DOCSLIB.ORG

The Official Journal of ATTD Advanced Technologies

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Official Journal of ATTD Advanced Technologies ATTD 2018 Invited Speaker Abstracts A-1 ATTD 2018 Oral Abstracts A-11 ATTD 2018 E-Poster Discussion Abstracts A-36 Downloaded by 187.178.95.102 from www.liebertpub.com at 04/09/18. For personal use only. ATTD 2018 E-Poster Viewing Abstracts A-48 ATTD 2018 Read By Title A-149 ATTD 2018 Abstract Author Index A-153 DIABETES TECHNOLOGY & THERAPEUTICS Volume 20, Supplement 1, 2018 ª Mary Ann Liebert, Inc. DOI: 10.1089/dia.2018.2525.abstracts ATTD 2018 ABSTRACTS ATTD 2018 Invited Speaker Abstracts 001 Clinicians are frequently confronted with discrepancies be- tween glucose values as noted by patients in their diaries and OPENING CEREMONY HbA1c values. Also in the CGM era, such discrepancies are still ATTD8-0442 seen. A number of explanations can co-exist. One of these is the glycation gap, the variation in HbA1c that can be seen between BEYOND A1C: CONSENSUS ON CGM OUTCOMES patients with identical mean glucose values. Whether this is more T. Danne1 than a mathematical phenomenon has been debated extensively over the years. More recently, the glycation gap has been pro- 1 Kinder- und Jugendkrankenhaus AUF DER BULT, Dep. of posed as a possible explanation for the ACCORD findings. All General Pediatrics-Diabetes-Endocrinology & Clinical this will be put in perspective in this talk. Reserach, Hannover, Germany Recently several panels of physicians, researchers, regulators 003 and individuals with diabetes who are experts in continuous glucose monitoring (CGM) technologies addressed the issue NEXT GENERATION SOLUTIONS how to move beyond the HbA1c measurement as the sole marker ATTD8-0446 of glycemic control. Although HbA1c has proved extremely valuable in for patient management, is a valuable measure of DEALING WITH PATIENT AND DEVICE population health and remains a validated indicator of glycation UNCERTAINTY IN THE ARTIFICIAL PANCREAS: as a risk factor for complications, it is not as helpful for per- MULTI-ZONES, ADAPTATION, AND TRUST INDICES sonalized diabetes management. The recently published ATTD F.J. Doyle1 consensus recommendations represent the current understand- ing of how CGM results can affect outcomes. CGM, either from 1Harvard University, School of Engineering and Applied real-time use (rtCGM) or intermittently-viewed continuous Sciences, Cambridge, USA glucose monitoring (iCGM), address many of the limitations inherent in HbA1c testing and SMBG. The reliable identifica- There have been well over 100 closed-loop clinical trials for tion of hypoglycemia is just as important as the measurement of the artificial pancreas (AP), in one form or another, over the last time in range (70–180 mg/dl [3.9–10.0 mmol/L]) in clinical decade. Commercial devices have also begun to emerge in the trials. Quantifying the duration and extent of glycemic excur- last year. Yet, in many respects, we have only scratched the sions and glycemic variability (by Coefficient of Variation, surface on algorithms for the AP as most of the current studies which defines stable glucose levels as CV <36%) provides an- focus on fairly traditional implementations of fuzzy logic, PID, other parameter for assessing glucose control. In clinical prac- or MPC control systems. In this talk I will highlight recent al- Downloaded by 187.178.95.102 from www.liebertpub.com at 04/09/18. For personal use only. tice, the advanced metrics of assessing continuous glucose data gorithm engineering results, including preliminary clinical data, are appropriate as outcome parameters that complement HbA1c on the next wave of algorithms that address the intrinsic uncer- for a wide range of patients with diabetes and should be con- tainty in the patient-device feedback loop. These include ex- sidered for use to help them improve glycemic control provided tensions of our successful zone MPC design to address multiple that appropriate educational and technical support is available. distinct zones and trust indices. CGM is also a robust research tool, and CGM data should be recognized by governing bodies as a valuable and meaningful endpoint to be used in clinical trials of new drugs and devices for 004 diabetes treatment. NEXT GENERATION SOLUTIONS 002 ATTD8-0447 GLUCOSE METRICX: BEYOND HBA1C NEXT GENERATION AUTOMATED INSULIN DELIVERY: ON-BODY ECOSYSTEM FOR ATTD8-0439 AUTOMATED INSULIN DELIVERY GLYCATION GAP: