Clinical Medicine Insights-Endocrinology and Diabetes最新文献

[This corrects the article DOI: 10.1177/11795514251344029.].

Background: Metformin is a widely popular drug to treat type 2 diabetes as it is efficacious, inexpensive and relatively well tolerated with minimal side effect profile. It is known that long term metformin use predisposes a person to develop Vitamin B12 deficiency, however guidelines to screen and treat are yet to be well established. Vitamin B12 deficiency is known to cause peripheral neuropathy and anemia.

Methods: Ours is a prospective, observational, cross sectional study based in a hospital setting in a tertiary care center. Study participants were subjected to serum Vitamin B12 analysis and Michigan neuropathy screening instrument was used to screen for peripheral neuropathy.

Results: We report statistically significant association between metformin use and development of Vitamin B12 deficiency. The average duration of metformin use that resulted in development of Vitamin B12 deficiency was 13.6 years. We also found statistically significant association of metformin use with development of peripheral neuropathy.

Conclusion: Long term metformin leading to Vitamin B12 deficiency is common knowledge, however we need more targeted guidelines on when to screen and treat for B12 deficiency. Some subsets of the population such as elderly and vegetarians are more prone and hence we need to educate more physicians and patients on the same.

Background: Abdominal obesity (AO) is associated with hyperuricemia (HU) in people with type 2 diabetes (T2DM), but most evidence comes from Asian studies and Latin American data are scarce. This study addresses that gap in a Peruvian setting. We aimed to evaluate the association between AO and HU in adult Peruvians diagnosed with T2DM.

Methods: We carried out a cross-sectional observational study in adults with T2DM in a private clinic in Lima - Peru. We defined HU as serum uric acid ⩾ 6 mg/dL and defined AO as waist circumference ⩾ 94 cm in men and ⩾88 cm in women. In addition, we estimated crude and adjusted prevalence ratios (PRs) with 95% CIs for the AO-HU association, adjusting for sex, glycosylated hemoglobin, estimated glomerular filtration rate, and systolic/diastolic blood pressure.

Results: We evaluated 815 adults with T2DM. 62.6% were male, and the average age was 57 years. AO was present in 82.9% and HU in 22.7%. The prevalence of HU in adults with AO was 24.3%, while the prevalence was 15.1% in those not obese. AO was associated with HU in the crude analysis (cPR: 1.60 95% CI 1.05-2.43) and remained statistically significant after adjustment for sex, glycosylated hemoglobin, estimated glomerular filtration rate, and systolic/diastolic blood pressure (aPR: 1.95 95% CI 1.31-2.90).

Conclusion: In Peruvian adults with T2DM, abdominal obesity was associated with nearly double the prevalence of hyperuricemia. Because waist circumference is simple and low-cost to measure, integrating it into routine diabetes visits, along with targeted uric acid screening and management, may enhance cardiometabolic risk stratification and guide timely interventions.

Iatrogenic Cushing syndrome can occur due to the use of external glucocorticoids. We present a case involving prolonged exposure to glucocorticoids from intramuscular dexamethasone injections, with diagnosis confirmed via abscess fluid analysis. This underscores the importance of considering altered pharmacokinetics when faced with unexplained hypercortisolism. A 46-year-old woman experienced hypertension, weakness, edema, and increasing abdominal striae over 6 months. Her history included undocumented intramuscular injections for back pain a year earlier, which resulted in bilateral gluteal abscesses. Laboratory results showed suppressed morning cortisol and adrenocorticotrophic hormone levels, while imaging ruled out structural abnormalities. Although serum tests were negative, liquid chromatography-mass spectrometry performed on abscess fluid detected dexamethasone (81.1 nmol/L), confirming iatrogenic Cushing syndrome. This case highlights how local tissue changes, such as abscesses, can significantly modify glucocorticoid pharmacokinetics, creating a prolonged reservoir effect and sustained systemic exposure lasting more than a year after injection. Overall, atypical pharmacokinetics are important in cases of unexplained hypercortisolism, especially when local tissue alterations influence drug absorption and clearance. Analyzing collections like abscess fluid can provide vital diagnostic clues in complex suspected cases of iatrogenic Cushing syndrome.

Background: Type 1 diabetes (T1D) is an autoimmune disease characterized by insulin deficiency and impaired glucose regulation. While sex hormones are known to influence insulin sensitivity, their specific roles in T1D remain underexplored. Prolactin and progesterone have been associated with glucose metabolism, yet their influence in individuals with T1D, particularly men, has not been well studied. This study investigated the relationship between key sex hormones and glycemic control in men and women with T1D.

Methods: Seventy-eight adults with T1D (25 men, 53 women) were recruited for a cross-sectional study examining associations between circulating sex hormone concentrations and hemoglobin A_1c (HbA_1c). Participants underwent anthropometric and body composition assessments and provided fasting blood samples for measurement of estradiol, progesterone, prolactin, total testosterone, free testosterone, and HbA_1c. Pearson's correlations were used to evaluate associations between hormone levels and HbA_1c.

Results: In men, higher concentrations of prolactin (r = -.571, P = .003) and progesterone (r = -.434, P = .030) were significantly associated with lower HbA_1c. No such associations were observed in women for prolactin, progesterone, estradiol, or testosterone. Similarly, in men, estradiol, total testosterone, and free testosterone were not significantly correlated with HbA_1c.

