Blood glucose levels may be influenced by hyperbaric oxygen treatment (HBOT). Patients with diabetes mellitus commonly receive HBOT but there is a lack of standardised blood glucose management ...guidelines. We documented relevant contemporary practices applied for patients with diabetes treated in hyperbaric medicine units.
A survey was administered in 2022 to the directors of all 13 accredited hyperbaric units in Australia and New Zealand to identify policies and practices related to management of patients with diabetes receiving HBOT.
Twelve of the 13 units routinely managed patients with diabetes. Three-quarters (9/12) used < 4 mmol·l
as their definition of hypoglycaemia, whereas the other three used < 5, < 3.6, and < 3 mmol·l
. Units reported 26% (range 13-66%) of their patients have a diagnosis of diabetes of which 93% are type 2. Ten (83%) units reported specific written protocols for managing blood glucose. Protocols were more likely to be followed by nursing (73%) than medical staff (45%). Ten (83%) units routinely tested blood glucose levels on all patients with diabetes. Preferred pre-treatment values for treatments in both multiplace and monoplace chambers ranged from ≥ 4 to ≥ 8 mmol·l
. Seven (58%) units reported continuation of routine testing throughout a treatment course with five (42%) units having criteria-based rules for discontinuing testing for stable patients over multiple treatments. Two-thirds of units were satisfied with their current policy.
This survey highlights the burden of diabetes on patients treated with HBOT and identifies considerable variability in practices which may benefit from further study to optimise management of these patients.
Background The effects of kidney disease on the risk of hospitalization or death from specific noncardiovascular causes, including pneumonia, are unclear. The objective of this study is to determine ...the associations between estimated glomerular filtration rate (eGFR) and hospitalization or death with pneumonia. Study Design Retrospective cohort study. Setting & Participants Community-based study from a Canadian health region of 252,516 participants with 1 or more outpatient serum creatinine measurements from July 1, 2003, to June 30, 2004, who were not receiving dialysis or kidney transplantation. Predictor eGFR calculated by using the 4-variable Modification of Diet in Renal Disease Study equation. Outcomes Hospitalization with pneumonia or death within 30 days after pneumonia hospitalization. Measurements Cox proportional hazards models adjusted for age, sex, socioeconomic status, and comorbidities with censoring at death, initiation of renal replacement therapy, or emigration. Results Lower eGFR was associated with increased risk of hospitalization with pneumonia, although the magnitude of effect varied with age. The risk associated with decreased eGFR was greatest in participants 18 to 54 years old; compared with participants with an eGFR of 60 to 104 mL/min/1.73 m2 , adjusted hazard ratios for hospitalization with pneumonia were 3.23 (95% confidence interval, 2.40 to 4.36) in those with eGFR of 45 to 59 mL/min/1.73 m2 , 9.67 (95% confidence interval, 6.36 to 14.69) for eGFR of 30 to 44 mL/min/1.73 m2 , and 15.04 (95% confidence interval, 9.64 to 23.47) for eGFR less than 30 mL/min/1.73 m2 . Associations became weaker with increasing age, although the graded inverse association between lower eGFR and risk remained for older participants. An age-dependent inverse relationship also was observed between eGFR and risk of death within 30 days of hospitalization with pneumonia. Limitations Residual confounding caused by severity of illness or unmeasured comorbidities may be present. Conclusion The risk of hospitalization and death with pneumonia is greater at lower eGFRs, especially in younger adults. This association may contribute to excess mortality in people with chronic kidney disease.
BACKGROUND Patients with end-stage renal disease requiring dialysis are at high risk for bloodstream infection and infection-related death. Whether patients with chronic kidney disease who are not ...receiving dialysis are also at increased risk of bloodstream infection is less clear. METHODS We examined the association between chronic kidney disease not being treated with dialysis and bloodstream infection in a cohort of patients 66 years or older. All patients required at least 1 outpatient serum creatinine measurement enabling estimation of glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study equation. Cox proportional hazards models with censoring at the initiation of renal replacement therapy or death were used to determine associations between eGFR, bloodstream infection, and death within 30 days of community-onset bloodstream infection, adjusting for potential confounders. RESULTS In 25 675 patients followed up for a median of 3.2 years, 797 developed at least 1 bloodstream infection, of which most (75%) were community-onset infections. Compared with patients with an eGFR of 60 mL/min/1.73 m2 or higher, adjusted hazard ratios (95% confidence intervals) for bloodstream infection according to eGFR were, respectively, 1.24 (1.01-1.52), 1.59 (1.24-2.04), and 3.54 (2.69-4.69) in those with an eGFR of 45 to 59, 30 to 44, and less than 30 mL/min/1.73 m2. The associations were consistent for both community-onset and nosocomial infections. Compared with patients with an eGFR of 60 mL/min/1.73 m2 or higher, the risk of death within 30 days of community-onset bloodstream infection was significantly greater in those with an eGFR less than 30 mL/min/1.73 m2 (hazard ratio, 4.10; 95% confidence interval, 2.06-8.14). CONCLUSION Older adults with chronic kidney disease not being treated with dialysis are at increased risk of bloodstream infection and of death following community-onset bloodstream infection.Arch Intern Med. 2008;168(21):2333-2339-->
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