{"title":"COVID-19, Ramadan, diabetes, thyroid, and more","authors":"S. Beshyah","doi":"10.4103/jdep.jdep_19_21","DOIUrl":"https://doi.org/10.4103/jdep.jdep_19_21","url":null,"abstract":"","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123420060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Treatment of hypothyroidism in the Middle East","authors":"H. Gharib","doi":"10.4103/jdep.jdep_20_21","DOIUrl":"https://doi.org/10.4103/jdep.jdep_20_21","url":null,"abstract":"","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128490659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report insulin autoimmune syndrome in a diet-controlled type 2 diabetes mellitus patient. She developed recurrent attacks of severe hypoglycemia 1 week after the initiation of clopidogrel. The evaluation revealed high insulin and C-peptide levels consistent with hyperinsulinemic hypoglycemia. The insulin-to-C-peptide ratio was reversed and >50. Anti-insulin antibody titers were highly positive.
{"title":"Clopidogrel induced autoimmune hypoglycemia","authors":"A. Alnuaimi, B. Afandi, Y. Othman","doi":"10.4103/jdep.jdep_8_21","DOIUrl":"https://doi.org/10.4103/jdep.jdep_8_21","url":null,"abstract":"We report insulin autoimmune syndrome in a diet-controlled type 2 diabetes mellitus patient. She developed recurrent attacks of severe hypoglycemia 1 week after the initiation of clopidogrel. The evaluation revealed high insulin and C-peptide levels consistent with hyperinsulinemic hypoglycemia. The insulin-to-C-peptide ratio was reversed and >50. Anti-insulin antibody titers were highly positive.","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"446 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132276733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Hypothyroidism is a common endocrine disorder that is managed by a wide range of physicians. There are no data on the pattern of clinical management of hypothyroidism in the Middle East and Africa (MEA) region. Objectives: We sought to document current practices in the management of primary hypothyroidism in the MEA region and compare these with international recommendations and practices elsewhere. Materials and Methods: A convenience sample of physicians practicing in the MEA in relevant disciplines were invited to take a web-based survey consisting of previously validated multiple-choice questions dealing with investigation and treatment of an index case of overt primary hypothyroidism in general and in three special situations. Results: Out of complete 397 responses, 368 were eligible for inclusion in the analysis. The majority were endocrinologists and internal medicine specialists; 82.2% of them have been in clinical practice for 10 years or more. Overt hypothyroidism would be treated using L-T4 alone by 97.2% of respondents; 1.7% would use a combination of L-T4 and liothyronine (L-T3) therapy. The rate of replacement would be gradual (66.5%), an empiric dose, adjusted to achieve target levels (14.7%); or a calculated full replacement dose (18.5%). A target thyroid-stimulating hormone (TSH) of 2.0–2.9 mU/L was favored in the index case of overt hypothyroidism (by 34.4%) followed by a target of 3.0–3.9 mU/L (by 26.0%) of respondents. However, a target of 4.0–4.9 mU/L was the most commonly selected TSH target for an octogenarian (by 33.5% of respondents). Persistent hypothyroid symptoms despite achieving a target TSH would prompt testing for other causes by 86.9% of respondents, a change to L-T4 plus L-T3 therapy by 5.8%, and an increase in the thyroid hormone dose by 4.6%. Evaluation of persistent symptoms would include measurements of complete blood count (82.4%), complete metabolic panel (68.7%), morning cortisol (65.3%), Vitamin B12 levels (54.5%), and serum T3 levels (27.9%). Subclinical disease with a TSH 7.8 mU/L would be treated without further justification by 9.0% of respondents, or in the presence of positive thyroid peroxidase antibodies (65.3%), hypothyroid symptoms (65.0%), high low-density lipoprotein (51.7%), or a goiter (36.7%). The TSH target for a newly pregnant patient was 2.0–2.4 mU/L for 28.5% of respondents, with 15.8% preferring a TSH target of 1.5–1.9 mU/L. Thyroid hormone levels would be checked every 4 weeks during pregnancy by 62.9% and every 8 weeks by an additional 17.6%. A hypothyroid patient with a TSH of 0.5 mU/L who becomes pregnant would receive an immediate L-T4 dose increase by only 28.5% of respondents. Conclusions: The survey revealed that (1) nearly exclusive preference for L-T4 alone for therapy, (2) use of age-specific TSH targets for replacement therapy, (3) a low threshold for treating mild thyroid failure, (4) complacent and variable attention to TSH targets in the pregnant and prepregn
