Clinical Medicine Insights-Endocrinology and Diabetes最新文献

Background: Evidence of efficacy and safety of digital ecosystems in Latin America is scarce, which has limited their implementation. The objective of this study is to evaluate the safety and efficacy of the use of a digital ecosystem (Zutrics) in people with Type 2 Diabetes (PwT2D) treated with insulin.

Methods: Analytical observational prospective cohort study in PwT2D, treated with insulin and oral or injectable antidiabetics, with HbA1c >8%, and followed up with a digital ecosystem (Zutrics). HbA1c and derived time in range (TIRd 70-180 mg/dL) were evaluated at baseline and at 3-month follow-up. Additionally, hypoglycemia events were evaluated during the follow-up.

Results: We analyzed 69 patients (age 62 ± 12.5 years, 56.6% female), 45.1% had chronic kidney disease (CKD) and 25.4% coronary artery disease. About 45.1% were on multiple dose insulin treatment. Median HbA1c levels decreased from a baseline value of 9.1% (interquartile range, IQR 7.5-11.4) to 7.0% (IQR 6.3-8.08) at 3-month follow-up (P = .044). The median of HbA1c changes over time was -1.3% (IQR -0.13, -4.2). The mean TIRd of 70 to 180 mg/dL increased from 74% at baseline to 76.1% at the end of follow-up. The TBRd of <70 mg/dL did not change significantly, going from 0.5% at baseline to 0.94% The incidence density of hypoglycemia episodes was 0.009 events/patient-day during the follow-up. About 95.6% of patients met the goal of TBRd <70 mg/dL less than 4.

Conclusion: This study suggests that the use of a digital ecosystem in the follow-up of PwT2D allows better glycemic control without increasing the risk of hypoglycemia.

Background: Despite the association of insulin resistance (IR) in the pathophysiology of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), few studies have evaluated the utility of acanthosis nigricans (AN) as a clinical predictor for this condition. Thus, we aimed to determine the role of AN as a risk factor and clinical predictor of MASLD.

Methods: This cross-sectional study conducted a comprehensive clinical history and physical examination. The presence of acanthosis nigricans was assessed in the neck, elbows, axillae, and knuckles. Liver biochemical parameters were measured, hepatic fat was analyzed using the controlled attenuation parameter (CAP), while hepatic stiffness was evaluated in kilopascals (kPA) with the FibrosScan 530 Compact and Smart Exam software. Multiple analyses were performed to determine the relationship between acanthosis nigricans and MASLD.

Results: We recruited 251 adult participants. The mean BMI was 29.9 ± 7.3 kg/m², including 40.2% of participants with obesity and 63.7% with AN. Transient elastography evaluation resulted in 65.7% and 6% participants with hepatic steatosis (S3, 48.6%) and fibrosis, respectively. A non-adjusted (OR 2.63, 95% CI 1.57-4.52) and adjusted model (OR 1.97, 95% CI 0.95-4.12) were determined for AN as a risk factor for liver steatosis. Furthermore, the presence of AN in knuckles resulted in an association to predict liver steatosis (OR 2.09, 95% CI 1.01-4.35), while a multivariate analysis indicated that AN predicts a higher steatosis grade (S2 OR = 6.58, CI 95% 1.18-36.53; S3 OR = 2.36, CI 95% 1.04-5.3).

Conclusions: Acanthosis nigricans demonstrated to predict a higher steatosis grade in adults with overweight and obesity. Our study supports the clinical applicability of AN as a screening tool for MASLD to identify high-risk subjects in resource-limited settings. Additional studies are needed to define alternative diagnostic tools for the early identification of metabolic risk factors in populations with specific clinical or demographic characteristics.

