Skip to main content
Top
Published in: Acta Diabetologica 8/2019

01-08-2019 | Insulins | Original Article

Hypoglycemia and hyperglycemia are risk factors for falls in the hospital population

Authors: Cesare Berra, Francesco De Fazio, Elena Azzolini, Marco Albini, Federico Zangrandi, Marco Mirani, Stefania Garbossa, Rodolfo Guardado-Mendoza, Gianluigi Condorelli, Franco Folli

Published in: Acta Diabetologica | Issue 8/2019

Login to get access

Abstract

Objective

To determine the role of hypoglycemia, hyperglycemia or the combination of both as independent risk factors for falls in a hospital population. Secondary objectives included evaluation of other risk factors for falling and their relationships with glucose levels.

Research design and methods

Retrospective cohort study over 2 years on hospitalized subjects (N = 57411) analyzing in-hospital-falls and capillary glucose values. Bivariate analysis (χ2 test) and multivariate analysis (logistic regression) were performed to test for correlation of glucose values, age, sex, Charlson index, service of care, diagnosis at discharge and diabetes treatment with risk of in-hospital-falls.

Results

The comparison of patients who experienced a fall (fall population) with the non-fall population suggested that: glucose determinations were significantly more frequent in the fall population (OR 3.45; CI 2.98–3.99; p < 0.0001); values of glucose below 70 mg/dl and over 200 mg/dl were significantly associated to falls during hospitalization (OR 1.76; CI 1.42–2.19; p < 0.001) as compared to glycemic values between 70 and 200 mg/dl; diabetes treatment was significantly correlated to risk of fall (OR 2.97; CI 2.54–3.49; p < 0.001); the frequency of glycemia measurements below 70 mg/dl and over 200 mg/dl in the same subject was significantly associated to falls during hospitalization (OR 1.01; CI 1.01–1.02; p < 0.001).

