Medicine (RMH) - Research Publications
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ItemIn-hospital hyperglycemia but not diabetes mellitus alone is associated with increased in-hospital mortality in community-acquired pneumonia (CAP): systematic review and meta-analysis of observational studies prior to COVID-19(BMJ PUBLISHING GROUP, 2022-07)The objective of this review was to quantify the association between diabetes, hyperglycemia, and outcomes in patients hospitalized for community-acquired pneumonia (CAP) prior to the COVID-19 pandemic by conducting a systematic review and meta-analysis. Two investigators independently screened records identified in the PubMed (MEDLINE), EMBASE, CINAHL, and Web of Science databases. Cohort and case-control studies quantitatively evaluating associations between diabetes and in-hospital hyperglycemia with outcomes in adults admitted to hospital with CAP were included. Quality was assessed using the Newcastle-Ottawa Quality Assessment Scale, effect size using random-effects models, and heterogeneity using I2 statistics. Thirty-eight studies met the inclusion criteria. Hyperglycemia was associated with in-hospital mortality (adjusted OR 1.28, 95% CI 1.09 to 1.50) and intensive care unit (ICU) admission (crude OR 1.82, 95% CI 1.17 to 2.84). There was no association between diabetes status and in-hospital mortality (adjusted OR 1.04, 95% CI 0.72 to 1.51), 30-day mortality (adjusted OR 1.13, 95% CI 0.77 to 1.67), or ICU admission (crude OR 1.91, 95% CI 0.74 to 4.95). Diabetes was associated with increased mortality in all studies reporting >90-day postdischarge mortality and with longer length of stay only for studies reporting crude (OR 1.50, 95% CI 1.11 to 2.01) results. In adults hospitalized with CAP, in-hospital hyperglycemia but not diabetes alone is associated with increased in-hospital mortality and ICU admission. Diabetes status is associated with increased >90-day postdischarge mortality. Implications for management are that in-hospital hyperglycemia carries a greater risk for in-hospital morbidity and mortality than diabetes alone in patients admitted with non-COVID-19 CAP. Evaluation of strategies enabling timely and effective management of in-hospital hyperglycemia in CAP is warranted.
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ItemAssistive technology for diabetes management: A toolkit(Mark Allen Group, 2022-05-02)This article provides an up-to-date guide to the types of assistive technology designed for patients with diabetes.
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ItemSex steroids and gender differences in muscle, bone, and fat(Elsevier, 2022)Sex steroids, comprising of the androgens, estrogens, and progestogens, are fundamentally important to the development of muscle, bone, and fat across the life course. Each has roles that differ between these tissues, the male and female sexes, and developmental stage. It is the differential production of sex steroids and expression of their receptors that mediates much of the pubertal development in muscle, bone, and fat, which in turn determines the typical dimorphic sexual phenotypes. It is similar to how this differential production changes over time that is responsible for much of the typical sex-specific changes seen with normal aging. This chapter considers the sex-specific production of sex steroids and their effects upon each muscle, bone, and fat. It additionally covers the developmental changes in sex steroid production, and how this contributes to age-related changes in these three tissues.
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ItemEnd-of-Life Care Requires Caution with Use of Continuous Glucose Monitoring(MARY ANN LIEBERT, INC, 2022-03-01)Use of medical device technologies for diabetes mellitus, including continuous glucose monitoring devices, is becoming more frequently encountered in end-of-life care. Good communication is paramount to determine patient and carer preferences for if, when, and how blood glucose monitoring should occur in the end-of-life setting. We present two differing cases of how continuous glucose monitoring in an Australian setting impacted end-of-life care for the patients and their carers.
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