Hyperglycemic crises, including diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS), significantly affect clinical outcomes and impose a heavy economic burden. Among the steadily increased recreational drug abuse, cocaine has become the most frequently misused substance. However, there is limited understanding of the relationship between cocaine use and hyperglycemic crises. We report 4 cases retrospectively to examine the relationship between cocaine abuse and DKA/HHS. In Case 1, a patient with Type 1 diabetes mellitus (T1DM) presented with altered mental status and a combination of DKA and HHS, where cocaine use led to missed insulin doses, resulting in the crisis. Case 2 involved the same patient who later developed DKA due to cavitary pneumonia and sepsis, requiring mechanical ventilation, vasopressors, and renal replacement therapy. Cocaine inhalation caused pulmonary damage that triggered DKA. Case 3 involved a patient with Type 2 diabetes mellitus (T2DM) who abused cocaine intravenously, leading to DKA-HHS and necrotizing fasciitis that required emergency surgery. Case 4 was a patient with obesity, insulin resistance, and T2DM on oral medications, where cocaine likely exacerbated insulin resistance and triggered DKA. In all 4 cases, treatment focused on aggressive rehydration, insulin infusion, electrolyte correction, and addressing underlying causes. The hyperglycemic crises resolved within 12 to 24 hours. However, managing cocaine-related complications proved difficult, leading to high morbidity and mortality rates, including altered mental status with airway issues, kidney failure, rhabdomyolysis, and infections that could result in septic shock or death. In Case 4, cocaine use significantly worsened insulin resistance and T2DM, contributing to DKA. In conclusion, cocaine abuse has multiple effects and can act as an unusual trigger for hyperglycemic crises by causing missed insulin doses, dehydration, infections, and chronic worsening of insulin resistance. Cocaine abuse can trigger and/or worsen hyperglycemic crises through various mechanisms, such as damage to the cardiopulmonary and renal systems, psychosocial changes, weakened immunity and infections, and alterations in hormones and metabolism (Figure 3). We suggest incorporating questions about substance abuse into routine patient history assessment and performing toxicology screenings, particularly for individuals who have frequent admissions for DKA/HHS. Additionally, we share our expertise in managing this specific group of patients.

Background: Serum thyrotropin levels rise above normal while thyroid hormone levels remain within normal ranges, indicating subclinical hypothyroidism. PLT and MPV levels significantly increase in AITD patients; PLT levels are higher in hypothyroidism and Hashimoto's disease, whereas MPV levels are higher in hyperthyroidism and Graeve's disease. An increased MPV and other abnormal platelet values lead to a higher incidence of cardiovascular events. The aim was to evaluate RDW and platelet indices in Egyptian patients with subclinical Hashimo's thyroiditis using high-sensitivity CRP Hs-CRP as an indicator of inflammation.

Methods: Data for patients (60 patients) with subclinical Hashimoto's thyroiditis who visited the Menoufia University Hospital, Internal Medicine outpatient clinic included. We measured RDW, MPV, PDW, PC, LPCR, (FT3), (FT4), (TSH), lipid profile, Hs-CRP, and Antithyroid antibodies. According to Antithyroid antibodies positivity the 60 patients subdivided into 3 groups 1 (negative for Abs), 2 (positive to 1 Ab), and 3 (positive for both Abs).

Results: Among our patients 40 (66.7%) tested positive for anti-thyroglobulin Abs while 36 (60.0%) tested positive for antiperoxidase Abs. RDW, MPV, and LPCR demonstrated positive significant correlations with serum Hs-CRP levels. The study revealed negative significant correlations between TSH levels and PDW and between T4 levels and MPV.

Conclusion: Early diagnosis of Hashimoto's thyroiditis can be supported by platelet indices and RDW as diagnostic tools and these markers can also offer prognostic insights into disease severity and complications to help initiate timely treatment for hypothyroidism and prevent atherosclerotic cardiovascular disease.

Background: Polycystic ovary syndrome (PCOS) is a complex condition linked to long-term health risks such as cardiovascular disease, type 2 diabetes, and metabolic syndrome. Subclinical hypothyroidism (SCH) shares overlapping symptoms with PCOS, but their relationship remains debated. SCH prevalence in PCOS patients and its impact on cardiovascular and metabolic health is debated and thus warrants further research. This research examined the association between SCH and PCOS in a Tunisian clinical-based population.

Methods: We conducted a prospective cross-sectional study of 161 PCOS patients and 75 age-matched controls recruited from 2023 to 2024. All participants underwent thyroid function testing, metabolic profiling, and hormonal assays. Statistical analyses included Mann-Whitney U, Kruskal-Wallis, and chi-square tests, with age/BMI-adjusted linear regression models.