DOES IT EXIST? IN TYPE 1 DIABETES H. De Vries1 E. Dassau1 1Academic Medical Center at the University of Amsterdam, 1Harvard University, Harvard John A. Paulson School of Endocrinology, Amsterdam, The Netherlands Engineering and Applied Sciences, Cambridge, USA A-1 A-2 ATTD 2018 INVITED SPEAKER ABSTRACTS Fully automated glucose management technologies for type 1 3. Generate data able to satisfy safety and efficacy re- diabetes (T1D) require advanced sensing and decision-support to quirements by regulatory agencies regarding the clin- function safely, intelligently, and efficiently. Recent academic ical testing of artificial pancreas device systems in the studies as well as early commercial devices have shown to be target population of people with type 1 diabetes. safe and effective in managing glucose across different chal- lenges and in outpatient settings. The iDCL Trial runs in 7 research sites in the U.S. and 3 sites New developments in wearable and embedded technology, in Europe coordinated by the Jaeb Center for Health Research. big data, fog and edge computing, wireless networks and cloud iDCL Protocol 1 is a trial of mobile closed-loop control using a computing, provide a unique opportunity to enhance automation, smart phone to run the control algorithm and communicate with manage therapeutic strategies and improve quality of care in subcutaneous continuous glucose monitor (CGM) and an insulin people with T1D by exploiting real-time medical information pump. Protocol 2 uses a mobile system as well, but the CGM is from a vast collection of sensors: the medical internet-of-things expected to be an implantable device. Protocol 3 is testing a (mIoT). In this talk I will highlight recent developments to enable hardware configuration in which the control algorithm is em- on-Body Ecosystem including a new platform to support the bedded in the insulin pump. First data from the active protocols clinical investigation of mIoT, results of fully embedded control will be presented. design on a chip and strategies to integrate mIoT in diabetes research and clinical studies. 007 BIOTECHNOLOGY AND DIABETES 005 ATTD8-0443 DEBATE: PUMP V. SENSOR – WHAT IS MORE IMPORTANT POST-TRANSPLANT DIABETES IN CHILDREN AND ADOLESCENTS ATTD8-0438 M. Sperling1 SENSORS 1Professorial Lecturer-Icahn School of Meicine at Mount Sinai, H. De Vries1 Pediatric Endocrinology and Diabetes, New York, USA 1Academic Medical Center at the University of Amsterdam, POST-TRANSPLANT DIABETES IN ADOLESCENTS Endocrinology, Amsterdam, The Netherlands Post-transplant diabetes (PTDM) is an increasingly recog- nized and common consequence of solid organ transplantation, Drs Leelarathna and DeVries will debate on the pro’s and cons present in the majority in the immediate post-operative period of insulin pump therapy in the age of continuous glucose mon- and persisting as ‘‘permanent’’ diabetes in about 12%–15% of itoring. Continuous glucose monitoring seems to establish itself transplant recipients. The immediate precipitating factors are the as the standard of care. What, if any, is the role of insulin pumps immunosuppressive agents; the calcineurin inhibitors cyclo- nowadays? sporine and tacrolimus, the molecular target of Rapamycin (mTOR) inhibitors sirolimus and everolimus, and high dose 006 steroids. Together, these agents combine to exert toxic effects on beta cells, induce hypomagnesemia, impair insulin secretion, CLOSING THE LOOP - NIH-FUNDED AP RESEARCH and induce insulin resistance, magnified by the inflammatory EFFORTS stressors of surgery. In addition, a family history and identified ATTD8-0452 SNPs associated with T1DM, T2DM, and MODY suggest a genetic predisposition in those who go on to permanent DM after THE INTERNATIONAL DIABETES CLOSED-LOOP the acute high doses of immuno-suppressive drugs used to (IDCL) TRIAL manage rejection are reduced. The criteria applied to diagnose Downloaded by 187.178.95.102 from www.liebertpub.com at 04/09/18. For personal use only. DM are based on glucose concentrations as defined by the B. Kovatchev1 American Diabetes Association and/or the International Diabetes 1University of Virginia, Center for Diabetes Technology, Federation; HbA1c measurements should not be used to diagnose Charlottesville, USA PTDM because they are unreliable in the post-operative patient receiving blood products. PTDM may interfere with post- The iDCL Trial is supported by NIH/NIDDK grant UC4 DK operative healing and recovery and predisposes the