer D, Friedman B, Andrews R. Multiple hospitalizations for patients with diabetes. Diabetes Care. 2003 May;26(5):1421–6.
dc.relationUmpierrez GE, Smiley D, Jacobs S, Peng L, Temponi A, Mulligan P, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care. 2011;34(2):256–61.
dc.relationKocher RP, Adashi EY. Hospital readmissions and the Affordable Care Act: paying for coordinated quality care. JAMA. 2011 Oct;306(16):1794–5.
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dc.rightshttp://purl.org/coar/access_right/c_14cb
dc.subjectDiabetes mellitus
dc.subjectGlycemic control
dc.subjectInpatient
dc.subjectCiencias médicas
dc.titleControl glucémico y desenlaces hospitalarios adversos en pacientes con antecedente de diabetes mellitus hospitalizados en sala general en un hospital de tercer nivel en Colombia 2022.
dc.typeTrabajo de grado - Especialización
dc.typehttp://purl.org/coar/resource_type/c_bdcc
dc.typeText
dc.typeinfo:eu-repo/semantics/masterThesis
dc.typehttps://purl.org/redcol/resource_type/TM
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