To protect from COVID-19 pandemic, several vaccines were developed infection with expected immunity against a SARS-CoV-2 infection. Short time side effects are reported. New onset diabetes was reported after SARS-CoV-...To protect from COVID-19 pandemic, several vaccines were developed infection with expected immunity against a SARS-CoV-2 infection. Short time side effects are reported. New onset diabetes was reported after SARS-CoV-2 infection. Here we report a case of new onset diabetes presenting with hyperosmolar hyperglycemic state, whose symptoms followed right after the second dose of Pfizer-BioNTech COVID-19 Vaccine. He is a 56-year old, obese Afro-American Veteran with no family history of diabetes and with HbA1C of 5.6 forty-five days prior to the hospitalization. He noted polyurea and excessive thirst following the second dose Pfizer-BioNTech COVID-19 vaccine. Hospitalized with hyperosmolar state and HbA1C of more than 14, he was treated initially with insulin drip and changed to basal, bolus regimen. In addition, he had new onset of oral thrush, requiring antifungal therapy. He needed higher doses of insulin during hospitalization and at discharge. He rapidly recovered and could be tapered off insulin in 4 months and recovered to normal glycemic state. We conclude that this is the second state to present with hyperosmolar state, and first case with rapid recovery of glycemic state.展开更多
AIM To evaluate the prevalence of vitamin D deficiency and its relation to diabetes and kidney disease in Veterans residing in the North East United States(VISN 2). METHODS In this retrospective study, we used data fr...AIM To evaluate the prevalence of vitamin D deficiency and its relation to diabetes and kidney disease in Veterans residing in the North East United States(VISN 2). METHODS In this retrospective study, we used data from the computerized patient record system at Stratton Veterans Administration Medical Center at Albany, NY(VHA) for those patients who had 25-hydroxyvitamin D levels and 1,25(OH) vitamin D levels measured between 2007 and 2010. We collected demographic information including age, sex, body mass index and race; clinical data including diabetes, hypertension and CAD; and laboratory data including calcium, creatinine and parathyroid hormone(PTH)(intact). Vitamin D deficiency is defined as a serum 25-hydroxyvitamin D level of less than 20 ng/mL(50 nmol/L), and insufficiency is defined as a serum 25-hydroxyvitamin D level of 20 to 30 ng/mL(50 to 75 nmol/L). RESULTS Data was available for approximately 68000 subjects. We identified 64144 subjects for analysis after exclusion of duplicates. Among them, 27098 had diabetes. Themean age of subjects with diabetes was 68 ± 11 with a mean body mass index(BMI) of 32 ± 7 and duration of diabetes of 5.6 ± 3.2 years. The mean 25(OH) vitamin D level among subjects with diabetes was 27 ± 11.6. There was no significant difference in 25(OH) vitamin D levels between subjects with diabetes and glomerular filtration rate(e-GFR) < 60 compared to those with e-GFR ≥ 60. As expected, subjects with e-GFR < 60 had significantly lower 1,25(OH) vitamin D levels and significantly elevated PTH-intact. Of the 64144 subjects, 580 had end-stage renal disease. Of those, 407 had diabetes and 173 did not. Vitamin D levels in both groups were in the insufficiency range and there was no significant difference irrespective of presence or absence of diabetes. Subjects with vitamin D levels less than 20 ng/mL had a higher BMI and elevated PTH, and higher HbA 1C levels compared to those with vitamin D levels more than 20 ng/mL. CONCLUSION We conclude that we need to keep a close eye on vitamin D levels in subjects with mild chronic kidney disease as well as those with moderate control of diabetes.展开更多
