BackgroundManaging hyperglycemia and diabetes is challenging in geriatric patients admitted to long-term care (LTC) facilities.MethodsThis randomized control trial enrolled patients with type 2 diabetes (T2D) with blood glucose (BG) >180 mg/dL or glycated hemoglobin >7.5% to receive low-dose basal insulin (glargine, starting dose 0.1 U/kg/day) or oral antidiabetic drug (OAD) therapy as per primary care provider discretion for 26 weeks. Both groups received supplemental rapid-acting insulin before meals for BG >200 mg/dL. Primary end point was difference in glycemic control as measured by fasting and mean daily glucose concentration between groups.ResultsA total of 150 patients (age: 79±8 years, body mass index: 30.1±6.5 kg/m2, duration of diabetes mellitus: 8.2±5.1 years, randomization BG: 194±97 mg/dL) were randomized to basal insulin (n=75) and OAD therapy (n=75). There were no differences in the mean fasting BG (131±27 mg/dL vs 123±23 mg/dL, p=0.06) between insulin and OAD groups, but patients treated with insulin had greater mean daily BG (163±39 mg/dL vs 138±27 mg/dL, p<0.001) compared to those treated with OADs. There were no differences in the rate of hypoglycemia (<70 mg/dL) between insulin (27%) and OAD (31%) groups, p=0.58. In addition, there were no differences in the number of hospital complications, emergency room visits, and mortality between treatment groups.ConclusionsThe results of this randomized study indicate that elderly patients with T2D in LTC facilities exhibited similar glycemic control, hypoglycemic events and complications when treated with either basal insulin or with oral antidiabetic drugs.Trial registration numberClinicalTrials.gov Identifier: NCT01131052.
We identified 851 patients undergoing TA from all 4 institutions for which complication data were available. Median age was 68.5 years (Interquartile range (IQR) 60.7, 75.0) with 66.5% being male. Median body mass index (BMI) was 30.6 (IQR 26.48, 25.7). Median Charlson Comorbidity Index (CCI) was 4 (IQR 2, 5). A total of 112 ablations (13.2%) had a post-procedure complication with 31 (3.6%) major complications. On univariate analysis, R.E.N.A.L. nephrometry score, maximum tumor diameter and number of probes were each significantly associated with any complication and major complications (Table 1). On multivariate analysis, only maximum tumor diameter was significantly associated with any (OR 1.33; 95% CI 1.14, 1.55) or major (OR 1.42; 95% CI 1.15, 1.76) complication. Although blood transfusion (6/543, 1.1%) and readmission (23/685, 3.4%) rates were low, both were significantly associated with occurrence of any or major complications as well as maximum tumor size (p<0.05). Patient age, gender, CCI or BMI were not associated with complication, transfusion and readmission (Table 1).CONCLUSIONS: TA is a safe treatment of RCC resulting in low complication, transfusion and readmission rates. As with other nephronsparing modalities, increased tumor size and complexity were associated with higher complication risks which then correlated with need for blood transfusion and readmission. However, patient age, gender and CCI did not influence complication risk which is important given that ablation patients typically are older and have multiple comorbidities.
INTRODUCTION AND OBJECTIVE: Our group previously published that maximization of membranous urethral length (MUL) during radical prostatectomy (RP) yields a significant improvement in continence recovery rates following RP. The present study seeks to further investigate the role of MUL preservation in improving urinary bother (QoL), American Urological Association Symptom Score (AUASS), and continence status following RP.METHODS: A retrospective analysis was conducted on RP patients from November 2004 to November 2018. Inclusion criteria consisted of RP as primary intervention, pad-free status at time of surgery, minimum 2-year follow-up, and outcome data availability at pre-op, 3 months, and one other time point. Primary outcomes were urinary symptoms measured by AUASS and QoL. Secondary outcomes were continence rates through pad-free status. Agestratification was conducted to investigate its confounding effect. While primary analysis used t-test and chi-squared, ad-hoc paired difference analysis was also performed.RESULTS: No differences in mean AUASS and QoL were observed for the overall sample. However, mean differences were greater for patients older than 65 years during paired difference analysis after the technique change (Figure 1A-B). Sample continence rates were reported as 34%, 72%, and 92% prior to the technique change and increased to 52% (p<0.001), 95% (p<0.001), and 96% (p[0.011) at 30-day, 9-month and greater than 15-month follow-up points, respectively (Table 1).CONCLUSIONS: This technique change significantly improved QoL and AUASS for those over the age of 65, those at highest risk for adverse symptoms as supported by their higher pre-and post-operative mean AUASS and QoL scores. Men under 65 did not show this substantial benefit. Time to continence improved for all patients. The results support the implementation of MUL maximization. However, further trials are encouraged.
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