Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association最新文献

Type 2 diabetes mellitus (T2DM) is often recognised as a major comorbidity of chronic obstructive pulmonary disease (COPD) and is being increasingly linked to elevated risk of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Accordingly the potential utility of antidiabetic medication, mostly in subjects suffering from both AECOPD and T2DM, has been investigated. The most widely studied medication is metformin. Although some studies showed no particular benefit, others assessed a diminished risk of AECOPD by 37% and reductions in hospitalisations, re-admissions, or the use of antibiotics/and corticosteroids. The same holds true for sulfonylureas and thiazolidinediones. Conversely, dipeptidyl-peptidase 4 inhibitors (DPP-4is) were not associated with any benefit. Data on insulin use are scarce, but insulin in AECOPD management has been linked with adverse outcomes. The strongest effect has been shown with glucagon-like peptide 1 receptor agonists (GLP-1RAs) and sodium sodium-glucose cotransporter 2 inhibitors (SGLT-2is): the former limited severe exacerbations by 30% and the latter by 32-36%. With SGLT-2is, the incidence diminished by 46%, while approximately 3 out of 4 emergency visits or hospitalisations were prevented. In conclusion, existing evidence suggests a benefit of antidiabetic medication in AECOPD-related outcomes, suggesting that this effect merits further investigation.

The aim of the present narrative review was to discuss data on contraception in diabetes mellitus (DM). Women with DM rarely discuss contraception with their physicians and the latter provide corresponding advice to a very limited number of them. Overall, 1 in 8 women with DM using contraception methods was found to use an ineffective one. A further issue relates to drug-drug interactions between anti-diabetic medication and oral contraceptives. Generally, anti-diabetic agents do not alter the pharmacologic profile of hormonal contraception. Of note, preliminary results indicate that some novel anti-diabetic agents may even render oral contraceptive methods ineffective. Several implants can be also generally applied to women with both DM types. The relationship between oral contraceptives and diabetic complications has not been clarified yet. In general, implants, intra-uterine devices or progestin-only contraceptives are considered a safe option for women with DM. However, short-term use of combined hormonal contraception is also feasible for women without severe complications or risk factors.

Diabetic cardiomyopathy (DCM) is a serious complication in patients with diabetes, which still lacks adequate therapy. Ferroptosis has recently been emphasized as a main contributor to the development of DCM. Hence, the current study aimed to assess the effects of morin, a well-known phytochemical, on the DCM. In this regard, DCM in Wistar rats was induced by streptozotocin (STZ). After treatment of animals with a dose of 25, 50, and 100 mg/kg of morin orally for 60 days, Sirtuin 1 (SIRT1), p53, solute carrier family 7 member 11 (SLC7A11), and glutathione peroxidase 4 (GPX4) in gene and protein levels in cardiac tissue were measured. Moreover, determination of redox status (GSH, SOD, CAT, and MDA) and inflammatory markers (IL-6, IL-1, and TNF-) in the cardiac tissue was performed and the levels of glucolipid profile, iron profile, and cardiac markers (troponin T and CK-MB) were assessed. The findings demonstrated that the administration of morin restored glucolipid and iron profiles, improved hypertension and cardiac hypertrophy, and suppressed inflammatory responses (p-value<0.001). Moreover, morin at a dose of 100 mg/kg/day was able to increase the levels of SLC7A11, SIRT1, GSH, SOD, CAT, and GPX4 while decreasing the cardiac levels of p53 and MDA (p-value<0.05). In conclusion, the findings suggest morin could alleviate DCM probably through modulation of ferroptosis via the SIRT1/p53/SLC7A11 signaling pathway activation and suppression of oxidative stress and inflammation.

Introduction: Little is known about temporal trends in the incidence of male hypogonadism and its correlation with socioeconomic status, which we examined in the present study.

Methods: We extracted data from the Maccabi Health Services computerized database between 2001-2017. The study population included 4,261 men aged 21 to 80 with biochemically proven hypogonadism defined and classified according to the European Male Aging Study criteria. We excluded patients on testosterone or testosterone-modifying drugs. The socioeconomic status was assessed based on verified financial data pertinent to the area of residence.

