Partial Hospitalization: An Intervention for Youth with Poorly Controlled Diabetes Mellitus

Objective: To examine the efficacy of an integrated medical/psychiatric partial hospitalization program (PHP) to improve glycemic control in youth with both diabetes mellitus and mental health disorders.Methods: This retrospective chart review is of patients admitted to a PHP between 2005–2015 with concerns about diabetes mellitus care. Clinical characteristics, laboratory data, diabetic ketoacidosis hospitalizations, and outpatient clinic visit frequency were collected from the year prior to the year after PHP admission.Results: A total of 43 individuals met inclusion criteria: 22 (51%) were female, 40 (93%) had type 1 diabetes, the mean age was 15.2 ± 2.3 years, and the mean diabetes mellitus duration was 4.6 ± 3.6 years. Of those individuals, 35 of these patients had hemoglobin A1c (HbA1c) data available at baseline, 6 months, and 1 year after PHP. The average HbA1c before PHP admission was 11.3 ± 2.3% (100.5 ± 25 mmol/mol), and decreased to 9.2 ± 1.3% (76.7 ± 14.8 mmol/mol) within 6 months of PHP admission (P<.001). The average HbA1c 1 year after PHP was 10.7 ± 1.7 % (93.3 ± 19.1 mmol/mol). Overall, 24 patients (68%) had lower HbA1c, and 75% of those with improvement maintained an HbA1c reduction of ≥1% (≥10 mmol/mol) at 1 year compared to before PHP.Conclusion: Most patients demonstrated improved glycemic control within 6 months of PHP admission, and many of those maintained a ≥1% (≥10 mmol/mol) reduction in HbA1c at 1 year following PHP admission. This program may represent a promising intervention that could serve as a model for intensive outpatient management of youth with poorly controlled diabetes mellitus.Abbreviations: ADA = American Diabetes Association; DKA = diabetic ketoacidosis; EMR = electronic medical record; HbA1c = hemoglobin A1c; ICD-9 = International Classification of Diseases, 9^th revision; PHP = partial hospitalization program     

Nicotinamide Effects Oxidative Burst Activity of Neutrophils in Patients with Poorly Controlled Type 2 Diabetes Mellitus

Neutrophil functions are impaired in patients with diabetes mellitus. Bacterial phagocytosis and oxidative burst activity are reduced at high glucose concentrations in diabetic patients. Defects in neutrophil oxidative burst capacity are of multifactorial origin in diabetes mellitus and correlate with glucose levels. It has been reported that neutrophil NADPH oxidase activity is impaired and superoxide production is reduced in diabetic patients with or without any infections. Nicotinamide is a vitamin B3 derivative and a NAD precursor with immunomodulatory effects. In vitro studies demonstrated that nicotinamide increases NAD and NADH content of beta cells. The authors hypothesized that nicotinamide may restore the impaired oxidative burst capacity of neutrophils in diabetic patients by increasing the NADH content as an electron donor and possibly through NADPH oxidase activity of the cell. In order to test the hypothesis, this placebo-controlled and open study was designed to evaluate neutrophil functions in infection-free poorly controlled type 2 diabetic patients as compared to healthy subjects and assess the effects of nicotinamide on neutrophil phagocytosis as well as oxidative burst activity. Thirty patients with type 2 diabetes mellitus were enrolled in the study. Sixteen were females and 14 were males, with a mean age 58 ± 10. All patients were on sulphonylurea treatment and their hemoglobin A_1c (HbA_1c) levels were above 7.5%. The control group consisted of 10 voluntary healthy subjects. Diabetic and control subjects were not significantly different in terms of age, body mass index (BMI), leucocyte and neutrophil counts, C-reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR), but HbA_1c and fasting glucose levels were significantly higher in patients with diabetes mellitus. Phagocytic activity and respiratory burst indexes were measured by flow cytometric analyses as previously described by Rothe and Valet (Methods Enzyml., 233, 539–548, 1994) and compared in diabetic subjects and healthy controls. Diabetic patients were grouped to receive either 50 mg/kg oral nicotinamide (n = 15) or placebo (n = 15) for a period of 1 month. The 2 groups did not differ in terms of treatment, frequency of hypertension, BMI, diabetes duration, age, fasting plasma glucose (FPG), HbA_1c, CRP, ESR, polymorphonuclear leukocyte (PNL) and neutrophil counts. Neutrophil functions were reassessed after the treatment period. Phagocytic activity represented as indexes were lower in diabetic patients when compared to healthy subjects, but the differences were not statistically significant (P > .05). Patients with diabetes mellitus had significantly lower oxidative burst indexes when compared to healthy controls (P values < .05). In diabetic patients, a negative correlation between neutrophil functions and HbA_1c was found which was not statistically significant (P values > .05). Phagocytic indexes were similar in nicotinamide and placebo groups after treatment period (P > .05). But oxidative burst activity in patients receiving nicotinamide was greater when compared with placebo and the difference was statistically significant at 30 and 45 minutes (P values .04 and .03). This effect of nicotinamide may be due to increased NADH content and NADPH oxidase activity of the cell, which needs to be further studied. Impaired neutrophil functions may aggravate various infections in patients with diabetes mellitus and blood glucose regulation is an important target of treatment to improve neutrophil functions. But nicotinamide treatment may help to improve prognosis in diabetic patients with severe infections.     

