Pub Date : 2019-08-01DOI: 10.17925/EE.2019.15.2.92
E. Gezer, B. Çetinarslan, Z. Cantürk, İIlhan Tarkun, M. Sözen, A. Selek
Abstract Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant endocrine tumour syndrome characterised by three main manifestations: primary hyperparathyroidism (78–94%), gastroenteropancreatic neuroendocrine tumours (GEP-NETs) (35–78%) and pituitary adenomas (20–65%). For metastatic and inoperable GEP-NETs, there are some interventional and medical therapies. Peptide receptor radionuclide therapy (PRRT) with Yttrium-90 (90Y) and Lutetium-177 (177Lu) is one of the important radiotherapies. Herein we describe a case of MEN1 syndrome with inoperable metastatic GEP-NETs who had excellent response to the treatment with six cycles of 177Lu-DOTATATE. The patient was admitted to our clinic with widening of hands and feet, polyuria, polydipsia, nausea, vomiting and constipation. His laboratory and screening findings were consistent with primary hyperparathyroidism, acromegaly, secondary hypogonadism and central diabetes insipidus. He underwent 3.5 parathyroidectomy and hypophysis adenomectomy. Under treatment with lanreotide and cabergoline, he developed metastatic duodenal NET. PRRT with 177Lu-DOTATATE was administered in six cycles and an excellent response was displayed without any side effect. In conclusion, the dramatic response of the patient to PRRT with 177Lu-DOTATATE, described in our case report and recent published articles indicating the beneficial efficacy and limited adverse effects of 177Lu-DOTATATE, should encourage clinicians to use PRRT for inoperable or metastatic NETs.
{"title":"Metastatic MEN1 Syndrome Treated with Lutetium-177 – A Case Report","authors":"E. Gezer, B. Çetinarslan, Z. Cantürk, İIlhan Tarkun, M. Sözen, A. Selek","doi":"10.17925/EE.2019.15.2.92","DOIUrl":"https://doi.org/10.17925/EE.2019.15.2.92","url":null,"abstract":"Abstract Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant endocrine tumour syndrome characterised by three main manifestations: primary hyperparathyroidism (78–94%), gastroenteropancreatic neuroendocrine tumours (GEP-NETs) (35–78%) and pituitary adenomas (20–65%). For metastatic and inoperable GEP-NETs, there are some interventional and medical therapies. Peptide receptor radionuclide therapy (PRRT) with Yttrium-90 (90Y) and Lutetium-177 (177Lu) is one of the important radiotherapies. Herein we describe a case of MEN1 syndrome with inoperable metastatic GEP-NETs who had excellent response to the treatment with six cycles of 177Lu-DOTATATE. The patient was admitted to our clinic with widening of hands and feet, polyuria, polydipsia, nausea, vomiting and constipation. His laboratory and screening findings were consistent with primary hyperparathyroidism, acromegaly, secondary hypogonadism and central diabetes insipidus. He underwent 3.5 parathyroidectomy and hypophysis adenomectomy. Under treatment with lanreotide and cabergoline, he developed metastatic duodenal NET. PRRT with 177Lu-DOTATATE was administered in six cycles and an excellent response was displayed without any side effect. In conclusion, the dramatic response of the patient to PRRT with 177Lu-DOTATATE, described in our case report and recent published articles indicating the beneficial efficacy and limited adverse effects of 177Lu-DOTATATE, should encourage clinicians to use PRRT for inoperable or metastatic NETs.","PeriodicalId":38860,"journal":{"name":"European Endocrinology","volume":"15 1","pages":"92 - 94"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43131396","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}
Pub Date : 2019-08-01DOI: 10.17925/EE.2019.15.2.70
Chelsea Zimmerman, Anastasia Albanese-O’Neill, M. Haller
Abstract The past 10 years have witnessed rapid advances in the technology used to treat patients with type 1 diabetes (T1D). While the disease burden is still high, these advances have contributed to improvements in both glycaemic control and quality of life for many of those affected. New technologies allow for individualisation of care, as patients are able to work with their providers to determine which systems best fit their lifestyle and needs. In addition, thanks to improved glucose monitoring technologies, patients can now simultaneously improve glycaemic control and reduce hypoglycaemia, thereby mitigating risk for acute and chronic complications. Technological advances in T1D care are rapidly moving us toward increasingly automated devices, which offer the promise of reduced disease burden. In this article, we review advances in glucose monitoring, insulin and glucagon delivery, and the applications and algorithms seeking to integrate novel technologies.