patient to 108483. This project includes three parallel protocols testing infections, particularly HCV and CMV viral infections. Sepsis is different hardware implementations of the inControl closed-loop more likely in those with poorly controlled PTDM. The source of algorithm originally developed at the University of Virginia and the donor organ also influences the subsequent development of then refined by TypeZero Technologies, Inc. A fourth protocol is PTDM; e.g. cadaveric kidney organs, related or unrelated to the planned for 2018 to test a control algorithm developed at Harvard recipient, are more likely to be associated with PTDM than or- University. The objectives of the iDCL Trial are to: gans from living donors, and this has been attributed to higher levels of pro-inflammatory
Load more

Recommended publications
  • Chapter 7: Monogenic Forms of Diabetes
    CHAPTER 7 MONOGENIC FORMS OF DIABETES Mark A. Sperling, MD, and Abhimanyu Garg, MD Dr. Mark A. Sperling is Emeritus Professor and Chair, University of Pittsburgh, Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA. Dr. Abhimanyu Garg is Professor of Internal Medicine and Chief of the Division of Nutrition and Metabolic Diseases at University of Texas Southwestern Medical Center, Dallas, TX. SUMMARY Types 1 and 2 diabetes have multiple and complex genetic influences that interact with environmental triggers, such as viral infections or nutritional excesses, to result in their respective phenotypes: young, lean, and insulin-dependence for type 1 diabetes patients or older, overweight, and often manageable by lifestyle interventions and oral medications for type 2 diabetes patients. A small subset of patients, comprising ~2%–3% of all those diagnosed with diabetes, may have characteristics of either type 1 or type 2 diabetes but have single gene defects that interfere with insulin production, secretion, or action, resulting in clinical diabetes. These types of diabetes are known as MODY, originally defined as maturity-onset diabetes of youth, and severe early-onset forms, such as neonatal diabetes mellitus (NDM). Defects in genes involved in adipocyte development, differentiation, and death pathways cause lipodystrophy syndromes, which are also associated with insulin resistance and diabetes. Although these syndromes are considered rare, more awareness of these disorders and increased availability of genetic testing in clinical and research laboratories, as well as growing use of next generation, whole genome, or exome sequencing for clinically challenging phenotypes, are resulting in increased recognition. A correct diagnosis of MODY, NDM, or lipodystrophy syndromes has profound implications for treatment, genetic counseling, and prognosis.
    [Show full text]
  • Living with Diabetes in the Family Iabetes Affects All Members of the Family, Fat Diet and the Twice-Daily Insulin Injections
    SA JOURNAL OF DIABETES & VASCULAR DISEASE REVIEW References 10. Hattersley A, Bruining J, Shield J, Njolstad P, Donaghue KC. The diagnosis of and management of monogenic diabetes in children and adolescents. Pediat Diabetes 1. Neel J. Diabetes mellitus: a geneticist’s nightmare. In: Creutzfeldt W, Kobberling 2009; 10(suppl 12): 33–42. J, Neel JV, eds. The Genetics of Diabetes Mellitus. Berlin: Springer-Verlag, 1976: 11. Slingerland AS. Monogenic diabetes in children and adults: Challenges for 1–11. researcher, clinician and patient. Rev Endocr Metab Disord 2006; 7: 171–185. 2. Keen H. The genetics of diabetes: from nightmare to headache. Br Med J 1987; 12. Barrett TG. Differential diagnosis of type 1 diabetes: which genetic syndromes 294: 917–919. need to be considered? Pediat Diabetes 2007; 8(suppl 6): 15–23. 3. Rotter JI. The modes of inheritance of insulin-dependent diabetes mellitus or the 13. Clinical genetics and genetic counseling. In: Jorde LB, et al., eds. Medical genetics of IDDM, no longer a nightmare but still a headache. Am J Hum Genet Genetics, 2nd edn. St Louis: Mosby, 1999: 292. 1981; 33: 835–851. 14. The National Society of Genetic Counselor’s Task Force: Resta R, et al. A new 4. Craig ME, Hattersley A, Donaghue KC. Definition, epidemiology and classification definition of genetic counselling: National Society of Genetic Counselor’s Task of diabetes in children and adolescents. Pediat Diabetes 2009; 10(suppl 12): 3–12 Force report. J Genet Couns 2006; 15(2): 77–83. 5. Jahromi MM, Eisenbarth GS. Cellular and molecular pathogenesis of type 1A 15.