The Effects of a Comprehensive Multidisciplinary Outpatient Diabetes Program on Hospital Readmission Rates in Patients with Diabetes: A Randomized Controlled Prospective Study

Objective: The diagnosis of diabetes mellitus is associated with an increased risk of hospital readmissions. The goal of this study was to determine whether there was a difference in the rates of 30-day and 365-day hospital readmissions between diabetic patients who, upon their discharge, received diabetes care in a standard primary care setting and those who received their care in a specialized multidisciplinary diabetes program.Methods: This was a randomized controlled prospective study.Results: One hundred and ninety two consecutive patients were recruited into the study, 95 (49%) into standard care (control group) and 97 (51%) into a multidisciplinary diabetes program (intervention group). The 30-day overall hospital readmission rates (including both emergency department and hospital readmissions) were 19% in the control group and 7% in the intervention group (P = .02). The 365-day overall hospital readmission rates were 38% in the control group and 14% in the intervention group (P = .0002).Conclusion: Patients with diabetes who are assigned to a specialized multidisciplinary diabetes program upon their discharge exhibit significantly reduced hospital readmission rates at 30 days and 365 days after discharge.     

Identifying Risk Factors for Severe Hypoglycemia in Hospitalized Patients with Diabetes

ObjectiveSome of the deleterious effects of hypoglycemia in hospitalized patients include increased rates of mortality and longer length of stay. Our primary objective was to identify the risk factors associated with severe hypoglycemia to identify those patients at highest risk.MethodsThe medical records of 5,026 patients with diabetes mellitus (DM) admitted in 2010 were reviewed to identify those patients that developed severe hypoglycemia (blood glucose [BG] < 40 mg/dL). We performed c2 tests to assess statistical significance. Adjusted logical regression was used to determine the risk factors for hypoglycemia in the hospital.ResultsOut of 5,026 DM patients included in our review, 81 experienced severe hypoglycemia (1.6%). Statistically higher proportions of chronic kidney disease (CKD; 69.1% vs. 46.9%, P < .001), congestive heart failure (CHF; 48.1% vs. 28.5%, P < .001), sepsis (49.4% vs. 12.5%, P < .001), insulin use (45.7% vs. 26.04%, P = .000), type 1 DM (21% vs. 5.1%, P = .000), and cirrhosis (14.8% vs. 7.2%, P = .009) were seen in the severe hypoglycemic group compared to the nonsevere hypoglycemic group. Overall, 84% of patients who experienced an episode of severe hypoglycemia in the hospital (BG < 40 mg/dL) had a previous episode of hypoglycemia (BG < 70 mg/dL). The odds ratios (ORs) for type 1 DM, sepsis, previous hypoglycemia, and insulin use were 3.43 (95% confidence interval [CI] 1.81, 6.49), 2.64 (95% CI 1.6, 4.35), 46.1 (95% CI 24.76, 85.74), and 1.66 (95% CI 1.02, 2.69), respectively.ConclusionPrior episodes of hypoglycemia in the hospital, the presence of type 1 DM, insulin use, and sepsis were identified as independent risk factors for the development of severe hypoglycemia in the hospital. (Endocr Pract. 2014;20:1051-1056)     

