Khadeeja Mohammed Khalid Mansoor, S. Iqbal, N. Nowshad, D. Abdelmannan
Introduction: Vitamin D deficiency and obesity have been classified as pandemic issues worldwide with high prevalence of both the risk factors in the United Arab Emirates. In recent years, obesity has been associated with vitamin D deficiency, but very few studies have been published about the correlation between them in the UAE population. Subjects and Methods: This is a cross-sectional study designed to find a correlation between vitamin D deficiency and obesity along with other metabolic factors. Data were collected from electronic medical records of 300 subjects ranging from 15 to 85 years of age of various ethnic origins residing in Dubai. Results: The study showed a high prevalence of obesity (44.9%) and vitamin D deficiency (40.1) in our study population. There is no evidence of a relation between vitamin D level and the obesity; 40.1% of the subjects were vitamin D deficient, out of which 46.7% were obese. However, a statistically significant relationship was found between cholesterol levels and vitamin D levels. Similarly, a significant relation was found between decreasing Vitamin D levels and increasing age but no relationship was detected with gender. Conclusions: The present study revealed an alarming prevalence of obesity and vitamin D deficiency. Further steps need to be taken to tackle this growing problem.
{"title":"Interplay between Vitamin D, Obesity, and Other Metabolic Factors in a Multiethnic Adult Cohort","authors":"Khadeeja Mohammed Khalid Mansoor, S. Iqbal, N. Nowshad, D. Abdelmannan","doi":"10.1159/000511687","DOIUrl":"https://doi.org/10.1159/000511687","url":null,"abstract":"Introduction: Vitamin D deficiency and obesity have been classified as pandemic issues worldwide with high prevalence of both the risk factors in the United Arab Emirates. In recent years, obesity has been associated with vitamin D deficiency, but very few studies have been published about the correlation between them in the UAE population. Subjects and Methods: This is a cross-sectional study designed to find a correlation between vitamin D deficiency and obesity along with other metabolic factors. Data were collected from electronic medical records of 300 subjects ranging from 15 to 85 years of age of various ethnic origins residing in Dubai. Results: The study showed a high prevalence of obesity (44.9%) and vitamin D deficiency (40.1) in our study population. There is no evidence of a relation between vitamin D level and the obesity; 40.1% of the subjects were vitamin D deficient, out of which 46.7% were obese. However, a statistically significant relationship was found between cholesterol levels and vitamin D levels. Similarly, a significant relation was found between decreasing Vitamin D levels and increasing age but no relationship was detected with gender. Conclusions: The present study revealed an alarming prevalence of obesity and vitamin D deficiency. Further steps need to be taken to tackle this growing problem.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"40 1","pages":"152 - 157"},"PeriodicalIF":0.0,"publicationDate":"2020-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83746570","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. Zabeen, J. Nahar, N. Islam, K. Azad, K. Donaghue
Objective: The objective of this study was to assess the effects of continuous subcutaneous insulin infusion (CSII) therapy on glycaemic control and acute complications in children, adolescents, and young adults with type 1 diabetes mellitus (T1DM). Methods: The prospective observational study was done in patients on multiple daily injection (MDI) switching to pump system. All patients were followed at the Paediatric Diabetes Clinic at BIRDEM Hospital. They were trained on carbohydrates counting and started on continuous basal insulin infusion in addition to meal and high blood glucose correction insulin boluses. They were followed on insulin pump therapy for a 6-month period. Results: Twenty patients were analysed, from baseline to visit 2 after 6 months. The patients included in the study had T1DM for a mean duration of 4.7 ± 3.1 years. The age ranged from 3 to 25 years (mean 13.7 ± 6.1). There was 1% reduction in haemoglobin A1c (HbA1c) after 6 months, though it did not reach the statistical significance (p = 0.084). There was significant reduction of mean fasting blood glucose level 13.4 ± 7.0 versus 6.9 ± 1.6 mmol/L (p = 0.001), total insulin requirement (p = 0.043), frequency of hypoglycaemic episodes (p = 0.006), and diabetic ketoacidosis (p = 0.002) events during CSII therapy. Conclusion: In our study, we found that switching young T1DM patients from MDI to insulin pump had been effective with achievement of a reduction in fasting blood glucose, HbA1c, and acute complications.
