Qilu Yu1,3, Maurice C. Johnson, Jr.1, Howard A. Fishbein1*, Rebecca J. Birch1, Xiaoshu Zhu1, Russ Mardon1, Wilson Pace2, Sunitha M. Mathew1, Holly L. Sawyer1, Lori S. Merrill1, Keith D. Umbel1, Sophia Jang1

1Westat, Rockville, MD, USA

2DARTNet, Aurora, CO, USA

3National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health (NIH), Bethesda, MD, USA

We identified trajectories of diabetes risk factors in the Longitudinal Epidemiologic Assessment of Diabetes Risk (LEADR) cohort analyzing 8 years of electronic health records on 1.4 million patients, and investigated associations between trajectories and progression to new onset Type 2 diabetes.

Design and Methods: Analyzing LEADR data (2010-2016), we applied Latent Class Trajectory Analysis (LCTA) to classify patterns of risk factor change. There were 824,043 patients with BMIs; 955,128 patients with systolic blood pressures; 957,491 patients with diastolic blood pressures; 300,137 patients with HDLs; 267,553 patients with non-HDL cholesterols; and 297,026 patients with triglycerides. Patients had to have data for all risk factors being assessed. Association between trajectories and incidence of type 2 diabetes for 94,551 patients was assessed using negative binomial regression analysis.

Results: Compared to a static BMI trajectory, those with a sustained weight increase (25%+ from starting BMI) were at higher risk of type 2 diabetes over 4.8 years of follow-up (range 2.0 to 8.0 years) (adjusted rate ratios ranged 1.53-1.62, p-value<0.05). Patients with a BMI decrease trajectory (of ~10%), were at reduced risk of diabetes (adjusted rate ratios ranged 0.54-0.74, p-value<.05). BP and lipid trajectories had significant associations with diabetes onset.

Conclusions: Regardless of the starting BMI, those who increased their BMI by 25% within two years and maintained the higher weight were significantly at increased risk of type 2 diabetes. Monitoring BMI change and other known risk factor trajectories, BP and lipids, are additional tools for identifying patients at risk for type 2 diabetes.

DOI: 10.29245/2767-5157/2021/1.1118 View / Download Pdf

Adekunle Olowu1*, Adel Abbas Alzehairy2

1Consultant Family Medicine, Al Thumama Health Centre, Primary Health Care Corporation, Doha, Qatar

2Formerly Specialist Family Medicine, Al Thumama Health Centre, Primary Health Care Corporation, Doha, Qatar

Adrenal cysts are rare lesions that could be epithelial, endothelial, parasitic or haemorrhagic1, as well as pseudocysts. Haemorrhagic adrenal cysts are extremely rare and are often asymptomatic, so diagnosis can be really challenging. This can prove really difficult for primary care physicians who are often the frontline clinicians these patients tend to present to. They are usually benign lesions and do not often cause mortality if detected early and prompt surgery is done, as was the case with the patient in our case report4. When they do become symptomatic, they can present with different systemic symptoms as documented in literature, including in our case report2,4. Diagnosis is usually through Ultrasound and CT Scan and management is largely laparoscopic or open excision depending on the size of the lesion, surgical expertise and local protocol. Most patients make full recovery and mortality is extremely low3. The aim of this review is to provide a broader overview of the subject, highlight salient points in several studies relating to haemorrhagic cysts, provide an up to date follow up information on the index patient in our case report and to explore possible areas for future study4,6. This review also includes a suggested management algorithm and intends to emphasize the fact that patients who present in primary, urgent or emergency care settings with persistent non-specific symptoms should be investigated for rare diseases.

DOI: 10.29245/2767-5157/2021/1.1117 View / Download Pdf

Maurice C. Johnson, Jr.1, Howard A. Fishbein1*, Rebecca Jeffries Birch1, Qilu Yu2, Russ Mardon1, Wilson Pace3, Natalie Ritchie4, Jennifer K. Carroll5, Daniella Meeker6

1Westat, Rockville, MD, USA

2National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health (NIH), Bethesda, MD, USA

3DARTNet, Aurora, CO, USA

4University of Colorado/Denver Health and Hospitals Authority, USA

5University of Colorado, USA

6University of Southern California, USA 

Objective: This study examined the influential role of making a prediabetes diagnosis resulting in the subsequent delay in onset of type 2 diabetes.

Research Design and Methods: Using electronic medical records, a multivariable logistic regression model examined demographic and clinical risk factors associated with a prediabetes diagnosis among patients with HbA1c evidence of prediabetes. A multivariable non-proportional Cox regression examined development to type 2 diabetes (maximum 7 year follow-up).

Results: Analysis includes 40,970 patients with incident prediabetes (76.8% undiagnosed). Logistic regression showed higher baseline HbA1c levels significantly influenced assigning a prediabetes diagnosis: compared to patients with HbA1c level 5.7-5.9% (low), OR 1.66 (99% CI 1.54-1.78) for HbA1c level 6.0-6.2% (medium) and OR 1.62 (CI 1.43-1.83) for HbA1c level 6.3-6.4% (high). Cox model results, which included an interaction between HbA1c and prediabetes diagnosis, found HbA1c the most significant predictor. Patients with diagnosed prediabetes progressed to type 2 diabetes slower than those undiagnosed. Comparing diagnosed patients to undiagnosed within the same HbA1c level, HRs ranged from 0.47 (CI 0.37-0.61) in the high HbA1c level to 0.83 (CI 0.67-1.02) in the low HbA1c level.