Effect of An Educational Inpatient Diabetes Management Program on Medical Resident Knowledge and Measures of Glycemic Control: A Randomized Controlled Trial

ObjectiveTo investigate the effectiveness of an Inpatient Diabetes Management Program (IDMP) on physician knowledge and inpatient glycemic control.MethodsResidents assigned to General Internal Medicine inpatient services were randomized to receive the IDMP (IDMP group) or usual education only (nonIDMP group). Both groups received an overview of inpatient diabetes management in conjunction with reminders of existing order sets on the hospital Web site. The IDMP group received print copies of the program and access to an electronic version for a personal digital assistant (PDA). A Diabetes Knowledge Test (DKT) was administered at baseline and at the end of the 1-month rotation. The frequency of hyperglycemia among patients under surveillance by each group was compared by using capillary blood glucose values and a dispersion index of glycemic variability. IDMP users completed a questionnaire related to the program.ResultsTwenty-two residents participated (11 in the IDMP group and 11 in the non-IDMP group). Overall Diabetes Knowledge Test scores improved in both groups (IDMP: 69% ± 1.7% versus 83% ± 2.1%, P = .003; nonIDMP: 76% ± 1.2% versus 84% ± 1.4%, P = .02). The percentage of correct responses for management of corticosteroid-associated hyperglycemia (P = .004) and preoperative glycemic management (P = .006) improved in only the IDMP group. The frequency of hyperglycemia (blood glucose level > 180 mg/dL) and the dispersion index (5.3 ± 7.6 versus 3.7 ± 5.6; P = .2) were similar between the 2 groups.ConclusionAn IDMP was effective at improving physician knowledge for managing hyperglycemia in hospitalized patients treated with corticosteroids or in preparation for surgical procedures. Educational programs directed at improving overall health care provider knowledge for inpatient glycemic management may be beneficial; however, improvements in knowledge do not necessarily result in improved glycemic outcomes. (Endocr Pract. 2012;18:238-249)     

Validation of Diagnostic Coding for Diabetes Mellitus in Hospitalized Patients

ObjectiveSome studies have shown that there is an undercoding of diabetes mellitus among hospitalized patients, which can have adverse clinical and financial implications for health systems. We aimed to validate the discharge diagnostic coding of diabetes mellitus in hospitalized patients using clinical and laboratory-based diagnostic indicators as the reference.MethodsThis was a retrospective cohort study of 83 690 discharges of 48 615 unique adult patients who were hospitalized in an academic medical center over 4.5 years and had at least 4 blood glucose measurements during admission. A missing diabetes code (MDC) was defined using 2 criteria. MDC₁ was defined as the presence of any of the following: blood glucose ≥200 (x2), A1C ≥6.5%, home antihyperglycemic medication, or preadmission code for diabetes, whereas MDC₂ was defined as preadmission diabetes or at least 2 other criteria in MDC₁. Multivariable logistic regression was used to identify factors associated with MDC compared to the present diabetes code.ResultsMDC₁ and MDC₂ were present in 12 186 (14.6%) and 3542 (4.7%) discharges, respectively. Factors associated with both MDC₁ and MDC₂ were medium-dose steroid use [adjusted odds ratio (aOR) 2.11, 2.01], high-dose steroid use (aOR 4.70, 2.50), intermediate medical care service (aOR 1.65, 1.55), infection (aOR 1.21, 1.34), and hepatic disease (aOR 1.93, 1.92).ConclusionIn this retrospective study, MDC ranged from 5% to 15% and was associated with various clinical factors. Further prospective studies are needed to validate these findings, explore the mechanisms behind these associations, and understand the clinical and financial implications.     