{"title":"Patterns of clinical management of hypothyroidism in adults: An electronic survey of physicians from the Middle East and Africa","authors":"S. Beshyah, I. Sherif, H. Mustafa, H. Saadi","doi":"10.4103/jdep.jdep_14_21","DOIUrl":"https://doi.org/10.4103/jdep.jdep_14_21","url":null,"abstract":"Background: Hypothyroidism is a common endocrine disorder that is managed by a wide range of physicians. There are no data on the pattern of clinical management of hypothyroidism in the Middle East and Africa (MEA) region. Objectives: We sought to document current practices in the management of primary hypothyroidism in the MEA region and compare these with international recommendations and practices elsewhere. Materials and Methods: A convenience sample of physicians practicing in the MEA in relevant disciplines were invited to take a web-based survey consisting of previously validated multiple-choice questions dealing with investigation and treatment of an index case of overt primary hypothyroidism in general and in three special situations. Results: Out of complete 397 responses, 368 were eligible for inclusion in the analysis. The majority were endocrinologists and internal medicine specialists; 82.2% of them have been in clinical practice for 10 years or more. Overt hypothyroidism would be treated using L-T4 alone by 97.2% of respondents; 1.7% would use a combination of L-T4 and liothyronine (L-T3) therapy. The rate of replacement would be gradual (66.5%), an empiric dose, adjusted to achieve target levels (14.7%); or a calculated full replacement dose (18.5%). A target thyroid-stimulating hormone (TSH) of 2.0–2.9 mU/L was favored in the index case of overt hypothyroidism (by 34.4%) followed by a target of 3.0–3.9 mU/L (by 26.0%) of respondents. However, a target of 4.0–4.9 mU/L was the most commonly selected TSH target for an octogenarian (by 33.5% of respondents). Persistent hypothyroid symptoms despite achieving a target TSH would prompt testing for other causes by 86.9% of respondents, a change to L-T4 plus L-T3 therapy by 5.8%, and an increase in the thyroid hormone dose by 4.6%. Evaluation of persistent symptoms would include measurements of complete blood count (82.4%), complete metabolic panel (68.7%), morning cortisol (65.3%), Vitamin B12 levels (54.5%), and serum T3 levels (27.9%). Subclinical disease with a TSH 7.8 mU/L would be treated without further justification by 9.0% of respondents, or in the presence of positive thyroid peroxidase antibodies (65.3%), hypothyroid symptoms (65.0%), high low-density lipoprotein (51.7%), or a goiter (36.7%). The TSH target for a newly pregnant patient was 2.0–2.4 mU/L for 28.5% of respondents, with 15.8% preferring a TSH target of 1.5–1.9 mU/L. Thyroid hormone levels would be checked every 4 weeks during pregnancy by 62.9% and every 8 weeks by an additional 17.6%. A hypothyroid patient with a TSH of 0.5 mU/L who becomes pregnant would receive an immediate L-T4 dose increase by only 28.5% of respondents. Conclusions: The survey revealed that (1) nearly exclusive preference for L-T4 alone for therapy, (2) use of age-specific TSH targets for replacement therapy, (3) a low threshold for treating mild thyroid failure, (4) complacent and variable attention to TSH targets in the pregnant and prepregn","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117234717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Reem Alawadhi, Ahmad M. Matalkah, Naveed Ahmed, A. Alduaij, A. Sabri, S. El-Kaissi, Y. Akmal
Background: Thyroid nodules are a common presentation in clinical practice. Fine-needle aspiration cytology (FNAC) is a useful method of triaging patients between benign, suspicious, and malignant categories. Materials and Methods: This is a retrospective review of the electronic medical record of all surgical thyroid patients presenting to our institution between July 2015 and June 2017. The cytological and histological data were reviewed and correlated based on the Bethesda system for reporting thyroid cytopathology. Results: Two hundred and seven patients underwent thyroidectomies during that period of which 164 had preoperative FNAC. The female-male ratio of 4.9:1. On histology, 52% of nodules were benign and 48% of nodules were malignant. When comparing with cytologic diagnosis, FNAC showed a sensitivity of 52%, specificity of 95%, positive predictive value of 92%, negative predictive value of 64%, false positive rate 5%, and false negative rate 48%. Total accuracy was found to be 72%. Conclusion: FNAC is a useful tool in deciding management options for patients, but has limitations, particularly when evaluating follicular lesions. This leads to discrepancy in the calculation of statistical values in literature.