    [Show full text]
  • LANTUS® (Insulin Glargine [Rdna Origin] Injection)
    Rev. March 2007 Rx Only LANTUS® (insulin glargine [rDNA origin] injection) LANTUS® must NOT be diluted or mixed with any other insulin or solution. DESCRIPTION LANTUS® (insulin glargine [rDNA origin] injection) is a sterile solution of insulin glargine for use as an injection. Insulin glargine is a recombinant human insulin analog that is a long-acting (up to 24-hour duration of action), parenteral blood-glucose-lowering agent. (See CLINICAL PHARMACOLOGY). LANTUS is produced by recombinant DNA technology utilizing a non- pathogenic laboratory strain of Escherichia coli (K12) as the production organism. Insulin glargine differs from human insulin in that the amino acid asparagine at position A21 is replaced by glycine and two arginines are added to the C-terminus of the B-chain. Chemically, it is 21A- B B Gly-30 a-L-Arg-30 b-L-Arg-human insulin and has the empirical formula C267H404N72O78S6 and a molecular weight of 6063. It has the following structural formula: LANTUS consists of insulin glargine dissolved in a clear aqueous fluid. Each milliliter of LANTUS (insulin glargine injection) contains 100 IU (3.6378 mg) insulin glargine. Inactive ingredients for the 10 mL vial are 30 mcg zinc, 2.7 mg m-cresol, 20 mg glycerol 85%, 20 mcg polysorbate 20, and water for injection. Inactive ingredients for the 3 mL cartridge are 30 mcg zinc, 2.7 mg m-cresol, 20 mg glycerol 85%, and water for injection. The pH is adjusted by addition of aqueous solutions of hydrochloric acid and sodium hydroxide. LANTUS has a pH of approximately 4. CLINICAL PHARMACOLOGY Mechanism of Action: The primary activity of insulin, including insulin glargine, is regulation of glucose metabolism.
    [Show full text]
  • Treatment of Diabetes Mellitus
    TREATMENT OF DIABETES MELLITUS DIABETES is a condition that affects how the body makes energy from food. Food is broken down into sugar (glucose) in the body and released into the blood. When the blood sugar level rises after a meal, insulin responds to let the sugar into the cells to be used as energy. In diabetes, the body either does not make enough insulin or it stops responding to insulin as well as it should. This results in sugar staying in the blood and leads to serious health problems over time. DIAGNOSIS OF DIABETES1 • A1C Test: Lab test measuring average blood sugar over past two to three months • Fasting Blood Sugar Test: Lab test measuring blood sugar after eight hours of no food or drink • Oral Glucose Tolerance Test (OGTT): Measures blood sugar before and two hours after drinking a specific sugary liquid • Random Blood Sugar Test: Measures blood sugar at a moment in time, without any kind of preparation (like fasting) FASTING BLOOD ORAL GLUCOSE TOLERANCE RANDOM BLOOD RESULT A1C TEST SUGAR TEST TEST SUGAR TEST Diabetes ≥ 6.5% ≥126 mg/dL ≥ 200 mg/dL ≥ 200 mg/dL Prediabetes 5.7 – 6.4% 100 – 125 mg/dL 140 – 199 mg/dL N/A Normal < 5.7% ≤99 mg/dL < 140 mg/dL N/A NON-DRUG TREATMENTS2 THERAPY COST WHAT TO EXPECT Diet (Mediterranean diet) and exercise (30 minutes a day, five days a week of moderate- Weight loss $-$$ intensity exercise); 7% weight loss decreases risk of diabetes3 Psychological intervention $$-$$$ Psychotherapy may reduce diabetic distress and improve glycemic control4,5 nationalcooperativerx.com PRESCRIPTION TREATMENTS
    [Show full text]
  • Not Every Diabetic Child Has Type 1 Diabetes Mellitus Nem Toda Criança Diabética É Tipo 1 Thais Della Manna*
    0021-7557/07/83-05-Supl/S178 Jornal de Pediatria Copyright © 2007 by Sociedade Brasileira de Pediatria ARTIGO DE REVISÃO Not every diabetic child has type 1 diabetes mellitus Nem toda criança diabética é tipo 1 Thais Della Manna* Resumo Abstract Objetivo: Apesar de o diabetes melito tipo 1 de origem Objective: Although it is type 1 diabetes mellitus of autoimmune autoimune ser o mais prevalente na infância e adolescência, outras origin that is most prevalent in childhood and adolescence, other formas de diabetes também podem acometer essa população, forms of diabetes can also affect this population, resulting in different implicando em prognóstico e tratamentos diferentes. prognosis