Conclusion

Hypoglycemia and hyperglycemia during hospital stays are correlated with an increased risk for falls in the hospitalized population. Presence of diabetes, use of insulin or glucose variability could potentially constitute risk factors for falls inside the hospital as well.
Literature
1.
2.
go back to reference Bergen G, Stevens MR, Burns ER (2016) Falls and fall injuries among adults aged ≥ 65 years—United States, 2014. MMWR Morb Mortal Wkly Rep 23(37):993–998 65(CrossRef Bergen G, Stevens MR, Burns ER (2016) Falls and fall injuries among adults aged ≥ 65 years—United States, 2014. MMWR Morb Mortal Wkly Rep 23(37):993–998 65(CrossRef
3.
go back to reference Rau CS, Lin TS, Wu SC, Yang JC, Hsu SY, Cho TY, Hsieh CH (2014 Nov) Geriatric hospitalizations in fall-related injuries. Scand J Trauma Resusc Emerg Med 12:22:63CrossRef Rau CS, Lin TS, Wu SC, Yang JC, Hsu SY, Cho TY, Hsieh CH (2014 Nov) Geriatric hospitalizations in fall-related injuries. Scand J Trauma Resusc Emerg Med 12:22:63CrossRef
4.
go back to reference Rudzińska M, Bukowczan S, Stożek J, Zajdel K, Mirek E, Chwała W, Wójcik-Pędziwiatr M, Banaszkiewicz K, Szczudlik A. Neurol Neurochir Pol. 2013 47(5):423–30CrossRef Rudzińska M, Bukowczan S, Stożek J, Zajdel K, Mirek E, Chwała W, Wójcik-Pędziwiatr M, Banaszkiewicz K, Szczudlik A. Neurol Neurochir Pol. 2013 47(5):423–30CrossRef
5.
go back to reference Lee K, Pressler SJ, Titler M. Falls in patients with heart failure: a systematic review. J Cardiovasc Nurs 29, 2015 Lee K, Pressler SJ, Titler M. Falls in patients with heart failure: a systematic review. J Cardiovasc Nurs 29, 2015
6.
go back to reference Minet LR, Peterson E, von Koch L, Ytterberg C (2015) Occurrence and predictors of falls in people with stroke: six-year prospective study. Stroke 46:2688–2690CrossRef Minet LR, Peterson E, von Koch L, Ytterberg C (2015) Occurrence and predictors of falls in people with stroke: six-year prospective study. Stroke 46:2688–2690CrossRef
7.
go back to reference Mamoto K, Inui K, Okano T, Sugioka Y, Tada M, Koike T, Nakamura H (2017) Incidence rate of falls and its risk factors in patients with rheumatoid arthritis compared to controls: four years of the TOMORROW study. Mod Rheumatol 27(1):8–14. (Epub 2016 May 4) CrossRef Mamoto K, Inui K, Okano T, Sugioka Y, Tada M, Koike T, Nakamura H (2017) Incidence rate of falls and its risk factors in patients with rheumatoid arthritis compared to controls: four years of the TOMORROW study. Mod Rheumatol 27(1):8–14. (Epub 2016 May 4) CrossRef
8.
go back to reference Ham AC, Swart KM, Enneman AW, van Dijk SC, Oliai Araghi S, van Wijngaarden JP, van der Zwaluw NL, Brouwer-Brolsma EM, Dhonukshe-Rutten RA, van Schoor NM, van der Cammen TJ, Lips P, de Groot LC, Uitterlinden AG, Witkamp RF, Stricker BH van der (2014) Velde N. Medication-related fall incidents in an older, ambulant population: the B-PROOF study. Drugs Aging 31(12):917–927CrossRef Ham AC, Swart KM, Enneman AW, van Dijk SC, Oliai Araghi S, van Wijngaarden JP, van der Zwaluw NL, Brouwer-Brolsma EM, Dhonukshe-Rutten RA, van Schoor NM, van der Cammen TJ, Lips P, de Groot LC, Uitterlinden AG, Witkamp RF, Stricker BH van der (2014) Velde N. Medication-related fall incidents in an older, ambulant population: the B-PROOF study. Drugs Aging 31(12):917–927CrossRef
9.
go back to reference Doherty K, Archambault E, Kelly B, Rudolph JL (2014 Nov) Delirium markers in older fallers: a case-control study. Clin Interv Aging 21:9:2013–2018CrossRef Doherty K, Archambault E, Kelly B, Rudolph JL (2014 Nov) Delirium markers in older fallers: a case-control study. Clin Interv Aging 21:9:2013–2018CrossRef
10.
go back to reference OʼNeil CA, Krauss MJ, Bettale J, Kessels A, Costantinou E, Dunagan WC, Fraser VJ (2018) Medications and Patient Characteristics Associated With Falling in the Hospital. J Patient Saf 14(1):27–33CrossRef OʼNeil CA, Krauss MJ, Bettale J, Kessels A, Costantinou E, Dunagan WC, Fraser VJ (2018) Medications and Patient Characteristics Associated With Falling in the Hospital. J Patient Saf 14(1):27–33CrossRef
