OBJECTIVEPhysical activity (PA) provides many benefits to adolescents with type 1 diabetes; however, these individuals tend to have lower fitness and PA levels than their disease-free counterparts. The purpose of this study was to examine the acute temporal associations between moderate-to-vigorous intensity PA (MVPA) and hypoglycemia (continuous glucose monitor [CGM] reading ≤70 mg/dL).RESEARCH DESIGN AND METHODSNineteen participants (53% females) 14–20 years old with type 1 diabetes were recruited. Participant fitness was evaluated via indirect calorimetry using a maximal exercise test; body composition was measured using air displacement plethysmography. An accelerometer was worn continuously (3–5 days) and acceleration data used to estimate MVPA (minutes per day). Blood glucose values were simultaneously tracked using CGM. Controlling for sex, percent body fat (%BF), fitness, and concurrent MVPA, the likelihood of nighttime and next-day hypoglycemia due to MVPA was examined using logistic regression.RESULTSParticipants were of average fitness (females: 43.9 mL/kg/min; males: 49.8 mL/kg/min) and adiposity (females: 26.2%; males: 19.2%); 63.2% met the U.S. federal guideline of accumulating 60 min/day of MVPA. Hypoglycemia was 31% more likely in those who accumulated 30 min/day more MVPA in the previous afternoon than those with less (95% CI 1.05–1.63; P = 0.017).CONCLUSIONSThe results suggest that participating in afternoon MVPA increases the risk of overnight and next-day hypoglycemia, independent of sex, %BF, fitness, and concurrent MVPA. While promoting PA as a healthy behavior, it is important to educate adolescents with type 1 diabetes on prevention of hypoglycemia following PA.
Although pulmonary function tests (PFTs) are routinely performed in patients during the evaluation period before liver transplantation (LT), their utility in predicting post-LT mortality and morbidity outcomes is not known. The aim of this study was to determine the impact of obstructive and/or restrictive lung disease on post-LT outcomes. We conducted a retrospective analysis of patients who had pre-LT PFTs and underwent a subsequent LT (2007LT ( -2013. We used statistical analyses to determine independent associations between PFT parameters and outcomes (graft/patient survival, time on ventilator, and hospital/intensive care unit [ICU] length of stay [LOS]). A total of 415 LT recipients with available PFT data were included: 65% of patients had normal PFTs; 8% had obstructive lung disease; and 27% had restrictive lung disease. There was no difference in patient and graft survival between patients with normal, obstructive, and restrictive lung disease. However, restrictive lung disease was associated with longer post-LT time on ventilator and both ICU and hospital LOS (P < 0.05). More specific PFT parameters (diffusing capacity of the lungs for carbon monoxide, total lung capacity, and residual volume) were all significant predictors of ventilator time and both ICU and hospital LOS (P < 0.05). Postoperative pulmonary complications following liver transplantation (LT) are common and have been associated with increased morbidity and mortality. Infectious complications, prolonged ventilator time, need for reintubation, atelectasis, pleural effusions, acute respiratory distress syndrome, and pulmonary edema have been identified as the main pulmonary complications following LT.(1,2) Both preoperative and intraoperative variables are thought to play a role in the development of pulmonary complications, and although there have been significant advances in critical care and hemodynamic monitoring of LT recipients, pulmonary complications continue to be a significant problem.Studies have identified pre-LT risk factors for postoperative pulmonary complications, including age, (3) severity of liver dysfunction, (4)(5)(6) perioperative fluid administration, smoking history, (7) female sex,and preexisting diabetes. (8,9) Few studies have evaluated preexisting pulmonary dysfunction as a risk factor for Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; CT, computed tomography; DLCO, diffusing capacity of the lungs for carbon monoxide; ESLD, end-stage liver disease; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; ICU, intensive care unit; IQR, interquartile range; LOS, length of stay; LT, liver transplantation; MELD, Model for End-Stage Liver Disease; OR, odds ratio; PFT, pulmonary function test; RV, residual volume; SD, standard deviation; TLC, total lung capacity.Address reprint requests to Josh Levitsky, M.D., M.S.,
Obtaining accurate history, appropriate evaluation and management can help to achieve meaningful improvement in symptoms in patients with chronic pancreatitis. Abstinence from alcohol and smoking cessation, when applicable, should be recommended in all patients to prevent disease recurrences and progression.
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