and treatment. Fontes dos dados: Foram utilizadas informações através de Sources: Information was obtained by means of a bibliographic revisão bibliográfica realizada por busca direta de artigos científicos review, carried out by running searches for scientific articles in the nas bases de dados MEDLINE e LILACS, além de publicações clássicas MEDLINE and LILACS databases, in addition to classic publications referentes ao tema, sendo escolhidas as mais representativas. on the subject, with the most representative being chosen. Síntese dos dados: Este artigo discute os mecanismos Summary of the findings: This article discusses the fisiopatológicos, quadro clínico e tratamento das diversas formas de pathophysiological mechanisms, clinical presentation and treatment diabetes que acometem a faixa etária pediátrica, como diabetes of the various forms of diabetes
    [Show full text]
  • Combining a Glucagon-Like Peptide-1 Receptor Agonist with Basal Insulin: the Why and How
    Combining a Glucagon-like Peptide-1 Receptor Agonist with Basal Insulin: The Why and How Case Study Mary is a 61 year-old female diagnosed with type 2 diabetes mellitus (T2DM) 8 years ago. She was initially managed with the combination of lifestyle modification and metformin. Since that time she was treated with a sulfonylurea, but it was discontinued due to symptomatic hypoglycemia. She was also treated with pioglitazone, but significant fluid retention led to it discontinuation. A year-and-a- half ago, basal insulin was added to her lifestyle and metformin management. She now administers 52 units (0.62 units/kg) once daily at bedtime. Since starting basal insulin, she has experienced 3 episodes of mild hypoglycemia. Since her diagnosis, Mary’s HbA1c has never been <7.0%; her current HbA1c is 7.9%. Over the past month, her fasting plasma glucose (FPG) has ranged from 103 mg/dL to 136 mg/dL and her postprandial glucose (PPG) from 164 mg/dL to 213 mg/dL. She has gained 2.6 kg since starting basal insulin and her body mass index is now 31 kg/m2. Her blood pressure is 134/82 mmHg. She experiences occasional tingling in her feet. Eye examination reveals grade 1 retinopathy. Current medications are: metformin 1000mg twice daily, basal insulin 52 units once daily at bedtime, and hydrochlorothiazide 25 mg once daily. Her family physician notes that Mary’s FPG is reasonably well-controlled, yet her HbA1c and PPG remain elevated. He is also concerned about her episodes of hypoglycemia and weight gain and the evidence indicating microvascular damage.
    [Show full text]
  • Footprints an Informational Newsletter for Patients of APMA Member Podiatrists October 2017
    footprints an informational newsletter for patients of APMA member podiatrists october 2017 special EDITION include a DPM for diabetes prevention & Manage Ment According to the CDC, more than 100 million US adults are living with either diabetes or prediabetes. If you have diabetes or prediabetes, it is essential to include a podiatrist for proper diabetes prevention and management. In fact, podiatrists can reduce amputation rates up to 80 percent. In order for you not to become a part of that statistic, here are a few simple things you can do to keep your risk for diabetic ulcers and amputation low: Inspect feet daily. Check your Don’t go barefoot. Don’t go 1 feet and toes every day for 5 without shoes, even in your cuts, bruises, sores, or changes to own home. The risk of cuts and the toenails, such as thickening or infection is too great for those discoloration. with diabetes. Wear thick, soft socks. Avoid Never try to remove calluses, 2 socks with seams, which could 6 corns, or warts by yourself. rub and cause blisters or other Over-the-counter products can burn skin injuries. the skin and cause irreparable damage to the foot for people Exercise. Walking can keep with diabetes. 3 weight down and improve circulation. Be sure to wear See a podiatrist. Regular appropriate athletic shoes when 7 checkups by a podiatrist— exercising. at least annually—are the best WALKING CAN KEEP way to ensure that your feet WEIGHT DOWN AND Have new shoes properly remain healthy. 4 measured and fitted. Foot size IMPROVE CIRCULATION.