11.
go back to reference Kozono A, Isami K, Shiota K, Tsumagari K, Nagano M, Inoue D, Adachi R, Hiraki Y, Nakagawa Y, Kamimura H, Yamamichi K (2016) Relationship of prescribed drugs with the risk of fall in inpatients. Yakugaku Zasshi 136(5):769–776CrossRef Kozono A, Isami K, Shiota K, Tsumagari K, Nagano M, Inoue D, Adachi R, Hiraki Y, Nakagawa Y, Kamimura H, Yamamichi K (2016) Relationship of prescribed drugs with the risk of fall in inpatients. Yakugaku Zasshi 136(5):769–776CrossRef
12.
go back to reference McDonnell ME, Umpierrez GE (2012) Insulin therapy for the management of hyperglycemia in hospitalized patients. Endocrinol Metab Clin North Am 41(1):175–201. Epub 2012 Feb 17CrossRef McDonnell ME, Umpierrez GE (2012) Insulin therapy for the management of hyperglycemia in hospitalized patients. Endocrinol Metab Clin North Am 41(1):175–201. Epub 2012 Feb 17CrossRef
13.
go back to reference Kalfon P, Le Manach Y, Ichai C, Bréchot N, Cinotti R, Dequin PF, Riu-Poulenc B, Montravers P, Annane D, Dupont H, Sorine M, Riou B, CGAO-REA Study Group (2015) Severe and multiple hypoglycemic episodes are associated with increased risk of death in ICU patients. Crit Care 8:19:153CrossRef Kalfon P, Le Manach Y, Ichai C, Bréchot N, Cinotti R, Dequin PF, Riu-Poulenc B, Montravers P, Annane D, Dupont H, Sorine M, Riou B, CGAO-REA Study Group (2015) Severe and multiple hypoglycemic episodes are associated with increased risk of death in ICU patients. Crit Care 8:19:153CrossRef
14.
go back to reference Timmons JG, Cunningham SG, Sainsbury CA, Jones GC (2017) Inpatient glycemic variability and long-term mortality in hospitalized patients with type 2 diabetes. J Diabetes Complications 31(2):479–482CrossRef Timmons JG, Cunningham SG, Sainsbury CA, Jones GC (2017) Inpatient glycemic variability and long-term mortality in hospitalized patients with type 2 diabetes. J Diabetes Complications 31(2):479–482CrossRef
15.
go back to reference Takeishi S, Mori A, Hachiya H, Yumura T, Ito S, Shibuya T, Hayashi S, Fushimi N, Ohashi N, Kawai H (2016) Hypoglycemia and glycemic variability are associated with mortality in non-intensive care unit hospitalized infectious disease patients with diabetes mellitus. J Diabetes Investig 7(3):429–435CrossRef Takeishi S, Mori A, Hachiya H, Yumura T, Ito S, Shibuya T, Hayashi S, Fushimi N, Ohashi N, Kawai H (2016) Hypoglycemia and glycemic variability are associated with mortality in non-intensive care unit hospitalized infectious disease patients with diabetes mellitus. J Diabetes Investig 7(3):429–435CrossRef
16.
go back to reference Mendez CE, Mok KT, Ata A, Tanenberg RJ, Calles-Escandon J, Umpierrez GE (2013) Increased glycemic variability is independently associated with length of stay and mortality in noncritically ill hospitalized patients. Diabetes Care 36(12):4091–4097CrossRef Mendez CE, Mok KT, Ata A, Tanenberg RJ, Calles-Escandon J, Umpierrez GE (2013) Increased glycemic variability is independently associated with length of stay and mortality in noncritically ill hospitalized patients. Diabetes Care 36(12):4091–4097CrossRef
17.
go back to reference Chiba Y, Kimbara Y, Kodera R, Tsuboi Y, Sato K, Tamura Y, Mori S, Ito H, Araki A (2015) Risk factors associated with falls in elderly patients with type 2 diabetes. J Diabetes Complicat 29(7):898–902CrossRef Chiba Y, Kimbara Y, Kodera R, Tsuboi Y, Sato K, Tamura Y, Mori S, Ito H, Araki A (2015) Risk factors associated with falls in elderly patients with type 2 diabetes. J Diabetes Complicat 29(7):898–902CrossRef
18.
go back to reference Lu CL1, Hsu PC, Shen HN, Chang YH, Chen HF, Li CY. Association between history of severe hypoglycemia and risk of falls in younger and older patients with diabetes. Medicine (Baltimore). 2015 94(33):e1339CrossRef Lu CL1, Hsu PC, Shen HN, Chang YH, Chen HF, Li CY. Association between history of severe hypoglycemia and risk of falls in younger and older patients with diabetes. Medicine (Baltimore). 2015 94(33):e1339CrossRef
