Browsing by Author "Dores, Jorge"
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- Hospitalization Costs Due to Hypoglycemia in Patients with Diabetes: A Microcosting ApproachPublication . Ferreira, João P.; Araújo, Francisco; Dores, Jorge; Santos, Lèlita; Pape, Estevão; Reis, Mónica; Chipepo, Árcia; Nascimento, Edite; Baptista, Ana; Pires, Vanessa; Marques, Carlos; Lages, Adriana S.; Conceição, João; Laires, Pedro A.; Pelicano-Romano, João; Alão, SílviaIntroduction: Hypoglycemia leading to hospitalization is associated with adverse economic outcomes, although the real burden is unknown. The HIPOS-WARD (Hypoglycemia In Portugal Observational Study-Ward) aimed to characterize ward admissions due to hypoglycemia episodes in treated patients with diabetes and assess their economic impact to the National Health System. Methods: Observational, cross-sectional study, conducted in 16 Portuguese centers for 22 months. The applied microcosting approach was based on healthcare resource data, collected from patients' charts upon ward admission until discharge, and unitary costs from official/public data sources. Absenteeism was also estimated for active workers on the basis of the human capital approach. Results: Of the 176 patients with diabetes mellitus enrolled, 86% had type 2 diabetes. Half of the patients (50.0%) were on insulin-based therapy, followed by 30.1% on a secretagogue-based regimen, 9.7% on non-secretagogue therapy, and 10.2% on a combination of insulin and secretagogue. Overall mean costs per patient were medication, 45.45 €; laboratory analysis, 218.14 €; examinations, 64.91 €; physician and nurse time, 268.55 € and 673.39 €, respectively. Bed occupancy was the main cost driver (772.09 €) and indirect cost averaged 140.44 €. Overall, the cost per hypoglycemia episode leading to hospitalization averaged 2042.52 € (range 194.76-16,762.87 €). Patients treated with insulin-based regimens (2267.76 €) and type 2 diabetes (2051.29 €) had the highest mean costs. The mean cost increased with repeated hypoglycemic events (2191.67 €), correlated complications (2109.26 €), and death (5253.38 €). Conclusion: HIPOS-WARD's findings confirm and support both the substantial clinical and economic impact of hospitalization due to hypoglycemia in Portugal.
- Hypoglycemic episodes in hospitalized people with diabetes in Portugal: the HIPOS-WARD studyPublication . Alão, Sílvia; Conceição, João; Dores, Jorge; Santos, Lèlita; Araújo, Francisco; Pape, Estevão; Reis, Mónica; Chipepo, Árcia; Nascimento, Edite; Baptista, Ana; Pires, Vanessa; Marques, Carlos; Lages, Adriana De Sousa; Pelicano-Romano, João; de Jesus, Paula M.Background: We intended to estimate the proportion hypoglycemic/hyperglycemic emergency episodes in treated diabetes mellitus (DM) patients admitted to a hospital ward, and calculate the prevalence of risk factors for hypoglycemia and diabetic complications. Methods: In this cross-sectional, multicentered study, the observational data was collected by physicians from patient's hospitalization to discharge/death. Statistical tests were 2-tailed considering 5% significance level. Results: There were 646 ward admissions due to hyperglycemic emergencies and 176 hypoglycemic episodes with a ratio hypoglycemia/hyperglycemia 0.27 for all DM patients. In T2DM patients the ratio was 0.38. These were mainly female (55.1%), functionally dependent (61.4%) and retired/disabled (73.1%). Median age was 75 years and median duration of disease 11 years. Half the patients were on insulin-based therapy and 30.1% on secretagogue-based therapy. Approximately 57% of patients needed occasional/full assistance to manage the disease. The most frequent risk factor for hypoglycemia was polypharmacy (85.0%). Hypoglycemia in the 12 months before admission was higher in insulin-based therapy patients (66.1%; p = 0.001). Conclusions: Hyperglycemic emergencies are the most frequent cause of hospitalization in Portugal, although severe hypoglycemic events represent a health and social problem in elderly/frail patients. There is still the need to optimize therapy in terms of the potential for hypoglycemia in this patient group and a review of anti-hyperglycemic agents to add on to insulin.
- Insulinoterapia na diabetes mellitus tipo 2Publication . Dores, JorgeType 2 diabetes is a growing prevalent disease, usually symptomless, with devastating chronic complications for the individual, family and society. Its progressive nature leads to the dose escalating and the association of different drugs which will rapidly become insufficient to achieve the glycemic goals established individually. Insulin is the most effective drug to control diabetes but there is frequently a silent contract to resist to its implementation between the healthcare team and people with type 2 diabetes. This publication aims to share information about this therapeutic option, eliminating old myths and giving an understandable teaching about all the process of insulin therapy centered on the person with type 2 diabetes. Sharing knowledge with different groups of healthcare professionals regarding the glycemic goals and how to reach them with distinct kinds of available insulins, will allow the release by multiprofessional teams of a homogeneous and non contradictory information to the people with type 2 diabetes. Moreover, a good engagement between physicians and nurse educators in the same team is the cornerstone to the initiation and intensification of insulin therapy. The decision of starting insulin therapy is not the end of the process. The progressive nature of the disease compels to empower the patient to adjust its dose of insulin according to the self monitoring blood glucose data and to realize that the decision of a single therapeutic scheme is not definitive, being adapted upon the clinical condition of the person along the diabetes evolution