Daily Inpatient Glycemic Survey (DINGS): A Process to Remotely Identify and Assist in the Management of Hospitalized Patients with Diabetes and Hyperglycemia

Objective: Hyperglycemia, hypoglycemia, and glycemic variability have been associated with increased morbidity, mortality, and overall costs of care in hospitalized patients. At the Stratton VA Medical Center in Albany, New York, a process aimed to improve inpatient glycemic control by remotely assisting primary care teams in the management of hyperglycemia and diabetes was designed.Methods: An electronic query comprised of hospitalized patients with glucose values <70 mg/dL or >350 mg/dL is generated daily. Electronic medical records (EMRs) are individually reviewed by diabetes specialist providers, and management recommendations are sent to primary care teams when applicable. Glucose data was retrospectively examined before and after the establishment of the daily inpatient glycemic survey (DINGS) process, and rates of hyperglycemia and hypoglycemia were compared.Results: Patient-day mean glucose slightly but significantly decreased from 177.6 ± 64.4 to 173.2 ± 59.4 mg/dL (P<.001). The percentage of patient-days with any value >350 mg/dL also decreased from 9.69 to 7.36% (P<.001), while the percentage of patient-days with mean glucose values in the range of 90 to 180 mg/dL increased from 58.1 to 61.4% (P<.001). Glycemic variability, assessed by the SD of glucose, significantly decreased from 53.9 to 49.8 mg/dL (P<.001). Moreover, rates of hypoglycemia (<70 mg/dL) decreased significantly by 41% (P<.001).Conclusion: Quality metrics of inpatient glycemic control improved significantly after the establishment of the DINGS process within our facility. Prospective controlled studies are needed to confirm a causal association.Abbreviations: DINGS = daily inpatient glycemic survey EMR = electronic medical record HbA1c = glycated hemoglobin ICU = intensive care unit VA = Veterans Affairs     

Inpatient to Outpatient Transfer of Diabetes Care: Planning for an Effective Hospital Discharge

ObjectiveTo review data on diabetes discharge planning, provide a definition of an effective diabetes discharge, and summarize one institution’s diabetes discharge planning processes in a teaching hospital.MethodsWe performed a MEDLINE search of the English-language literature published between January 1998 and December 2007 for articles related to the inpatient to outpatient transition of diabetes care. Regulatory guidelines about discharge planning were reviewed. We also analyzed our institution’s procedures regarding hospital discharge.ResultsWe define an effective diabetes discharge as one where the patient has received the necessary skills training and been provided with a clear and understandable postdischarge plan for diabetes care that has been clearly documented and is accessible by the patient’s outpatient health care team. Diabetes is one of the most common conditions managed in the hospital, yet how to transition a patient with diabetes to the outpatient setting is understudied, and the outcome of patients with diabetes after discharge is unknown. Strategies that can be used to ensure an effective diabetes discharge are early identification of patients in need of education, implementation of a clinical pathway, and clear instructions about medications and follow-up appointments at the time of discharge.ConclusionsEffective transfer of care from the inpatient to the outpatient setting remains a priority in the United States. Studies are needed to better define how best to ensure that patients with diabetes are successfully transitioned to ambulatory care. (Endocr Pract. 2009;15:263-269)     

老年疼痛住院患者健康教育流程改造及效果评价

目的：探索老年疼痛住院患者健康教育流程改造的实施效果。方法：以2012年3月~10月入住我科的老年疼痛患者为试验组,采用自行设计的一体式《住院患者健康教育表单》进行健康教育,在重点环节进行改进。2011年7月~2012年2月入住我科的老年疼痛患者为对照组,对比分析两组的满意度、跌倒人次、给予护士表扬次数。结果：试验组患者满意度为（95.81±3.01）%,对照组满意度为（99.61±0.74）%,差异有统计学意义（t=-3.46,P〈0.01）。结论：采用一体式的健康教育表单,改造健康教育流程,有助于提高老年患者满意度,改善住院体验,值得临床推广。     

