T. Horiuchi, J. Adachi, Yoshihiro Sekiguchi, A. Kanamaru
Introduction: Intermittent flash glucose monitoring (FGM) and real-time continuous glucose monitoring (CGM) are used to monitor glycemic excursions for 14 days and can demonstrate time in range (TIR), time above range (TAR), and time below range (TBR). The utility of CGM metrics, such as TIR, TBR, and TAR, in diabetics treated with insulin combined with antihyperglycemic drugs is uncertain. Methods: In a cross-sectional and retrospective study, we investigated the relationship between target metrics from CGM/FGM and HbA1c or glucose variabilities in 80 type 1 and 2 diabetic patients receiving insulin treatment with ≥1 injections per day. The proportions of TIR, TAR, and TBR from FGM in relation to HbA1c and coefficient of variation (CV)% in types 1 and 2 diabetics were analyzed. Multivariable analyses were performed regarding the associations of TIR with biochemical factors and glycemic variabilities. TBR was also examined in relation to antidiabetic agents and diabetic type in multiple regression analyses. Finally, the association of retinopathy with FGM-CGM metrics was examined using a logistic analysis. Results: When patients were grouped by sex and diabetic type, significant differences in age, TIR, TBR, high-density lipoprotein cholesterol (HDLC), and insulin dose were detected using Kruskal-Wallis analyses. HbA1c significantly correlated with TIR (p < 0.001) and TAR (p < 0.001) using Pearson’s correlation analysis. TBR significantly correlated with CV% (p < 0.001). Multivariable analysis of TIR showed a significant negative association with HbA1c (p = 0.02). Incretin combined with insulin therapy reduced the TBR proportion significantly according to the multivariate analysis. Retinopathy tended to be related to HbA1c (p = 0.059) and duration (p = 0.078) but not TIR (p = 0.891), according to the logistic analysis. Conclusions: These results demonstrate that CGM metrics reflect glucose control for 2 weeks using TIR. In addition, combined therapy with incretin and insulin therapy is superior for reducing hypoglycemia, based on TBR. Thus, TBR is also useful for monitoring hypoglycemia. However, FGM/CGM metrics do not predict retinopathy accurately.
{"title":"Evaluation of the Association of CGM Metrics with Antihyperglycemic Drugs in Insulin-Treated Diabetics","authors":"T. Horiuchi, J. Adachi, Yoshihiro Sekiguchi, A. Kanamaru","doi":"10.1159/000519438","DOIUrl":"https://doi.org/10.1159/000519438","url":null,"abstract":"Introduction: Intermittent flash glucose monitoring (FGM) and real-time continuous glucose monitoring (CGM) are used to monitor glycemic excursions for 14 days and can demonstrate time in range (TIR), time above range (TAR), and time below range (TBR). The utility of CGM metrics, such as TIR, TBR, and TAR, in diabetics treated with insulin combined with antihyperglycemic drugs is uncertain. Methods: In a cross-sectional and retrospective study, we investigated the relationship between target metrics from CGM/FGM and HbA1c or glucose variabilities in 80 type 1 and 2 diabetic patients receiving insulin treatment with ≥1 injections per day. The proportions of TIR, TAR, and TBR from FGM in relation to HbA1c and coefficient of variation (CV)% in types 1 and 2 diabetics were analyzed. Multivariable analyses were performed regarding the associations of TIR with biochemical factors and glycemic variabilities. TBR was also examined in relation to antidiabetic agents and diabetic type in multiple regression analyses. Finally, the association of retinopathy with FGM-CGM metrics was examined using a logistic analysis. Results: When patients were grouped by sex and diabetic type, significant differences in age, TIR, TBR, high-density lipoprotein cholesterol (HDLC), and insulin dose were detected using Kruskal-Wallis analyses. HbA1c significantly correlated with TIR (p < 0.001) and TAR (p < 0.001) using Pearson’s correlation analysis. TBR significantly correlated with CV% (p < 0.001). Multivariable analysis of TIR showed a significant negative association with HbA1c (p = 0.02). Incretin combined with insulin therapy reduced the TBR proportion significantly according to the multivariate analysis. Retinopathy tended to be related to HbA1c (p = 0.059) and duration (p = 0.078) but not TIR (p = 0.891), according to the logistic analysis. Conclusions: These results demonstrate that CGM metrics reflect glucose control for 2 weeks using TIR. In addition, combined therapy with incretin and insulin therapy is superior for reducing hypoglycemia, based on TBR. Thus, TBR is also useful for monitoring hypoglycemia. However, FGM/CGM metrics do not predict retinopathy accurately.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"41 1","pages":"137 - 142"},"PeriodicalIF":0.0,"publicationDate":"2021-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88574459","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}
Noorah Bawady, O. Aldafrawy, Elham Mohamed ElZobair, Wafaa Suliman, Amal Alzaabi, Suad H. Ahmed
Background: Diabetes is a highly prevalent global and local major health problem according to the International Diabetes Federation (IDF) and will double by 2045. A strong relationship between obesity and type 2 diabetes has been found. Both are leading causes of cardiovascular disease and death; thus, understanding the prevalence of obesity in type 2 diabetes is crucial for planning obesity management and preventing complications. Objectives: This study aimed to determine the prevalence of obesity and overweight among people with type 2 diabetes attending primary healthcare centers (PHC) in the Dubai Health Authority (DHA). Methods: The study sample consisted of type 2 diabetes mellitus patients who attended family medicine clinics in primary healthcare centers in DHA. All cases with type 2 diabetes attending family clinics for their periodic health checkup screening were included in the study. Patients <18 years old, pregnant, and/or those with cancer and/or chronic kidney disease were excluded. Results: Our study sample had 9,198 type 2 diabetes mellitus cases with 51.6% males, 69.7% United Arab Emirates nationals, 7.9% who exercised regularly, and 1.8% who followed a healthy diet. Obesity and overweight cases were 49.5% and 35.5%, respectively. Conclusion: Without an aggressive obesity management approach, control of diabetes is difficult. The prevalence of obesity and overweight among people with type 2 diabetes is high. Obesity and overweight cases were 49.5% and 35.5%, respectively, among diabetic patients attending PHC. Over 50% (55%) of UAE nationals were obese, while 31.8% were overweight, suggesting that active interventions to control weight gain would be appropriate.