Prevalence of diabetes and prediabetes, as well as cardiovascular disease is very high among Veterans. The aim of the study is to evaluate the rate of progression of prediabetes and the factors associated with progres...Prevalence of diabetes and prediabetes, as well as cardiovascular disease is very high among Veterans. The aim of the study is to evaluate the rate of progression of prediabetes and the factors associated with progression to diabetes. This is an observational, retrospective data-base study of progression of prediabetes to diabetes at Veterans Health Administration at Columbia, South Carolina, diagnosed between 2008 and 2019 based on HbA1C (5.7 to 6.4). We calculated the time interval to progress to diabetes from the date of baseline data, and then the percentage of subjects progressed to diabetes is calculated as 1<sup>st</sup> year, 2<sup>nd</sup> year and so on. Statistical analysis included descriptive statistics and correlation of parameters with progression to diabetes. Subjects with prediabetes identified include 72,604 with mean age 66 and mean HbA1C of 5.9. Among the study population, only 8% were women. Association of hypertension was 55% and atherosclerotic coronary artery disease was 13%. Among the study population, 10,710 subjects did not have follow up. Among 61,894 prediabetics 21,954 (35%) progressed to diabetes, while 39,940 (65%) remained as prediabetic. Those progressed to diabetes had relatively higher HbA1C and associated with higher prevalence of atherosclerotic cardiovascular disease, hypertension and are older by age. About 60% of those progressed to diabetes are within 2 years from baseline. We conclude that aggressive measures are necessary to prevent progression to diabetes to decrease the morbidity associated with diabetes and health care burden. It is essential to identify those progress to diabetes, such as biomarker evaluation.展开更多
Prevalence of diabetes and prediabetes, post-traumatic stress disorder (PTSD) as well as atherosclerotic cardiovascular disease is very high among veterans. The primary aim of this study is to compare the rate of prog...Prevalence of diabetes and prediabetes, post-traumatic stress disorder (PTSD) as well as atherosclerotic cardiovascular disease is very high among veterans. The primary aim of this study is to compare the rate of progression of prediabetes to diabetes among veterans with or without PTSD and associated conditions and or risk factors for that. This retrospective observational database study included all subjects with prediabetes based on HbA1C (5.7 to 6.4), after exclusion criteria between 2008 and 2019 at Veterans Health Administration at Columbia, South Carolina. PTSD codes were used to identify veterans with PTSD. Subjects with prediabetes identified include 72,604 with mean age of 66 and mean HbA1C of 5.9% and 29% of them had PTSD. Follow-up data is available for 62,184 subjects. Among those who had follow-up, 35% progressed to diabetes, while 65% remained as prediabetic. Progression to diabetes negatively is correlated with HbA1C (r = 0.34;p < 0.001). Associated other risks include obesity, hypertension and atherosclerotic cardiovascular disease. The rate of progression was higher among subjects with PTSD though much younger than those without PTSD.展开更多
文摘To protect from COVID-19 pandemic, several vaccines were developed infection with expected immunity against a SARS-CoV-2 infection. Short time side effects are reported. New onset diabetes was reported after SARS-CoV-2 infection. Here we report a case of new onset diabetes presenting with hyperosmolar hyperglycemic state, whose symptoms followed right after the second dose of Pfizer-BioNTech COVID-19 Vaccine. He is a 56-year old, obese Afro-American Veteran with no family history of diabetes and with HbA1C of 5.6 forty-five days prior to the hospitalization. He noted polyurea and excessive thirst following the second dose Pfizer-BioNTech COVID-19 vaccine. Hospitalized with hyperosmolar state and HbA1C of more than 14, he was treated initially with insulin drip and changed to basal, bolus regimen. In addition, he had new onset of oral thrush, requiring antifungal therapy. He needed higher doses of insulin during hospitalization and at discharge. He rapidly recovered and could be tapered off insulin in 4 months and recovered to normal glycemic state. We conclude that this is the second state to present with hyperosmolar state, and first case with rapid recovery of glycemic state.
