Uncontrolled dm
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Summary
10 papers analyzed
These studies suggest that uncontrolled diabetes mellitus is associated with increased risks of hospitalization, cardiovascular events, infections, surgical complications, and higher mortality, particularly in certain demographics and regions.
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Uncontrolled Diabetes Mellitus: Trends, Risks, and Management
Increasing Hospitalizations and Improved Outcomes
Trends in Uncontrolled Diabetes Hospitalizations
From 2003 to 2011, hospitalizations due to uncontrolled diabetes mellitus (UDM) in the U.S. increased by approximately 25% across all demographic groups. Despite this rise, outcomes for these patients improved, with reductions in both the length of hospital stays and risk-adjusted in-hospital mortality rates.
Cardiovascular Risks and Mortality
Cardiovascular Events and Mortality in South Korea
A study in South Korea found that uncontrolled diabetes significantly increases the risk of major adverse cardiovascular events (MACE) and mortality. Patients with uncontrolled diabetes had a higher incidence of MACE and death from any cause compared to those with controlled diabetes. This highlights the critical need for effective management of blood glucose levels to mitigate cardiovascular risks.
Cardiovascular Risk in the U.S.
Similarly, in the U.S., patients with uncontrolled diabetes showed a higher prevalence of cardiovascular risk factors and complications. The Framingham risk score indicated that individuals with uncontrolled diabetes had a significantly higher 10-year cardiovascular risk compared to those with controlled diabetes or non-diabetic individuals.
Complications and Infections
Increased Risk of Infections in Cirrhosis Patients
Uncontrolled diabetes is associated with a higher risk of bacterial infections in patients with advanced cirrhosis. This risk is particularly pronounced in elderly patients, who also face increased inpatient mortality rates. Effective glycemic control is essential to reduce these risks and improve patient outcomes.
Postoperative Complications
Patients with uncontrolled diabetes undergoing posterior lumbar fusion surgery are at a higher risk of postoperative complications, including surgical site infections, cerebrovascular events, and acute kidney injury. These patients also incur higher healthcare costs due to these complications.
Socioeconomic Factors and Demographics
Impact of Socioeconomic Status
In Philadelphia, younger adults and those living in lower socioeconomic neighborhoods exhibited higher rates of uncontrolled hyperglycemia. This suggests that socioeconomic factors play a significant role in diabetes management and outcomes.
Prevalence in Northern Sudan
In Northern Sudan, a high prevalence of uncontrolled diabetes was observed, particularly among older adults, housewives, and those with inactive lifestyles. This underscores the need for targeted interventions to address lifestyle factors and improve diabetes control in these populations.
Management Strategies
Aggressive Blood Glucose and Blood Pressure Control
While aggressive control of blood glucose and blood pressure has been recommended, recent studies suggest that overly stringent targets may not provide additional benefits and could be detrimental. Current guidelines advocate for more moderate targets to balance efficacy and safety.
Endocrine Consultations in Emergency Settings
Implementing standardized endocrine consultations for patients with severely uncontrolled diabetes (HbA1c ≥ 9%) in emergency departments has shown promising results. This approach led to significant medication adjustments and improved patient adherence to diabetes management post-discharge.
Conclusion
Uncontrolled diabetes mellitus poses significant risks, including increased hospitalizations, cardiovascular events, infections, and postoperative complications. Socioeconomic factors and lifestyle choices further influence diabetes control. Effective management strategies, including moderate glycemic targets and specialized consultations, are essential to improve outcomes and reduce the burden of uncontrolled diabetes.
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