{"title":"Prevalence of Overweight and Obesity in Type 2 Diabetic Patients Visiting PHC in the Dubai Health Authority","authors":"Noorah Bawady, O. Aldafrawy, Elham Mohamed ElZobair, Wafaa Suliman, Amal Alzaabi, Suad H. Ahmed","doi":"10.1159/000519444","DOIUrl":"https://doi.org/10.1159/000519444","url":null,"abstract":"Background: Diabetes is a highly prevalent global and local major health problem according to the International Diabetes Federation (IDF) and will double by 2045. A strong relationship between obesity and type 2 diabetes has been found. Both are leading causes of cardiovascular disease and death; thus, understanding the prevalence of obesity in type 2 diabetes is crucial for planning obesity management and preventing complications. Objectives: This study aimed to determine the prevalence of obesity and overweight among people with type 2 diabetes attending primary healthcare centers (PHC) in the Dubai Health Authority (DHA). Methods: The study sample consisted of type 2 diabetes mellitus patients who attended family medicine clinics in primary healthcare centers in DHA. All cases with type 2 diabetes attending family clinics for their periodic health checkup screening were included in the study. Patients <18 years old, pregnant, and/or those with cancer and/or chronic kidney disease were excluded. Results: Our study sample had 9,198 type 2 diabetes mellitus cases with 51.6% males, 69.7% United Arab Emirates nationals, 7.9% who exercised regularly, and 1.8% who followed a healthy diet. Obesity and overweight cases were 49.5% and 35.5%, respectively. Conclusion: Without an aggressive obesity management approach, control of diabetes is difficult. The prevalence of obesity and overweight among people with type 2 diabetes is high. Obesity and overweight cases were 49.5% and 35.5%, respectively, among diabetic patients attending PHC. Over 50% (55%) of UAE nationals were obese, while 31.8% were overweight, suggesting that active interventions to control weight gain would be appropriate.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"37 1","pages":"20 - 24"},"PeriodicalIF":0.0,"publicationDate":"2021-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77512975","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}
K. Kikkawa, H. Hoshi, A. Isoda, Kazuya Okada, Junichi Okada, Takuya Watanabe, Eijiro Yamada, Kihachi Ohshima, S. Okada
Case Presentation: We report a case of a male patient with rheumatoid arthritis (RA) diagnosed during treatment with a long-acting glucagon-like peptide-1 (GLP-1) receptor agonist (once-weekly dulaglutide injection). At 3 months after dulaglutide initiation, he began experiencing left shoulder pain that continued despite treatment by an acupuncturist, indicating that the pain was not due to periarthritis scapulohumeralis. His HbA1c level was 7.3% at the 3-month follow-up. At the 6-month follow-up visit, the HbA1c level was 8.2%, the low-density lipoprotein cholesterol level was 132 mg/dL, and he expressed right shoulder pain. After 3 months, the HbA1c level was 9.0%, and his bilateral shoulder pain worsened, due to which he could not use his arms well. Routine laboratory testing revealed no other abnormalities at that time. However, several inflammatory and serological RA markers were detected, including an erythrocyte sedimentation rate of 73 (normal range, <10) mm/h, a C-reactive protein level of 1.89 (normal range, 0.0–0.14) mg/dL, a rheumatoid factor level of 26 (normal range, 0–15) IU/mL, and an anti-cyclic citrullinated protein antibody level of 195 (normal range, <4.5) U/mL. However, tests for antinuclear antibodies, anti-SS-A/Ro antibodies, and anti-RNP antibodies showed negative results. He was diagnosed with RA, and salazosulfapyridine (500 mg/day) was started. At 1 month after RA treatment initiation, his shoulder pain began showing improvement and improved HbA1c levels from 9.0% to 8.0%. Discussion: Thus, this case report suggests an association between RA and GLP-1. Based on a literature search in PubMed, we believe that this case report is the first to demonstrate that a patient with type 2 diabetes mellitus treated with a long-acting GLP-1 receptor agonist had RA. However, further research is needed to determine whether RA is one of the adverse effects of long-acting GLP-1 receptor agonists. Conclusion: During treatment with long-acting GLP-1 receptor agonists, it is necessary to consider the possibility of RA as a differential diagnosis when patients complain of persistent joint pain.
