Indian Journal of Endocrinology and Metabolism最新文献

Artificial Intelligence (AI) in the healthcare sector is expanding quickly. It is significantly assisting us in assimilating the growing volume of data and applying it to enhance patient care while maintaining the present state of cost-effectiveness. AI has often been used in developing screening and diagnostic tools in endocrinology, with some limited uses in disease management. AI has assisted in the accurate diagnosis of thyroid nodules, detection of adrenal malignancies, prediction of diabetes microvascular complications, calculation of correct bone age, and estimation of the risks of osteoporosis. Additionally, it has been used successfully in the insulin algorithm of closed-loop insulin delivery and predicting survival in endocrinological malignancies. With an emphasis on the key concepts of artificial intelligence, such as machine learning algorithms and deep-learning models, this article seeks to present a brief overview of the state of AI applications in endocrinology and metabolism.

Malnutrition-modulated diabetes (MMDM) has been extensively studied by the various investigators over the last 70 years. It initially emerged as a distinct clinical entity as youth-onset diabetes in the twenties, having severe hyperglycaemia, ketosis resistance, and requiring a high insulin dose. In 1985, World Health Organisation (WHO) placed it under a major type of diabetes along with type 1 and type 2. Subsequently, it was removed from classification when research revealed that patients with MMDM, though had severe hyperglycaemia, were not immune to ketosis, had no insulin resistance on systematic investigation. With the availability of anti-GAD and IA-2 antibody assays, several investigators assessed a large cohort of MMDM. Demonstration of islet cell antibodies, especially anti-GAD65 led to the realisation that MMDM is possibly a variant of type-1 diabetes. However, the spread of autoimmunity was limited to fewer autoantigens and organs due to the prevailing malnutrition. Limited pancreatic beta cell autoimmunity led to better C-peptide reserves than those of type 1 diabetes. This further brings MMDM near Type-1 in pathogenesis. Alternative MMDM can be called a hybrid of Type-1 and severe Type-2. It will be in the fitness to categorise it as a type of 'hybrid diabetes in the WHO, 2019 classification. Recently, the 'International Diabetes Federation' renamed MMDM as type-5 diabetes. Giving a new name to MMDM is like putting old wine in a new bottle. The current review provides details of MMDM, its possible place in the current classification, and independent views on the term 'Type-5 diabetes'.

Introduction: Levothyroxine has a narrow therapeutic index, with many factors affecting bioavailability. Overtreatment and undertreatment of hypothyroidism are common in clinical practice.

Methods: In this study, we assessed the prevalence of incorrect levothyroxine administration technique (ILAT) in clinical practice and the impact of correction on follow-up. The study had two phases. The first phase was that all consecutive patients with primary hypothyroidism on treatment for at least 1 year with a minimal dose of 25 mcg were enrolled, and ILAT was assessed. Second phase: Participants with abnormal Serum TSH or ILAT were followed on the correct technique for euthyroidism.

Results: Among 444 participants (358 female and 86 male) at baseline, 46.2% had raised TSH, 41.3% were euthyroid, and 12.4% had iatrogenic thyrotoxicosis. The levothyroxine administration technique (LAT) was incorrect in 77.4% of participants. In participants with raised Serum TSH at baseline with incorrect LAT, on correction of the technique, the levothyroxine dose decreased in 26.3%, no dose change was required in 14.9%, and only 58.8% required dose escalation. Even among euthyroid at baseline with incorrect LAT, 64.4% needed dose reduction to remain euthyroid on correction of the technique. Among participants with suppressed TSH at baseline and ILAT, the levothyroxine dose at baseline was 97.5 ± 28.7 mcg/day, and with correction of the technique, the final dose was 71.1 ± 23.9 mcg/day. The decrease in dose was statistically significant (P = 0.001).

Conclusion: Ensuring the correct administration technique at each contact, especially before any dose adjustment, is essential to prevent suboptimal or overtreatment in primary hypothyroidism.

Introduction: Intermittent fasting (IF) has emerged as a popular dietary approach that has gained popularity among individuals concerned with weight and diabetes control. This scoping review evaluated the effects of IF on glycaemic control and weight reduction by analysing various IF protocols.

Methods: A scoping review was conducted according to PRISMA-ScR guidelines. The PubMed, Embase, Cochrane Library, and Medline databases were searched (2019-2024) for randomised controlled trials (RCTs) and observational studies. The primary outcomes were the effectiveness of IF on glycaemic control, measured by changes in fasting blood glucose (FBG), insulin sensitivity, and HbA1c. The secondary outcomes assessed the impact of IF on weight management.