{"title":"Effects of Continuous Subcutaneous Insulin Infusion on Glycaemic Control and Acute Complications in Young People with Type 1 Diabetes in Bangladesh","authors":"B. Zabeen, J. Nahar, N. Islam, K. Azad, K. Donaghue","doi":"10.1159/000511241","DOIUrl":"https://doi.org/10.1159/000511241","url":null,"abstract":"Objective: The objective of this study was to assess the effects of continuous subcutaneous insulin infusion (CSII) therapy on glycaemic control and acute complications in children, adolescents, and young adults with type 1 diabetes mellitus (T1DM). Methods: The prospective observational study was done in patients on multiple daily injection (MDI) switching to pump system. All patients were followed at the Paediatric Diabetes Clinic at BIRDEM Hospital. They were trained on carbohydrates counting and started on continuous basal insulin infusion in addition to meal and high blood glucose correction insulin boluses. They were followed on insulin pump therapy for a 6-month period. Results: Twenty patients were analysed, from baseline to visit 2 after 6 months. The patients included in the study had T1DM for a mean duration of 4.7 ± 3.1 years. The age ranged from 3 to 25 years (mean 13.7 ± 6.1). There was 1% reduction in haemoglobin A1c (HbA1c) after 6 months, though it did not reach the statistical significance (p = 0.084). There was significant reduction of mean fasting blood glucose level 13.4 ± 7.0 versus 6.9 ± 1.6 mmol/L (p = 0.001), total insulin requirement (p = 0.043), frequency of hypoglycaemic episodes (p = 0.006), and diabetic ketoacidosis (p = 0.002) events during CSII therapy. Conclusion: In our study, we found that switching young T1DM patients from MDI to insulin pump had been effective with achievement of a reduction in fasting blood glucose, HbA1c, and acute complications.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"107 1","pages":"174 - 179"},"PeriodicalIF":0.0,"publicationDate":"2020-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77409818","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}
C. V. Ugwueze, B. Ezeokpo, Bede Nnolim, Emmanuel A. Agim, Nnamdi C. Anikpo, Kenechukwu E. Onyekachi
Background: Coronavirus disease 2019 (COVID-19) is a pandemic viral infection that has ravaged the world in recent times, and the associated morbidity and mortality have been much more pronounced in those with noncommunicable disease. Diabetes mellitus is one of commonest noncommunicable diseases associated with worsening clinical status in COVID-19 patients. Summary: The aim of this review was to evaluate the receptors and pathogenetic link between diabetes and COVID-19. Both disease conditions involve inflammation with the release of inflammatory markers. The roles of angiotensin-converting enzyme molecule and dipeptidyl peptidase were explored to show their involvement in COVID-19 and diabetes. Pathogenetic mechanisms such as impaired immunity, microangiopathy, and glycemic variability may explain the effect of diabetes on recovery of COVID-19 patients. The effect of glucocorticoids and catecholamines, invasion of the pancreatic islet cells, drugs used in the treatment of COVID-19, and the lockdown policy may impact negatively on glycemic control of diabetic patients. The outcome studies between diabetic and nondiabetic patients with COVID-19 were also reviewed. Some drug trials are still ongoing to determine the suitability or otherwise of some drugs used in diabetic patients with COVID-19, such as dapagliflozin trial and linagliptin trial.
{"title":"COVID-19 and Diabetes Mellitus: The Link and Clinical Implications","authors":"C. V. Ugwueze, B. Ezeokpo, Bede Nnolim, Emmanuel A. Agim, Nnamdi C. Anikpo, Kenechukwu E. Onyekachi","doi":"10.1159/000511354","DOIUrl":"https://doi.org/10.1159/000511354","url":null,"abstract":"Background: Coronavirus disease 2019 (COVID-19) is a pandemic viral infection that has ravaged the world in recent times, and the associated morbidity and mortality have been much more pronounced in those with noncommunicable disease. Diabetes mellitus is one of commonest noncommunicable diseases associated with worsening clinical status in COVID-19 patients. Summary: The aim of this review was to evaluate the receptors and pathogenetic link between diabetes and COVID-19. Both disease conditions involve inflammation with the release of inflammatory markers. The roles of angiotensin-converting enzyme molecule and dipeptidyl peptidase were explored to show their involvement in COVID-19 and diabetes. Pathogenetic mechanisms such as impaired immunity, microangiopathy, and glycemic variability may explain the effect of diabetes on recovery of COVID-19 patients. The effect of glucocorticoids and catecholamines, invasion of the pancreatic islet cells, drugs used in the treatment of COVID-19, and the lockdown policy may impact negatively on glycemic control of diabetic patients. The outcome studies between diabetic and nondiabetic patients with COVID-19 were also reviewed. Some drug trials are still ongoing to determine the suitability or otherwise of some drugs used in diabetic patients with COVID-19, such as dapagliflozin trial and linagliptin trial.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"22 1","pages":"1 - 9"},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83724929","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}
