Clinical Medicine Insights-Endocrinology and Diabetes最新文献

Background: Many individuals living with type 2 diabetes mellitus (T2DM) struggle to maintain optimal glycaemic control. Reports from Nigeria show particularly high rates of poor glycaemic control, increasing the risk of microvascular and macrovascular complications. Little research has explored the lived experiences of individuals living with T2DM with poor glycaemic control in Nigeria, particularly in secondary healthcare settings, to guide improvements in care.

Objective: This study explored the experiences of individuals living with T2DM with poor glycaemic control.

Method: A qualitative research design was used. Semi-structured, individual interviews were conducted with 14 participants, aged 35 to 74 years, recruited from 3 secondary healthcare institutions in Lagos, Nigeria.

Results: Four key themes were generated: (1) Beyond the T2DM diagnosis, which captures the perceptions of T2DM, the financial burden of the condition, and the onset of physical health issues associated with T2DM; (2) Psychological impact of T2DM, which highlights mental health difficulties and experiences of stigma; (3) Managing and living with T2DM, which describes the use of traditional medicine, the influence of religious beliefs and the importance of community and social networks and (4) Diabetes care at secondary healthcare institutions, which highlights patient-provider interactions and the gaps in information and education.

Conclusion: The findings provide valuable insight into the lived experiences of individuals with T2DM with poor glycaemic control and underscore the importance of addressing knowledge gaps and providing psychological support as integral components of comprehensive diabetes care.

Background: Pregnancy induces a reversible expansion of pancreatic islet and beta-cell mass, but the impact of multiple pregnancies on these processes remains unclear.

Methods: To further investigate this phenomenon, the current study employed transgenic models with beta- or alpha-cell lineage tracing capabilities, namely Ins1 ^Cre/+ ;Rosa26-eYFP and Glu ^CreERT2 ;Rosa26-eYFP male mice, respectively. Using these models, we explored late-stage morphological islet adaptations and cellular plasticity in response to primi-, bi- and tri-parity.

Results: All pregnant mice exhibited augmented islet and beta-cell areas, associated with decreased beta-cell apoptosis and increased proliferation. Notably, beta-cell proliferative capacity decreased as parity increased, but was still elevated in triparous mice when compared to null parous controls. Interestingly, alpha-cells also exhibited augmented growth and survival in all pregnant mice. In terms of cellular transdifferentiation, ductal to beta-cell conversion appeared greater in primiparous Ins1 ^Cre/+ ;Rosa26-eYFP mice, but was much less obvious in bi- and tri-parous mice. Whilst quantification of beta- to alpha-cell transition events was more pronounced during pregnancy, it was less obvious in multiparity than primiparity. There were also notable reductions in beta-cell dedifferentiation, supporting positive effects of islet cell plasticity towards retention and expansion of beta-cell mass in multiparity. In harmony, alpha- to beta-cell transdifferentiation appeared markedly increased in multiparous Glu ^CreERT2 ;Rosa26-eYFP mice, coupled with augmented alpha-cell neogenesis and dedifferentiation, suggesting that these cells act as a principal source for beta-cell expansion.

Conclusion: Together, these findings indicate that reduced beta-cell proliferation in multiparity is offset by enhanced islet cell plasticity, contributing to sustained islet adaptation across multiple gestations.

The global rise in diabetes mellitus presents a major healthcare challenge due to its associated complications. Effective glycemic control, crucial for reducing diabetes-related morbidity and mortality, encompasses 3 key components: fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and glycated hemoglobin (HbA1c). While FPG and HbA1c are commonly used for evaluating glycemic control, PPG also significantly influences overall glucose management. Postprandial hyperglycemia, the early deviation in type 2 diabetes mellitus (T2DM), plays a dominant role in individuals with near-target HbA1c levels. Advances in continuous glucose monitoring (CGM) provide a more comprehensive understanding of PPG fluctuations, offering real-time data and reducing the limitations of traditional monitoring methods. CGM technology revolutionizes glycemic monitoring, enhancing the management of PPG and supporting better diabetes care. This review emphasizes the importance of monitoring and managing PPG throughout the postprandial state in individuals with diabetes. It further consolidates evidence highlighting the importance of viewing PPG as a continuum and the potential of CGM in improving PPG management.

