Indian Journal of Endocrinology and Metabolism最新文献

Introduction: There is limited data regarding the prevalence and predictors of diabetes distress in Indians with type 2 diabetes (T2D). The study aimed to determine the occurrence and predictors of diabetes distress in adult persons with T2D.

Methods: In a cross-sectional study, persons with T2D on pharmacotherapy for at least 1 year were evaluated. They were administered three questionnaires namely- Diabetes Distress Scale-17, Patient Health Questionnaire-9, and Morisky Medication Adherence Scale-8. Clinically meaningful data regarding diabetes complications, anthropometry, and biochemical parameters were recorded.

Results: Two hundred persons completed the study (mean age 57 ± 9.89 years, 59% males). Overall 140 (70%) of the patients had diabetes distress (mean DDS score ≥2). Clinically significant diabetes distress (CSDD) that requires a physician's attention (mean DDS score ≥3) was seen in 75 (37.50%) of the study participants. The mean HbA1c was significantly higher in participants with CSDD (10.24 ± 2.01 vs. 7.85 ± 1.14; P = <0.001). Both microvascular [retinopathy (28% vs. 5.60%; P ≤ 0.001), neuropathy (28% vs. 0%; P ≤ 0.001), nephropathy (32% vs. 6.40%; P ≤ 0.001)] and macrovascular (CAD 24% vs. 4.80%; P ≤ 0.001) and (CVA 6.67% vs. 1.60%; P = 0.059) complications were significantly correlated with CSDD. Medication adherence was significantly lower in patients with CSDD (p=<0.001). An increased number of insulin injections increased BMI and HbA1c, and the presence of nephropathy were independent predictors of CSDD.

Conclusion: Diabetes distress is a common co-morbid condition in persons with T2D. CSDD had a significant correlation with poor glycaemic control, higher BMI, presence of nephropathy, and higher number of insulin injections.

Introduction: Previous Sri Lankan studies have shown an increase in diabetes and pre-diabetes prevalence. Therefore, we aimed to determine their prevalence and correlates among adults in the Western province.

Methods: Between 2018 and 2020, a cross-sectional sample of 1800 aged ≥20 years was recruited by a multi-stage stratified random cluster sampling technique. Fasting plasma glucose and HbA1C (in all participants) and a 75 g oral glucose tolerance test (in non-diabetic individuals) were used to categorise glycaemic status. Data are presented as % (95% CI).

Results: The response rate was 78.2% (n = 1408). Data from 1333 subjects were analysed, males = 36.4% and mean age = 49.8 (±14.9) years. The age-sex standardised prevalence of diabetes among adults in the Western Province was 27.8% (25.4%-30.3%) [males 29.9% (25.9%-33.9%) and females 25.8% (22.9%-28.8%)]. The highest prevalence was seen in the 60-69 age group (55.1%, 46.8%-63.4%) and the Colombo district (42.6%, 34.7%-50.5%). Those in urban areas had higher prevalence than those in rural areas [41.9% (33.3%-50.7%) vs 33.3% (28.6%-37.9%)]. Previously undiagnosed diabetes was present among 37.1% of diabetic individuals and in 13.4% (10.2%-16.5%) of the whole sample. The prevalence of isolated impaired glucose tolerance, isolated impaired fasting glucose, having both together, and overall pre-diabetes was 9.6% (7.3%-11.8%), 11.0% (8.7%-13.4%), 9.1% (5.6%-12.7%), and 35.6% (33.1%-38.2%), respectively. Those with diabetes and pre-diabetes compared with normoglycaemia were older, urban living, sedentary, and obese and had positive family history. They had higher blood pressure, triglycerides, serum transaminases, and urine albumin-creatinine ratio.

Conclusions: Among adults in the Western Province, more than 70% had diabetes or pre-diabetes with over one-third of those with diabetes being undiagnosed.

Introduction: Childhood obesity and nonalcoholic fatty liver disease (NAFLD) are emerging as significant health concerns. While liver biopsy remains the gold standard for diagnosis, there is a pressing need for a noninvasive alternative to identify early fibrosis.

Methods: A cross-sectional investigation was carried out from January 2020 to December 2021 involving overweight and obese children attending the pediatric outpatient department (OPD). The aim is to determine the occurrence of fibrotic and steatotic changes in the liver of overweight and obese children using transient elastography (TE) and to establish correlations between TE results, Pediatric NAFLD Fibrosis Index (PNFI), and other biochemical parameters. TE was utilized to assess both fibrotic and steatosis changes, while ultrasound (USG) was employed to detect steatosis in the liver.

Results: Two hundred and fifty-nine eligible children participated in the study. Mean age of the study cohort was 10.8 years, with males constituting 63%. Mean Z score for BMI was 1.71 ± 0.57. Fibrosis was detected in 29.3% of children by TE, while steatosis was observed in 27.7% of children. Steatosis was identified in 23.8% of cases through USG. BMI Z score, ALT (Alanine aminotransferase), AST and PNFI score exhibited significant associations with grades of liver fibrosis and steatosis as determined by TE, as well as with grades of steatosis according to USG findings.

Conclusion: A notable prevalence of increased liver stiffness was observed in overweight and obese children. TE proves to be a valuable tool in identifying fibrotic and steatotic changes in these children, complementing existing noninvasive modalities.

Introduction: The causative factors of diabetic retinopathy and nephropathy are genetic as well as environmental. The Glutathione S-transferase gene family is involved in redox balance to reduce oxidative stress, which is an important factor associated with these major diabetic complications. The objective of this study was to investigate the association between the polymorphism of glutathione S-transferase genes (GSTM1 and GSTT1) and type 2 diabetes mellitus (T2DM) patients with diabetic retinopathy (DR) and diabetic nephropathy (DN).