19.
go back to reference Hung YC, Lin CC, Chen HJ, Chang MP, Huang KC, Chen YH, Chen CC (2017) Severe hypoglycemia and hip fracture in patients with type 2 diabetes: a nationwide population-based cohort study. Osteoporos Int 28(7):2053–2060CrossRef Hung YC, Lin CC, Chen HJ, Chang MP, Huang KC, Chen YH, Chen CC (2017) Severe hypoglycemia and hip fracture in patients with type 2 diabetes: a nationwide population-based cohort study. Osteoporos Int 28(7):2053–2060CrossRef
20.
go back to reference Johnston SS, Conner C, Aagren M, Ruiz K, Bouchard J (2012) Association between hypoglycaemic events and fall-related fractures in Medicare-covered patients with type 2 diabetes. Diabetes Obes Metab 14(7):634–643CrossRef Johnston SS, Conner C, Aagren M, Ruiz K, Bouchard J (2012) Association between hypoglycaemic events and fall-related fractures in Medicare-covered patients with type 2 diabetes. Diabetes Obes Metab 14(7):634–643CrossRef
21.
go back to reference Yau RK, Strotmeyer ES, Resnick HE, Sellmeyer DE, Feingold KR, Cauley JA, Vittinghoff E, De Rekeneire N, Harris TB, Nevitt MC, Cummings SR, Shorr RI, Schwartz AV (2013) Diabetes and risk of hospitalized fall injury among older adults. Diabetes Care 36(12):3985–3991CrossRef Yau RK, Strotmeyer ES, Resnick HE, Sellmeyer DE, Feingold KR, Cauley JA, Vittinghoff E, De Rekeneire N, Harris TB, Nevitt MC, Cummings SR, Shorr RI, Schwartz AV (2013) Diabetes and risk of hospitalized fall injury among older adults. Diabetes Care 36(12):3985–3991CrossRef
22.
go back to reference Quan H, Sundararajan V, Halfon P et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005 43(11):1073–1077CrossRef Quan H, Sundararajan V, Halfon P et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005 43(11):1073–1077CrossRef
23.
go back to reference Quan H, Parsons GA, Ghali WA. Validity of information on comorbidity derived from ICD-9-CM administrative data. Med Care 2002 40(8):675–685CrossRef Quan H, Parsons GA, Ghali WA. Validity of information on comorbidity derived from ICD-9-CM administrative data. Med Care 2002 40(8):675–685CrossRef
24.
go back to reference Charlson ME, Pompei P, Ales KL, McKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40(5):373–383CrossRef Charlson ME, Pompei P, Ales KL, McKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40(5):373–383CrossRef
25.
go back to reference Inouye SK, Brown CJ, Tinetti ME (2009) Medicare nonpayment, hospital falls, and unintended consequences. N Engl J Med 360:2390–2393CrossRef Inouye SK, Brown CJ, Tinetti ME (2009) Medicare nonpayment, hospital falls, and unintended consequences. N Engl J Med 360:2390–2393CrossRef
26.
go back to reference Cameron ID, Gillespie LD, Robertson MC et al (2012) Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 12:CD005465PubMed Cameron ID, Gillespie LD, Robertson MC et al (2012) Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 12:CD005465PubMed
27.
go back to reference al Tehewy MM, Amin GE, Nassar NW (2015) A study of rate and predictors of fall among elderly patients in a university hospital. J Patient Saf 11:210–214CrossRef al Tehewy MM, Amin GE, Nassar NW (2015) A study of rate and predictors of fall among elderly patients in a university hospital. J Patient Saf 11:210–214CrossRef
28.
go back to reference Anderson DC, Postler TS, Dam TT. Epidemiology of hospital system patient falls: a retrospective analysis. Am J Med Qual 2015 Anderson DC, Postler TS, Dam TT. Epidemiology of hospital system patient falls: a retrospective analysis. Am J Med Qual 2015
29.
go back to reference Basic D, Hartwell TJ (2015) Falls in hospital and new placement in a nursing home among older people hospitalized with acute illness. Clin Interv Aging 10:1637–1643CrossRef Basic D, Hartwell TJ (2015) Falls in hospital and new placement in a nursing home among older people hospitalized with acute illness. Clin Interv Aging 10:1637–1643CrossRef