Background: The International Diabetes Federation-Diabetes and Ramadan (IDF-DAR) Practical Guidelines 2021 provide a risk stratification tool to guide the assessment of people with diabetes before they observe Ramadan. Here we conducted a survey study to explore the predictability of the IDF-DAR 2021 guidelines, and the factors associated with breaking fast, in people with type 1 diabetes (PwT1D) during Ramadan.

Methods: This cross-sectional study included adult PwT1D living in Saudi Arabia, aged 18 years and above, who observed Ramadan 2022. Between May and August 2022, a standardized online questionnaire was used to collect data regarding socio-demographics, medical history (including the modality of T1D management and other components of the IDF-DAR risk calculator), and Ramadan fasting experience.

Results: The study included 963 PwT1D (257 males and 706 females, mean age 26.5 ± 8.4 years). Applying the IDF-DAR risk calculator revealed that the study respondents included 66% high-risk PwT1D, 34% moderate-risk PwT1D (34%), and no low-risk PwT1D. Compared to the moderate-risk group, the high-risk group had significantly more days during which fasting was broken, a higher prevalence of diabetes complications, and more frequent diabetes-related ER visits (P < .01). Attending a pre-Ramadan education session was associated with 47% lower odds of visiting the ER during Ramadan (odds ratio 0.53; 95% confidence interval 0.34-0.82; P = .005).

Conclusion: The IDF-DAR 2021 risk calculator predicts the risk of acute diabetes complications and ER visits during Ramadan fasting. Pre-Ramadan education sessions are important and may reduce acute complications among PwT1D during Ramadan fasting.

Parathyroid carcinoma (PC) is an exceptionally rare endocrine malignancy characterized by severe hypercalcemia and high recurrence rates. We present the case of a 34-year-old male with chronic kidney disease who developed pathological fractures and progressive pulmonary metastases secondary to PC. Genetic analysis revealed a pathogenic variant in the CDC73 gene, indicating a hereditary predisposition. Following surgical resection, the patient experienced early biochemical relapse. Initial management with bisphosphonates, denosumab, and cinacalcet achieved temporary control of hypercalcemia. Upon radiological progression, lenvatinib therapy was initiated, resulting in 9 months of biochemical control and stabilization of both local disease and pulmonary metastases. However, discontinuation of denosumab and cinacalcet due to limited access led to a relapse of severe hypercalcemia and disease progression, necessitating the cessation of lenvatinib and transition to palliative care. This case underscores the diagnostic and therapeutic challenges of PC, highlights the potential role of targeted therapies like lenvatinib in advanced disease, and emphasizes the critical importance of sustained access to essential treatments.

Background: Wilson's disease (WD) is a rare genetic disorder that impairs copper metabolism, leading to its deposition in various organs, including the liver, brain, and cornea. Endocrine disorders, particularly hyperparathyroidism, are uncommon in WD. Methanol toxicity, a medical emergency, is rarely associated with WD and hyperparathyroidism, making this case particularly unique. We report a rare instance of this complex triad.

Case presentation: A 53-year-old male with untreated WD presented with nausea, vomiting, dizziness, and blurred vision after ingesting methanol. Clinical examination revealed optic neuropathy, consistent with methanol toxicity, despite normal fundoscopy. Laboratory investigations revealed significant hypercalcemia and elevated parathyroid hormone (PTH) levels, confirming hyperparathyroidism. Imaging, including a prior technetium-99m sestamibi scan, indicated hyperfunctioning parathyroid tissue. Dialysis was initiated for methanol toxicity, and metabolic acidosis was corrected.