{"title":"Advances in Type 1 Diabetes Technology Over the Last Decade","authors":"Chelsea Zimmerman, Anastasia Albanese-O’Neill, M. Haller","doi":"10.17925/EE.2019.15.2.70","DOIUrl":"https://doi.org/10.17925/EE.2019.15.2.70","url":null,"abstract":"Abstract The past 10 years have witnessed rapid advances in the technology used to treat patients with type 1 diabetes (T1D). While the disease burden is still high, these advances have contributed to improvements in both glycaemic control and quality of life for many of those affected. New technologies allow for individualisation of care, as patients are able to work with their providers to determine which systems best fit their lifestyle and needs. In addition, thanks to improved glucose monitoring technologies, patients can now simultaneously improve glycaemic control and reduce hypoglycaemia, thereby mitigating risk for acute and chronic complications. Technological advances in T1D care are rapidly moving us toward increasingly automated devices, which offer the promise of reduced disease burden. In this article, we review advances in glucose monitoring, insulin and glucagon delivery, and the applications and algorithms seeking to integrate novel technologies.","PeriodicalId":38860,"journal":{"name":"European Endocrinology","volume":"15 1","pages":"70 - 76"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43663367","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}
Pub Date : 2019-08-01DOI: 10.17925/EE.2019.15.2.113
M. Baruah, S. Kalra
Abstract Introduction: This retrospective analysis compared the real-world effectiveness and safety of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with type 2 diabetes mellitus in India. Methods: All patients initiated on canagliflozin (C; 100 mg), dapagliflozin (D; 10 mg) and empagliflozin (E; 10 mg) between January and December 2016 were identified from an urban outpatient facility. Intra- and inter-group changes in glycaemic and metabolic parameters were recorded. Results: At week 48 (median follow-up), mean changes from baseline in the C (n=29), D (n=65) and E groups (n=27), respectively, were -1.3% (p=0.0002), -0.9% (p<0.0001) and -0.7% (p=0.34) for glycated haemoglobin; -60.9 mg/dL (p=0.00), -50.2 mg/dL (p=0.00) and -46.7 mg/dL (p=0.01) for fasting plasma glucose; -100.6 mg/dL (p=0.00), -79.8 mg/dL (p=0.00) and -90.2 mg/dL (p=0.00) for postprandial plasma glucose; -1.7 kg (p<0.05), -2.1 kg (p=0.0004) and -3.7 kg (p=0.002) for body weight; -5.2 mmHg (p=0.10), -5.8 mmHg (p=0.009); 0.0 mmHg (p=0.80) for systolic blood pressure and -12.2% (p=0.26), -9.2% (p=0.27) and -9.7% (p=0.50) for proportion of patients taking insulin. The incidence rate of hypoglycaemia was 2.4% for C, 1.3% for D, and 6.4% for E group. No significant inter-group differences were noted. Conclusion: Overall intra-group changes in glycaemic and metabolic parameters were significant; however, inter-group changes among SGLT2i were not significant, thereby indicating a class effect of the efficacy and safety parameters.