30.
go back to reference Twibell RS, Siela D, Sproat T, Coers G (2015) Perceptions related to falls and fall prevention among hospitalized adults. Am J Crit Care 24:e78–e85CrossRef Twibell RS, Siela D, Sproat T, Coers G (2015) Perceptions related to falls and fall prevention among hospitalized adults. Am J Crit Care 24:e78–e85CrossRef
31.
go back to reference Sircar M, Bhatia A, Munshi M (2016) Review of hypoglycemia in the older adult: clinical implications and management. Can J Diabetes 40(1):66–72CrossRef Sircar M, Bhatia A, Munshi M (2016) Review of hypoglycemia in the older adult: clinical implications and management. Can J Diabetes 40(1):66–72CrossRef
32.
go back to reference Wong CW (2015) Avoiding hypoglycaemia: a new target of care for elderly diabetic patients. Hong Kong Med J 21(5):444–454PubMed Wong CW (2015) Avoiding hypoglycaemia: a new target of care for elderly diabetic patients. Hong Kong Med J 21(5):444–454PubMed
33.
go back to reference Malabu UH, Vangaveti VN, Kennedy RL (2014) Disease burden evaluation of fall-related events in the elderly due to hypoglycemia and other diabetic complications: a clinical review. Clin Epidemiol 14:6:287–294CrossRef Malabu UH, Vangaveti VN, Kennedy RL (2014) Disease burden evaluation of fall-related events in the elderly due to hypoglycemia and other diabetic complications: a clinical review. Clin Epidemiol 14:6:287–294CrossRef
34.
go back to reference Kachroo S, Kawabata H, Colilla S, Shi L, Zhao Y, Mukherjee J, Iloeje U, Fonseca V (2015) Association between hypoglycemia and fall-related events in type 2 diabetes mellitus: analysis of a U.S. commercial database. J Manag Care Spec Pharm 21(3):243–253PubMed Kachroo S, Kawabata H, Colilla S, Shi L, Zhao Y, Mukherjee J, Iloeje U, Fonseca V (2015) Association between hypoglycemia and fall-related events in type 2 diabetes mellitus: analysis of a U.S. commercial database. J Manag Care Spec Pharm 21(3):243–253PubMed
35.
go back to reference Wu TY, Chie WC, Yang RS, Liu JP, Kuo KL, Wong WK, Liaw CK (2013) Factors associated with falls among community-dwelling older people in Taiwan. Ann Acad Med Singapore 42(7):320–327PubMed Wu TY, Chie WC, Yang RS, Liu JP, Kuo KL, Wong WK, Liaw CK (2013) Factors associated with falls among community-dwelling older people in Taiwan. Ann Acad Med Singapore 42(7):320–327PubMed
36.
go back to reference Federici M, Hribal M, Perego L, Ranalli M, Caradonna Z, Perego C, Usellini L, Nano R, Bonini P, Bertuzzi F, Marlier LN, Davalli AM, Carandente O, Pontiroli AE, Meino G, Marchetti P, Lauro R, Sesti G, Folli F. High glucose causes apoptosis in cultured hman pancreatic islets of Langerhans: a potential role for regulation of specific Bcl family genes toward an apoptotic cell death program. Diabetes 2001 50 (6): 1290–1301CrossRef Federici M, Hribal M, Perego L, Ranalli M, Caradonna Z, Perego C, Usellini L, Nano R, Bonini P, Bertuzzi F, Marlier LN, Davalli AM, Carandente O, Pontiroli AE, Meino G, Marchetti P, Lauro R, Sesti G, Folli F. High glucose causes apoptosis in cultured hman pancreatic islets of Langerhans: a potential role for regulation of specific Bcl family genes toward an apoptotic cell death program. Diabetes 2001 50 (6): 1290–1301CrossRef
37.
go back to reference Folli F, Okada T, Perego C, Gunton J, Liew CW, Akiyama M, D’Amico A, La Rosa S, Placidi C, Lupi R, Marchetti P, Sesti G, Hellerstein M, Perego L, Kulkarni RN. Altered insulin receptor signalling and beta-cell cycle dynamics in type 2 diabetes mellitus. PLoS ONE 6(11): e28050 Folli F, Okada T, Perego C, Gunton J, Liew CW, Akiyama M, D’Amico A, La Rosa S, Placidi C, Lupi R, Marchetti P, Sesti G, Hellerstein M, Perego L, Kulkarni RN. Altered insulin receptor signalling and beta-cell cycle dynamics in type 2 diabetes mellitus. PLoS ONE 6(11): e28050