Conclusions: This study provides novel evidence that prolactin and progesterone may be linked to improved glycemic control in men with T1D. These associations were not observed in women. The findings underscore the importance of sex-specific approaches in endocrine and metabolic research. Further longitudinal and mechanistic studies are needed to confirm these relationships and explore the potential of prolactin and progesterone as therapeutic targets in T1D management.

[This corrects the article DOI: 10.1177/11795514241300998.].

Background: T2DM is a significant contributor to hypoglycemia, mortality, CVD, as well as a leading cause of CKD. Understanding and managing glycosylation discrepancies in T2DM patients with CKD is critical because they are important in disease causation and progression. Aim of this correlation study was to investigate the accuracy of HbA1c and fructosamine as predictors of declining renal function in the context of T2DM, by comparing and evaluating their relationships with eGFR across stages 1 to 5.

Methods: We included individuals with T2DM aged over 18 years, diagnosed per ADA guidelines, and potential CKD (stage 1-5) in T2DM patients. Outcomes involved measuring HbA1c and fructosamine levels of all participants.

Results: We recruited 424 participants from Department of Medicine, Kasturba Medical College, MAHE, Manipal on OPD & IPD. For patient in CKD stage 1 to 4, a weak positive correlation was noticed between HbA1c and eGFR. For patient in CKD stage 1 to 4, a weak negative correlation was found between eGFR and Fructosamine.

Conclusion: For determining long-term blood sugar management and forecasting the course of kidney disease in individuals with type 2 diabetes, the HbA1c test remains a crucial and dependable tool. However, it might occasionally be more difficult to interpret HbA1c values in later stages of CKD. Fructosamine, a shorter-term blood sugar indicator, can offer useful further information in certain situations. We advise combining the 2 tests for optimal diabetes management: fructosamine for prompt medication modifications, particularly in advanced CKD and HbA1c for long term trends and risk assessments.

Background: The 2025 American Diabetes Association guidelines emphasize the benefits of continuous glucose monitoring (CGM) for patients with diabetes receiving insulin therapy. CGM measures interstitial fluid glucose levels, offering an alternative to capillary (finger-stick) devices. This study aimed to evaluate the real-world impact of CGM devices on patients with uncontrolled type 2 diabetes (T2D) compared to traditional blood glucose monitoring (BGM) in a resource-limited population.

Methods: This is a retrospective study of patients 18 years or older, with T2D, with a glycated hemoglobin (HbA1c) > 9% at enrollment during the study period of December 1, 2021, to February 12, 2023, at an inner-city hospital. Patients with T2D using CGM devices were compared to a historical cohort of patients from the same population using BGM devices in the same period. The primary outcome was the HbA1c at 3 months. In total, 64 patients were included in the analysis after screening: 27 in the CGM group and 37 in the non-CGM group.

Results: For the primary end point of HbA1c at 3-months, the study found no significant difference between groups. After adjustment for baseline differences (age, HbA1c, creatinine, point-of-care glucose, and number of patients on injectables), average treatment effect (ATE) was -0.48% (SE = 0.27) in favor of the non-CGM group (P = .07). Potential outcome means were 8.8% (SE = 0.17) and 8.3% (SE = 0.2) for CGM and non-CGM groups respectively. Both groups achieved clinically meaningful reduction in HbA1c.

Conclusion: Our study did not find that CGM titrated regimens resulted in a statistically significant difference in HbA1c change at 3 months compared to non-CGM based treatment. This may indicate that while diabetes technology can help achieve glucose goals in more controlled settings, optimal results in the real world is influenced by many factors, such as insurance coverage, patient adoption, and provider training. More research can be done on identifying factors that yield optimal results in CGM utilization in outpatient settings.

Background: The use of continuous glucose monitoring (CGM) has grown, extending its use to people without diabetes. CGM helps prevent hyperglycaemia-related complications in diabetes, however, its value in people without diabetes remains uncertain. Despite online sources framing glucose spikes as harmful, studies show that overall, most healthy individuals maintain normal glucose levels - therefore questioning the significance of these spikes. This project aims to examine whether glucose spikes affect the health of people without diabetes. By comparing the medical and grey literature, we aim to determine whether the grey literature aligns with the peer-reviewed medical literature, or whether it could cause harm through misinformation.

Methods: Population: people without diabetes and human endothelial cells; Concept: the effect of glucose spikes on health; Context: global studies and grey literature. Following the PRISMA-ScR guidelines, a systematic search was undertaken via Medline, Embase and Proquest. Fifty-nine sources were reviewed - 11 medical research papers and 48 grey literature sources. Excel spreadsheets were developed and piloted for the medical and grey literature respectively. Data was extracted and charted, and a narrative synthesis was formulated.

Results: Both the medical and grey literature reported glucose spikes can cause endothelial dysfunction, oxidative stress and inflammation in people without diabetes or human endothelial cells. However, the grey literature reported additional effects that is, increased risk of cancer and effects on mental health, energy, mood and sleep.

Conclusions: Glucose spikes may impact the health of people without diabetes, but significant health outcomes likely stem from long-term frequent spikes rather than isolated acute spikes. Discrepancies between the medical and grey literature highlight potential for misinformation in the grey literature, although the author does not claim cited sources are misleading, nor does the absence of claims in medical literature mean grey literature is misinforming. Further research is needed to verify if grey literature claims align with peer-reviewed evidence, as hypothetically, misinformation could significantly impact consumer wellbeing.