{"title":"Comparative Efficacy and Safety Among Sodium-glucose Cotransporter-2 Inhibitors in Type 2 Diabetes – Results from a Retrospective Single-centre Study","authors":"M. Baruah, S. Kalra","doi":"10.17925/EE.2019.15.2.113","DOIUrl":"https://doi.org/10.17925/EE.2019.15.2.113","url":null,"abstract":"Abstract Introduction: This retrospective analysis compared the real-world effectiveness and safety of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with type 2 diabetes mellitus in India. Methods: All patients initiated on canagliflozin (C; 100 mg), dapagliflozin (D; 10 mg) and empagliflozin (E; 10 mg) between January and December 2016 were identified from an urban outpatient facility. Intra- and inter-group changes in glycaemic and metabolic parameters were recorded. Results: At week 48 (median follow-up), mean changes from baseline in the C (n=29), D (n=65) and E groups (n=27), respectively, were -1.3% (p=0.0002), -0.9% (p<0.0001) and -0.7% (p=0.34) for glycated haemoglobin; -60.9 mg/dL (p=0.00), -50.2 mg/dL (p=0.00) and -46.7 mg/dL (p=0.01) for fasting plasma glucose; -100.6 mg/dL (p=0.00), -79.8 mg/dL (p=0.00) and -90.2 mg/dL (p=0.00) for postprandial plasma glucose; -1.7 kg (p<0.05), -2.1 kg (p=0.0004) and -3.7 kg (p=0.002) for body weight; -5.2 mmHg (p=0.10), -5.8 mmHg (p=0.009); 0.0 mmHg (p=0.80) for systolic blood pressure and -12.2% (p=0.26), -9.2% (p=0.27) and -9.7% (p=0.50) for proportion of patients taking insulin. The incidence rate of hypoglycaemia was 2.4% for C, 1.3% for D, and 6.4% for E group. No significant inter-group differences were noted. Conclusion: Overall intra-group changes in glycaemic and metabolic parameters were significant; however, inter-group changes among SGLT2i were not significant, thereby indicating a class effect of the efficacy and safety parameters.","PeriodicalId":38860,"journal":{"name":"European Endocrinology","volume":"15 1","pages":"113 - 118"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43360857","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}
Pub Date : 2019-08-01DOI: 10.17925/ee.2019.15.2.67
S. Kalra, N. Kamaruddin, J. Visvanathan, R. Santani
Abstract This communication shares insights into the definition of disease progression and drug durability in type 2 diabetes. Disease progression may be defined as gradual worsening of beta-cell function, clinically observed as an increase in drug dosage, drug frequency or number of glucose lowering drugs needed to maintain HbA1c control; and/or a ≥0.5% rise in HbA1c, unexplained by acute, modifiable factors, while using the same drug regimen; and/or as the occurrence or worsening of cardiovascular or microvascular complications, in spite of standard care, over a pre-specified time period. Durability of a drug or a drug combination may be defined as its ability to postpone or delay progression of disease, in a safe and well tolerated manner. Thus, all drugs that are able to prevent disease progression (i.e., postpone loss of glycaemic control, need for intensification of therapy or onset or worsening of complications) may be termed ‘durable’.
{"title":"Defining Disease Progression and Drug Durability in Type 2 Diabetes Mellitus","authors":"S. Kalra, N. Kamaruddin, J. Visvanathan, R. Santani","doi":"10.17925/ee.2019.15.2.67","DOIUrl":"https://doi.org/10.17925/ee.2019.15.2.67","url":null,"abstract":"Abstract This communication shares insights into the definition of disease progression and drug durability in type 2 diabetes. Disease progression may be defined as gradual worsening of beta-cell function, clinically observed as an increase in drug dosage, drug frequency or number of glucose lowering drugs needed to maintain HbA1c control; and/or a ≥0.5% rise in HbA1c, unexplained by acute, modifiable factors, while using the same drug regimen; and/or as the occurrence or worsening of cardiovascular or microvascular complications, in spite of standard care, over a pre-specified time period. Durability of a drug or a drug combination may be defined as its ability to postpone or delay progression of disease, in a safe and well tolerated manner. Thus, all drugs that are able to prevent disease progression (i.e., postpone loss of glycaemic control, need for intensification of therapy or onset or worsening of complications) may be termed ‘durable’.","PeriodicalId":38860,"journal":{"name":"European Endocrinology","volume":"15 1","pages":"67 - 69"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43717809","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}
Pub Date : 2019-08-01DOI: 10.17925/EE.2019.15.2.83
C. Fernandez, Elias C. Chacko, Joseph M Pappachan
Abstract The single most significant risk factor for testosterone deficiency in men is obesity. The pathophysiological mechanisms involved in male obesity-related secondary hypogonadism are highly complex. Obesity-induced increase in levels of leptin, insulin, proinflammatory cytokines and oestrogen can cause a functional hypogonadotrophic hypogonadism with the defect present at the level of the hypothalamic gonadotrophin-releasing hormone (GnRH) neurons. The resulting hypogonadism by itself can worsen obesity, creating a self-perpetuating cycle. Obesity-induced hypogonadism is reversible with substantial weight loss. Lifestyle-measures form the cornerstone of management as they can potentially improve androgen deficiency symptoms irrespective of their effect on testosterone levels. In selected patients, bariatric surgery can reverse the obesity-induced hypogonadism. If these measures fail to relieve symptoms and to normalise testosterone levels, in appropriately selected men, testosterone replacement therapy could be started. Aromatase inhibitors and selective oestrogen receptor modulators are not recommended due to lack of consistent clinical trial-based evidence.