病例介绍:我们报告一例患有类风湿性关节炎(RA)的男性患者在接受长效胰高血糖素样肽-1 (GLP-1)受体激动剂(每周一次的杜拉鲁肽注射)治疗期间被诊断出来。在杜拉鲁肽开始治疗3个月后，他开始经历左肩疼痛，尽管针灸师治疗，但疼痛仍在继续，这表明疼痛不是由于肩周炎引起的。3个月随访时HbA1c水平为7.3%。随访6个月，HbA1c水平为8.2%，低密度脂蛋白胆固醇水平为132 mg/dL，表现为右肩疼痛。3个月后，HbA1c水平为9.0%，双侧肩部疼痛加重，无法正常使用手臂。当时的常规实验室检查没有发现其他异常。然而，检测到几种炎症和血清学RA标志物，包括红细胞沉降率73(正常范围，<10)mm/h, c反应蛋白水平1.89(正常范围，0.0-0.14)mg/dL，类风湿因子水平26(正常范围，0-15)IU/mL，抗环瓜氨酸蛋白抗体水平195(正常范围，<4.5)U/mL。然而，抗核抗体、抗ss - a /Ro抗体和抗rnp抗体的检测结果均为阴性。他被诊断为类风湿性关节炎，并开始使用萨拉唑磺胺吡啶(500 mg/天)。在RA治疗开始1个月后，他的肩痛开始改善，HbA1c水平从9.0%改善到8.0%。讨论:因此，本病例报告提示RA与GLP-1之间存在关联。根据PubMed的文献检索，我们认为该病例报告是第一个证明2型糖尿病患者接受长效GLP-1受体激动剂治疗患有RA的病例。然而，RA是否是长效GLP-1受体激动剂的不良反应之一还需要进一步研究。结论:在使用长效GLP-1受体激动剂治疗时，当患者主诉持续关节疼痛时，有必要考虑RA的可能性作为鉴别诊断。
{"title":"Long-Acting Glucagon-Like Peptide-1 Receptor Agonist-Induced Rheumatoid Arthritis in a Patient with Type 2 Diabetes Mellitus","authors":"K. Kikkawa, H. Hoshi, A. Isoda, Kazuya Okada, Junichi Okada, Takuya Watanabe, Eijiro Yamada, Kihachi Ohshima, S. Okada","doi":"10.1159/000519008","DOIUrl":"https://doi.org/10.1159/000519008","url":null,"abstract":"Case Presentation: We report a case of a male patient with rheumatoid arthritis (RA) diagnosed during treatment with a long-acting glucagon-like peptide-1 (GLP-1) receptor agonist (once-weekly dulaglutide injection). At 3 months after dulaglutide initiation, he began experiencing left shoulder pain that continued despite treatment by an acupuncturist, indicating that the pain was not due to periarthritis scapulohumeralis. His HbA1c level was 7.3% at the 3-month follow-up. At the 6-month follow-up visit, the HbA1c level was 8.2%, the low-density lipoprotein cholesterol level was 132 mg/dL, and he expressed right shoulder pain. After 3 months, the HbA1c level was 9.0%, and his bilateral shoulder pain worsened, due to which he could not use his arms well. Routine laboratory testing revealed no other abnormalities at that time. However, several inflammatory and serological RA markers were detected, including an erythrocyte sedimentation rate of 73 (normal range, <10) mm/h, a C-reactive protein level of 1.89 (normal range, 0.0–0.14) mg/dL, a rheumatoid factor level of 26 (normal range, 0–15) IU/mL, and an anti-cyclic citrullinated protein antibody level of 195 (normal range, <4.5) U/mL. However, tests for antinuclear antibodies, anti-SS-A/Ro antibodies, and anti-RNP antibodies showed negative results. He was diagnosed with RA, and salazosulfapyridine (500 mg/day) was started. At 1 month after RA treatment initiation, his shoulder pain began showing improvement and improved HbA1c levels from 9.0% to 8.0%. Discussion: Thus, this case report suggests an association between RA and GLP-1. Based on a literature search in PubMed, we believe that this case report is the first to demonstrate that a patient with type 2 diabetes mellitus treated with a long-acting GLP-1 receptor agonist had RA. However, further research is needed to determine whether RA is one of the adverse effects of long-acting GLP-1 receptor agonists. Conclusion: During treatment with long-acting GLP-1 receptor agonists, it is necessary to consider the possibility of RA as a differential diagnosis when patients complain of persistent joint pain.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"3 2-3 1","pages":"114 - 117"},"PeriodicalIF":0.0,"publicationDate":"2021-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88314023","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}
Introduction: The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing and is fueled by a twin-epidemic of obesity and diabetes mellitus in India. The objective of the study was to estimate various noninvasive NAFLD scores (NINS) for the baseline risk-assessment of NAFLD in patients with type 2 diabetes mellitus (T2DM). Methods: An observational, cross-sectional, open label, study of investigator-rated NINS was conducted ensuring adherence to relevant ethical standards. Results: In a 3-month period, 29 patients with T2DM were enrolled (age [mean ± SD]: 55.8 ± 9.72 years; men [n, %]: 18, 62%). One patient (3.45%) by fibrosis-4 index (cutoff for advanced fibrosis ≥2.67) and by AST to platelet ratio index (cutoff ≥0.98); 2 (6.90%) by NAFLD fibrosis score (cutoff ≥0.676); 20 (69%) by body mass index (BMI), AST to ALT ratio, and DM score (BARD; cuff-off ≥2); and 27 (93.10%) by BMI, age, ALT, triglyceride score (cutoff ≥1) indicated high risk for advanced hepatic fibrosis. Only the BARD score (median [min-max]: 3 [1–4]) was elevated above the cutoff values while other scores were below cutoff values. The study failed to demonstrate any correlation between age, gender, anthropometric and metabolic parameters, and NINS. Conclusion: While this study did not demonstrate significant elevation of NINS, scores were found be elevated in some T2DM patients and they may be at high risk of advanced liver fibrosis. Further well-designed studies in this domain are required for early detection, management, and reducing the burden of liver disease in Indian patients with diabetes.