Methods: In this cross-sectional study, GSTM1 and GST1 gene polymorphisms were studied in T2DM patients with three groups of 125 cases each: the 1^st group DM without DN and DR, the 2^nd group with DR, and the 3^rd group with DN from December 2019 to January 2023. Polymerase chain reaction (PCR) was performed on DNA. GSTM1 and GSTT1 genotyping was conducted using gel electrophoresis. Statistical analysis was performed using SPSS software.

Results: Compared to the DM group, in the DR group, the GSTT1 null and GSTM1 null genotypes were more prevalent and showed 2.68-folds (OR = 2.68; 95% CI = 1.60-4.48; P < 0.001) and 2.5-folds (OR = 2.50; 95% CI = 1.50-4.18; P < 0.001) increased risk of developing DR respectively. In the DN group, the GSTM1 null genotype was more prevalent, with a 1.97-fold increased risk of developing DR (OR = 1.97, 95% CI = 1.19-3.26; P = 0.008) when compared to the DM group. However, no significant difference was found in the GSTT1 null genotype between the DN and DM groups.

Conclusion: The significant association between null genotypes of both GSTT1 and GSTM1 with DR and only the GSTM1 null genotype with DN suggests their roles as risk factors.

Introduction: Thyroid eye disease (TED) can be classified into an active phase with rapid progression and an inactive phase with symptom stabilization. Recent studies found a higher choroidal thickness in patients with active TED. Less is known about the effect of disease on the retina. More extensive study is warranted for generalizing the role of choroidal thickness as a biomarker for disease severity. The study aims to investigate the correlation between the subfoveal choroidal and circumpapillary retinal nerve fibre layer (cp RNFL) thickness with the severity of the disease. TED.

Methods: This cross-sectional study was conducted in the Ophthalmology department of a tertiary hospital in Central Kerala. A total of 16 participants with TED were included in the study after obtaining informed consent. Based on the CAS score, participants were divided into active and inactive TED groups. Visual acuity, colour vision, and contrast sensitivity were measured. SD-OCT was used to measure choroidal and RNFL thickness. Karl Pearson's correlation coefficient was used to assess the correlation between choroidal thickness and RNFL thickness with CAS.

Results: The difference in the choroidal thickness between the active and inactive groups was statistically significant. There was a significant correlation between the CAS and choroidal thickness (P < 0.05). The difference in the RNFL thickness and different functions of vision between active and inactive groups was statistically insignificant.

Conclusion: In conclusion, our study states that different phases of TED can have a profound effect on choroid.

Introduction: Acute adrenal insufficiency or adrenal crisis (AC) has a mortality rate of 0.5 / 100 patient-years and is a major cause of death in patients with adrenal insufficiency (AI). Non-compliance to steroids and inadequate stress dosing of glucocorticoids can precipitate AC in subjects with AI. In this study we tried to assess the knowledge pertaining to the disease, stress dosing and practice among individuals with AI.

Methods: Ninety-two subjects diagnosed with AI and visiting Endocrinology Outpatient Department (OPD) were subjected to a structured researcher administered questionnaire including questions on knowledge about the disease, symptoms of AI, stress dosing, and practice with respect to cortisol replacement therapy (CRT).

Results: Of the 92 participants, 13% were ignorant of the symptoms of AC, while about 78.2% of the entrants were aware that the dose of glucocorticoid must be doubled during illness. Around 20.7% of the subjects had intermittently stopped therapy on their own, while 13% partakers had failed to increase dose of glucocorticoid during illness. Hospitalization for AC was seen in 18.5% of entrants since the initial diagnosis of AI, with the most common precipitating cause being infection (70.6%).

Conclusion: There were lacunae in the knowledge about AC, CRT and stress dosing of glucocorticoids, and self-care among a significant number of patients with AI despite prior patient education. Hence, it is pertinent to reassess the knowledge, educate and reinforce good practices at multiple follow up visits to prevent AC and improve quality of life in individuals with AI.

Introduction: The molecular testing of indeterminate thyroid nodules (ITNs) empowers clinicians to make informed treatment decisions. Despite being recommended by the ATA 2015 guidelines, the utility of molecular testing in India is hindered by challenges related to availability and cost-effectiveness, thereby limiting its widespread adoption. We aimed to evaluate the clinical utility of next-generation sequencing (NGS)-based molecular testing in Indian patients with ITNs.

Methods: The study included patients with Bethesda III and IV and selected Bethesda II nodules who underwent Thyrotrack NGS-based assay on fine needle aspirate (FNA) material. Surgery was recommended for patients with clinically significant mutations, while others were followed sonographically. Post-surgical histopathology results were compared with mutation variants to calculate the sensitivity, specificity, and negative predictive value of the NGS assay.

Results: Among 35 patients (mean age 37.7 ± 12.4 years, 80% female), 20 (57%) had clinically significant mutations. Surgery was performed on 11 patients. The most common mutation was RAS (detected in 15 patients), followed by BRAF, TSH-R, ETV6/NTRK3, and PAX8/PPARG. Post-surgical outcomes showed an overall sensitivity of 86% and a specificity of 74%, with a negative predictive value of 94%. Among the mutation-negative group, only one patient had a malignancy, and the rest were benign showing a high negative predictive value of the NGS-based testing.

Conclusion: NGS-based assays provide a reliable and cost-effective option for ruling out malignancy in ITNs in India, offering a high negative predictive value and complementing ACR-TIRADS and Bethesda cytology classifications.