{"title":"Male Obesity-related Secondary Hypogonadism – Pathophysiology, Clinical Implications and Management","authors":"C. Fernandez, Elias C. Chacko, Joseph M Pappachan","doi":"10.17925/EE.2019.15.2.83","DOIUrl":"https://doi.org/10.17925/EE.2019.15.2.83","url":null,"abstract":"Abstract The single most significant risk factor for testosterone deficiency in men is obesity. The pathophysiological mechanisms involved in male obesity-related secondary hypogonadism are highly complex. Obesity-induced increase in levels of leptin, insulin, proinflammatory cytokines and oestrogen can cause a functional hypogonadotrophic hypogonadism with the defect present at the level of the hypothalamic gonadotrophin-releasing hormone (GnRH) neurons. The resulting hypogonadism by itself can worsen obesity, creating a self-perpetuating cycle. Obesity-induced hypogonadism is reversible with substantial weight loss. Lifestyle-measures form the cornerstone of management as they can potentially improve androgen deficiency symptoms irrespective of their effect on testosterone levels. In selected patients, bariatric surgery can reverse the obesity-induced hypogonadism. If these measures fail to relieve symptoms and to normalise testosterone levels, in appropriately selected men, testosterone replacement therapy could be started. Aromatase inhibitors and selective oestrogen receptor modulators are not recommended due to lack of consistent clinical trial-based evidence.","PeriodicalId":38860,"journal":{"name":"European Endocrinology","volume":"15 1","pages":"83 - 90"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43352952","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}
Pub Date : 2019-08-01DOI: 10.17925/EE.2019.15.2.106
Madhur Verma, S. Grover, J. Tripathy, T. Singh, S. Nagaraja, S. Kathirvel, Gopal K Singh, R. Nehra
Abstract Background: There is scant literature from India assessing the burden of mental disorders among elderly patients with non-communicable diseases (NCDs). This study aimed to determine the prevalence of depression and generalised anxiety disorder (GAD) among the elderly population with diabetes and/or hypertension and risk factors for psychiatric morbidity. Methodology: A cross-sectional study was conducted between September–December 2017 by using a semi-structured questionnaire amongst an elderly population (n=320), who were attending an NCD clinic in a rural district in the northern state of Punjab, India. The Geriatric Depression Scale (30-item) and GAD-7 scale were used to assess depression and GAD. Result: Depression was found in 58.1% (95% confidence interval [CI] 52.6–63.4%) of the study participants; of whom, 34.1% had severe depression. The proportion of GAD was found to be 38.7% (95% CI 33.6–44.2%), with 19.7% scoring in the severe range. Both GAD and depression was found in 37.8% (95% CI 32.7–43.2%). Female gender, nuclear family, being single/separated/divorced/widowed, low-income status and comorbid NCDs (especially hypertension) were found to be risk factors associated with depression and GAD. Conclusion: NCDs with co-morbid mental illness are a growing public health problem amongst the elderly population of the country. The NCD programme should make immediate efforts to provide mental-health care as part of a holistic care package to elderly with NCDs.