{"title":"Baseline Values of Nonalcoholic Fatty Liver Disease Scores and Its Risk Assessment in Patients with Type 2 Diabetes Mellitus","authors":"Kalpesh Joshi, S. Chandrakar, Smita V. Patil","doi":"10.1159/000518155","DOIUrl":"https://doi.org/10.1159/000518155","url":null,"abstract":"Introduction: The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing and is fueled by a twin-epidemic of obesity and diabetes mellitus in India. The objective of the study was to estimate various noninvasive NAFLD scores (NINS) for the baseline risk-assessment of NAFLD in patients with type 2 diabetes mellitus (T2DM). Methods: An observational, cross-sectional, open label, study of investigator-rated NINS was conducted ensuring adherence to relevant ethical standards. Results: In a 3-month period, 29 patients with T2DM were enrolled (age [mean ± SD]: 55.8 ± 9.72 years; men [n, %]: 18, 62%). One patient (3.45%) by fibrosis-4 index (cutoff for advanced fibrosis ≥2.67) and by AST to platelet ratio index (cutoff ≥0.98); 2 (6.90%) by NAFLD fibrosis score (cutoff ≥0.676); 20 (69%) by body mass index (BMI), AST to ALT ratio, and DM score (BARD; cuff-off ≥2); and 27 (93.10%) by BMI, age, ALT, triglyceride score (cutoff ≥1) indicated high risk for advanced hepatic fibrosis. Only the BARD score (median [min-max]: 3 [1–4]) was elevated above the cutoff values while other scores were below cutoff values. The study failed to demonstrate any correlation between age, gender, anthropometric and metabolic parameters, and NINS. Conclusion: While this study did not demonstrate significant elevation of NINS, scores were found be elevated in some T2DM patients and they may be at high risk of advanced liver fibrosis. Further well-designed studies in this domain are required for early detection, management, and reducing the burden of liver disease in Indian patients with diabetes.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"34 1","pages":"150 - 157"},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91382881","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}
This is a case series of recurrent hypocalcemic tetany as the initial presentation in some cases of hyperthyroidism. Literature review has revealed more reports of hypercalcemia than hypocalcemia as a feature of hyperthyroidism. The recurrence of hypocalcemic tetany in the 3 cases reported ceased following the treatment of hyperthyroidism. The aim of this case series is to alert clinicians to the fact that hypocalcemic tetany can be the initial clinical presentation of hyperthyroidism. It also highlights the resilience of managing endocrine patients in resource-poor settings with the aid of high clinical acumen and fewer-than-expected laboratory investigations. Further research is needed to investigate our hypothesis that disordered calcium metabolism in thyrotoxicosis may manifest in successive phases of hypercalcemia-normocalcemia-hypocalcemia. The rate at which individual thyrotoxic patient traverses these phases may be directly proportional to the background vitamin D deficiency, negative calcium balance, and bone mineral density.