{"title":"Accuracy of fine-needle aspiration cytology for detecting cancer in resected thyroid nodules at a referral hospital","authors":"Reem Alawadhi, Ahmad M. Matalkah, Naveed Ahmed, A. Alduaij, A. Sabri, S. El-Kaissi, Y. Akmal","doi":"10.4103/jdep.jdep_5_20","DOIUrl":"https://doi.org/10.4103/jdep.jdep_5_20","url":null,"abstract":"Background: Thyroid nodules are a common presentation in clinical practice. Fine-needle aspiration cytology (FNAC) is a useful method of triaging patients between benign, suspicious, and malignant categories. Materials and Methods: This is a retrospective review of the electronic medical record of all surgical thyroid patients presenting to our institution between July 2015 and June 2017. The cytological and histological data were reviewed and correlated based on the Bethesda system for reporting thyroid cytopathology. Results: Two hundred and seven patients underwent thyroidectomies during that period of which 164 had preoperative FNAC. The female-male ratio of 4.9:1. On histology, 52% of nodules were benign and 48% of nodules were malignant. When comparing with cytologic diagnosis, FNAC showed a sensitivity of 52%, specificity of 95%, positive predictive value of 92%, negative predictive value of 64%, false positive rate 5%, and false negative rate 48%. Total accuracy was found to be 72%. Conclusion: FNAC is a useful tool in deciding management options for patients, but has limitations, particularly when evaluating follicular lesions. This leads to discrepancy in the calculation of statistical values in literature.","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"16 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122475943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Thyroid nodules in the gulf: Renewed interest and ongoing debate","authors":"Aly B Khalil, B. Altrabulsi, R. Dina","doi":"10.4103/jdep.jdep_10_21","DOIUrl":"https://doi.org/10.4103/jdep.jdep_10_21","url":null,"abstract":"","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"440 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129319524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Identifying and treating hypoglycemia in insulin-treated diabetes","authors":"B. Frier","doi":"10.4103/jdep.jdep_11_21","DOIUrl":"https://doi.org/10.4103/jdep.jdep_11_21","url":null,"abstract":"","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115805095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Citing this paper Please note that where the full-text provided on King's Research Portal is the Author Accepted Manuscript or Post-Print version this may differ from the final Published version. If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.
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{"title":"Journal of diabetes and endocrine practice 2021 and beyond: New affiliation; Same mission","authors":"S. Beshyah","doi":"10.4103/jdep.jdep_6_21","DOIUrl":"https://doi.org/10.4103/jdep.jdep_6_21","url":null,"abstract":"Citing this paper Please note that where the full-text provided on King's Research Portal is the Author Accepted Manuscript or Post-Print version this may differ from the final Published version. If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126040950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The salivary fluid has an old history of study, but its physiological importance has only been recognized recently. In the past 50 years, the pace of salivary research has accelerated with the advent of new techniques that illuminated the biochemical and physicochemical properties of saliva. The recent introduction of molecular biology opens up, once again, new vistas and a new search of the role of salivary fluid as a potential diagnostic tool which has an added advantage of being noninvasive. The role of saliva in the diagnosis as well as monitoring of glycemic control has also been attracting the attention of clinical researchers in recent times although results have been conflicting. The present review presents such insight into the possible use of salivary fluid for the monitoring of serum glucose levels and in the detection of glycemic control in diabetic patients with the evidence of its reliability based on the existing literature.
