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Identifying older diabetic patients at risk of poor glycemic control.

Incalzi RA, Corsonello A, Pedone C, Corica F, Carosella L, Mazzei B, Perticone F, Carbonin P, Gruppo Italiano di Farmacovigilanza nell'Anzia - BMC Geriatr (2002)

Bottom Line: The purpose of this study was to identify predictors of poor short-term and long-term glycemic control in older diabetic in-patients.Independent correlates of a discharge glycemia > or = 140 mg/dl in the training population were assessed by logistic regression analysis and a clinical prediction rule was developed.Selected admission variables (diastolic arterial pressure < 80 mmHg, glycemia = 143-218 mg/dl, glycemia > 218 mg/dl, history of insulinic or combined hypoglycemic therapy, Charlson's index > 2) were combined to obtain a score predicting a discharge fasting glycemia > or = 140 mg/dl in the training population.

View Article: PubMed Central - HTML - PubMed

Affiliation: 1Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Rome, Italy. raffaele_antonelli@rm.unicatt.it

ABSTRACT

Background: Optimal glycemic control prevents the onset of diabetes complications. Identifying diabetic patients at risk of poor glycemic control could help promoting dedicated interventions. The purpose of this study was to identify predictors of poor short-term and long-term glycemic control in older diabetic in-patients.

Methods: A total of 1354 older diabetic in-patients consecutively enrolled in a multicenter study formed the training population (retrospective arm); 264 patients consecutively admitted to a ward of general medicine formed the testing population (prospective arm). Glycated hemoglobin (HbA1c) was measured on admission and one year after the discharge in the testing population. Independent correlates of a discharge glycemia > or = 140 mg/dl in the training population were assessed by logistic regression analysis and a clinical prediction rule was developed. The ability of the prediction rule and that of admission HbA1c to predict discharge glycemia > or = 140 mg/dl and HbA1c > 7% one year after discharge was assessed in the testing population.

Results: Selected admission variables (diastolic arterial pressure < 80 mmHg, glycemia = 143-218 mg/dl, glycemia > 218 mg/dl, history of insulinic or combined hypoglycemic therapy, Charlson's index > 2) were combined to obtain a score predicting a discharge fasting glycemia > or = 140 mg/dl in the training population. A modified score was obtained by adding 1 if admission HbA1c exceeded 7.8%. The modified score was the best predictor of both discharge glycemia > or = 140 mg/dl (sensitivity = 79%, specificity = 63%) and 1 year HbA1c > 7% (sensitivity = 72%, specificity = 71%) in the testing population.

Conclusion: A simple clinical prediction rule might help identify older diabetic in-patients at risk of both short and long term poor glycemic control.

No MeSH data available.


Related in: MedlinePlus

Design of the study.
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Figure 1: Design of the study.

Mentions: The first part of this study aimed at developing a predictive score targeting subjects at risk of poor glycemic control at discharge in a population of diabetic patients enrolled in the GIFA (Gruppo Italiano di Farmacovigilanza nell'Anziano) study (retrospective arm of the study). The predictive score was, then, prospectively validated in a population of 264 diabetic in-patients consecutively admitted to a ward of general medicine. Accordingly, we will define "training" and "testing" population the ones in which the score was developed and validated, respectively [18]. The ability of both predictive score and admission HbA1c values to predict abnormal HbA1c one year after discharge was assessed in the testing population. The study design was approved by Ethical Committees of participating institutions. Patients gave their informed consent to participate in the study. The study design is summarized in figure 1 (see additional file: figure1.ppt).


Identifying older diabetic patients at risk of poor glycemic control.

Incalzi RA, Corsonello A, Pedone C, Corica F, Carosella L, Mazzei B, Perticone F, Carbonin P, Gruppo Italiano di Farmacovigilanza nell'Anzia - BMC Geriatr (2002)

Design of the study.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC123723&req=5

Figure 1: Design of the study.
Mentions: The first part of this study aimed at developing a predictive score targeting subjects at risk of poor glycemic control at discharge in a population of diabetic patients enrolled in the GIFA (Gruppo Italiano di Farmacovigilanza nell'Anziano) study (retrospective arm of the study). The predictive score was, then, prospectively validated in a population of 264 diabetic in-patients consecutively admitted to a ward of general medicine. Accordingly, we will define "training" and "testing" population the ones in which the score was developed and validated, respectively [18]. The ability of both predictive score and admission HbA1c values to predict abnormal HbA1c one year after discharge was assessed in the testing population. The study design was approved by Ethical Committees of participating institutions. Patients gave their informed consent to participate in the study. The study design is summarized in figure 1 (see additional file: figure1.ppt).

Bottom Line: The purpose of this study was to identify predictors of poor short-term and long-term glycemic control in older diabetic in-patients.Independent correlates of a discharge glycemia > or = 140 mg/dl in the training population were assessed by logistic regression analysis and a clinical prediction rule was developed.Selected admission variables (diastolic arterial pressure < 80 mmHg, glycemia = 143-218 mg/dl, glycemia > 218 mg/dl, history of insulinic or combined hypoglycemic therapy, Charlson's index > 2) were combined to obtain a score predicting a discharge fasting glycemia > or = 140 mg/dl in the training population.

View Article: PubMed Central - HTML - PubMed

Affiliation: 1Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Rome, Italy. raffaele_antonelli@rm.unicatt.it

ABSTRACT

Background: Optimal glycemic control prevents the onset of diabetes complications. Identifying diabetic patients at risk of poor glycemic control could help promoting dedicated interventions. The purpose of this study was to identify predictors of poor short-term and long-term glycemic control in older diabetic in-patients.

Methods: A total of 1354 older diabetic in-patients consecutively enrolled in a multicenter study formed the training population (retrospective arm); 264 patients consecutively admitted to a ward of general medicine formed the testing population (prospective arm). Glycated hemoglobin (HbA1c) was measured on admission and one year after the discharge in the testing population. Independent correlates of a discharge glycemia > or = 140 mg/dl in the training population were assessed by logistic regression analysis and a clinical prediction rule was developed. The ability of the prediction rule and that of admission HbA1c to predict discharge glycemia > or = 140 mg/dl and HbA1c > 7% one year after discharge was assessed in the testing population.

Results: Selected admission variables (diastolic arterial pressure < 80 mmHg, glycemia = 143-218 mg/dl, glycemia > 218 mg/dl, history of insulinic or combined hypoglycemic therapy, Charlson's index > 2) were combined to obtain a score predicting a discharge fasting glycemia > or = 140 mg/dl in the training population. A modified score was obtained by adding 1 if admission HbA1c exceeded 7.8%. The modified score was the best predictor of both discharge glycemia > or = 140 mg/dl (sensitivity = 79%, specificity = 63%) and 1 year HbA1c > 7% (sensitivity = 72%, specificity = 71%) in the testing population.

Conclusion: A simple clinical prediction rule might help identify older diabetic in-patients at risk of both short and long term poor glycemic control.

No MeSH data available.


Related in: MedlinePlus