Results: The scoping review identified improvements in FBG levels and insulin sensitivity among individuals practicing IF, with HbA1c reductions observed in multiple studies. Weight loss and favourable changes in body composition have consistently been reported. The ethnic inequalities, particularly for South Asians, were also reported, revealing gaps in geographical evidence and proposing population-specific IF interventions. However, adherence challenges and adverse effects, such as hunger, fatigue, and irritability, were noted, highlighting the need for personalised IF protocols. Variability in outcomes due to individual factors such as age, gender, and baseline metabolic health was evident.

Conclusion: IF is a promising strategy for glycaemic control and sustainable weight management in patients with diabetes mellitus. Despite its benefits, individualisation and medical supervision are crucial for addressing compliance issues and minimizing risks. The ethnic and cultural factors must be considered in ongoing clinical care and future IF research.

Introduction: Early gestational diabetes mellitus (EGDM) is a relatively new entity, and there is a lack of clarity regarding treatment. This study was carried out to compare the maternal and neonatal outcomes between treated EGDM and late GDM.

Methods: This prospective cohort study was conducted in a tertiary care teaching hospital in South India. Pregnant women more than 18 years of age with a singleton foetus and diagnosed with GDM on a 75 g oral glucose tolerance test (OGTT) using the World Health Organization (WHO) 2013 criteria were included in the study. The study participants were divided into two groups of 306 each, based on their gestational age at the time of GDM diagnosis. EGDM was diagnosed before 24 weeks of gestation, and late gestational diabetes mellitus (LGDM) was diagnosed at or after 24 weeks of gestation. They were followed until delivery, and the pregnancy outcomes, maternal, and perinatal were documented using a predesigned proforma.

Results: Among the 612 participants, a significantly higher proportion of elderly gravida (>35 years) was observed in the EGDM group compared to LGDM (9.5% vs. 4.3%, P = 0.01). The need for insulin (13.1% vs. 6.9%; adjusted relative risk [aRR]: 1.91, 95% confidence interval [CI]: 1.15-3.14; P = 0.011) was significantly higher in women with EGDM relative to LGDM, after adjusting for confounders. There were no other significant differences in outcomes between women with EGDM and LGDM.

Conclusions: Women with treated EGDM are older and have a significantly higher insulin requirement than LGDM.

Introduction: Immunoassays used to measure thyroid function tests (TFTs) are prone to interference due to several factors that could potentially affect clinical decisions. With increased awareness and frequency of testing TFT, even 1% prevalence of assay interferences would possibly increase the occurrence of deranged TFT significantly. In this study, we report six cases of thyroid hormone assay interference in acute scrub typhus infection.

Methods: A prospective observational study was conducted in patients admitted with acute scrub typhus infection. TFT was done for some indication that showed discordance with clinical suspicion. Initial assay was performed by electrochemiluminescence immunoassay (ECLIA) using a Roche Cobas e411 analyzer, which was verified by Chemiluminescent Microparticle Immuno Assay (CMIA) with an ARCHITECT i1000SR analyzer.

Results: Initial TFT done by ECLIA showed elevated FT4 and FT3(FT4>> FT3) with a normal or low-normal TSH in all cases. Samples were re-analyzed in the CMIA platform within 24 hours, which showed normal TFT, raising the suspicion of assay interference. TFT performed by ECLIA 6 weeks after recovery was normal in all patients.

Conclusion: Assay interference with TFT should always be considered when there is a discrepancy between clinical suspicion and biochemical values. It is prudent to confirm abnormal values on another platform to avoid misdiagnosis and unwarranted therapeutic decisions.

Introduction: Patients with Sheehan's syndrome (SS) commonly exhibit cardiovascular risk factors, including abdominal obesity, dyslipidaemia, hepatic steatosis and chronic inflammation. In addition, quality of life (QOL) is poor despite adequate replacement with glucocorticoids and thyroxine. This study evaluated the effects of growth hormone (GH) replacement on body mass index (BMI), lipid profile, body/hepatic fat and QOL in SS patients.