{"title":"Recurrent Hypocalcemic Tetany as the Initial Presentation in Some Persons with Hyperthyroidism: A Case Series","authors":"Y. Lawal, U. Dahuwa, I. Abdullahi, F. Anumah","doi":"10.1159/000517482","DOIUrl":"https://doi.org/10.1159/000517482","url":null,"abstract":"This is a case series of recurrent hypocalcemic tetany as the initial presentation in some cases of hyperthyroidism. Literature review has revealed more reports of hypercalcemia than hypocalcemia as a feature of hyperthyroidism. The recurrence of hypocalcemic tetany in the 3 cases reported ceased following the treatment of hyperthyroidism. The aim of this case series is to alert clinicians to the fact that hypocalcemic tetany can be the initial clinical presentation of hyperthyroidism. It also highlights the resilience of managing endocrine patients in resource-poor settings with the aid of high clinical acumen and fewer-than-expected laboratory investigations. Further research is needed to investigate our hypothesis that disordered calcium metabolism in thyrotoxicosis may manifest in successive phases of hypercalcemia-normocalcemia-hypocalcemia. The rate at which individual thyrotoxic patient traverses these phases may be directly proportional to the background vitamin D deficiency, negative calcium balance, and bone mineral density.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"12 1","pages":"66 - 70"},"PeriodicalIF":0.0,"publicationDate":"2021-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78924674","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}
Introduction: Masked hypertension (MHTN) is the finding of elevated out-of-office blood pressure (BP) measurement. This is a pilot study to evaluate the prevalence of MHTN in adolescents with type 1 diabetes mellitus (T1DM). Patients and Methods: Normotensive, adolescents with T1DM were recruited from Tawam Adolescents Diabetes Clinic at Tawam hospital, Al Ain, UAE. They consented to wear the ambulatory BP monitoring (ABPM) device. The heart rate and ambulatory BP were recorded at 15-min intervals for 24 h. Abnormal systolic BP (SBP) and diastolic BP (DBP) were defined as readings above 135 and 85 mm Hg; respectively. Results: Thirteen patients (10 females) were recruited from “Tawam Adolescents Diabetes Clinic.” The median age was 17 (15–19) years, median BMI 21.4 (14.8–29), and median diabetes duration 9 (3–12) years. All patients had normal retinal examination within the past 12 months. Family history of hypertension (HTN) was present in 6/13 (46%) patients. Office BP measurements revealed a mean DBP ± SD of 72 ± 6.9 mm Hg and mean SBP ± SD116 ± 5.5 mm Hg. The median HbA1c was 8.4% (5.6–13.7) and median GFR 125 mL/min/m2 (87–134). Two patients had microalbuminuria. Twenty-four hour ABPM revealed elevated SBP and DBP in 12.2 and 5.8% of the values; respectively. Further analysis confirmed MHTN in 4 (30%) patients, nondipping pattern of BP in 5 (38%) patients, and elevated pulse pressure in 8 (61.5%) patients. Only 4 (30%) patients had normal studies. Conclusions: ABPM uncovered a very high prevalence of MHTN in our patients. Whenever available, ABPM provides an excellent tool for diagnosis and hence early evaluation and management of HTN in adolescents with T1DM. Well-designed large-scale studies are needed to examine the magnitude of MHTN among adolescents with T1DM.
隐蔽性高血压(MHTN)是指办公室外血压(BP)测量结果升高。这是一项评估青少年1型糖尿病(T1DM)中MHTN患病率的初步研究。患者和方法:从阿联酋Tawam医院Tawam青少年糖尿病诊所招募患有T1DM的血压正常的青少年。他们同意佩戴动态血压监测(ABPM)装置。心率和动态血压每隔15分钟记录一次，持续24小时。收缩压(SBP)和舒张压(DBP)异常定义为读数高于135和85 mm Hg;分别。结果:从“Tawam青少年糖尿病诊所”招募13名患者(10名女性)。中位年龄为17(15-19)岁，中位BMI为21.4(14.8-29)，中位糖尿病病程为9(3-12)年。所有患者在过去12个月内视网膜检查正常。6/13(46%)患者有高血压家族史。办公室血压测量显示，平均DBP±SD为72±6.9 mm Hg，平均SBP±SD116±5.5 mm Hg，中位HbA1c为8.4%(5.6-13.7)，中位GFR为125 mL/min/m2(87-134)。2例患者有微量白蛋白尿。24小时ABPM显示收缩压和舒张压升高的比例分别为12.2%和5.8%;分别。进一步分析证实4例(30%)患者为MHTN, 5例(38%)患者为血压不下降，8例(61.5%)患者为脉压升高。只有4例(30%)患者检查正常。结论:ABPM揭示了MHTN在我们的患者中非常高的患病率。无论何时，ABPM都为T1DM青少年HTN的诊断、早期评估和管理提供了极好的工具。需要精心设计的大规模研究来检验青少年T1DM患者中MHTN的程度。
{"title":"Masked Hypertension in Adolescents with Type 1 Diabetes Mellitus: An Exploratory Study","authors":"B. Afandi, B. Bernieh, Sana Roubi, J. Al Kaabi","doi":"10.1159/000515953","DOIUrl":"https://doi.org/10.1159/000515953","url":null,"abstract":"Introduction: Masked hypertension (MHTN) is the finding of elevated out-of-office blood pressure (BP) measurement. This is a pilot study to evaluate the prevalence of MHTN in adolescents with type 1 diabetes mellitus (T1DM). Patients and Methods: Normotensive, adolescents with T1DM were recruited from Tawam Adolescents Diabetes Clinic at Tawam hospital, Al Ain, UAE. They consented to wear the ambulatory BP monitoring (ABPM) device. The heart rate and ambulatory BP were recorded at 15-min intervals for 24 h. Abnormal systolic BP (SBP) and diastolic BP (DBP) were defined as readings