38.
go back to reference Guardado-Mendoza R, Davalli AM, Chavez AO, Hubbard GB, Dick EJ, Majluf-Cruz A, Tene-Perez CE, Goldschmidt L, Hart J, Perego C, Comuzzie AG, Tejero ME, Finzi G, Placidi C, La Rosa S, Capella C, Halff G, Gastaldelli A, De Fronzo RA, Folli F. Pancreatic islet amyloidosis, beta-cell apoptosis, and alfa-cell proliferation are determinants of islet remodeling in type-2 diabetic baboons PNAS 2009, 106 33 13992–13997CrossRef Guardado-Mendoza R, Davalli AM, Chavez AO, Hubbard GB, Dick EJ, Majluf-Cruz A, Tene-Perez CE, Goldschmidt L, Hart J, Perego C, Comuzzie AG, Tejero ME, Finzi G, Placidi C, La Rosa S, Capella C, Halff G, Gastaldelli A, De Fronzo RA, Folli F. Pancreatic islet amyloidosis, beta-cell apoptosis, and alfa-cell proliferation are determinants of islet remodeling in type-2 diabetic baboons PNAS 2009, 106 33 13992–13997CrossRef
39.
go back to reference Folli F, La Rosa S, Finzi G, Davalli AM, Galli A, Dick EJ, Perego C, Guardado-Mendoza R (2018) Pancreatic islets of Langherans cytoarchitecture and ultrastructure in normal glucose tolerance and in type 2 diabetes mellitus. Diabetes Obes Metab 20(Suppl 2):137–144CrossRef Folli F, La Rosa S, Finzi G, Davalli AM, Galli A, Dick EJ, Perego C, Guardado-Mendoza R (2018) Pancreatic islets of Langherans cytoarchitecture and ultrastructure in normal glucose tolerance and in type 2 diabetes mellitus. Diabetes Obes Metab 20(Suppl 2):137–144CrossRef
40.
go back to reference Keenan HA, Sun JK, Levine J, Doria A, Aiello LP, Eisenbarth G, Bonner-Weir S, King GL. Residual insulin production and pancreatic beta-cell turnover after 50 years of diabetes: Joslin medalist study. Diabetes 2010; 59 (11): 2846–53CrossRef Keenan HA, Sun JK, Levine J, Doria A, Aiello LP, Eisenbarth G, Bonner-Weir S, King GL. Residual insulin production and pancreatic beta-cell turnover after 50 years of diabetes: Joslin medalist study. Diabetes 2010; 59 (11): 2846–53CrossRef
41.
go back to reference Butler AE, Janson J, Bonner-Weir S, Ritzel R, Rizza RA, Butler PC (2003) Beta-cell deficit and increased beta-cell apoptosis in humans with type 2 diabetes. Diabetes 52(1):102–110CrossRef Butler AE, Janson J, Bonner-Weir S, Ritzel R, Rizza RA, Butler PC (2003) Beta-cell deficit and increased beta-cell apoptosis in humans with type 2 diabetes. Diabetes 52(1):102–110CrossRef
42.
go back to reference Jurgens CA, Toukatly MN, Fligner CL, Udayasankar J, Subramanian SL, Zraika S, Aston-Mourney K, Carr DB, Westermark P, Westermark GT, Kahn SE, Hull RL (2011) β-cell loss and β-cell apoptosis in human type 2 diabetes are related to islet amyloid deposition. Am J Pathol 178(6):2632–2640CrossRef Jurgens CA, Toukatly MN, Fligner CL, Udayasankar J, Subramanian SL, Zraika S, Aston-Mourney K, Carr DB, Westermark P, Westermark GT, Kahn SE, Hull RL (2011) β-cell loss and β-cell apoptosis in human type 2 diabetes are related to islet amyloid deposition. Am J Pathol 178(6):2632–2640CrossRef
43.
go back to reference Berra C, Azzolini E, Zangrandi F, Mirani M, Albini M, De Fazio F, Favacchio G, Mauer N, Meroni P In-hospital glucose monitoring: adequacy and resource management. Biomed J Sci Tech Res 5 (5): 2018 Berra C, Azzolini E, Zangrandi F, Mirani M, Albini M, De Fazio F, Favacchio G, Mauer N, Meroni P In-hospital glucose monitoring: adequacy and resource management. Biomed J Sci Tech Res 5 (5): 2018
Metadata
Title
Hypoglycemia and hyperglycemia are risk factors for falls in the hospital population
Authors
Cesare Berra
Francesco De Fazio
Elena Azzolini
Marco Albini
Federico Zangrandi
Marco Mirani
Stefania Garbossa
Rodolfo Guardado-Mendoza
Gianluigi Condorelli
Franco Folli
Publication date
01-08-2019
Publisher
Springer Milan
Published in
Acta Diabetologica / Issue 8/2019
Print ISSN: 0940-5429
Electronic ISSN: 1432-5233
DOI
https://doi.org/10.1007/s00592-019-01323-8

Other articles of this Issue 8/2019

Acta Diabetologica 8/2019 Go to the issue