Objective: Fasting for lipid profiles is a deeply-rooted tradition that is being revisited. In patients with diabetes, such fasting poses a risk of hypoglycemia, as observed in recent studies and case reports. This ia...Objective: Fasting for lipid profiles is a deeply-rooted tradition that is being revisited. In patients with diabetes, such fasting poses a risk of hypoglycemia, as observed in recent studies and case reports. This iatrogenic, overlooked, form of hypoglycemia has been referred to as Fasting-Evoked En-route Hypoglycemia in Diabetes (FEEHD). The objective of the study is to determine the prevalence of FEEHD in clinical practice. Methods: A two-page survey was administered to adults with diabetes on anti-diabetic medication(s). Patients were asked if they recalled having experienced hypoglycemia while fasting for laboratory tests (FEEHD) during the preceding 12 months. Results: Of 168 patients enrolled, 166 completed the survey, with a mean age of 55.3 (SD: 15.4) years. Seventy-nine (47.6%) were females. Of these 166 patients, 119 (71 %) had type 2 diabetes. Forty-five patients (27.1%) reported having experienced one or more FEEHD events. Notably, only 31.1% of the patients who experienced a FEEHD event informed their provider of the event, and only 40% of FEEHD events reportedly resulted in any subsequent provider-made medication change(s) to prevent future events. Conclusions: This is the first study of FEEHD prevalence in clinical practice, the results of which serve to increase awareness amongst clinicians about the occurrence of FEEHD. We believe that FEEHD appears to be overlooked by clinicians. The prevalence of FEEHD in clinical practice is strikingly high (27.1%). More concerning is the significant underreporting of FEEHD events by patients to their clinicians (31%). We hope this study will trigger further investigation to confirm these preliminary findings and modify practice guidelines.展开更多
Objective: This study was designed to develop a dental-office-friendly diabetes self-screening tool for diabetes mellitus (DM) and prediabetes (PreDM). Methods: Consecutive dental patients, aged 18 years or older, wit...Objective: This study was designed to develop a dental-office-friendly diabetes self-screening tool for diabetes mellitus (DM) and prediabetes (PreDM). Methods: Consecutive dental patients, aged 18 years or older, without history of DM or PreDM, completed a 14-question questionnaire without assistance. They subsequently underwent onsite finger-sticks for capillary blood collection for glycohemoglobin (A1c) measurement. Results: Of the total 500 patients who completed the study, 302 were women (60.4%) and 198 were men (39.6%), with a collective mean age of 47.8 (±16.8) years old. The prevalence of PreDM and DM was 19.2% and 1.2%, respectively. Predictors of PreDM or DM included age, >10% above ideal body weight, waist size above 40” for men or 35” for women, reported hypertension, reported abnormal lipids, tingling of hands or feet, and visual symptoms or conditions (blurring, cataracts, glaucoma). Conclusions: This study introduces a newly developed, user-friendly, PreDM and DM self-screening tool, abbreviated as DiDDO (Diabetes detection in the dental office). This screening tool requires no body weighing or BMI calculation (undesirable by dentists) nor laboratory tests or blood pressure measurement, allowing dentists to identify patients at moderate and high risk for DM/PreDM, and perform (or refer for) diagnostic A1c testing. This dental-office-friendly self-screening tool is proposed for validation in other dental populations.展开更多
Background: A recent study reported that some patients with diabetes who fast overnight for laboratory tests are at risk of developing hypoglycemia, which could occur while patients are in risky situations which could...Background: A recent study reported that some patients with diabetes who fast overnight for laboratory tests are at risk of developing hypoglycemia, which could occur while patients are in risky situations which could result in harm to patients or others. Due to limitation in study design of the aforementioned study, the causes of hypoglycemia could not be elucidated. Objective: To better understand fasting-evoked en route hypoglycemia in diabetes (FEEHD), a recently recognized overlooked safety problem in diabetes management. Methods and Patients: A recent study reported that some patients with diabetes who fast overnight for laboratory tests are at risk of developing hypoglycemia, which could occur while patients are in risky situations which could result in harm to patients or others. Due to limitation in study design of the aforementioned study, the causes of hypoglycemia could not be elucidated. We undertook this retrospective case series study, which enrolled 4 consecutive cases of fasting hypoglycemia in patients with diabetes who were on diverse antidiabetic medications. The study duration was June 1, 2010 to June 1, 2012. Results: The 4 cases (3 women, 1 man), with either type 1 or type 2 diabetes, revealed multiple defects in either the patients’ knowledge and education regarding preparation for lab tests requiring fasting. The degree of hypoglycemia ranged from mild (65 mg/dl) to severe (31 mg/dl), and the events were either mildly symptomatic or asymptomatic. The possible causes of, and contributing factors to hypoglycemia are discussed, and recommendations for preventive measures are provided. Conclusion: Some patients with diabetes who fast for lab tests are at risk of hypoglycemia, and there seems to be an overall lack of proper education of patients with diabetes about this form of hypoglycemia. This overlooked problem can be prevented by proper education and preparation.展开更多