Conclusion: This case emphasizes the rare coexistence of WD, hyperparathyroidism, and methanol toxicity, presenting significant diagnostic and therapeutic challenges. The pathophysiological interactions between these conditions are not well understood and warrant further research to improve management strategies and clinical outcomes.

Background: Insulin resistance (IR) contributes significantly to major adverse cardio-cerebrovascular events (MACCE), with the estimated glucose disposal rate (eGDR) serving as a novel marker for assessing IR. This systematic review and meta-analysis investigate the association between eGDR and MACCE outcomes, aiming to clarify its predictive value across different diabetes statuses.

Methods: We searched databases for studies examining the relationship between eGDR and MACCE, including myocardial infarction (MI), stroke, ischemic heart disease (IHD), cardiovascular disease (CVD), and all-cause mortality. We compared groups with the lowest versus highest eGDR. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using random effect models. Subgroup analyses assessed eGDR efficacy by diabetes status.

Results: Our search identified 16 studies with 198 626 participants. The group with the lowest eGDR had a significantly higher risk of MACCE compared to the group with the highest eGDR (HR = 2.21, 95% CI 1.17-4.18). Additionally, the group with the lowest eGDR had notably worse outcomes for all-cause mortality, MI, stroke, CVD, and IHD with HRs of 2.03 (95% CI 1.05-3.90), 1.82 (95% CI 1.30-2.55), 2.82 (95% CI 1.66-4.69), 2.95 (95% CI 1.99-4.37), and 7.97 (95% CI 2.57-24.73), respectively. Subgroup analyses revealed consistent results for CVD in both populations with diabetes and non-diabetes status, for stroke in the population with non-diabetes status, and for IHD in the population with diabetes.

Conclusions: Lower eGDR, indicating higher IR, is linked with a significantly increased risk of MACCE. This parameter could enhance risk stratification models for predicting MACCE. Further studies are needed to evaluate the clinical role of eGDR in managing cardio-cerebrovascular risk across subgroups.

Background: Emerging lipid-related biomarkers, including the Visceral Adiposity Index (VAI), Lipid Accumulation Product (LAP), and Atherogenic Index of Plasma (AIP), have demonstrated potential in predicting metabolic disorders such as diabetes mellitus (DM) and associated microvascular complications, particularly diabetic kidney disease (DKD) and diabetic retinopathy (DR).

Objectives: This systematic review and meta-analysis aims to evaluate the association between these biomarkers and microvascular complications in individuals with DM, as well as to assess their diagnostic performance.

Data sources and methods: A systematic literature search was performed in PubMed, Scopus, Embase, and Web of Science following PRISMA guidelines. Eligible studies examined the relationship between VAI, LAP, and AIP and microvascular complications in DM. The meta-analysis synthesized data using pooled weighted mean differences (WMDs) and area under the receiver operating characteristic curve (AUC) values to evaluate the predictive utility of these biomarkers for DKD and DR.

Results: A total of 23 studies were included. Patients with DKD had significantly higher levels of LAP (WMD: 12.67; 95% CI: 7.83-17.51; P < .01), AIP (WMD: 0.11; 95% CI: 0.03-0.19; P < .01), and VAI (WMD: 0.63; 95% CI: 0.38-0.89; P < .01) compared to those without DKD. Additionally, each 1-unit increase in LAP (OR: 1.005; 95% CI: 1.003-1.006; P < .01), AIP (OR: 1.08; 95% CI: 1.04-1.12; P < .01), and VAI (OR: 1.05; 95% CI: 1.03-1.07; P < .01) was associated with an elevated risk of DKD. In contrast, no significant associations were identified between these biomarkers and DR. The diagnostic performance of VAI, LAP, and AIP was limited for both DR and DKD, with low discriminatory power.