Results: Among 236 participants (161 PCOS, 75 controls), SCH prevalence was higher in PCOS patients (14.9%) compared to controls (5.3%, $p$  = .048). Adjusted for age and BMI, median TSH levels were higher in the PCOS group (2.2 mIU/L vs 1.75 mIU/L, $p$  = .006), while FT4 levels were lower (14.26 pmol/L vs 15.26 pmol/L, $p$  = .007). Positive TPOAb prevalence was higher in PCOS (12.4% vs 2.7%, $p$  = .049). TSH levels varied across PCOS phenotypes ( $p$  = .003), with Phenotypes A and B showing higher levels than Phenotype C (A > C, $p$  = .019; B > C, $p$ < .001). SCH was highest in Phenotype A. SCH in PCOS was associated with impaired glucose tolerance ( $p$  = .011), higher blood fasting glucose ( $p$  = .033), higher total cholesterol ( $p$  = .022), and hypertriglyceridemia ( $p$  = .018).

Conclusion: SCH is more prevalent in PCOS and may worsen insulin resistance and dyslipidemia. Addressing thyroid dysfunction in PCOS patients may be beneficial for more effective management strategies, ultimately improving reproductive, metabolic, and cardiovascular outcomes for affected women.

Incidental adrenal cysts are quite rare and thus can present a diagnostic conundrum for even experienced clinicians. Here, we present the case of a patient with an incidentally identified 5 cm adrenal mass. Her evaluation was notable for evidence of mild autonomous cortisol secretion and imaging findings concerning for malignancy with possible invasion of the inferior vena cava. Adrenalectomy was performed; pathology ultimately demonstrated an adrenal cortical pseudocyst without evidence of malignancy. All patients with solid, high-density, or large adrenal tumors require further imaging for characterization and biochemical testing for hormone secretion. While simple, low-density adrenal adenomas and cysts do not require further imaging evaluation beyond non-contrast CT, mixed cystic and solid lesions or pseudocystic lesions should be evaluated similarly to solid tumors, with the caveat that pseudocysts cannot always be well-differentiated from benign cysts on imaging. All adrenal incidentalomas should be evaluated with a biochemical work-up to assess hormonal activity. Tumors suspicious for malignancy require surgical excision. Patients with benign, hormonally active tumors should be managed surgically or medically, according to their primary pathology.

Background: Studies suggested irisin's involvement in insulin sensitivity, conversion of white adipose tissue into brown which is more metabolically active. Studies have been shown negative correlation of irisin levels with presence of diabetes mellitus (DM). Association of irisin levels with body mass index (BMI) and lipid profile could be useful in monitoring metabolic disorders and potential complications in DM.

Methods: This cross-sectional study enrolled patients which were divided in 3 groups based on diabetes status and BMI: participants without DM, patients with DM, and a normal BMI (<25 kg/m²) and patients with DM and an increased BMI (⩾25 kg/m²). Irisin levels were measured from blood samples and correlation was made with parameters of lipid profile. We wanted to find differences in irisin concentration in comparing groups and to examine the correlation of irisin and metabolic parameters. The relationships between irisin levels and metabolic parameters, including lipid profile and the triglyceride-glucose (TyG) index, were assessed using Pearson's, and Spearman's correlation analysis, depending on data distribution.

Results: Irisin levels were significantly lower in patients with DM compared to non-diabetic individuals, regardless to BMI (patients without diabetes: median 25.47 ng/ml, IQR (22.27-27.54), with diabetes and BMI < 25 kg/m²: 22.16 ng/ml, IQR (19.29-23.76) and patients with diabetes and BMI ⩾ 25 kg/m²: mean ± SD (21.77 ± 5.72) ng/ml, P = .004). Additionally, we report a 1.15-fold decrease in irisin levels in group with diabetes, and BMI < 25 kg/m² compared to non-diabetic individuals and a 1.18-fold decrease in group with diabetes and BMI ⩾ 25 kg/m² compared to non-diabetic individuals. Additionally, lower irisin levels were correlated with higher triglycerides (r = -.343, P = .024), lower HDL cholesterol (r = .363, P = .017), and higher TyG index (r = -.315, P = .04), indicating a potential link between irisin and metabolic dysregulation. No significant association was observed between irisin levels and BMI.

Conclusion: Our findings suggest that irisin may serve as a biomarker for monitoring metabolic dysregulation in diabetes, particularly in relation to lipid metabolism and insulin resistance. Further research is needed to clarify its role in metabolic disease progression and potential therapeutic implications.

