OBJECTIVETo investigate the association between glycemic variability (GV) and both length of stay (LOS) and 90-day mortality in noncritically ill hospitalized patients.RESEARCH DESIGN AND METHODSThis study retrospectively analyzed 4,262 admissions to the general medicine or surgery services during a 2 year period. Patients with point-of-care glucose monitoring and a minimum of two glucose values per day on average were selected. GV was assessed by SD and coefficient of variation (CV). Data were analyzed with linear and logistic multivariate regression analysis in separate models for SD and CV. Analysis was performed with generalized estimating equations to adjust for correlation between multiple admissions in some individual cases.RESULTSAfter exclusions, 935 admissions comprised the sample. Results of adjusted analysis indicate that for every 10 mg/dL increase in SD and 10–percentage point increase in CV, LOS increased by 4.4 and 9.7%, respectively. Relative risk of death in 90 days also increased by 8% for every 10-mg/dL increase in SD. These associations were independent of age, race, service of care (medicine or surgery), previous diagnosis of diabetes, HbA1c, BMI, the use of regular insulin as a sole regimen, mean glucose, and hypoglycemia occurrence during the hospitalization.CONCLUSIONSOur results indicate that increased GV during hospitalization is independently associated with longer LOS and increased mortality in noncritically ill patients. Prospective studies with continuous glucose monitoring are necessary to investigate this association thoroughly and to generate therapeutic strategies targeted at decreasing GV.
Background: More than half of the U.S. population has experienced Adverse Childhood Experiences (ACE), which are linked to physical and mental health issues. This study examines the relationship between ACEs and life satisfaction, psychological well-being, and social wellbeing. Methods: Data of 6323 participants from three waves of the Midlife Development in the United States (MIDUS) (1995-1996, 2004-2006, and 2011-2014) were used. Repeated measures models were used to test the associations between ACEs and all three psychosocial scales. Generalized estimating equations (GEE) were used to account for multiple survey measures. Adjusting for demographics and survey wave, GEE models were run for each ACE construct. Results: After controlling for demographic covariables, those reporting an ACE had significantly lower levels of life satisfaction (β=−0.20, 95% CI −0.26-−0.15) compared to those without an ACE. Those reporting higher ACE counts were associated with lower life satisfaction compared to those with no ACE (β=−0.38, 95% CI −0.56-−0.20; β=−0.36, 95% CI −0.46-−0.27; and β= −0.13, 95% CI −0.19-−0.08 for ACE counts of 3, 2, and 1, respectively). Abuse (β=−0.41, 95% CI −0.48-−0.33) and household dysfunction (β=−0.18, 95% CI −0.25-−0.10) were associated with significantly lower life satisfaction. Overall, those exposed to ACEs had significantly lower sense of social well-being.
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