above 135 and 85 mm Hg; respectively. Results: Thirteen patients (10 females) were recruited from “Tawam Adolescents Diabetes Clinic.” The median age was 17 (15–19) years, median BMI 21.4 (14.8–29), and median diabetes duration 9 (3–12) years. All patients had normal retinal examination within the past 12 months. Family history of hypertension (HTN) was present in 6/13 (46%) patients. Office BP measurements revealed a mean DBP ± SD of 72 ± 6.9 mm Hg and mean SBP ± SD116 ± 5.5 mm Hg. The median HbA1c was 8.4% (5.6–13.7) and median GFR 125 mL/min/m2 (87–134). Two patients had microalbuminuria. Twenty-four hour ABPM revealed elevated SBP and DBP in 12.2 and 5.8% of the values; respectively. Further analysis confirmed MHTN in 4 (30%) patients, nondipping pattern of BP in 5 (38%) patients, and elevated pulse pressure in 8 (61.5%) patients. Only 4 (30%) patients had normal studies. Conclusions: ABPM uncovered a very high prevalence of MHTN in our patients. Whenever available, ABPM provides an excellent tool for diagnosis and hence early evaluation and management of HTN in adolescents with T1DM. Well-designed large-scale studies are needed to examine the magnitude of MHTN among adolescents with T1DM.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"97 1","pages":"50 - 54"},"PeriodicalIF":0.0,"publicationDate":"2021-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84543019","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}
Abdulrazzaq Almadania, Alaaeldin MK Bashierb, Asma Binjabc, ElAmin Abdelgaderb, Elham Al Amiric, Fatheya Al Awadib, Fauzia Rashidb, Hussein Saadid, Iyad Ksseirye, Juma AlKaabif, Khadija Hafidhg, Khaled Aldahmanih, Mohamed A. Hassaneinb, Muhammad Hamed Farooqii, Salah Abusnanaj
s Published online: June 25, 2021 Conference Papers Editors Abdulrazzaq Almadania, Alaaeldin MK Bashierb, Asma Binjabc, ElAmin Abdelgaderb, Elham Al Amiric, Fatheya Al Awadib, Fauzia Rashidb, Hussein Saadid, Iyad Ksseirye, Juma AlKaabif, Khadija Hafidhg, Khaled Aldahmanih, Mohamed Hassaneinb, Muhammad Hamed Farooqii, Salah Abusnanaj aAlborj Medical Centre, Dubai, UAE; bEndocrinology Section, Dubai Hospital, Dubai Health Authority, Dubai, UAE; cDepartment of Pediatrics, Al Qassimi Hospital, Ministry of Health, Sharjah, UAE; dDepartment of Endocrinology, Medical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, UAE; eMediclinic, City Hospital, Dubai, UAE; fCollege of Medicine and Health Sciences, UAE University, Al Ain, UAE; gMedical Department, Rashid Hospital, Dubai Health Authority, Dubai, UAE; hEndocrinology Division, Tawam Hospital, Al Ain, UAE; iDubai Diabetes Centre, Dubai Health Authority, Dubai, UAE; jUniversity Hospital in Sharjah, Sharjah University, Sharjah, UAE (Names are arranged alphabetically) Basel • Freiburg • Hartford • Oxford • Bangkok • Dubai • Kuala Lumpur • Melbourne • Mexico City • Moscow • New Delhi • Paris • Shanghai • Tokyo
{"title":"Proceedings of the 10th Emirates Diabetes and Endocrine Congress, February 27-29, 2020, Dubai, UAE","authors":"Abdulrazzaq Almadania, Alaaeldin MK Bashierb, Asma Binjabc, ElAmin Abdelgaderb, Elham Al Amiric, Fatheya Al Awadib, Fauzia Rashidb, Hussein Saadid, Iyad Ksseirye, Juma AlKaabif, Khadija Hafidhg, Khaled Aldahmanih, Mohamed A. Hassaneinb, Muhammad Hamed Farooqii, Salah Abusnanaj","doi":"10.1159/000514044","DOIUrl":"https://doi.org/10.1159/000514044","url":null,"abstract":"s Published online: June 25, 2021 Conference Papers Editors Abdulrazzaq Almadania, Alaaeldin MK Bashierb, Asma Binjabc, ElAmin Abdelgaderb, Elham Al Amiric, Fatheya Al Awadib, Fauzia Rashidb, Hussein Saadid, Iyad Ksseirye, Juma AlKaabif, Khadija Hafidhg, Khaled Aldahmanih, Mohamed Hassaneinb, Muhammad Hamed Farooqii, Salah Abusnanaj aAlborj Medical Centre, Dubai, UAE; bEndocrinology Section, Dubai Hospital, Dubai Health Authority, Dubai, UAE; cDepartment of Pediatrics, Al Qassimi Hospital, Ministry of Health, Sharjah, UAE; dDepartment of Endocrinology, Medical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, UAE; eMediclinic, City Hospital, Dubai, UAE; fCollege of Medicine and Health Sciences, UAE University, Al Ain, UAE; gMedical Department, Rashid Hospital, Dubai Health Authority, Dubai, UAE; hEndocrinology Division, Tawam Hospital, Al Ain, UAE; iDubai Diabetes Centre, Dubai Health Authority, Dubai, UAE; jUniversity Hospital in Sharjah, Sharjah University, Sharjah, UAE (Names are arranged alphabetically) Basel • Freiburg • Hartford • Oxford • Bangkok • Dubai • Kuala Lumpur • Melbourne • Mexico City • Moscow • New Delhi • Paris • Shanghai • Tokyo","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"73 1","pages":"18 - 36"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83966133","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}
B. K. Riaz, S. Selim, M. Neo, M. N. Karim, M. Zaman