基金salary support from Veterans Health Administration
文摘AIM To evaluate the prevalence of vitamin D deficiency and its relation to diabetes and kidney disease in Veterans residing in the North East United States(VISN 2). METHODS In this retrospective study, we used data from the computerized patient record system at Stratton Veterans Administration Medical Center at Albany, NY(VHA) for those patients who had 25-hydroxyvitamin D levels and 1,25(OH) vitamin D levels measured between 2007 and 2010. We collected demographic information including age, sex, body mass index and race; clinical data including diabetes, hypertension and CAD; and laboratory data including calcium, creatinine and parathyroid hormone(PTH)(intact). Vitamin D deficiency is defined as a serum 25-hydroxyvitamin D level of less than 20 ng/mL(50 nmol/L), and insufficiency is defined as a serum 25-hydroxyvitamin D level of 20 to 30 ng/mL(50 to 75 nmol/L). RESULTS Data was available for approximately 68000 subjects. We identified 64144 subjects for analysis after exclusion of duplicates. Among them, 27098 had diabetes. Themean age of subjects with diabetes was 68 ± 11 with a mean body mass index(BMI) of 32 ± 7 and duration of diabetes of 5.6 ± 3.2 years. The mean 25(OH) vitamin D level among subjects with diabetes was 27 ± 11.6. There was no significant difference in 25(OH) vitamin D levels between subjects with diabetes and glomerular filtration rate(e-GFR) < 60 compared to those with e-GFR ≥ 60. As expected, subjects with e-GFR < 60 had significantly lower 1,25(OH) vitamin D levels and significantly elevated PTH-intact. Of the 64144 subjects, 580 had end-stage renal disease. Of those, 407 had diabetes and 173 did not. Vitamin D levels in both groups were in the insufficiency range and there was no significant difference irrespective of presence or absence of diabetes. Subjects with vitamin D levels less than 20 ng/mL had a higher BMI and elevated PTH, and higher HbA 1C levels compared to those with vitamin D levels more than 20 ng/mL. CONCLUSION We conclude that we need to keep a close eye on vitamin D levels in subjects with mild chronic kidney disease as well as those with moderate control of diabetes.
文摘Prevalence of diabetes and prediabetes, as well as cardiovascular disease is very high among Veterans. The aim of the study is to evaluate the rate of progression of prediabetes and the factors associated with progression to diabetes. This is an observational, retrospective data-base study of progression of prediabetes to diabetes at Veterans Health Administration at Columbia, South Carolina, diagnosed between 2008 and 2019 based on HbA1C (5.7 to 6.4). We calculated the time interval to progress to diabetes from the date of baseline data, and then the percentage of subjects progressed to diabetes is calculated as 1<sup>st</sup> year, 2<sup>nd</sup> year and so on. Statistical analysis included descriptive statistics and correlation of parameters with progression to diabetes. Subjects with prediabetes identified include 72,604 with mean age 66 and mean HbA1C of 5.9. Among the study population, only 8% were women. Association of hypertension was 55% and atherosclerotic coronary artery disease was 13%. Among the study population, 10,710 subjects did not have follow up. Among 61,894 prediabetics 21,954 (35%) progressed to diabetes, while 39,940 (65%) remained as prediabetic. Those progressed to diabetes had relatively higher HbA1C and associated with higher prevalence of atherosclerotic cardiovascular disease, hypertension and are older by age. About 60% of those progressed to diabetes are within 2 years from baseline. We conclude that aggressive measures are necessary to prevent progression to diabetes to decrease the morbidity associated with diabetes and health care burden. It is essential to identify those progress to diabetes, such as biomarker evaluation.
文摘Prevalence of diabetes and prediabetes, post-traumatic stress disorder (PTSD) as well as atherosclerotic cardiovascular disease is very high among veterans. The primary aim of this study is to compare the rate of progression of prediabetes to diabetes among veterans with or without PTSD and associated conditions and or risk factors for that. This retrospective observational database study included all subjects with prediabetes based on HbA1C (5.7 to 6.4), after exclusion criteria between 2008 and 2019 at Veterans Health Administration at Columbia, South Carolina. PTSD codes were used to identify veterans with PTSD. Subjects with prediabetes identified include 72,604 with mean age of 66 and mean HbA1C of 5.9% and 29% of them had PTSD. Follow-up data is available for 62,184 subjects. Among those who had follow-up, 35% progressed to diabetes, while 65% remained as prediabetic. Progression to diabetes negatively is correlated with HbA1C (r = 0.34;p < 0.001). Associated other risks include obesity, hypertension and atherosclerotic cardiovascular disease. The rate of progression was higher among subjects with PTSD though much younger than those without PTSD.
