Clinical Care

Researchers who examined a representative sample of the US population using NHANES data found that 55% of the population would not meet criteria to donate a kidney, mostly because of preventable health conditions (19% hypertension, 15% obesity, 11.6% excessive alcohol intake, 12% diabetes). Sixty percent of individuals with an adjusted income of $35,000 per year could not donate due to medical conditions vs. 49% of individuals making >$100,000 per year. Including non-US citizenship as criteria for not being able to donate, 68.5% of the population would not be able to donate.

Gestational hypertension or preeclampsia occurred in 15 of 131 pregnancies (11%) among living kidney donors vs. 38 in 788 pregnancies (5%) among nondonors in a recent study. This corresponds to a 2.4-times increased risk for donors. There were no significant differences between donors and nondonors with respect to rates of preterm birth (8% vs. 7%) or low birth weight (6% vs. 4%). There were no reports of maternal death, stillbirth, or neonatal death among the donors. Most women had uncomplicated pregnancies after donation.

A systematic review of published studies comparing long-term outcomes between 2 revascularization techniques—coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI)—found a 33% increased risk for a composite of death, non-fatal myocardial infarction, and stroke for diabetic patients undergoing PCI. PCI resulted in increased mortality, no change in the number of myocardial infarctions, and fewer strokes.

In a recent randomized trial, use of coronary computed tomography angiography (CCTA) to screen for coronary artery disease in asymptomatic patients with type 1 or type 2 diabetes did not reduce the composite rate of death, nonfatal myocardial infarction, or unstable angina requiring hospitalization over an average follow-up of 4 years. The trial assigned 900 patients with diabetes of ≥3 to 5 years' duration to screening with CCTA or to standard national guidelines-based optimal diabetic care. The primary outcome event rates were 6.2% and 7.6% in the CCTA and control groups, respectively.

Three of 10 US adults with diabetes remain undiagnosed, according to an Annals of Internal Medicine study. An analysis of NHANES data revealed that an estimated 28.4 million (11.8%) US adults had diabetes in 2012, of whom 20.5 million were aware of their diagnosis. Among diagnosed adults, 95.3% had a usual care provider and 91.7% made 2 or more visits in the past year, compared to 84.5% and 66.5% for undiagnosed adults.

Implementing interventions to optimize patients’ readiness for surgery was associated with reduced risk of mortality and morbidity, shorter intubation times, and shorter hospital stays for urgent patients after coronary artery bypass graft surgery.

The development of midlife diabetes was linked with a 19% greater cognitive decline over 20 years compared to no diabetes in an analysis of the community-based ARIC (Atherosclerosis Risk in Communities) study. Study participants with poorly controlled diabetes experienced cognitive decline approximately 5 years sooner than healthy individuals of the same age. Also, longer-duration diabetes was associated with greater late-life cognitive decline.