综合护理干预对老年住院糖尿病患者影响的临床观察

目的：观察综合护理干预对老年住院糖尿病患者的临床影响,探讨改善老年住院糖尿病患者临床表现及预后的护理方式。方法：选择老年住院糖尿病患者160例,随机均分为对照组和观察组,对照组采取常规专科护理,观察组加行综合护理干预,治疗2周后比较两组患者焦虑自评量表（SAS）和抑郁自评量表（SDS）评分;出院3个月后比较两组患者自我管理和生活质量（GQOL-100）评分结果：治疗2周和出院3个月后,两组患者在上述方面比较,差异具有统计学意义（P〈0.01,P〈0.05）,观察组优于对照组。结论：对老年住院DM患者施行综合护理干预措施,具有积极的临床意义。     

综合护理干预对老年住院糖尿病患者影响的临床观察

目的:观察综合护理干预对老年住院糖尿病患者的临床影响,探讨改善老年住院糖尿病患者临床表现及预后的护理方式。方法:选择老年住院糖尿病患者160例,随机均分为对照组和观察组,对照组采取常规专科护理,观察组加行综合护理干预,治疗2周后比较两组患者焦虑自评量表(SAS)和抑郁自评量表(SDS)评分;出院3个月后比较两组患者自我管理和生活质量(GQOL-100)评分结果:治疗2周和出院3个月后,两组患者在上述方面比较,差异具有统计学意义(P<0.01,P<0.05),观察组优于对照组。结论:对老年住院DM患者施行综合护理干预措施,具有积极的临床意义。     

Hypoglycemia and Medical Expenses in Patients with Type 2 Diabetes Mellitus: An Analysis Based on the Korea National Diabetes Program Cohort

Background and Aims

Hypoglycemia is one of the most important adverse events in individuals with type 2 diabetes mellitus (T2DM). However, hypoglycemia-related events are usually overlooked and have been documented less in clinical practice.

Materials and Methods

We evaluated the incidence, clinical characteristics, and medical expenses of hypoglycemia related events in T2DM patients based on the Korea National Diabetes Program (KNDP), which is the largest multi-center, prospective cohort in Korea (n = 4,350). For accurate outcomes, the KNDP data were merged with claims data from the Health Insurance Review and Assessment Service (HIRA) of Korea.

Results

During a median follow-up period of 3.23 years (95% CI: 3.14, 3.19), 88 subjects (2.02%) were newly diagnosed with hypoglycemia, and the incidence of hypoglycemia was 6.44 cases per 1,000 person-years (PY). Individuals with hypoglycemia were significantly older (59.7±10.7 vs. 53.3±10.4 years, p < 0.001), had more hospital visits (121.94±126.88 days/PY, p < 0.001), had a longer hospital stays (16.13±29.21 days/PY, p < 0.001), and incurred greater medical costs ($2,447.56±4,056.38 vs. $1,336.37±3,403.39 /PY, p < 0.001) than subjects without hypoglycemia.

Conclusion

Hypoglycemia-related events were infrequently identified among the medical records of T2DM subjects. However, they were associated significantly with poor clinical outcomes, and thus, hypoglycemia could have a substantial burden on the Korean national healthcare system.     