背景:印度缺乏评估非传染性疾病(ncd)老年患者精神障碍负担的文献。本研究旨在确定老年糖尿病和/或高血压患者中抑郁症和广泛性焦虑症(GAD)的患病率以及精神疾病的危险因素。方法:在2017年9月至12月期间，在印度北部旁遮普邦农村地区的一家非传染性疾病诊所就诊的老年人(n=320)中使用半结构化问卷进行了一项横断面研究。采用老年抑郁量表(30项)和GAD-7量表评估抑郁和广泛性焦虑症。结果:58.1%(95%可信区间[CI] 52.6-63.4%)的研究参与者存在抑郁症;其中34.1%患有重度抑郁症。GAD的比例为38.7% (95% CI 33.6-44.2%)，其中19.7%评分在严重范围。37.8%的患者同时存在广泛性焦虑症和抑郁症(95% CI 32.7-43.2%)。女性、核心家庭、单身/分居/离婚/丧偶、低收入状况和共病非传染性疾病(特别是高血压)被发现是与抑郁和广广性焦虑症相关的危险因素。结论:非传染性疾病合并精神疾病是我国老年人口中日益严重的公共卫生问题。非传染性疾病方案应立即作出努力，提供精神保健，作为对患有非传染性疾病的老年人的整体护理方案的一部分。
{"title":"Co-existing Non-communicable Diseases and Mental Illnesses Amongst the Elderly in Punjab, India","authors":"Madhur Verma, S. Grover, J. Tripathy, T. Singh, S. Nagaraja, S. Kathirvel, Gopal K Singh, R. Nehra","doi":"10.17925/EE.2019.15.2.106","DOIUrl":"https://doi.org/10.17925/EE.2019.15.2.106","url":null,"abstract":"Abstract Background: There is scant literature from India assessing the burden of mental disorders among elderly patients with non-communicable diseases (NCDs). This study aimed to determine the prevalence of depression and generalised anxiety disorder (GAD) among the elderly population with diabetes and/or hypertension and risk factors for psychiatric morbidity. Methodology: A cross-sectional study was conducted between September–December 2017 by using a semi-structured questionnaire amongst an elderly population (n=320), who were attending an NCD clinic in a rural district in the northern state of Punjab, India. The Geriatric Depression Scale (30-item) and GAD-7 scale were used to assess depression and GAD. Result: Depression was found in 58.1% (95% confidence interval [CI] 52.6–63.4%) of the study participants; of whom, 34.1% had severe depression. The proportion of GAD was found to be 38.7% (95% CI 33.6–44.2%), with 19.7% scoring in the severe range. Both GAD and depression was found in 37.8% (95% CI 32.7–43.2%). Female gender, nuclear family, being single/separated/divorced/widowed, low-income status and comorbid NCDs (especially hypertension) were found to be risk factors associated with depression and GAD. Conclusion: NCDs with co-morbid mental illness are a growing public health problem amongst the elderly population of the country. The NCD programme should make immediate efforts to provide mental-health care as part of a holistic care package to elderly with NCDs.","PeriodicalId":38860,"journal":{"name":"European Endocrinology","volume":"15 1","pages":"106 - 112"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67586474","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}
Pub Date : 2019-08-01DOI: 10.17925/EE.2019.15.2.101
Laura C. Hautala, E. Englund, Sahruh Turkmen
Abstract Introduction: Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes. The strategies used to screen for GDM vary both internationally and nationally. Therefore, we investigated the performance of the capillary random plasma glucose (RPG) test, maternal body mass index (BMI) and maternal age in predicting GDM. Methods: In a retrospective cohort study, we included pregnant women without pre-existing diabetes or metabolic disease who gave birth in Västernorrland County, Sweden, in 2015–2016. Values for RPG in gestational weeks 23–28 were obtained from obstetric medical records for each pregnancy. The development of GDM was confirmed by evaluating data in the obstetric records. The ability of RPG, maternal BMI, and age to predict GDM was assessed with receiver-operating characteristic curves. Results: In total, 4,698 pregnancies were included in the final statistical analysis. RPG was fairly effective in screening (area under the curve [AUC] 0.73; 95% confidence interval [CI] 0.66–0.80), and BMI performed slightly better (AUC 0.75; 95% CI 0.68–0.82), whereas maternal age performed poorly (AUC 0.61; 95% CI 0.53–0.68). Combining RPG ≥7 and BMI ≥27.9 yielded the best overall sensitivity (75.4%), specificity (70.1%), and AUC (0.75; 95% CI 0.68–0.82). Conclusions: Our results show that the sensitivity of capillary RPG alone in predicting GDM is fair. The combination of RPG with maternal BMI or age showed greater sensitivity. However, none of the screening factors (RPG, BMI, and maternal age), alone or combined, showed sufficiently good performance in predicting GDM.