Results: The incidence of male hypogonadism increased with age in all the socioeconomic strata. 75% of the hypogonadal men had hypogonadotropic hypogonadism. The overall incidence of hypogonadism increased 1.4-fold between the 2001-2009 and 2010-2017 periods [from 41.7 (39.7-43.8) to 58.5 (56.4-60.8) per 100,000 person-years) (95% CI)], mainly due to an increase in hypogonadotropic hypogonadism. The temporal increase in hypogonadotropic hypogonadism occurred in all age groups and all socioeconomic strata but was notably more prominent in >51 age groups of the more affluent socioeconomic strata. The mean body mass index remained unchanged throughout the study period.

Conclusions: We observed a temporal increase in male hypogonadism, mainly hypogonadotropic hypogonadism, corresponding with previously observed temporal decreases in testosterone levels in men. We discuss the possibility that this trend could be partly attributed to an underappreciated increase in mental distress due to decreasing global happiness indices, increasing stress, and occupational burnout in specific occupations associated with more affluent populations (i.e., high-tech, finance, medical). This preliminary proposition deserves further investigation.

This brief narrative review discusses the clinical manifestations, diagnosis, and management of trigeminal nerve-related conditions, such as neuropathy and neuralgia, in patients with diabetes mellitus (DM). Although these conditions are not very common, there is a solid connection between them in diabetic patients. Symptoms typically include facial pain, sensory disturbances, and muscle weakness for neuropathy and severe, stabbing pain for neuralgia. Diagnosis is based on characteristic clinical manifestations, along with laboratory investigation and magnetic resonance imaging to exclude other potential causes, such as tumours, multiple sclerosis, or vascular compression. Treatment focuses on strict glycaemic control, modification of vascular risk factors, pharmacological agents (carbamazepine and oxcarbazepine), and neurostimulation to improve symptoms and quality of life.

Introduction: Maintaining and optimizing quality of life (QoL) is a central issue and one of the most important goals in therapy for patients with chronic diseases, such as diabetes mellitus (DM). Despite its importance, there is little data on the QoL of patients with DM in Austria. The objective of this study was to extend an established population-based cohort, the Diabetes-Landeck cohort, by including patient-reported outcomes.

Methods: We performed a survey on quality of life (QoL) and treatment satisfaction in patients from the Diabetes-Landeck cohort using the EQ-5D-5L, the problem areas in diabetes survey (PAID), and the diabetes treatment satisfaction questionnaire (DTSQ). Mean sum scores were calculated and compared between patient characteristic subgroups.

Results: In total 58 patients were recruited, with a mean age of 63 years and a mean hemoglobin A1c (HbA1c) of 7.1%. The mean sum score of EQ-5D-5L was 92 (SD=10.6), and that of DTSQ and PAID were 32.2 (SD=6.6) and 10.8 (SD=11.6), respectively. Patients with obesity (body mass index ≥ 30 kg/m²) showed a statistically significant decreased mean sum score of EQ-5D-5L and a statistically significant increased mean sum score of DTSQ. Patients with HbA1c ≥7.5% showed a statistically significant decreased mean sum score of DTSQ.

Conclusion: We observed patient-reported outcomes significantly associated with obesity and HbA1c, which could be used for targeted patient monitoring. Limited by small sample size and questions in generalizability, we strongly suggest the rollout of a larger study.

Diabetic foot ulcer (DFU) represents a severe complication of diabetes, mainly caused by peripheral vascular occlusion and infection, presenting significant clinical challenges in treatment and potentially resulting in gangrene, amputation, or even fatality. This study aimed to investigate the involvement and underlying mechanisms of Meteorin-like (Metrnl) in the pathogenic process of DFU. Mice underwent diabetes induction by streptozotocin, while human umbilical vein endothelial cells (HUVECs) were exposed to 5.5, 10, 20 or 40 mM glucose. HUVECs were transfected with negative or Metrnl or si-nc or si-Metrnl plasmids via Lipofectamine 2000. The expression of Metrnl was down-regulated in both patients and the murine model of DFU. Elevated glucose levels diminished Metrnl through enhanced Metrnl ubiquitination. The suppression of Metrnl exacerbated foot ulcer in the mouse model of DFU. Metrnl alleviated oxidative stress and ferroptosis in the DFU model by inhibiting mitochondrial damage. Metrnl induced liver kinase B1 (LKB1)/AMP-activated protein kinase (AMPK) signaling in the DFU model. LKB1 attenuated the effects of Metrnl on oxidative stress and ferroptosis in the DFU model.  The data cumulatively demonstrate that Metrnl ameliorates ferroptosis in the DFU model by inhibiting mitochondrial damage via LKB1/AMPK signaling, suggesting that targeting Metrnl may emerge as a potential preventive approach against ferroptosis of DFU or other diabetes.