C. Amadi, O. Ayoade, S. Onung, S. Essien, Anietie A. Etuk, C. J. Okafor
Background: Unlike what obtains in childhood-onset type 1 diabetes, there remains a paucity of data on adult-onset type 1 diabetes in Nigeria. Hence, the current study aimed to determine the general characteristics of adult-onset type 1 diabetes among subjects (aged ≥18 years) presenting at the University of Uyo Teaching Hospital (UUTH) in Akwa Ibom State, South-south Nigeria. Methods: A 5-year (2014–2018) retrospective records review of subjects with type 1 diabetes was undertaken, using hospital medical records retrieved from the Department of Health Information Management of UUTH. Diagnosed adult cases of type 1 diabetes were meticulously identified and the relevant data at the point of initial diagnosis were acquired on a specially designed data acquisition template. Results: A total of 47,357 medical cases were identified of which 362 adults were diagnosed with type I diabetes (mean age 33.12 ± 4.40, range 20–51 years) and the females (n = 204; 56.4%) predominated among those diagnosed. The overall, male gender, and female gender prevalence was 7.4/1,000 (95% confidence interval [CI]: 6.89–7.98), 3.3/1,000 (95% CI: 2.52–4.08), and 4.3/1,000 (95% CI: 3.61–4.99), respectively. The females exhibited the highest trough, peak, annual, and overall prevalence during the study period. The female gender (OR: 2.334; 95% CI: 1.407–3.478; p = 0.010), age ≤30 years (OR: 1.976; 95% CI: 0.875–3.211; p < 0.001), urban-dwelling (OR: 3.243; 95% CI: 2.3407.780; <0.001), diabetes family history (OR: 1.365; 95% CI: 0.678–2.010; p = 0.033), and the rainy season (OR: 1.129; 95% CI: 0.401–1.910; p < 0.001) were independent predictors among the overall adult type 1 diabetics. On gender-segregated analyses, age ≤30 years, urban-dwelling, diabetes family history, and the rainy season remained independent predictors among the male and female adult type 1 diabetics (p < 0.05). Conclusion: The study demonstrated a high burden of type 1 diabetes among adult residents of Uyo, Akwa Ibom State, South-South Nigeria. The predictors of adult type 1 diabetes, identified in the present study, are valuable epidemiologic evidence for the design of type 1 diabetes-targeted preventive programs by various concerned stakeholders.
{"title":"Pattern, Trend and Predictors of Adult-Onset Type 1 Diabetes in Uyo, Nigeria","authors":"C. Amadi, O. Ayoade, S. Onung, S. Essien, Anietie A. Etuk, C. J. Okafor","doi":"10.1159/000511242","DOIUrl":"https://doi.org/10.1159/000511242","url":null,"abstract":"Background: Unlike what obtains in childhood-onset type 1 diabetes, there remains a paucity of data on adult-onset type 1 diabetes in Nigeria. Hence, the current study aimed to determine the general characteristics of adult-onset type 1 diabetes among subjects (aged ≥18 years) presenting at the University of Uyo Teaching Hospital (UUTH) in Akwa Ibom State, South-south Nigeria. Methods: A 5-year (2014–2018) retrospective records review of subjects with type 1 diabetes was undertaken, using hospital medical records retrieved from the Department of Health Information Management of UUTH. Diagnosed adult cases of type 1 diabetes were meticulously identified and the relevant data at the point of initial diagnosis were acquired on a specially designed data acquisition template. Results: A total of 47,357 medical cases were identified of which 362 adults were diagnosed with type I diabetes (mean age 33.12 ± 4.40, range 20–51 years) and the females (n = 204; 56.4%) predominated among those diagnosed. The overall, male gender, and female gender prevalence was 7.4/1,000 (95% confidence interval [CI]: 6.89–7.98), 3.3/1,000 (95% CI: 2.52–4.08), and 4.3/1,000 (95% CI: 3.61–4.99), respectively. The females exhibited the highest trough, peak, annual, and overall prevalence during the study period. The female gender (OR: 2.334; 95% CI: 1.407–3.478; p = 0.010), age ≤30 years (OR: 1.976; 95% CI: 0.875–3.211; p < 0.001), urban-dwelling (OR: 3.243; 95% CI: 2.3407.780; <0.001), diabetes family history (OR: 1.365; 95% CI: 0.678–2.010; p = 0.033), and the rainy season (OR: 1.129; 95% CI: 0.401–1.910; p < 0.001) were independent predictors among the overall adult type 1 diabetics. On gender-segregated analyses, age ≤30 years, urban-dwelling, diabetes family history, and the rainy season remained independent predictors among the male and female adult type 1 diabetics (p < 0.05). Conclusion: The study demonstrated a high burden of type 1 diabetes among adult residents of Uyo, Akwa Ibom State, South-South Nigeria. The predictors of adult type 1 diabetes, identified in the present study, are valuable epidemiologic evidence for the design of type 1 diabetes-targeted preventive programs by various concerned stakeholders.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"90 1","pages":"119 - 127"},"PeriodicalIF":0.0,"publicationDate":"2020-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77026900","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}
