Indian Journal of Endocrinology and Metabolism最新文献

Introduction: Impact of COVID-19 on endocrine system due to the widespread distribution of Angiotensin Converting Enzyme-2 (ACE2) receptors in different endocrine organs of the body has been shown in several studies. However, most of these studies were in the setting of acute COVID-19. The present study was planned to comprehensively evaluate endocrine abnormalities in COVID-19-recovered individuals.

Methods: Eighty-three COVID-19-recovered individuals were recruited 8-20 weeks following the recovery. They were further stratified according to disease severity as defined by the Indian Council of Medical Research (ICMR). After recording their demographic and clinical details, an evaluation of inflammatory markers and different hypothalamic-pituitary axes involving thyroid, adrenal, gonadal and prolactin axes was carried out in them. Those who were on treatment for a previous endocrine disorder were not included in the study.

Results: Eighty-three patients [33 (39.7%): mild and 50 (60.3%): moderate to severe COVID-19] were recruited after a period of 14.7 ± 3.4 weeks after recovery. Forty-four patients (53%) had some form of endocrine dysfunction. Central pituitary axis dysfunction was observed in 28 patients (33.7%), of which alterations in prolactin (20.4%) were the most common. Thyroid function abnormalities were noted in 25 (30.1%) patients, while gonadal dysfunction was detected in 14% of males and 6% of reproductive-aged females, respectively.

Conclusion: Endocrine function test abnormalities were seen in a significant proportion of individuals even after a mean period of more than 3 months post-recovery from COVID-19. These have implications for the long-term endocrine and metabolic health of COVID-19-recovered individuals, besides alerting physicians to interpret endocrine function tests with caution after recovery from acute COVID-19 illness.

Introduction: The 'acclimatization time' before temperature assessment for diagnosis and monitoring of active unilateral Charcot neuro-osteoarthropathy (CNO) of foot is not known. Therefore, we aimed to assess the appropriate acclimatization time for foot temperature at diagnosis and during follow-up assessment of patients with active CNO.

Methods: Patients of diabetes with active unilateral CNO of foot were assessed for inter-feet temperature difference [affected foot-unaffected foot (°C)] at 10-, 30- and 45-minutes following shoe-off with a handheld infrared dermal thermometer. The primary objective was to assess the significance of different individual and paired time points for inter-feet temperature differences.

Results: Overall, 30 patients were recruited and 96 paired inter-feet temperature difference readings were obtained. The median inter-feet temperature difference at 10 minutes was 3°C (2.4-4.4°C), 30 minutes was 3.2°C (2.5-4.45°C) and 45 minutes was 3.3°C (2.3-4.63°C) (P = 0.623). The correlation between paired temperature readings at 30 and 45 minutes (r = 0.914; P < 0.001) was better than that at 10 and 30 minutes (r = 0.724; P < 0.001).

Conclusion: Paired inter-feet temperature difference obtained at 30 and 45 minutes following footwear removal is clinically-meaningful for the diagnosis and monitoring of active unilateral CNO of feet.

This systematic review compares the efficacy and safety of gliclazide and glimepiride in managing type 2 diabetes mellitus (T2DM). A comprehensive search was conducted in multiple databases, including PubMed and Cochrane Library, to identify relevant randomised controlled trials and observational studies. Five studies were included based on pre-defined eligibility criteria, focussing on glycaemic control (HbA1c, fasting blood glucose, and post-prandial blood glucose) and safety outcomes like hypoglycaemia and cardiovascular events. Data were extracted and synthesised using established systematic review methodologies, and risk of bias was assessed with Cochrane tools. Both gliclazide and glimepiride effectively reduced HbA1c, but gliclazide showed a lower risk of hypoglycaemia. However, elderly patients using gliclazide had an increased risk of severe hypoglycaemia and fractures. This review indicates that while both drugs are effective, gliclazide may have a safer profile in middle-aged adults, with glimepiride potentially being a better option for older adults.

Introduction: The transcription factor 7-like 2 (TCF7L2) gene emerged as the most promising gene causing type 2 diabetes mellitus, which is associated with obesity. However, the genetic factors underlying obesity in the South Asian population remain largely unexplored.