{"title":"Serum and salivary glucose levels in diabetes mellitus: A review on the quest for diagnostics","authors":"A. Nayyar","doi":"10.4103/jdep.jdep_7_19","DOIUrl":"https://doi.org/10.4103/jdep.jdep_7_19","url":null,"abstract":"The salivary fluid has an old history of study, but its physiological importance has only been recognized recently. In the past 50 years, the pace of salivary research has accelerated with the advent of new techniques that illuminated the biochemical and physicochemical properties of saliva. The recent introduction of molecular biology opens up, once again, new vistas and a new search of the role of salivary fluid as a potential diagnostic tool which has an added advantage of being noninvasive. The role of saliva in the diagnosis as well as monitoring of glycemic control has also been attracting the attention of clinical researchers in recent times although results have been conflicting. The present review presents such insight into the possible use of salivary fluid for the monitoring of serum glucose levels and in the detection of glycemic control in diabetic patients with the evidence of its reliability based on the existing literature.","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"20 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127060644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdullah M Al Zahrani, Sarah Al-Zaidi, Adnan Al Shaikh, Abdulrahman Alghamdi, F. Farahat
Background: Hypoglycemia has a significant impact on an individual's quality of life. This study aimed to assess knowledge of adult patients with diabetes on hypoglycemia and its management. Methods: A cross-sectional study using a newly developed self-administered questionnaire was conducted from April to May 2017, at National Guard Primary Health Care Centers, Jeddah, Saudi Arabia. Simple descriptive statistics were used. Inferential statistics was performed in the form of Student's t-test and one-way ANOVA. Regarding knowledge questions, a score of (1) was given to the right answer, and summation of scores was computed (the total score was 42). Knowledge scores were categorized into good, moderate, and poor based on the mean score. Results: A total of 361 adult patients with diabetes were involved (208 (57.6%) women; 153 (42.4%)). The majority (341; 94.5%) were Type 2 diabetes patients. Mean knowledge score was 32.0 (±8.2), and a score of ≥31.5 represented good knowledge, while a score between 21 and 31.5 represented a moderate level of knowledge, and a score below 21 represented poor knowledge. The majority (92.2%) had poor level of knowledge. Factors associated with better knowledge were male sex, younger age, being a student, or holding a bachelor degree, being single, receiving high monthly income, Type 1 diabetes, and having previous hypoglycemia experience. Regarding hypoglycemia management, 66.8% identified the right management, which was “eating 15 g of fast-acting carbohydrate.” Conclusion: Most participants showed poor knowledge regarding hypoglycemia. More efforts and time should be made during regular visits to provide the necessary health education about hypoglycemia signs for all patients with diabetes.
{"title":"Lack of knowledge about hypoglycemia among adult patients with diabetes in Saudi Arabia: A cross-sectional study","authors":"Abdullah M Al Zahrani, Sarah Al-Zaidi, Adnan Al Shaikh, Abdulrahman Alghamdi, F. Farahat","doi":"10.4103/jdep.jdep_2_20","DOIUrl":"https://doi.org/10.4103/jdep.jdep_2_20","url":null,"abstract":"Background: Hypoglycemia has a significant impact on an individual's quality of life. This study aimed to assess knowledge of adult patients with diabetes on hypoglycemia and its management. Methods: A cross-sectional study using a newly developed self-administered questionnaire was conducted from April to May 2017, at National Guard Primary Health Care Centers, Jeddah, Saudi Arabia. Simple descriptive statistics were used. Inferential statistics was performed in the form of Student's t-test and one-way ANOVA. Regarding knowledge questions, a score of (1) was given to the right answer, and summation of scores was computed (the total score was 42). Knowledge scores were categorized into good, moderate, and poor based on the mean score. Results: A total of 361 adult patients with diabetes were involved (208 (57.6%) women; 153 (42.4%)). The majority (341; 94.5%) were Type 2 diabetes patients. Mean knowledge score was 32.0 (±8.2), and a score of ≥31.5 represented good knowledge, while a score between 21 and 31.5 represented a moderate level of knowledge, and a score below 21 represented poor knowledge. The majority (92.2%) had poor level of knowledge. Factors associated with better knowledge were male sex, younger age, being a student, or holding a bachelor degree, being single, receiving high monthly income, Type 1 diabetes, and having previous hypoglycemia experience. Regarding hypoglycemia management, 66.8% identified the right management, which was “eating 15 g of fast-acting carbohydrate.” Conclusion: Most participants showed poor knowledge regarding hypoglycemia. More efforts and time should be made during regular visits to provide the necessary health education about hypoglycemia signs for all patients with diabetes.","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132557704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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