Methodology: Biochemically confirmed type 2 diabetes mellitus (T2DM) patients (n = 1,114) were recruited from the outpatient department of 2 tertiary care hospitals in Dhaka, Bangladesh. Face-to-face interview was conducted using a semi-structured questionnaire containing sociodemographic parameters and relevant information about depression and diabetes. Biochemical test results and treatment-related information were taken from patients’ records. The Hospital Anxiety and Depression Scale (HADS) was used to screen all patients for psychiatric manifestation. Those diagnosed by HADS were subsequently reassessed using structured clinical interview for DSM-5 Disorders – Clinician Version. T2DM diagnosed at age <40 years were considered as early onset T2DM. Association between age of onset category and depression was assessed using multivariable mixed-effect logistic regression adjusting for random variation of the area of residence and plausible confounders. Results: Around a third of the participants (32.5%) were diagnosed with T2DM before the age of 40 years. Early onset T2DM patients were found to have 57% increase in the risk of developing depression (OR 1.57; 95% CI 1.13–2.28; p = 0.011) in comparison to those with usual onset T2DM (≥40 years). Among other factors a positive family history for diabetes (OR 1.33; 95% CI 1.03–1.78; p = 0.038), poor glycemic control (OR 1.31; 95% CI 1.03–1.68; p = 0.028), presence of 1, or more diabetic complications (OR 1.37; 95% CI 1.03–1.78; p = 0.011) also showed increased risk of depression. Conclusion: Early onset T2DM patients are at greater risk of developing depression. The finding is likely to help in setting preventive strategies aiming to reduce the presence of concomitant depression symptoms among diabetes.
方法:从孟加拉国达卡的2家三级医院的门诊部招募生化确诊的2型糖尿病(T2DM)患者(n = 1,114)。采用半结构化问卷进行面对面访谈，问卷包含社会人口学参数和抑郁症和糖尿病的相关信息。生化检测结果及治疗相关信息取自患者病历。采用医院焦虑抑郁量表(HADS)筛查所有患者的精神表现。经HADS诊断的患者随后使用DSM-5疾病-临床医师版的结构化临床访谈进行重新评估。年龄<40岁诊断为T2DM为早发性T2DM。使用多变量混合效应逻辑回归来评估发病年龄类别与抑郁症之间的关联，该回归调整了居住区域和可信混杂因素的随机变化。结果:大约三分之一的参与者(32.5%)在40岁之前被诊断为T2DM。发现早发型T2DM患者发生抑郁症的风险增加57% (OR 1.57;95% ci 1.13-2.28;p = 0.011)与常发T2DM(≥40岁)患者相比。除其他因素外，糖尿病家族史阳性(OR 1.33;95% ci 1.03-1.78;p = 0.038)，血糖控制不良(OR 1.31;95% ci 1.03-1.68;p = 0.028)，存在1个或更多的糖尿病并发症(or 1.37;95% ci 1.03-1.78;P = 0.011)也显示抑郁风险增加。结论:早发T2DM患者发生抑郁症的风险较大。这一发现可能有助于制定预防策略，旨在减少糖尿病患者伴随抑郁症状的出现。
{"title":"Risk of Depression among Early Onset Type 2 Diabetes Mellitus Patients","authors":"B. K. Riaz, S. Selim, M. Neo, M. N. Karim, M. Zaman","doi":"10.1159/000515683","DOIUrl":"https://doi.org/10.1159/000515683","url":null,"abstract":"Methodology: Biochemically confirmed type 2 diabetes mellitus (T2DM) patients (n = 1,114) were recruited from the outpatient department of 2 tertiary care hospitals in Dhaka, Bangladesh. Face-to-face interview was conducted using a semi-structured questionnaire containing sociodemographic parameters and relevant information about depression and diabetes. Biochemical test results and treatment-related information were taken from patients’ records. The Hospital Anxiety and Depression Scale (HADS) was used to screen all patients for psychiatric manifestation. Those diagnosed by HADS were subsequently reassessed using structured clinical interview for DSM-5 Disorders – Clinician Version. T2DM diagnosed at age <40 years were considered as early onset T2DM. Association between age of onset category and depression was assessed using multivariable mixed-effect logistic regression adjusting for random variation of the area of residence and plausible confounders. Results: Around a third of the participants (32.5%) were diagnosed with T2DM before the age of 40 years. Early onset T2DM patients were found to have 57% increase in the risk of developing depression (OR 1.57; 95% CI 1.13–2.28; p = 0.011) in comparison to those with usual onset T2DM (≥40 years). Among other factors a positive family history for diabetes (OR 1.33; 95% CI 1.03–1.78; p = 0.038), poor glycemic control (OR 1.31; 95% CI 1.03–1.68; p = 0.028), presence of 1, or more diabetic complications (OR 1.37; 95% CI 1.03–1.78; p = 0.011) also showed increased risk of depression. Conclusion: Early onset T2DM patients are at greater risk of developing depression. The finding is likely to help in setting preventive strategies aiming to reduce the presence of concomitant depression symptoms among diabetes.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"43 1","pages":"55 - 65"},"PeriodicalIF":0.0,"publicationDate":"2021-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89789943","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}
R. Nawar, el S R Ibrahim, S. Abusnana, F. A. Al Awadi, Fatema Hasan Al Hammadi, M. Farghaly, T. Fiad, Hazem Aly, Yasmin Aly Mohamed, Zainab Ben Serghin