Recent studies have suggested that improved glycemic control in patients with diabetes may cause acute Charcot foot. To conduct a narrative review of studies investigating whether improved glycemic control in patients with diabetes causes acute Charcot foot.Publications found by searching PubMed, EMBASE, and Cochrane Library as well as reference lists of identified publications were reviewed.Very few publications were found, primarily consisting of case reports and case studies without control groups, documenting instances where cases of acute Charcot foot had been preceded by improved glycemic control. Recent large multicenter randomized placebo-controlled clinical trials of anti-hyperglycemic agents in patients with diabetes, where significant improvement of glycemic control occurred, have not reported incidences of acute Charcot foot.There is so far no solid evidence to suggest that improvement of glycemic control in patients with diabetes causes acute Charcot foot.

Currently, no data are available using standardized instruments for evaluating the postpartum mental health of women with previous bariatric surgery. The aim of this pilot study was to assess postpartum mental health in women following bariatric surgery and to establish appropriate tools for a prospective registry study in the future. In this survey, the mental health of 22 women during the first weeks postpartum was examined (T1) and their status at least 6 months after childbirth was prospectively assessed (T2). Symptoms of depression and anxiety were evaluated with standardized questionnaires and depression was diagnosed with structured diagnostic interviews (SCID-5). At T1, 3/22 women (14%) reported depressive or anxiety symptoms, and in these women, the diagnosis of depression was established. In comparison with T1, at T2, symptomatology for depression or anxiety increased to 32% and 27% of patients, respectively, but only one woman was diagnosed with depression. In comparison to patients without symptoms, patients with signs of depression or anxiety or both had lower total body weight loss and, more often, a personal or family history of depressive disorders. Our pilot study suggests that the rate of postpartum depression in women after BS might be higher than in the general population. High symptom levels of depression and anxiety emphasize the necessity of long-term bariatric follow-up care. Further research is needed to evaluate if prevalence of depression or anxiety disorder or both is higher in this patient group as compared to other patients after bariatric surgery.

The impact of different drinking solutions used for an oral glucose tolerance test (oGTT) on 2-h glucose values and gastrointestinal side effects are not clear. This study compared a commercially produced solution (Accu-Chek Roche solution) and a standardized pharmacy solution (NRF 13.8. oGTT solution) within the German National Cohort (NAKO), including the assessment of gastrointestinal symptoms.The Accu-Chek Roche solution comprises mono- and oligosaccharides with blackcurrant juice for enhanced flavor. The NRF 13.8. oGTT solution contained glucose monohydrates only, with citric acid to maintain the pH for preservation, and did not include flavor enhancers. Within a subgroup of the NAKO participants obtaining a standardized 75g oGTT, 818 participants each received the Accu-Chek Roche solution and the NRF 13.8. oGTT solution matched by study center, sex, age, body mass index, and fasting glucose values. Intra-class correlations for 2-h glucose values were calculated and agreement evaluated with Bland-Altman plots; additionally, coefficients of variation and their difference were estimated for the two solutions.The mean difference of the 2-h glucose concentrations between the Accu-Chek Roche and NRF 13.8. oGTT solution was - 3.4 [95% CI - 6.1; - 0.9] mg/dL. The Bland-Altman plot showed increasing variability of differences with increasing 2-h glucose concentrations without a systematic pattern. The intra-class correlations of 2-h glucose values within matched pairs were 22% [95%CI: 16%; 29%]. The coefficients of variation for 2-h glucose observed with the Accu-Chek Roche and NRF 13.8. oGTT solutions were 25% [24%; 27%] and 25% [23%; 26%], respectively, with a difference of 1% [- 1%; 3%]. Nausea or vomiting were observed in<0.1% of matched participants with no differences between the solutions.The differences in 2-h glucose values and frequency of acute gastrointestinal side effects were not clinically different in participants following the consumption of the Accu-Chek Roche or the NRF 13.8. oGTT solutions.