Objective: Serum uric acid (SUA) has been linked with development and progression of diabetic kidney disease (DKD). In this study, we intend to compare the effects of hyperuricemia (HUA) on beta-cell function, renal function, and lipid panels of patients with DKD. Methods: A total of 492 patients with DKD were included for data collection and analysis. Males and females have different standard SUA levels; thus, we analyzed these 2 groups separately. Normouricemia (NUA) for men (n = 253) was ≤428 μmol/L and for women (n = 83) was ≤357 μmol/L, whereas HUA for men (n = 94) was >428 μmol/L and for women (n = 62) was >357 μmol/L. Clinical characteristics of patients were analyzed based on gender-specific NUA and HUA. The Spearman rank correlation test was used to evaluate the correlation between SUA and other clinical variables. Finally, stepwise multinomial logistic regression test was performed to identify the factors that are independently associated with HUA. Results: A total of 492 patients were included in this study. The regression analysis showed that there was a significant association between HUA and decreased estimated glomerular filtration rate (eGFR) in both male and female patients (odds ratio (OR) [95% confidence interval (CI)] = 4.73 [2.19–10.24], p value ≤0.01 in male patients and OR [95% CI] = 3.07 [], p value = 0.04 in female patients). FBG, 2hPBG, and HbA1c were negatively correlated with SUA in male patients (r = −0.182, p value ≤0.01; r = −0.168, p value ≤0.01; and r = −0.187, p value ≤0.01, respectively), whereas fasting insulin was positively correlated in male patients (r = 0.131, p value = 0.023) and female patients (r = 0.192, p value = 0.041). The atherogenic index of plasma was significantly high in patients with HUA (OR [95% CI] = 5.75 [2.32–14.23], p value ≤0.01 in male patients and OR [95% CI] = 8.37 [1.96–35.78], p value ≤0.01 in female patients). Other indices of lipid profile such as lipoprotein combine index, atherosclerosis index, and triglyceride/high-density lipoprotein ratio were also independently associated with HUA in both male and female patients. Conclusion: SUA can affect various clinical parameters in patients with DKD. There is a significant association between HUA and decline in eGFR in both male and female patients. HUA is also associated with dyslipidemia in DKD, increasing the risk of cardiac complications and mortality.
{"title":"Effects of Hyperuricemia on Beta-Cell Function, Renal Function, and Lipid Panels of Patients with Diabetic Kidney Disease: A Gender-Based Retrospective Study","authors":"Prateek Rajkarnikar, Yancheng Xu, Arun Bhattarai","doi":"10.1159/000510895","DOIUrl":"https://doi.org/10.1159/000510895","url":null,"abstract":"Objective: Serum uric acid (SUA) has been linked with development and progression of diabetic kidney disease (DKD). In this study, we intend to compare the effects of hyperuricemia (HUA) on beta-cell function, renal function, and lipid panels of patients with DKD. Methods: A total of 492 patients with DKD were included for data collection and analysis. Males and females have different standard SUA levels; thus, we analyzed these 2 groups separately. Normouricemia (NUA) for men (n = 253) was ≤428 μmol/L and for women (n = 83) was ≤357 μmol/L, whereas HUA for men (n = 94) was >428 μmol/L and for women (n = 62) was >357 μmol/L. Clinical characteristics of patients were analyzed based on gender-specific NUA and HUA. The Spearman rank correlation test was used to evaluate the correlation between SUA and other clinical variables. Finally, stepwise multinomial logistic regression test was performed to identify the factors that are independently associated with HUA. Results: A total of 492 patients were included in this study. The regression analysis showed that there was a significant association between HUA and decreased estimated glomerular filtration rate (eGFR) in both male and female patients (odds ratio (OR) [95% confidence interval (CI)] = 4.73 [2.19–10.24], p value ≤0.01 in male patients and OR [95% CI] = 3.07 [], p value = 0.04 in female patients). FBG, 2hPBG, and HbA1c were negatively correlated with SUA in male patients (r = −0.182, p value ≤0.01; r = −0.168, p value ≤0.01; and r = −0.187, p value ≤0.01, respectively), whereas fasting insulin was positively correlated in male patients (r = 0.131, p value = 0.023) and female patients (r = 0.192, p value = 0.041). The atherogenic index of plasma was significantly high in patients with HUA (OR [95% CI] = 5.75 [2.32–14.23], p value ≤0.01 in male patients and OR [95% CI] = 8.37 [1.96–35.78], p value ≤0.01 in female patients). Other indices of lipid profile such as lipoprotein combine index, atherosclerosis index, and triglyceride/high-density lipoprotein ratio were also independently associated with HUA in both male and female patients. Conclusion: SUA can affect various clinical parameters in patients with DKD. There is a significant association between HUA and decline in eGFR in both male and female patients. HUA is also associated with dyslipidemia in DKD, increasing the risk of cardiac complications and mortality.