摘要简介:妊娠期糖尿病(GDM)与不良妊娠结局相关。用于筛查GDM的策略在国际和国内各不相同。因此，我们研究了毛细管随机血糖(RPG)测试、母亲体重指数(BMI)和母亲年龄在预测GDM中的作用。方法:在一项回顾性队列研究中，我们纳入了2015-2016年在瑞典Västernorrland县分娩的无既往糖尿病或代谢性疾病的孕妇。妊娠23-28周的RPG值来自每次妊娠的产科医疗记录。通过评估产科记录中的数据证实了GDM的发展。通过受试者-工作特征曲线评估RPG、母亲BMI和年龄预测GDM的能力。结果:共4698例妊娠纳入最终统计分析。RPG在筛选中相当有效(曲线下面积[AUC] 0.73;95%可信区间[CI] 0.66-0.80)， BMI表现稍好(AUC 0.75;95% CI 0.68-0.82)，而母亲年龄表现较差(AUC 0.61;95% ci 0.53-0.68)。结合RPG≥7和BMI≥27.9可获得最佳的总灵敏度(75.4%)、特异性(70.1%)和AUC (0.75;95% ci 0.68-0.82)。结论:我们的结果表明，单独的毛细管RPG预测GDM的敏感性是公平的。RPG与母亲BMI或年龄的结合显示出更高的敏感性。然而，没有一个筛查因素(RPG、BMI和母亲年龄)单独或联合在预测GDM方面表现出足够好的效果。
{"title":"Performance of Variables in Screening for Gestational Diabetes","authors":"Laura C. Hautala, E. Englund, Sahruh Turkmen","doi":"10.17925/EE.2019.15.2.101","DOIUrl":"https://doi.org/10.17925/EE.2019.15.2.101","url":null,"abstract":"Abstract Introduction: Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes. The strategies used to screen for GDM vary both internationally and nationally. Therefore, we investigated the performance of the capillary random plasma glucose (RPG) test, maternal body mass index (BMI) and maternal age in predicting GDM. Methods: In a retrospective cohort study, we included pregnant women without pre-existing diabetes or metabolic disease who gave birth in Västernorrland County, Sweden, in 2015–2016. Values for RPG in gestational weeks 23–28 were obtained from obstetric medical records for each pregnancy. The development of GDM was confirmed by evaluating data in the obstetric records. The ability of RPG, maternal BMI, and age to predict GDM was assessed with receiver-operating characteristic curves. Results: In total, 4,698 pregnancies were included in the final statistical analysis. RPG was fairly effective in screening (area under the curve [AUC] 0.73; 95% confidence interval [CI] 0.66–0.80), and BMI performed slightly better (AUC 0.75; 95% CI 0.68–0.82), whereas maternal age performed poorly (AUC 0.61; 95% CI 0.53–0.68). Combining RPG ≥7 and BMI ≥27.9 yielded the best overall sensitivity (75.4%), specificity (70.1%), and AUC (0.75; 95% CI 0.68–0.82). Conclusions: Our results show that the sensitivity of capillary RPG alone in predicting GDM is fair. The combination of RPG with maternal BMI or age showed greater sensitivity. However, none of the screening factors (RPG, BMI, and maternal age), alone or combined, showed sufficiently good performance in predicting GDM.","PeriodicalId":38860,"journal":{"name":"European Endocrinology","volume":"15 1","pages":"101 - 105"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44636491","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}
Pub Date : 2019-08-01DOI: 10.17925/EE.2019.15.2.95
A. Al-Sharefi, Usman Javaid, P. Perros, J. Ealing, P. Truran, S. Nag, Shafie Kamaruddin, K. Abouglila, Fiona Cains, Lauren Lewis, R. James
Abstract Introduction: Patients with neurofibromatosis type 1 (NF1) are at risk of developing phaeochromocytomas/paragangliomas (PHAEO/PG). Unlike in other familial PHAEO/PG syndromes, there are no published guidelines regarding screening in asymptomatic or normotensive patients with NF1. This strategy may be associated with preventable morbidities in those patients who ultimately present with symptomatic PHAEO/PG. Objective: To describe the mode of presentation and the incidence of adverse clinical outcomes attributed to PHAEO/PG in NF1. Methods: A retrospective study was performed in a tertiary referral centre in collaboration with a national complex NF1 centre. Hospital records and databases between 1998–2018 were searched. Results: Twenty-seven patients with NF1 and PHAEO/PG were identified. In all but one, PHAEO/PG was diagnosed after NF1. The median age at the time of diagnosis of PHAEO/PG was 43 years (range 22–65) and 21/27 (78%) were females. The diagnosis was mostly incidental in 13/27 (48%) while classical PHAEO/PG symptoms were found in 15/27 (56%), and hypertension was found in 14/27 (52%) of NF1 patients prior to PHAEO/PG diagnosis. No patient had undergone biochemical screening for PHAEO/PG. Metastatic disease was evident in 2/27 patients, 8 suffered potentially avoidable complications attributed to PHAEO/PG (including two deaths). Conclusion: The course of PHAEO/PG in NF1 is associated with an unpredictable presentation and potentially avoidable adverse outcomes. We recommend that routine biochemical screening for PHAEO/PG should be part of the care package offered to all patients with NF1 by regular measurements of plasma free or urinary fractionated metanephrines starting from early adolescence and repeated every 3 years.
