Browsing by Subject "diabetes mellitus"
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Item Open Access CABG or PCI for Diabetic Patients With Left Ventricular Dysfunction: Closing in on the Truth?(Journal of the American College of Cardiology, 2018-02) Velazquez, Eric J; Petrie, Mark CItem Open Access Concurrent Diabetes Mellitus may Negatively Influence Clinical Progression and Response to Androgen Deprivation Therapy in Patients with Advanced Prostate Cancer.(Frontiers in oncology, 2015-01) Shevach, Jeffrey; Gallagher, Emily Jane; Kochukoshy, Teena; Gresia, Victoria; Brar, Manpreet; Galsky, Matthew D; Oh, William KObjective
To determine if a concurrent diagnosis of diabetes mellitus is associated with worse outcomes in advanced prostate cancer (PC). The effect diabetes may have on the progression of advanced PC is poorly understood.Methods
Data on 148 advanced PC patients (35 with concurrent diabetes) were collected from an institutional database to obtain diabetic status, data on treatment types and durations, and prostate-specific antigen (PSA) values before, during, and after treatment. Time to castration resistance following the onset of androgen deprivation therapy (ADT) and overall survival (OS) in patients with and without diabetes were compared using univariate Cox regression analyses as the primary endpoints. Differences in PSA response to treatments were compared using chi-squared tests as a secondary endpoint.Results
With a median follow-up of 29 months, time to castration resistance did not differ significantly between patients with and without diabetes who underwent ADT. However, in a subset of patients who received ADT without radiographic evidence of metastases (N = 47), those with diabetes progressed to castration-resistant disease more quickly than those without DM (hazard ratio for progression with diabetes = 4.58; 95% CI: 1.92-10.94; p = 0.0006). Also, a lower percentage of patients undergoing ADT with diabetes had PSA declines of at least 50% (p = 0.17) and reached a nadir PSA <0.2 ng/mL (p = 0.06). OS did not differ based on diabetic status. No differences were seen in response to first-line therapy for castration-resistant prostate cancer.Conclusion
Diabetes mellitus may have a detrimental effect on progression of advanced PC, particularly in those patients without radiographic evidence of metastases. Further study is necessary to fully elucidate the effect of diabetes on PC outcomes.Item Open Access Does diabetes affect outcome or reoperation rate after lumbar decompression or arthrodesis? A matched analysis of the Quality Outcomes Database data set.(Journal of neurosurgery. Spine, 2023-12) Mooney, James; Nathani, Karim Rizwan; Zeitouni, Daniel; Michalopoulos, Giorgos D; Wang, Michael Y; Coric, Domagoj; Chan, Andrew K; Lu, Daniel C; Sherrod, Brandon A; Gottfried, Oren N; Shaffrey, Christopher I; Than, Khoi D; Goldberg, Jacob L; Hussain, Ibrahim; Virk, Michael S; Agarwal, Nitin; Glassman, Steven D; Shaffrey, Mark E; Park, Paul; Foley, Kevin T; Chou, Dean; Slotkin, Jonathan R; Tumialán, Luis M; Upadhyaya, Cheerag D; Potts, Eric A; Fu, Kai-Ming G; Haid, Regis W; Knightly, John J; Mummaneni, Praveen V; Bisson, Erica F; Asher, Anthony L; Bydon, MohamadObjective
Diabetes mellitus (DM) is a known risk factor for postsurgical and systemic complications after lumbar spinal surgery. Smaller studies have also demonstrated diminished improvements in patient-reported outcomes (PROs), with increased reoperation and readmission rates after lumbar surgery in patients with DM. The authors aimed to examine longer-term PROs in patients with DM undergoing lumbar decompression and/or arthrodesis for degenerative pathology.Methods
The Quality Outcomes Database was queried for patients undergoing elective lumbar decompression and/or arthrodesis for degenerative pathology. Patients were grouped into DM and non-DM groups and optimally matched in a 1:1 ratio on 31 baseline variables, including the number of operated levels. Outcomes of interest were readmissions and reoperations at 30 and 90 days after surgery in addition to improvements in Oswestry Disability Index, back pain, and leg pain scores and quality-adjusted life-years at 90 days after surgery.Results
The matched decompression cohort comprised 7836 patients (3236 [41.3] females) with a mean age of 63.5 ± 12.6 years, and the matched arthrodesis cohort comprised 7336 patients (3907 [53.3%] females) with a mean age of 64.8 ± 10.3 years. In patients undergoing lumbar decompression, no significant differences in nonroutine discharge, length of stay (LOS), readmissions, reoperations, and PROs were observed. In patients undergoing lumbar arthrodesis, nonroutine discharge (15.7% vs 13.4%, p < 0.01), LOS (3.2 ± 2.0 vs 3.0 ± 3.5 days, p < 0.01), 30-day (6.5% vs 4.4%, p < 0.01) and 90-day (9.1% vs 7.0%, p < 0.01) readmission rates, and the 90-day reoperation rate (4.3% vs 3.2%, p = 0.01) were all significantly higher in the DM group. For DM patients undergoing lumbar arthrodesis, subgroup analyses demonstrated a significantly higher risk of poor surgical outcomes with the open approach.Conclusions
Patients with and without DM undergoing lumbar spinal decompression alone have comparable readmission and reoperation rates, while those undergoing arthrodesis procedures have a higher risk of poor surgical outcomes up to 90 days after surgery. Surgeons should target optimal DM control preoperatively, particularly for patients undergoing elective lumbar arthrodesis.Item Open Access Improving diabetes medication adherence: successful, scalable interventions.(Patient preference and adherence, 2015-01) Zullig, Leah L; Gellad, Walid F; Moaddeb, Jivan; Crowley, Matthew J; Shrank, William; Granger, Bradi B; Granger, Christopher B; Trygstad, Troy; Liu, Larry Z; Bosworth, Hayden BEffective medications are a cornerstone of prevention and disease treatment, yet only about half of patients take their medications as prescribed, resulting in a common and costly public health challenge for the US health care system. Since poor medication adherence is a complex problem with many contributing causes, there is no one universal solution. This paper describes interventions that were not only effective in improving medication adherence among patients with diabetes, but were also potentially scalable (ie, easy to implement to a large population). We identify key characteristics that make these interventions effective and scalable. This information is intended to inform health care systems seeking proven, low resource, cost-effective solutions to improve medication adherence.Item Open Access Modifiers of Plasma 25-hydroxyvitamin D and Chronic Kidney Disease Outcomes in Black Americans: The Jackson Heart Study Supplemental FileLunyera, J; Davenport, Clemontina; Bhavsar, Nrupen; Sims, Mario; Pendergast, Jane; Musani, Solomon; Mwasongwe, Stanford; Wolf, Myles; Diamantidis, Clarissa; Boulware, Ebony; Scialla, Julia