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"55 1","pages":"103 - 111"},"PeriodicalIF":0.0,"publicationDate":"2020-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77638827","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. Franceschi, Caterina Rizzardi, V. Cauvin, Federica Berchielli, A. Liguori, M. Soffiati
Variety of media have popularized restrictive diets in diabetes mellitus reporting that carbohydrates are the cause of glycemic excursion, excessive insulin dosage, and weight gain. We report 2 cases of children with type 1 diabetes where adherence to restricted carbohydrate diets caused growth failure. Two prepubertal patients with type 1 diabetes presented at follow-up visit during the honeymoon period with no weight increase and low height velocity. Dietetic evaluation revealed a low-carbohydrate diet had been introduced in an attempt to achieve less postprandial excursions in the blood glucose readings. The 2 patients started to improve weight and height when the appropriate amount of carbohydrates was given. There are few published data to support not to restrict carbohydrate; therefore, we report 2 cases of children with type 1 diabetes where adherence to this diet caused growth failure. We want to emphasize the importance of educating families of children with type 1 diabetes on this aspect, particularly when they are in the honeymoon phase or this one is concluding.
{"title":"Carbohydrate Restriction and Growth Failure in Two Children with Type 1 Diabetes: A Case Report","authors":"R. Franceschi, Caterina Rizzardi, V. Cauvin, Federica Berchielli, A. Liguori, M. Soffiati","doi":"10.1159/000510819","DOIUrl":"https://doi.org/10.1159/000510819","url":null,"abstract":"Variety of media have popularized restrictive diets in diabetes mellitus reporting that carbohydrates are the cause of glycemic excursion, excessive insulin dosage, and weight gain. We report 2 cases of children with type 1 diabetes where adherence to restricted carbohydrate diets caused growth failure. Two prepubertal patients with type 1 diabetes presented at follow-up visit during the honeymoon period with no weight increase and low height velocity. Dietetic evaluation revealed a low-carbohydrate diet had been introduced in an attempt to achieve less postprandial excursions in the blood glucose readings. The 2 patients started to improve weight and height when the appropriate amount of carbohydrates was given. There are few published data to support not to restrict carbohydrate; therefore, we report 2 cases of children with type 1 diabetes where adherence to this diet caused growth failure. We want to emphasize the importance of educating families of children with type 1 diabetes on this aspect, particularly when they are in the honeymoon phase or this one is concluding.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"22 1","pages":"134 - 138"},"PeriodicalIF":0.0,"publicationDate":"2020-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91307240","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}
María Luz Gunturiz Albarracín, Ana Yibby Forero Torres
The global obesity epidemic has motivated a large number of investigations related to adipose tissue. Within the advances in this area, a variety of factors secreted by adipose tissue and with regulatory activity on caloric intake, energy expenditure, reproduction, locomotor activity, glycidic and lipid metabolism, immune response, and bone physiology have been described. Among these adipocyte hormones, collectively called “adipokines” or “adipocytokines,” leptin (LEP) and adiponectin are addressed in this review. The regulation of adipocytokines is altered in diseases such as obesity, atherosclerosis, type 2 diabetes mellitus, and metabolic syndrome (MS) due to the increase in the mass of white adipose tissue. LEP and adiponectin have a broad spectrum of functions in regulating metabolism and are an important link between obesity and MS. Because these adipocytokines have opposite effects on subclinical inflammation and insulin resistance, it has been suggested that the combined use of these 2 adipocytokines may work as a better biomarker in the diagnosis of MS than using them individually. In this review, we address the characteristics and main functions of adipocytokines derived from adipose tissue such as adiponectin and LEP, which in the Colombian context could give good guidance for the management of MS, especially in populations of children and adolescents.