    [Show full text]
  • A History of Diabetes NYSNA Continuing Education the New
    A History of Diabetes NYSNA Continuing Education The New York State Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This course has been awarded 1.2 contact hours. All American Nurses Credentialing Center (ANCC) accredited organizations' contact hours are recognized by all other ANCC accredited organizations. Most states with mandatory continuing education requirements recognize the ANCC accreditation/approval system. Questions about the acceptance of ANCC contact hours to meet mandatory regulations should be directed to the Professional licensing board within that state. NYSNA has been granted provider status by the Florida State Board of Nursing as a provider of continuing education in nursing (Provider number 50-1437). A History of Diabetes 1 © 2004 NYSNA, all rights reserved. Material may not be reproduced without written permission. How to Take This Course Please take a look at the steps below; these will help you to progress through the course material, complete the course examination and receive your certificate of completion. 1. REVIEW THE OBJECTIVES The objectives provide an overview of the entire course and identify what information will be focused on. Objectives are stated in terms of what you, the learner, will know or be able to do upon successful completion of the course. They let you know what you should expect to learn by taking a particular course and can help focus your study. 2. STUDY EACH SECTION IN ORDER Keep your learning "programmed" by reviewing the materials in order. This will help you understand the sections that follow.
    [Show full text]
  • Diabetic Foot Ulcers
    REVIEW Review Diabetic foot ulcers William J Jeffcoate, Keith G Harding Ulceration of the foot in diabetes is common and disabling and frequently leads to amputation of the leg. Mortality is high and healed ulcers often recur. The pathogenesis of foot ulceration is complex, clinical presentation variable, and management requires early expert assessment. Interventions should be directed at infection, peripheral ischaemia, and abnormal pressure loading caused by peripheral neuropathy and limited joint mobility. Despite treatment, ulcers readily become chronic wounds. Diabetic foot ulcers have been neglected in health-care research and planning, and clinical practice is based more on opinion than scientific fact. Furthermore, the pathological processes are poorly understood and poorly taught and communication between the many specialties involved is disjointed and insensitive to the needs of patients. In this review, we describe the epidemiology, pathogenesis, operations above the ankle or those proximal to the and management of diabetic foot ulceration, and its effect tarsometatarsal joint, and a multinational WHO survey on on patients and society. The condition deserves more lower extremity amputation also included cases of attention, both from those who provide care and those who unoperated gangrene.13 fund research. Moreover, amputation is a marker not just of disease but also of disease management. The decision to operate Epidemiology is determined by many factors, which vary between Incidence and prevalence centres and patients. A high amputation rate might result Although accurate figures are difficult to obtain for the from high disease prevalence, late presentation, and prevalence or incidence of foot ulcers, the results of cross- inadequate resources, but could also reflect a particular sectional community surveys in the UK showed that 5·3% approach by local surgeons.
    [Show full text]
  • Diabetic Coma
    University of Nebraska Medical Center DigitalCommons@UNMC MD Theses Special Collections 5-1-1932 Diabetic coma J. Milton Margolin University of Nebraska Medical Center This manuscript is historical in nature and may not reflect current medical research and practice. Search PubMed for current research. Follow this and additional works at: https://digitalcommons.unmc.edu/mdtheses Part of the Medical Education Commons Recommended Citation Margolin, J. Milton, "Diabetic coma" (1932). MD Theses. 218. https://digitalcommons.unmc.edu/mdtheses/218 This Thesis is brought to you for free and open access by the Special Collections at DigitalCommons@UNMC. It has been accepted for inclusion in MD Theses by an authorized administrator of DigitalCommons@UNMC. For more information, please contact [email protected]. DIAB3TIC COMA J. MIJ/rON 1l1LARGOLIN THE illnVERSITY OF NlsBRASKA COLLEGE OF ~~DICINE -- OMAHA, NEBHASKA 1932 - DIAB3TIG COl£.<\ Diabetic coma is a true medical emergency. It is just as much an emergency as an acute appendicitis or an incarcerated hernia, and as in the latter condition, with every hour that passes without treatment the chances for life decrease. It is early intervention that counts. Therefore, a physician should never let an engagement or any personal desires keep him from the bedside of a patient whom he thinks may be in coma. HISTORY Diabetic coma has been known as a clinical entity since l8bO when a German, Von Dusch and a Scotchman, March firs t de scri bed it. 'l'wen ty years later, Kus smaul publ i shed his classical description of diabetic coma. It is the IlKussmaul breathing, II as described by the author which is the outstanding and characteristic feature of diabetic coma.