Conclusion: VAI, LAP, and AIP are significant predictors of DKD in individuals with DM but exhibit limited relevance for the detection of DR. Although these biomarkers show potential in identifying DKD risk, their overall diagnostic accuracy for DKD and DR remains modest, underscoring the need for further studies to enhance their clinical applicability.

Aldosterone-producing adenomas and cortisol-secreting adenomas are among the most common functional tumors of the adrenal gland. Primary aldosteronism often leads to refractory hypertension and significantly increases the long-term risk of stroke and cardiovascular events. Autonomous cortisol-secreting adenomas are associated with various complications, including hypertension, hyperglycemia, osteoporosis, infections, and thrombosis. This report presented 2 cases of adrenal tumors: one case involving an aldosterone-producing adenoma and the other involving a cortisol-secreting adenoma. The endocrine functionality of these tumors was assessed using standardized endocrine function tests, including supine and standing aldosterone tests and dexamethasone suppression tests. Bilateral adrenal vein blood sampling (AVS) was performed to localize the lesion responsible for the conditions. Both patients underwent treatment with Kangbo knife cryoablation. No immediate adverse events, such as puncture site pain, hematoma, or pneumothorax, were observed following the procedure. The patient with cortisol-secreting adenoma developed a postoperative pulmonary infection and minor pulmonary thrombosis, which were successfully managed. Postoperatively, both patients achieved biochemical remission, with normalization of aldosterone and cortisol levels. Clinical symptoms, including hypertension, hypokalemia, and moon facies, were significantly improved. Currently, there are no published reports on the use of cryoablation for the treatment of adrenal cortisol-secreting adenomas. To our knowledge, this study presents the first documented cases of AVS-guided Kangbo knife cryoablation for the treatment of aldosterone-producing adenoma and autonomous cortisol-secreting adenoma. The favorable clinical and biochemical outcomes achieved in this study highlight the potential of Kangbo knife cryoablation as a safe and effective novel therapeutic approach for these functional adrenal tumors.

Background: Diabetes mellitus (DM) is a critical risk factor associated with postoperative complications. Preoperative glycemic control, commonly assessed by glycated hemoglobin (HbA1c), may help stratify patients with DM. However, association between DM, HbA1c levels and perioperative outcomes in multi-ethnic Asian populations with distinct cardiometabolic profiles remains underexplored.

Objectives: This study aimed to study the association between pre-existing DM, suboptimal glycemic control (HbA1c ≥ 7%), and postoperative complications in elective non-cardiac surgical patients, focusing on the role of HbA1c as a risk stratification tool.

Methods: This secondary analysis included 688 patients from a prospective cohort at Singapore's largest tertiary hospital. Postoperative complication(s) were assessed using the Comprehensive Complication Index. Patients were categorized into 2 groups-DM (regardless of HbA1c) and no DM (HbA1c ≤ 6%). We used multivariable logistic regression to explore associations within the entire cohort and DM subgroup. The relationship between preoperative HbA1c levels and postoperative complication(s) was also explored.

Results: The overall incidence of postoperative complication(s) was 20.78%. DM was independently associated with increased postoperative complication(s) (adjusted OR 2.57, 95% CI 1.20-5.50, P = .015). A trend toward a higher likelihood of postoperative complication(s) was observed in patients with DM and suboptimal glycemic control (adjusted OR 1.39, 95% CI 0.56-3.45, P = .482) though this did not reach statistical significance. A noteworthy U-shaped relationship was identified between preoperative HbA1c levels and postoperative complication(s), with increased complications at both low and high HbA1c levels.

Conclusion: This study highlights a significant association between DM and increased postoperative complications. The observed U-shaped relationship between HbA1c levels and complications underscores the need for comprehensive risk assessment across the full glycemic spectrum. Routine HbA1c screening and tailored perioperative strategies in multi-ethnic Asian populations could enhance surgical outcomes, reduce healthcare costs, and support broader public health goals in DM management.