Background: Besides the observed risks in type 2 diabetes mellitus (T2DM), intima-media thickness (IMT) is a surrogate marker for early diagnosing atherosclerosis and assessing the risk of subsequent developing cardiovascular disease. Low-grade inflammation (LGI) plays an important role in the development of intima-media damage of blood vessels in diabetes. Compared with IMT in the carotid artery, thickening IMT in the femoral artery occurs earlier and well reflects atherosclerosis process in diabetes mellitus.

Objectives: To investigate the relationship between LGI and common femoral artery IMT in patients with newly diagnosed T2DM.

Methods: A descriptive and cross-sectional study on 332 patients with T2DM diagnosed for the first time administered to Vietnam National Hospital of Endocrinology. LGI is defined as patients with high sensitive C-reactive protein (hs-CRP) from 3 to 10 mg/L. hs-CRP-to-albumin ratio (CAR) was used as a marker for LGI. The position for IMT assessment is 2 cm from the bifurcation of the common femoral artery toward the groin following Pignoli's method by B-mode ultrasound.

Results: Patients with LGI showed higher IMT than those without LGI (P < .05). In multivariate linear regression, CAR positively correlated with IMT after adjusting with age, waist-to-hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and LDL-C, with a standardized beta of 0.296 and P < .001. There were significant differences in CAR among groups stratified by IMT. In the logistic regression model, covariates for gender, BMI, HbA1c, LDL-C, insulin resistance (HOMA-IR), triglyceride, and triglyceride-to-HDL ratio were adjusted. It was determined that the likelihood of an increase in IMT was 3.68 times higher than the baseline (Q1) risk for Q4 and 2.27 times higher for Q2 of CAR. There was a positive correlation between elevated levels of CAR and an increased risk of IMT.

Conclusion: In patients with newly diagnosed T2DM, there is a relationship between LGI and common femoral artery IMT. Particularly, IMT positively correlated with CAR.

Background: Controlling HbA1c can help reduce the symptoms and complications of diabetes. However, only about 25% of adults with diabetes achieve this diabetes care goal. It can be seen that diabetes requires more research investment and breakthroughs, as well as a more complete discussion of related factors that affect diabetes control, in order to better control the disease. This study explored the effects of diabetes self-care behavior, healthy lifestyle, diabetes symptoms, social support, demographic variables, and physical examination values on HbA1c levels in individuals with type 2 diabetes.

Methods: This study used a cross-sectional design and recruited 305 subjects with type 2 diabetes at a medical center. Personal data were collected using a structured questionnaire and same-day outpatient medical records.

Results: Multiple linear regression analysis identified significant predictors of HbA1c levels. These include insulin treatment (P < .001), age (P < .001), gender (P < .001), diabetes duration (P = .003), proteinuria (P < .001), diabetes self-care behaviors (P = .021), physical activity (running; P = .018), and spousal involvement in care (P = .031). Female gender, insulin treatment, longer diabetes duration, spousal involvement in care, and the presence of proteinuria were positively associated with higher HbA1c levels. In contrast, higher age, better diabetes self-care behaviors, and regular physical activity (running) were associated with lower HbA1c levels. These findings underscore the importance of considering both demographic factors and lifestyle behaviors in the management of HbA1c levels.

Conclusions: For reasons that hinder subjects from controlling HbA1c levels, individual self-management intervention programs should be provided to improve the effectiveness of subjects in controlling HbA1c levels. The care giver should be included in the educational program of diabetes management. Running exercise contributes to the control of HbA1c levels.

Complex glycerol kinase deficiency (CGKD), also known as Xp21 contiguous gene deletion syndrome, is a rare X-linked recessive disorder resulting from partial deletion of the Xp21.3 chromosomal region. CGKD encompasses several loci, including glycerol kinase (GK), Duchenne muscular dystrophy (DMD), X-linked adrenal hypoplasia congenita (NR0B1), and intellectual developmental disorder (IL1RAPL1). We present the cases of two male siblings diagnosed with CGKD. The elder sibling was initially suspected of having congenital adrenal hypoplasia (CAH). Whole exome sequencing (WES) revealed an interstitial deletion of 6.6 Mb on Xp21.3p21.1, encompassing critical genes including GK, DMD, NR0B1, and IL1RAPL1. The younger sibling was diagnosed shortly after birth based on family history, clinical and biochemical findings. The presented report highlights the diagnostic challenges associated with CGKD and the important role of genetic testing in confirming the diagnosis. A multidisciplinary team approach is necessary.