Introduction: Obesity is a chronic relapsing disease of which, globally, the prevalence has reached epidemic proportions. The ACTION-IO study (NCT03584191) investigated the perceptions, attitudes, and behaviors of people with obesity (PwO) and healthcare professionals (HCPs), which can help in devising strategies for its optimal management. Here, we present the results from the United Arab Emirates (UAE). Methods: The ACTION-IO study was a cross-sectional study conducted in 11 countries, including the UAE, that collected data via a survey. Eligible UAE PwO were ≥18 years with a BMI of ≥30 kg/m2 (self-reported height and weight). Eligible HCPs were in direct patient care. Data were collected in the UAE between July 11, 2018, and September 5, 2018. Results: A total of 750 PwO and 200 HCPs completed the survey in the UAE. Both PwO (82%) and HCPs (78%) acknowledged obesity as a chronic disease and agreed that it has a large impact on overall health (PwO 88% and HCPs 80%). More HCPs felt that diabetes and stroke (both 91%) had a larger impact on overall health than did obesity. Many PwO (76%) assumed full responsibility for their weight loss; 84% of HCPs acknowledged responsibility for actively contributing to patient weight loss efforts. The top motivator for weight loss among PwO was wanting to be more fit/in better shape (45%), while HCPs believed the main motivator was general health concerns (83%). The top barrier against initiating weight management discussions provided by HCPs was that they felt PwO were not interested in losing weight (69%), whereas only 10% of PwO selected this response. The mean delay between struggling with excess weight and having a weight management discussion with an HCP was 4 years. Discussion/Conclusion: These UAE results highlight differences in the perceptions and attitudes toward obesity from PwO and HCPs and reflect a need to understand weight management concerns to initiate earlier and more effective PwO–HCP conversations. The findings will inform educational needs on the biological basis of obesity and its clinical management and will help to address regional barriers for effective obesity care.
{"title":"Understanding the Gaps in Obesity Management in the UAE: Perceptions, Barriers, and Attitudes","authors":"R. Nawar, el S R Ibrahim, S. Abusnana, F. A. Al Awadi, Fatema Hasan Al Hammadi, M. Farghaly, T. Fiad, Hazem Aly, Yasmin Aly Mohamed, Zainab Ben Serghin","doi":"10.1159/000514359","DOIUrl":"https://doi.org/10.1159/000514359","url":null,"abstract":"Introduction: Obesity is a chronic relapsing disease of which, globally, the prevalence has reached epidemic proportions. The ACTION-IO study (NCT03584191) investigated the perceptions, attitudes, and behaviors of people with obesity (PwO) and healthcare professionals (HCPs), which can help in devising strategies for its optimal management. Here, we present the results from the United Arab Emirates (UAE). Methods: The ACTION-IO study was a cross-sectional study conducted in 11 countries, including the UAE, that collected data via a survey. Eligible UAE PwO were ≥18 years with a BMI of ≥30 kg/m2 (self-reported height and weight). Eligible HCPs were in direct patient care. Data were collected in the UAE between July 11, 2018, and September 5, 2018. Results: A total of 750 PwO and 200 HCPs completed the survey in the UAE. Both PwO (82%) and HCPs (78%) acknowledged obesity as a chronic disease and agreed that it has a large impact on overall health (PwO 88% and HCPs 80%). More HCPs felt that diabetes and stroke (both 91%) had a larger impact on overall health than did obesity. Many PwO (76%) assumed full responsibility for their weight loss; 84% of HCPs acknowledged responsibility for actively contributing to patient weight loss efforts. The top motivator for weight loss among PwO was wanting to be more fit/in better shape (45%), while HCPs believed the main motivator was general health concerns (83%). The top barrier against initiating weight management discussions provided by HCPs was that they felt PwO were not interested in losing weight (69%), whereas only 10% of PwO selected this response. The mean delay between struggling with excess weight and having a weight management discussion with an HCP was 4 years. Discussion/Conclusion: These UAE results highlight differences in the perceptions and attitudes toward obesity from PwO and HCPs and reflect a need to understand weight management concerns to initiate earlier and more effective PwO–HCP conversations. The findings will inform educational needs on the biological basis of obesity and its clinical management and will help to address regional barriers for effective obesity care.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"1 1","pages":"37 - 49"},"PeriodicalIF":0.0,"publicationDate":"2021-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74809945","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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