An Outpatient-Based Clinical Program for Type 2 Diabetes Prevention

ObjectiveTo review first-year results of a clinic-based type 2 diabetes prevention program.MethodsFrom January through December 2007, patients with a diagnosis of prediabetes participated in the Diet-Exercise-Activity-Lifestyle program for instruction in lifestyle changes. Physical therapy assessments were retospectively reviewed to search for symptoms or findings of physical impairments. Changes in weight and 2-hour glucose tolerance test results were assessed at 6 months. Patient satisfaction with the program was evaluated.ResultsNinety-two patients qualified for the program. Mean baseline fasting glucose concentration was 108 mg/dL, and 2-hour glucose concentration was 134 mg/dL. Mean age was 62 years, and 66% were women. Review of physical therapy assessments demonstrated gait/balance disturbances in 47% of patients, peripheral neuropathy in 43%, and musculoskeletal problems in 63%. Among 47 patients who had 6-month follow-up visits, 72% lost weight. Fasting glucose levels improved in 58% in persons with impaired fasting glucose, and 2-hour glucose values decreased in patients who had impaired glucose tolerance. Seventy-eight percent graded the program as either “very good” or “excellent.”ConclusionsPrograms geared toward type 2 diabetes prevention can be feasibly implemented on an outpatient basis. Preliminary data suggest that improvements in weight and glucose values can be achieved. As the prevalence of prediabetes increases, health care systems must gain further experience with effective outpatient diabetes prevention strategies. (Endocr Pract 2010;16:21-29)     

Feasibility,Acceptability, and Preliminary Efficacy of an Intensive Clinic-Based Intervention for Children With Poorly Controlled Type 1 Diabetes

ObjectiveTo evaluate the feasibility, acceptability, and preliminary efficacy of a team-based intervention for youth with type 1 diabetes (T1D) with suboptimal glycemia, as detected based on the measurement of hemoglobin A1C (HbA1C).MethodsForty participants with T1D for >1 year and an HbA1C level of ≥9.5% (80 mmol/mol) enrolled for a multidisciplinary intervention that included pediatric endocrinologists, pediatric psychologists, and a certified diabetes care and education specialist (CDCES). The CDCES-integrated medical management, while reinforcing physical, emotional, and behavioral health, connected with families to set and monitor goals and reviewed medication adjustments. The feasibility was assessed based on enrollment targets; acceptability based on retention rates; and preliminary efficacy based on changes in HbA1C levels, quality of life, diabetes-related strengths and resilience, hospital admissions, emergency room visits, and missed school days.ResultsOf 43 patients and families approached, 40 agreed to participate, 36 completed the 4-month intervention, and 31 completed full 8 months of follow-up data collection. The CDCES coach averaged 6.8 contacts per participant during the 8-month study period. The HbA1C level reduced significantly from baseline to 4 months (12.1% ± 1.6% to 11.0% ± 1.9%, P = .001) and was sustained at 8 months (10.7% ± 1.9%, P < .001). The participants reported significant increases in diabetes-specific quality of life (P < .05) and diabetes-related strength and resilience (P = .003). The missed school days reduced from 7.23 ± 7.5 days to 1.55 ± 1.9 days (P < .001), and the diabetes-related hospitalizations decreased from 0.4 ± 0.6 to 0.1 ± 0.3 (P = .009).ConclusionPreliminary data suggest that a multidisciplinary intervention leveraging a team-based approach with a physician, psychologist, and CDCES can support improvements in glycemic control and psychosocial outcomes among youth with T1D with an HbA1C level above the target.     