文摘Objective: Fasting for lipid profiles is a deeply-rooted tradition that is being revisited. In patients with diabetes, such fasting poses a risk of hypoglycemia, as observed in recent studies and case reports. This iatrogenic, overlooked, form of hypoglycemia has been referred to as Fasting-Evoked En-route Hypoglycemia in Diabetes (FEEHD). The objective of the study is to determine the prevalence of FEEHD in clinical practice. Methods: A two-page survey was administered to adults with diabetes on anti-diabetic medication(s). Patients were asked if they recalled having experienced hypoglycemia while fasting for laboratory tests (FEEHD) during the preceding 12 months. Results: Of 168 patients enrolled, 166 completed the survey, with a mean age of 55.3 (SD: 15.4) years. Seventy-nine (47.6%) were females. Of these 166 patients, 119 (71 %) had type 2 diabetes. Forty-five patients (27.1%) reported having experienced one or more FEEHD events. Notably, only 31.1% of the patients who experienced a FEEHD event informed their provider of the event, and only 40% of FEEHD events reportedly resulted in any subsequent provider-made medication change(s) to prevent future events. Conclusions: This is the first study of FEEHD prevalence in clinical practice, the results of which serve to increase awareness amongst clinicians about the occurrence of FEEHD. We believe that FEEHD appears to be overlooked by clinicians. The prevalence of FEEHD in clinical practice is strikingly high (27.1%). More concerning is the significant underreporting of FEEHD events by patients to their clinicians (31%). We hope this study will trigger further investigation to confirm these preliminary findings and modify practice guidelines.
文摘Objective: This study was designed to develop a dental-office-friendly diabetes self-screening tool for diabetes mellitus (DM) and prediabetes (PreDM). Methods: Consecutive dental patients, aged 18 years or older, without history of DM or PreDM, completed a 14-question questionnaire without assistance. They subsequently underwent onsite finger-sticks for capillary blood collection for glycohemoglobin (A1c) measurement. Results: Of the total 500 patients who completed the study, 302 were women (60.4%) and 198 were men (39.6%), with a collective mean age of 47.8 (±16.8) years old. The prevalence of PreDM and DM was 19.2% and 1.2%, respectively. Predictors of PreDM or DM included age, >10% above ideal body weight, waist size above 40” for men or 35” for women, reported hypertension, reported abnormal lipids, tingling of hands or feet, and visual symptoms or conditions (blurring, cataracts, glaucoma). Conclusions: This study introduces a newly developed, user-friendly, PreDM and DM self-screening tool, abbreviated as DiDDO (Diabetes detection in the dental office). This screening tool requires no body weighing or BMI calculation (undesirable by dentists) nor laboratory tests or blood pressure measurement, allowing dentists to identify patients at moderate and high risk for DM/PreDM, and perform (or refer for) diagnostic A1c testing. This dental-office-friendly self-screening tool is proposed for validation in other dental populations.
文摘Background: A recent study reported that some patients with diabetes who fast overnight for laboratory tests are at risk of developing hypoglycemia, which could occur while patients are in risky situations which could result in harm to patients or others. Due to limitation in study design of the aforementioned study, the causes of hypoglycemia could not be elucidated. Objective: To better understand fasting-evoked en route hypoglycemia in diabetes (FEEHD), a recently recognized overlooked safety problem in diabetes management. Methods and Patients: A recent study reported that some patients with diabetes who fast overnight for laboratory tests are at risk of developing hypoglycemia, which could occur while patients are in risky situations which could result in harm to patients or others. Due to limitation in study design of the aforementioned study, the causes of hypoglycemia could not be elucidated. We undertook this retrospective case series study, which enrolled 4 consecutive cases of fasting hypoglycemia in patients with diabetes who were on diverse antidiabetic medications. The study duration was June 1, 2010 to June 1, 2012. Results: The 4 cases (3 women, 1 man), with either type 1 or type 2 diabetes, revealed multiple defects in either the patients’ knowledge and education regarding preparation for lab tests requiring fasting. The degree of hypoglycemia ranged from mild (65 mg/dl) to severe (31 mg/dl), and the events were either mildly symptomatic or asymptomatic. The possible causes of, and contributing factors to hypoglycemia are discussed, and recommendations for preventive measures are provided. Conclusion: Some patients with diabetes who fast for lab tests are at risk of hypoglycemia, and there seems to be an overall lack of proper education of patients with diabetes about this form of hypoglycemia. This overlooked problem can be prevented by proper education and preparation.