{"title":"Adiponectin and Leptin Adipocytokines in Metabolic Syndrome: What Is Its Importance?","authors":"María Luz Gunturiz Albarracín, Ana Yibby Forero Torres","doi":"10.1159/000510521","DOIUrl":"https://doi.org/10.1159/000510521","url":null,"abstract":"The global obesity epidemic has motivated a large number of investigations related to adipose tissue. Within the advances in this area, a variety of factors secreted by adipose tissue and with regulatory activity on caloric intake, energy expenditure, reproduction, locomotor activity, glycidic and lipid metabolism, immune response, and bone physiology have been described. Among these adipocyte hormones, collectively called “adipokines” or “adipocytokines,” leptin (LEP) and adiponectin are addressed in this review. The regulation of adipocytokines is altered in diseases such as obesity, atherosclerosis, type 2 diabetes mellitus, and metabolic syndrome (MS) due to the increase in the mass of white adipose tissue. LEP and adiponectin have a broad spectrum of functions in regulating metabolism and are an important link between obesity and MS. Because these adipocytokines have opposite effects on subclinical inflammation and insulin resistance, it has been suggested that the combined use of these 2 adipocytokines may work as a better biomarker in the diagnosis of MS than using them individually. In this review, we address the characteristics and main functions of adipocytokines derived from adipose tissue such as adiponectin and LEP, which in the Colombian context could give good guidance for the management of MS, especially in populations of children and adolescents.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"34 1","pages":"93 - 102"},"PeriodicalIF":0.0,"publicationDate":"2020-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84485557","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: Promising results of clinical trials involving SGLT2 inhibitors urge every clinician managing diabetes to use them. However, upcoming real-world data still show increased incidence of adverse events, but efficacy is comparable to clinical trials. Objectives: Genitourinary infection is the most commonly reported adverse effect with SGLT2 inhibitors. We evaluated effectiveness of patient screening protocol and advice of hygiene and hydration to avoid adverse effects of SGLT2 inhibitors in real-world setting. Method: This was a prospective observational longitudinal study which included consecutive subjects with uncontrolled T2DM recommended with SGLT2i after a simple screening protocol from December 2017 to November 2018. The adverse effects and metabolic parameters were evaluated at 1st, 3rd, 6th, and 12th months for each patient. Results: Of 413 patients recommended for SGLT2 inhibitors, 335 patients started the medication. At baseline, average age, glycosylated haemoglobin (HbA1c), and weight were 53 years, 9.5%, and 82 kg, respectively. Data of 332, 299, 270, and 231 patients were available at the 1st, 3rd, 6th, and 12th months for safety follow-up, respectively. Genitourinary tract infection was the most common adverse effect (8%) followed by ketosis (4%). Two patients needed to stop the drug permanently due to recurrent transient ischaemic attack and emphysematous pyelonephritis. Significant reduction in mean weight and HbA1c was observed at 6 months (n = 270): 2.9 kg and 1.1%, respectively, and at 12 months (n = 231): 3.8 kg and 1.6%, respectively. Conclusion: Simple screening protocol for patients considered for SGLT2i significantly reduced incidence of genitourinary adverse events.
