Indian Journal of Endocrinology and Metabolism最新文献

Introduction: Nonalcoholic fatty liver disease (NAFLD) is a common disorder with a complex aetiology. The polymorphic variant rs738409 in the PNPLA3 gene has been reported to be associated with NAFLD among several ethnic populations. The present study aims to identify the potential association of rs738409 with NAFLD and correlate it with disease severity and biochemical parameters.

Methods: The Ile148Met variant was genotyped using polymerase chain reaction (PCR)-RFLP-based techniques among 99 NAFLD cases and 100 ethnicity-matched controls.

Results: We identified statistically significant differences in genotype and allele frequencies of rs738409 between cases and controls. The risk genotype and allele were associated with higher FIB-4 and controlled attenuation parameter (CAP) scores but not with liver stiffness measurement (LSM) values. The mean CAP score was significantly higher among carriers of the risk allele.

Conclusion: The Ile148Met variant of the PNPLA3 gene is a predisposing risk factor for the development of NAFLD and is associated with increased severity of hepatic steatosis among the ethnic Bengali population of West Bengal.

Introduction: Gestational diabetes mellitus (GDM) affects up to 31% of pregnancies in South Asia, posing significant risks to maternal and neonatal health. Despite their potential, Indian primary health centres (PHCs) are underutilised in GDM prevention. This study aims to evaluate the effectiveness of a multipronged intervention compared to standard care in reducing GDM incidence among high-risk pregnant women and to explore barriers to adherence.

Methods: This is a mixed-methods, two-arm, parallel-group cluster randomised controlled trial involving 12 PHCs randomised (1:1) to intervention or control arms. The intervention includes personalised dietary counselling (Medical Nutrition Therapy with millet-based, low-glycaemic index meals), structured physical activity guidance, educational booklets, WhatsApp-based reminders, and PHC staff training. Control PHCs will provide routine antenatal care. A total of 1200 participants (600 per arm) will be recruited. The primary outcome is GDM incidence, assessed via OGTT at 23-25 and 37 weeks using IADPSG criteria. Secondary outcomes include adherence to intervention, changes in metabolic biomarkers, and maternal and neonatal health indicators. Qualitative data from in-depth interviews and focus group discussions will undergo deductive content analysis.

Results: This protocol outlines planned analyses. Both intention-to-treat and per-protocol analyses will be conducted. A conceptual framework will be developed to represent qualitative findings.

Conclusion: This trial implements a culturally tailored, scalable intervention integrated into India's primary healthcare system. Findings may guide national GDM prevention strategies, support early intervention, and improve maternal and neonatal outcomes in resource-constrained settings.

Introduction: Clinical screening for diabetic neuropathy diagnoses only the tip of the iceberg and may miss sub-clinical neuropathies whose progression can be prevented/reversed if detected early. Hence, this study was conducted to compare nerve conduction (NCS) parameters of adolescents with type 1 Diabetes (T1D) with healthy controls and to assess prevalence and risk factors for sub-clinical peripheral neuropathy in Indian adolescents with T1D.

Methods: Case-control study. Cases (n = 120): 10-19 years, T1D duration >2 years. Exclusion: Comorbidities/illnesses/medication affecting nerve function. Controls (n = 40): Healthy, age, sex-matched.

Results: Mean age: 15.1 ± 3 years; diabetes duration: 7 ± 3.5 years, HbA1c: 9.6 ± 2.1%. None had symptoms/signs of peripheral neuropathy. NCS comparison demonstrated significantly prolonged latency, reduced action potential duration, and nerve conduction velocity (P < 0.01) in motor nerves (median, ulnar, peroneal, tibial) in patients with T1D. Sensory action potential duration in median and ulnar nerves, and sural conduction velocity were significantly lower in T1D (P < 0.05). 26.7% had at least one abnormal NCS parameter. Sub-clinical neuropathy prevalence- demyelinating motor: upper limbs (UL)-5.8%, lower limbs (LL)-11.7%; demyelinating sensory: UL-5.0%, LL-5.0%; axonal motor: UL-4.2%, LL-2.5%; axonal sensory: UL-2.5%, LL-5.0%. Six (5.0%) had stage-1a distal symmetrical polyneuropathy. HbA1c (OR = 1.5), age (OR = 1.4), female gender (OR = 0.2), iron intake (OR = 0.8), and hypertension (OR = 19.7) were significantly associated with sub-clinical neuropathy.

Conclusion: The prevalence of sub-clinical peripheral neuropathy in Indian adolescents with T1D was considerable, with the highest prevalence observed in the lower limbs. Despite no symptoms, NCS parameters were adversely affected in T1D, highlighting the need for early NCS-based screening. Poor glycaemic control, reduced iron intake, and hypertension were modifiable risk factors associated with sub-clinical neuropathy, apart from non-modifiable factors like male gender, age.

Introduction: Night shift work has been associated with obesity, cardiovascular diseases, and certain cancers. The primary objective of this study was to assess the differences in metabolic and endocrine profiles between night shift and day shift workers in a South Indian cohort.

Methods: This cross-sectional study included 45 night shift workers (NSWs) and 45 day shift workers (DSWs). Metabolic parameters measured were HOMA IR, HDL-C, triglycerides, adiponectin, free fatty acids, and BMI. Hormonal parameters measured were total T3, total T4, TSH, 8 am cortisol, LH, FSH, testosterone, oestradiol, growth hormone, IGF-1, and 25 (OH) vitamin D₃.

Results: NSWs were younger (28.6 ± 5.7 years vs. 31.1 ± 7.2 years; P = 0.022) with a lower mean BMI (24.2 ± 5 kg/m² vs. 25.2 ± 5.7 kg/m²; P = 0.33) and higher mean HOMA IR (6.3 ± 5.4 vs. 5.2 ± 4.4; P = 0.26). 77% (n = 35) of NSW had HOMA-IR ≥ 2.5 in comparison to 62% (n = 28) of DSW (P = 0.031). NSW had higher median triglycerides (195^[90] mg/dl vs. 180^[44] mg/dl; P = 0.045) and lower mean HDL-C levels (35 ± 2.7 mg/dl vs. 40 ± 3 mg/dl; P < 0.001). NSW males had lower mean LH levels (2.8 ± 1.4 mIU/ml vs. 5.6 ± 3 mIU/ml; P = <0.001) and testosterone levels (373.6 ± 146 ng/dl vs. 400 ± 140 ng/dl; P = 0.5). The mean oestradiol levels were elevated in female NSW (181 ± 84 pg/ml vs. 100 ± 62 pg/ml; P = 0.006). 25(OH) vitamin D₃ levels were significantly low in the NSW (10.4 ± 4.8 ng/ml vs. 13.7 ± 4.5 ng/ml; P = 0.032).

Conclusion: The present study shows night shift work is associated with increased risk of insulin resistance, hypertriglyceridemia, low HDL-C, low LH and testosterone in males, high oestradiol among females, and vitamin D deficiency.

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.