{"title":"Clinical Presentation and Outcomes of Phaeochromocytomas/Paragangliomas in Neurofibromatosis Type 1","authors":"A. Al-Sharefi, Usman Javaid, P. Perros, J. Ealing, P. Truran, S. Nag, Shafie Kamaruddin, K. Abouglila, Fiona Cains, Lauren Lewis, R. James","doi":"10.17925/EE.2019.15.2.95","DOIUrl":"https://doi.org/10.17925/EE.2019.15.2.95","url":null,"abstract":"Abstract Introduction: Patients with neurofibromatosis type 1 (NF1) are at risk of developing phaeochromocytomas/paragangliomas (PHAEO/PG). Unlike in other familial PHAEO/PG syndromes, there are no published guidelines regarding screening in asymptomatic or normotensive patients with NF1. This strategy may be associated with preventable morbidities in those patients who ultimately present with symptomatic PHAEO/PG. Objective: To describe the mode of presentation and the incidence of adverse clinical outcomes attributed to PHAEO/PG in NF1. Methods: A retrospective study was performed in a tertiary referral centre in collaboration with a national complex NF1 centre. Hospital records and databases between 1998–2018 were searched. Results: Twenty-seven patients with NF1 and PHAEO/PG were identified. In all but one, PHAEO/PG was diagnosed after NF1. The median age at the time of diagnosis of PHAEO/PG was 43 years (range 22–65) and 21/27 (78%) were females. The diagnosis was mostly incidental in 13/27 (48%) while classical PHAEO/PG symptoms were found in 15/27 (56%), and hypertension was found in 14/27 (52%) of NF1 patients prior to PHAEO/PG diagnosis. No patient had undergone biochemical screening for PHAEO/PG. Metastatic disease was evident in 2/27 patients, 8 suffered potentially avoidable complications attributed to PHAEO/PG (including two deaths). Conclusion: The course of PHAEO/PG in NF1 is associated with an unpredictable presentation and potentially avoidable adverse outcomes. We recommend that routine biochemical screening for PHAEO/PG should be part of the care package offered to all patients with NF1 by regular measurements of plasma free or urinary fractionated metanephrines starting from early adolescence and repeated every 3 years.","PeriodicalId":38860,"journal":{"name":"European Endocrinology","volume":"15 1","pages":"95 - 100"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43740320","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}
Pub Date : 2019-08-01DOI: 10.17925/EE.2019.15.2.77
L. Gupta, D. Khandelwal, P. Lal, S. Kalra, D. Dutta
Abstract Introduction: The Palaeolithic diet is designed to resemble that of human hunter-gatherer ancestors thousands to millions of years ago. This review summarises the evidence and clinical application of this diet in various disorders. An empiric vegan variant of it has been provided, keeping in mind vegan food habits. Review of the literature: different types of Palaeolithic diets in vogue include the 80/20, the autoimmune, the lacto, the Palaeolithic vegan and the Palaeolithic ketogenic. We have developed an Indian variant of the Palaeolithic vegan diet, which excludes all animal-based foods. The Palaeolithic diet typically has low carbohydrate and lean protein of 30–35% daily caloric intake in addition to a fibre diet from non-cereal, plant-based sources, up to 45–100 g daily. In different observational studies, beneficial effects on metabolic syndrome, blood pressure, glucose tolerance, insulin secretion, lipid profiles and cardiovascular risk factors have been documented with the Palaeolithic diet. Short-term randomised controlled trials have documented weight loss, and improved glycaemia and adipo-cytokine profiles. Few concerns of micronutrient deficiency (e.g. calcium) have been raised. Conclusion: Initial data are encouraging with regard to the use of the Palaeolithic diet in managing diabesity. There is an urgent need for large randomised controlled trials to evaluate the role of the Palaeolithic diet with different anti-diabetes medications for glycaemic control and the reversal of type 2 diabetes.