{"title":"Real-World Clinical Experience with SGLT2 Inhibitors: Use of Special Screening Tool for Type 2 Diabetes Patients to Avoid Serious Adverse Events: A Single-Centre Prospective Study","authors":"Vishwa B Unadkat, Sandeep Sharma, Ruchi Omar","doi":"10.1159/000510262","DOIUrl":"https://doi.org/10.1159/000510262","url":null,"abstract":"Background: Promising results of clinical trials involving SGLT2 inhibitors urge every clinician managing diabetes to use them. However, upcoming real-world data still show increased incidence of adverse events, but efficacy is comparable to clinical trials. Objectives: Genitourinary infection is the most commonly reported adverse effect with SGLT2 inhibitors. We evaluated effectiveness of patient screening protocol and advice of hygiene and hydration to avoid adverse effects of SGLT2 inhibitors in real-world setting. Method: This was a prospective observational longitudinal study which included consecutive subjects with uncontrolled T2DM recommended with SGLT2i after a simple screening protocol from December 2017 to November 2018. The adverse effects and metabolic parameters were evaluated at 1st, 3rd, 6th, and 12th months for each patient. Results: Of 413 patients recommended for SGLT2 inhibitors, 335 patients started the medication. At baseline, average age, glycosylated haemoglobin (HbA1c), and weight were 53 years, 9.5%, and 82 kg, respectively. Data of 332, 299, 270, and 231 patients were available at the 1st, 3rd, 6th, and 12th months for safety follow-up, respectively. Genitourinary tract infection was the most common adverse effect (8%) followed by ketosis (4%). Two patients needed to stop the drug permanently due to recurrent transient ischaemic attack and emphysematous pyelonephritis. Significant reduction in mean weight and HbA1c was observed at 6 months (n = 270): 2.9 kg and 1.1%, respectively, and at 12 months (n = 231): 3.8 kg and 1.6%, respectively. Conclusion: Simple screening protocol for patients considered for SGLT2i significantly reduced incidence of genitourinary adverse events.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"38 1","pages":"38 - 43"},"PeriodicalIF":0.0,"publicationDate":"2020-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80305592","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}
With the first sunrise of 2020, the world woke up to a completely new reality; the era of COVID-19 had begun. What was first reported as an outbreak of pneumonia in Wuhan on the last day of the year before quickly became a pandemic, influencing nearly every human being, either directly or indirectly [1]. This resulted in the implementation of widespread public health measures that were unprecedented in human history. Personal protective procedures such as the use of masks and gloves, hand hygiene measures, sneezing precautions, environmental sterilization, and restrictions on local or international movement became the norm. Diagnosed cases were isolated, and known contacts were put in quarantine. Even whole countries were placed under lockdown, if needed. Stay-at-home measures and physical distancing guidelines were mandated. In the blink of an eye, we were living in a different world. As far as healthcare was concerned, providers and resources were rapidly redeployed towards the in-patient management of people affected by COVID-19. All non-emergency clinic visits and elective procedures were cancelled. Whenever possible, patients were remotely managed with the help tele-health technology. We learnt from experience that patients with diabetes were at a higher risk for severe illness from COVID-19 [2]. Therefore, most scheduled clinic visits for diabetes management were also converted into tele-health consultations. Although the majority of our colleagues in diabetes management think that things would go back to normal, we do need to ask ourselves what lasting impact would this epidemic have in a the outpatient management of diabetes in a post-COVID-19 world? In terms of the usual management of diabetes, the normal process to date has focussed around multiple clinic visits over the course of a year, with the time interval determined by the severity of the disease as well as the availability of appointments with the healthcare providers. However, as time passes, tele-health continues to assume a larger role in clinical diabetes management, given the ongoing restrictions in place. Therefore, it would be better to start comprehending this paradigm shift in clinical management as well as be acquainted with what technology has to offer. Generally, telehealth technology can be utilized at 3 different levels in outpatient diabetes management.
{"title":"Tele-Management of Diabetes in the Post-COVID-19 Era","authors":"M. Farooqi","doi":"10.1159/000510273","DOIUrl":"https://doi.org/10.1159/000510273","url":null,"abstract":"With the first sunrise of 2020, the world woke up to a completely new reality; the era of COVID-19 had begun. What was first reported as an outbreak of pneumonia in Wuhan on the last day of the year before quickly became a pandemic, influencing nearly every human being, either directly or indirectly [1]. This resulted in the implementation of widespread public health measures that were unprecedented in human history. Personal protective procedures such as the use of masks and gloves, hand hygiene measures, sneezing precautions, environmental sterilization, and restrictions on local or international movement became the norm. Diagnosed cases were isolated, and known contacts were put in quarantine. Even whole countries were placed under lockdown, if needed. Stay-at-home measures and physical distancing guidelines were mandated. In the blink of an eye, we were living in a different world. As far as healthcare was concerned, providers and resources were rapidly redeployed towards the in-patient management of people affected by COVID-19. All non-emergency clinic visits and elective procedures were cancelled. Whenever possible, patients were remotely managed with the help tele-health technology. We learnt from experience that patients with diabetes were at a higher