    [Show full text]
  • Health Reports for Mutual Recognition of Medical Prescriptions: State of Play
    The information and views set out in this report are those of the author(s) and do not necessarily reflect the official opinion of the European Union. Neither the European Union institutions and bodies nor any person acting on their behalf may be held responsible for the use which may be made of the information contained therein. Executive Agency for Health and Consumers Health Reports for Mutual Recognition of Medical Prescriptions: State of Play 24 January 2012 Final Report Health Reports for Mutual Recognition of Medical Prescriptions: State of Play Acknowledgements Matrix Insight Ltd would like to thank everyone who has contributed to this research. We are especially grateful to the following institutions for their support throughout the study: the Pharmaceutical Group of the European Union (PGEU) including their national member associations in Denmark, France, Germany, Greece, the Netherlands, Poland and the United Kingdom; the European Medical Association (EMANET); the Observatoire Social Européen (OSE); and The Netherlands Institute for Health Service Research (NIVEL). For questions about the report, please contact Dr Gabriele Birnberg ([email protected] ). Matrix Insight | 24 January 2012 2 Health Reports for Mutual Recognition of Medical Prescriptions: State of Play Executive Summary This study has been carried out in the context of Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross- border healthcare (CBHC). The CBHC Directive stipulates that the European Commission shall adopt measures to facilitate the recognition of prescriptions issued in another Member State (Article 11). At the time of submission of this report, the European Commission was preparing an impact assessment with regards to these measures, designed to help implement Article 11.
    [Show full text]
  • Data Entry II Training Course: Supervisor
    Training Data Entry II Training Course: Supervisor PCC Supervisor/Manager PCC Operation Guidelines Rating for one Operator Annual Production Rating Formula Fair 20,000 visits 85 forms per day x 230 days per year Good 40,000 visits 170 forms per day x 230 days per year Outstanding 60,000 visits 260 forms per day x 230 days per year 2 PCC Data Entry Needs and Qualifications • On-Reference Material including: • English & Medical Dictionaries • Medical Abbreviations Book • Up-to-date ICD Coding Books • Drug Handbook-Nursing • Data Entry of 20,000 Forms per year by Trained Individual (about 80 forms per day using six to eight mnemonics). • Number of forms processed or data items entered dependent upon each Area or Site. 3 PCC Data Entry Needs and Qualifications (cont.) • Data Entry Staff with the following skills: • Computer keyboard skills • Ability to read provider’s handwriting • Knowledge and understanding of Medical Terminology • Knowledge and understanding of ICD Coding • Knowledge and understanding of Anatomy and Physiology 4 The International Classification of Diseases • ICD-9-CM: 9th Revision, Clinical Modification • The RPMS Coding System for Diagnoses and Procedures 5 ICD Lookup Process • Enter Provider Narrative • FQ Used File • Synonym File • Key Word File • Possible Code(s) 6 Diabetes Diagnosis Codes 250.00 - 250.93 • Type 1 Diabetes - Insulin Dependent Diabetes (Fairly Rare) • Use the Following fifth digit: • 1 - Indicates controlled • 3 - Indicates uncontrolled Note: Requires insulin to survive 7 Diabetes Diagnosis Codes 250.00 - 250.93 (cont.) • Type 2 Diabetes - Non-Insulin Dependent Diabetes (Most frequent Type) • Use the Following fifth-digit: • 0 - Indicates controlled • 2- Indicates uncontrolled Note: Not dependent on insulin to survive; can produce sufficient amounts but may receive insulin to assist the body in using the insulin present in the body.
    [Show full text]