{"title":"Palaeolithic Diet in Diabesity and Endocrinopathies – A Vegan’s Perspective","authors":"L. Gupta, D. Khandelwal, P. Lal, S. Kalra, D. Dutta","doi":"10.17925/EE.2019.15.2.77","DOIUrl":"https://doi.org/10.17925/EE.2019.15.2.77","url":null,"abstract":"Abstract Introduction: The Palaeolithic diet is designed to resemble that of human hunter-gatherer ancestors thousands to millions of years ago. This review summarises the evidence and clinical application of this diet in various disorders. An empiric vegan variant of it has been provided, keeping in mind vegan food habits. Review of the literature: different types of Palaeolithic diets in vogue include the 80/20, the autoimmune, the lacto, the Palaeolithic vegan and the Palaeolithic ketogenic. We have developed an Indian variant of the Palaeolithic vegan diet, which excludes all animal-based foods. The Palaeolithic diet typically has low carbohydrate and lean protein of 30–35% daily caloric intake in addition to a fibre diet from non-cereal, plant-based sources, up to 45–100 g daily. In different observational studies, beneficial effects on metabolic syndrome, blood pressure, glucose tolerance, insulin secretion, lipid profiles and cardiovascular risk factors have been documented with the Palaeolithic diet. Short-term randomised controlled trials have documented weight loss, and improved glycaemia and adipo-cytokine profiles. Few concerns of micronutrient deficiency (e.g. calcium) have been raised. Conclusion: Initial data are encouraging with regard to the use of the Palaeolithic diet in managing diabesity. There is an urgent need for large randomised controlled trials to evaluate the role of the Palaeolithic diet with different anti-diabetes medications for glycaemic control and the reversal of type 2 diabetes.","PeriodicalId":38860,"journal":{"name":"European Endocrinology","volume":"15 1","pages":"77 - 82"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41377663","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}
Obesity has been called the mother of all diseases and, historically, has been strongly linked to diabetes. However, there are still some paradoxes that exist in diabetes epidemiology and obesity and no unifying hypothesis has been proposed to explain these paradoxical phenomena. Despite the ever-increasing prevalence of both obesity and diabetes, differential relationships exist between diabetes and the extent of obesity in various different ethnic groups. In addition, people with a higher body mass index have been shown to have an improved survival advantage in terms of chronic diabetes complications, especially cardiovascular complications. This narrative review attempts to explain these paradoxical and complex relationships with a single unifying theory. We propose that adipocytes are actually friends of the human body to prevent the occurrence of diabetes and also help in mitigating the complications of diabetes. Adipose tissue actually acts as a reservoir of free fatty acids, responsible for insulin resistance, and prevents their overflow into insulin-sensitive tissues and, therefore, friendly fat theory.
{"title":"Friendly Fat Theory - Explaining the Paradox of Diabetes and Obesity.","authors":"Rajiv Singla, Mithun Murthy, Sweta Singla, Yashdeep Gupta","doi":"10.17925/EE.2019.15.1.25","DOIUrl":"https://doi.org/10.17925/EE.2019.15.1.25","url":null,"abstract":"<p><p>Obesity has been called the mother of all diseases and, historically, has been strongly linked to diabetes. However, there are still some paradoxes that exist in diabetes epidemiology and obesity and no unifying hypothesis has been proposed to explain these paradoxical phenomena. Despite the ever-increasing prevalence of both obesity and diabetes, differential relationships exist between diabetes and the extent of obesity in various different ethnic groups. In addition, people with a higher body mass index have been shown to have an improved survival advantage in terms of chronic diabetes complications, especially cardiovascular complications. This narrative review attempts to explain these paradoxical and complex relationships with a single unifying theory. We propose that adipocytes are actually friends of the human body to prevent the occurrence of diabetes and also help in mitigating the complications of diabetes. Adipose tissue actually acts as a reservoir of free fatty acids, responsible for insulin resistance, and prevents their overflow into insulin-sensitive tissues and, therefore, friendly fat theory.</p>","PeriodicalId":38860,"journal":{"name":"European Endocrinology","volume":"15 1","pages":"25-28"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/67/15/euendo-15-25.PMC6587901.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37106841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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