risk for severe illness from COVID-19 [2]. Therefore, most scheduled clinic visits for diabetes management were also converted into tele-health consultations. Although the majority of our colleagues in diabetes management think that things would go back to normal, we do need to ask ourselves what lasting impact would this epidemic have in a the outpatient management of diabetes in a post-COVID-19 world? In terms of the usual management of diabetes, the normal process to date has focussed around multiple clinic visits over the course of a year, with the time interval determined by the severity of the disease as well as the availability of appointments with the healthcare providers. However, as time passes, tele-health continues to assume a larger role in clinical diabetes management, given the ongoing restrictions in place. Therefore, it would be better to start comprehending this paradigm shift in clinical management as well as be acquainted with what technology has to offer. Generally, telehealth technology can be utilized at 3 different levels in outpatient diabetes management.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"43 1","pages":"1 - 3"},"PeriodicalIF":0.0,"publicationDate":"2020-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81213733","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: Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by the incapability of pancreas to increase insulin secretion to compensate for insulin resistance in the peripheral tissues. T2DM is a multifactorial disease including several environmental factors with the presence of genetic predisposition. The transcription factor 7-like-2 gene (TCF7L2) rs7903146 (C/T) polymorphism is one of the most susceptible genes to T2DM discovered to date, with contribution to the disease through the Wnt/β-catenin signaling pathway affecting pancreatic islet development, expression of several genes involved in insulin granules exocytosis, and the incretin glucagon-like peptide 1 (GLP-1) gene. Then, TCF7L2 gene seems to affect diabetes susceptibility through B-cell dysfunction that is why we studied its association with T2DM in particular. Objectives: To investigate the potential association of the transcription factor 7-like-2 (TCF7L2) rs7903146 (C/T) gene polymorphism in patients with T2DM. Methods: A case-control study conducted on 70 T2DM patients recruited from the endocrinology clinic at Ain Shams University Hospitals, and 30 non-diabetic healthy controls age- and sex-matched with the patients. All subjects underwent full history taking; thorough clinical examination; routine laboratory investigations including hemoglobin A1c, total cholesterol, triglycerides, high-density lipoprotein-cholesterol, and low-density lipoprotein-cholesterol; and determination of TCF7L2 gene polymorphism by qRT-PCR. Results: The minor T allele of the rs7903146(C/T) SNP was associated with high risk of development of T2DM with an OR of 1.35 (95% CI: 0.68–2.6) and the heterozygous genotype (CT) with an OR 1.16 (95% CI: 0.49–2.7); however, they were statistically insignificant (p value >0.05). Conclusion: Our study did not confirm the presence of significant association between the TCF7L2 rs7903146(C/T) polymorphism and T2DM; however, it pointed out the possibility of presence of high risk of development of T2DM in patients with TT genotype. Further studies with higher sample size are needed to clarify the association.
{"title":"Transcription Factor 7-Like-2 (TCF7L2) rs7903146 (C/T) Polymorphism in Patients with Type 2 Diabetes Mellitus","authors":"A. Bahaaeldin, A. Seif, A. Hamed, W. Kabiel","doi":"10.1159/000509756","DOIUrl":"https://doi.org/10.1159/000509756","url":null,"abstract":"Introduction: Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by the incapability of pancreas to increase insulin secretion to compensate for insulin resistance in the peripheral tissues. T2DM is a multifactorial disease including several environmental factors with the presence of genetic predisposition. The transcription factor 7-like-2 gene (TCF7L2) rs7903146 (C/T) polymorphism is one of the most susceptible genes to T2DM discovered to date, with contribution to the disease through the Wnt/β-catenin signaling pathway affecting pancreatic islet development, expression of several genes involved in insulin granules exocytosis, and the incretin glucagon-like peptide 1 (GLP-1) gene. Then, TCF7L2 gene seems to affect diabetes susceptibility through B-cell dysfunction that is why we studied its association with T2DM in particular. Objectives: To investigate the potential association of the transcription factor 7-like-2 (TCF7L2) rs7903146 (C/T) gene polymorphism in patients with T2DM. Methods: A case-control study conducted on 70 T2DM patients recruited from the endocrinology clinic at Ain Shams University Hospitals, and 30 non-diabetic healthy controls age- and sex-matched with the patients. All subjects underwent full history taking; thorough clinical examination; routine laboratory investigations including hemoglobin A1c, total cholesterol, triglycerides, high-density lipoprotein-cholesterol, and low-density lipoprotein-cholesterol; and determination of TCF7L2 gene polymorphism by qRT-PCR. Results: The minor T allele of the rs7903146(C/T) SNP was associated with high risk of development of T2DM with an OR of 1.35 (95% CI: 0.68–2.6) and the heterozygous genotype (CT) with an OR 1.16 (95% CI: 0.49–2.7); however, they were statistically insignificant (p value >0.05). Conclusion: Our study did not confirm the presence of significant association between the TCF7L2 rs7903146(C/T) polymorphism and T2DM; however, it pointed out the possibility of presence of high risk of development of T2DM in patients with TT genotype. Further studies with higher sample size are needed to clarify the association.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"237 2 1","pages":"112 - 118"},"PeriodicalIF":0.0,"publicationDate":"2020-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85656474","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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