利拉鲁肽对二甲双胍控制不佳的肥胖/超重2型糖尿病患者氧化应激、NLRP3炎症小体及脂肪因子水平的影响

摘要 目的：探讨利拉鲁肽对二甲双胍控制不佳的肥胖/超重2型糖尿病（T2DM）患者氧化应激、NLRP3炎症小体及脂肪因子水平的影响。方法：选择2018年2月-2020年1月期间河北北方学院附属第一医院收治的二甲双胍控制不佳的肥胖/超重T2DM患者160例。按照随机数字表法将患者分为对照组（80例,阿卡波糖治疗）和研究组（80例,阿卡波糖联合利拉鲁肽治疗）。观察两组的收缩压（SBP）、腰臀比（WHR）、体质量指数（BMI）、胰岛素抵抗指标、糖脂代谢指标、氧化应激指标、核苷酸结合寡聚化结构域样受体蛋白3（NLRP3）炎症小体及脂肪因子水平变化情况。结果：两组治疗后BMI、WHR、SBP均下降,且研究组的下降幅度更大（P<0.05）。两组治疗后胰岛?茁细胞分泌功能指数（HOMA-?茁）升高,胰岛素抵抗指数（HOMA-IR）下降,且研究组的改变幅度更大（P<0.05）。两组治疗后甘油三酯（TG）、总胆固醇（TC）、糖化血红蛋白（HbA1c）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FPG）下降,高密度脂蛋白胆固醇（HDL-C）升高,且研究组的改变幅度更大（P<0.05）。两组治疗后丙二醛（MDA）下降,谷胱甘肽过氧化物酶（GSH-PX）、超氧化物歧化酶（SOD）升高,且研究组的改变幅度更大（P<0.05）。两组治疗后NLRP3炎症小体均下降,且研究组的改变幅度更大（P<0.05）。两组治疗后脂联素升高,瘦素下降,且研究组的改变幅度更大（P<0.05）。结论：利拉鲁肽应用于治疗二甲双胍控制不佳的肥胖/超重T2DM患者,可减轻氧化应激,有效改善糖脂代谢,调节NLRP3炎症小体及脂肪因子水平。     

门诊高血压患者健康教育加个体化治疗的效果观察

摘要目的：探讨门诊高血压患者健康教育加个体化治疗的效果。方法：选取在本院门诊收治原发性高血压的患者258例,随机均分为观察组和对照组,每组129例。观察组使用健康教育和个体化治疗,而对照组使用常规治疗。记录并比较两组治疗前后对高血压病掌握情况,血压下降率,服药依从性,治疗后达标、并发症情况。结果：治疗前,观察组对高血压病掌握情况与对照组差异无统计学意义（P〉0．05）;治疗后,观察组对高血压诊断（91．5％）、高血压病因（98．4％）、高血压症状（100．0％）、高血压并发症（92．2％）掌握情况明显比对照组要好,差异有统计学意义（P〈0．05）;观察组服药依从性明显好于对照组,差异具有统计学意义（P〈0．05）;观察组的血压下降率为81．4％,明显高于对照组49．6％,差异具有统计学意义（P〈0．05）;观察组的达标率高达74．4％,明显高于对照组的34．9％,差异具有统计学意义（P〈0．01）;观察组未达标率和并发症发生率分别为25．6％和9-3％,明显低于对照组的65．1％和20．9％,差异有统计学意义（P〈0．01）。结论：对不同高血压患者采用健康教育加个体化的治疗方法,对提高高血压的控制率和降低相应并发症的发生率有非常好的临床效果,值得临床进一步推广和应用。     

Trends in the Prevalence of Depression in Hospitalized Patients with Type 2 Diabetes in Spain: Analysis of Hospital Discharge Data from 2001 to 2011

BackgroundThis study aims to describe trends in the prevalence of depression among hospitalized patients with type 2 diabetes in Spain, 2001–2011.MethodsWe selected patients with a discharge diagnosis of type 2 diabetes using national hospital discharge data. Discharges were grouped by depression status. Prevalence of depression globally and according to primary diagnoses based on the Charlson comorbidity index (CCI) were analyzed. We calculated length of stay (LOHS) and in-hospital mortality (IHM). Multivariate analysis was adjusted by age, year and comorbidity.ResultsFrom 2001 to 2011, 4,723,338 discharges with type 2 diabetes were identified (4.93% with depression). Prevalence of depression in diabetic patients increased from 3.54% in 2001 to 5.80% in 2011 (p<0.05). The prevalence of depression was significantly higher in women than in men in each year studied and increased from 5.22% in 2001 to 9.24% in 2011 (p<0.01). The highest prevalence was observed in the youngest age group (35–59 years). The median LOHS decreased significantly over this period. Men with diabetes and depression had higher IHM than women in all the years studied (p<0.05). Older age and greater comorbidity were significantly associated with a higher risk of dying, among diabetic patients with concomitant depression.ConclusionsPrevalence of depression increased significantly among hospitalized diabetic patients from 2001 to 2011 even if the health profile and LOHS have improved over this period. Programs targeted at preventing depression among persons with diabetes should be reinforced in Spain.