Objectives: This study aimed to evaluate the relationship between the TCF7L2 gene polymorphism (rs12255372 G > T) and obesity, along with weight-related traits, in the Bangladeshi participants.

Methods: This cross-sectional study was conducted in the Department of Endocrinology of a medical university. Eighty adults were enrolled by non-random sampling who met the inclusion and exclusion criteria and were categorized as obese and non-obese based on the WHO Expert Consultation 2004. The rs12255372 (G > T) polymorphism was genotyped using the polymerase chain reaction-restriction fragment length polymorphism technique, and statistical analysis was carried out using SPSS version 26.0 for Windows.

Results: Out of 80 participants, 28 were obese and 52 non-obese. An allelic odds ratio (OR) of 3.86 (95% confidence interval (CI) 1.56-9.54; P = 0.002) was found for the minor T allele of TCF7L2 rs12255372 in obesity. A significant difference in GT genotype was observed between participants with obesity and without obesity (OR 3.53, 95% CI 1.13-11.07; P = 0.02).

Conclusion: The minor T allele frequency of rs12255372 (G > T) among participants with obesity and without obesity were about 27% and 9%, respectively, indicating the rs12255372 (G > T) polymorphism of the TCF7L2 gene may be associated with the risk of obesity in the studied Bangladeshi population.

Introduction: Fenofibrate forms the standard of care for managing hypertriglyceridemia. Many of these patients have associated metabolic dysfunction-associated steatotic liver disease (MASLD). No systematic review and meta-analysis (SRM) has analysed the impact of fenofibrate in MASLD. Hence, we undertook this SRM.

Methods: Electronic databases were searched for randomised controlled trials (RCTs) involving MASLD patients receiving fenofibrate as an intervention and placebo/active comparator as control. The primary outcome was changes in alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Secondary outcomes were alterations in liver fat (ultrasonography or magnetic resonance imaging), lipid parameters, and adverse events.

Results: From initially screened 395 articles, data from 5 RCTs were analysed. Fenofibrate had comparable changes in ALT (mean difference [MD]-0.32 IU/L [95% confidence interval [CI]: -6.70-7.33]; P = 0.931; I ² = 60%) and AST (MD-0.17 IU/L [95% CI: -3.83-3.48]; P = 0.932; I ² = 31%) as compared to active controls (atorvastatin, omega-3 fatty acids [O3FA] and pioglitazone). Fenofibrate users had a greater increase in liver-fat content as compared to active controls (pioglitazone and O3FA) (MD 5.37 [95% CI: 0.30-10.44]; P = 0.041; I ² = 85%). O3FA and pioglitazone use is associated with reduction in liver fat, which explains the apparent increase in liver fat with fenofibrate in our analysis. Fenofibrate was associated with a significantly greater decrease in triglycerides compared to active controls (MD-0.22 mmol/l [95% CI: -0.31--0.12]; P < 0.001; I ² = 0%). Fenofibrate was associated with comparable change in total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, weight, and waist circumference compared to active controls.

Conclusion: This SRM provides us with reassuring safety data on use of fenofibrate in MASLD. Fenofibrate is largely MASLD neutral and continues to have good triglyceride lowering properties in MASLD.

Diabetic gastroparesis (DGP) is a microvascular complication of diabetes, characterised by delayed gastric emptying and cardinal symptoms such as nausea, vomiting, early satiety, post-meal discomfort, bloating, and appetite loss. Diagnosis relies on identifying these symptoms and excluding obstructions. India-specific DGP management algorithm was developed by 50 expert gastroenterologists across India. It offers a systematic approach tailored to Indian clinical settings, emphasising a comprehensive evaluation encompassing medical history, clinical examination, and laboratory investigations for diagnosing DGP. The management strategy involves glycemic control, dietary adjustments, prokinetics with antiemetics, and stepwise treatment modification if initial approaches prove ineffective. Additionally, the algorithm underscores the significance of endoscopic evaluation and gastric emptying studies in DGP diagnosis, as well as the use of prokinetics, antiemetics, and neuromodulators in treatment. Notably, the experts favoured itopride as the preferred and relatively safer prokinetic for treating DGP and its varied clinical presentations.