Methods: This prospective study enrolled 14 SS patients with GH deficiency on stable hormonal therapy (excluding GH). Waist-hip ratio (WHR), BMI, lipids, liver steatosis and fibrosis, body fat (by dual energy X-ray absorptiometry) and QoL (using QOL in Adult GH Deficiency Assessment (QoL-AGHDA)) were assessed at baseline and after 24 weeks of GH replacement.

Results: The mean age of the patients was 55.7 ± 6.9 years, with a mean disease duration of 19.4 ± 1.6 years (range, 8-27 years). After GH replacement, total cholesterol decreased from 213.35 ± 43.66 to 189.29 ± 23.49 mg/dl, LDL-cholesterol from 120.79 ± 38.73 to 89.36 ± 20.47 mg/dl and triglycerides from 288.79 ± 91 to 231.50 ± 47.15 mg/dl, while HDL-cholesterol increased from 41.29 ± 11.44 to 45.64 ± 4.39 mg/dl. Total body fat reduced from 39.97 ± 5.0% to 37.99 ± 4.5% (P = 0.015); WHR and BMI remained unchanged. Liver fat (controlled attenuation parameter) decreased from 248.64 ± 42.14 to 230.29 ± 36.86 dB/m (P = 0.025) and liver stiffness from 5.13 ± 0.90 to 4.53 ± 1.25 kPa (P = 0.025). QoL-AGHDA scores improved from 11.79 ± 3.14 to 4 ± 3.06.

Conclusion: GH replacement in SS patients improves lipid parameters, reduces body and hepatic fat and enhances QOL.

Introduction: Individuals living with obesity are prone to vitamin D deficiency. On supplementing vitamin D, lower serum 25(OH)D levels may be achieved in them. The present study aimed to compare the change in serum 25(OH)D after supplementation with vitamin D in children living with obesity versus children with normal body mass index (nBMI) and to study its correlation with BMI and fat mass (FM).

Method: Sixty vitamin D-deficient children (Groups 1-30 with BMI ≥23^rd adult equivalent of Indian Academy of Pediatrics BMI charts and Groups 2-30 nBMI children) were administered oral vitamin D3 (60,000 IU weekly for five doses) in an open-labelled nonrandomised controlled trial. Serum 25(OH)D was measured before intervention and at days 7, 30 and 90 post-intervention, along with serum and urine calcium.

Results: The change/rise in 25(OH)D was significantly less in Group 1at days 7, 30 and 90. At day 30, the rise was 25% lower than in Group 2 and had a negative correlation with BMI (r = -0.412, P = 0.001) and FM (r = -0.452, P = 0.002). The mean circulating levels at days 30 and 90 were 20% lower in Group 1. The area under curve of the 25(OH)D profile in the two groups demonstrated a significant difference between the groups (3776.9 ± 780.0 in Group 1 vs 4857.9 ± 1267.8 in Group 2, P = 0.0002). Transient hypervitaminosis (without hypercalcaemia or hypercalciuria) was seen in 2/28 of Group 1 and 8/30 of Group 2 (only at day 7).

Conclusion: The higher BMI children had a 25% lower rise in serum 25(OH)D levels.

Introduction: The risk of recurrent/persistent disease (RD/PD) in differentiated thyroid cancer (DTC) is predicted using American Thyroid Association (ATA) Risk Stratification System (RSS) guidelines - 2009 followed by revision in 2015, which necessitated a more detailed histopathology report which was not available in resource poor settings. A comparative study of the two systems was done to assess the change in risk status and the impact on outcome in a cohort of DTC patients.

Methods: Clinico-pathologic parameters of 221 adults with DTC who had total thyroidectomy with subsequent radioactive iodine ablation were analysed to reassign risk category according to the ATA RSS 2009 and 2015, and the clinical end points were compared between both systems.

Results: Among the 127 subjects in the intermediate risk category of ATA RSS-2009, when re-categorised under ATA RSS-2015, only 12 subjects (9.4%) had a change of risk status. Response to therapy at 1 year and final outcome were comparable among the similar risk categories, irrespective of the ATA system used. ATA RSS-2009 and ATA RSS-2015 were comparable in predicting the outcome at final follow-up.

Conclusion: When risk status was reassigned with ATA RSS-2015, the study showed a shift in the intermediate risk category of ATA RSS-2009, but this was not statistically significant. Moreover, in predicting the outcome, ATA RSS 2015 was similar to ATA RSS-2009. This implies that the ATA RSS-2009 can be used for the initial risk stratification of patients in a resource-poor setting where the availability of complete histopathological data may be lacking.