Conclusions: From the LEADR cohort (1) HbA1c levels were the principle factor associated with risk for prediabetes diagnosis. Modeling development to diabetes, baseline HbA1c was the significant predictor of risk. Findings suggest assignment of a prediabetes diagnosis is associated with slower development of diabetes and this protective benefit of being diagnosed increases with a higher baseline HbA1c. Prediabetes diagnosis is useful for delaying onset of type 2 diabetes.

DOI: 10.29245/2767-5157/2021/1.1114 View / Download Pdf

Nitchakarn Laichuthai1, Ralph A. DeFronzo2*

1Hormonal and Metabolic Disorders Research Unit and Excellence Center in Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

2Diabetes Division, UT Health San Antonio and Texas Diabetes Institute, San Antonio, Texas, USA

Newly discovered abnormal glucose tolerance is common in patients who present with acute myocardial infarction (MI). These individuals are at very high risk for recurrent major adverse cardiovascular events (MACE), cardiovascular (CV) mortality, and all-cause mortality compared to normal-glucose-tolerant individuals who present with acute MI. Early and aggressive intervention with lifestyle and pharmacologic treatment are essential for the prevention of prediabetes progression to diabetes and recurrent cardiovascular events in this high risk population. Management, both with regard to prevention of recurrent cardiovascular events and development of diabetes, has been poorly addressed in current cardiology and diabetes guidelines. In this article, we review current evidence regarding the use of glucagon-like peptide 1 receptor agonists (GLP-1 RAs), sodium glucose cotransporter 2 inhibitors (SGLT2i), and pioglitazone to prevent recurrent cardiovascular events and propose areas of research to be explored in the future.

DOI: 10.29245/2767-5157/2021/1.1115 View / Download Pdf

Salma Ahi

Research Center for Noncommunicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran

View / Download Pdf

Sunil J. Wimalawansa

Professor of Medicine, Endocrinology & Nutrition, Cardiometabolic and Endocrine Institute, NJ, USA

In addition to being involved in the regulation of calcium and phosphate metabolism and the musculoskeletal functions, vitamin D has immune modulatory effects through several independent pathways. Its active hormone, calcitriol [1,25(OH)2D] effect both innate and adaptive immune systems essential for optimal immune functions. Vitamin D deficiency exacerbates immune-related disorders, including type 1 diabetes, multiple sclerosis, rheumatoid arthritis, psoriasis, respiratory infections, including COVID-19. In those with COVID-19, complications and the number of deaths is higher in those who are older than 70 years, persons with a darker skin colour and/or ethnic minorities living in colder climatic regions, institutionalized persons, and with pre-existing chronic diseases. These groups of people have exceedingly high prevalence of severe vitamin D deficiency and thereof weaker immune systems. Collectively, these increases the vulnerability to microbial infections, particularly respiratory viruses, and for developing severe complications and deaths. Vitamin D related immune protective effects includes, the generation of anti-microbial peptides cathelicidin and defensins and antibodies against invading pathogens; the initiation of immune defences via natural killer cells, macrophages, and epithelial cells; the enhanced expression of angiotensin-converting enzyme 2 (ACE-2) and diminish expression of inflammatory cytokines; and reduce replication and enhance elimination of viruses from the body. The severity of complications and deaths associated with COVID-19 markedly increases in the presence of severe hypovitaminosis D: serum 25(OH)D concentration of less than 10 ng/mL. Excess complications and deaths from COVID-19 can be cost-effectively prevented with rapidly boosting the immunity using upfront loading, high doses of vitamin D; this will create an equivalent of internal “body armour”-defence system, that protects against COVID-19.

View / Download Pdf

Lorena V. Rincones Rojas, Amenaida C. Ferrer Marcano, Juan S. Mojica Muñoz, Angelica M. García, Luis G. Celis*

Faculty of Medicine – Universidad de la Sabana, Bogotá, Colombia

Overweight and obesity are considered a global epidemic in the twenty first century, it is a multifactorial disease due, in part, to a genetic component. The most common genetic alteration is one that affects the neuroregulatory pathway of Leptin, a fundamental hormone for appetite regulation. Mutations that affect the LEP gene are present in the different exons of this gene and have been described for many years. Although obesity due to a genetic mutation is not the most common cause, its diagnosis is of paramount importance since it can affect the quality of life and life expectancy of the patients suffering from this condition.

The purpose of this mini review is to present up-to-date evidence regarding Leptin gene mutations, possible treatment strategies such as Leptin Replacement Therapy (LRT), leptin sensitizers and anti-inflammatory drugs, and discuss the importance of stablishing health policies worldwide to achieve a timely and successful approach to this disease.

View / Download Pdf

Dawood Khan, R Charlotte Moffett*

SAAD Centre for Pharmacy and Diabetes, Ulster University, Coleraine, Northern Ireland, UK

Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with infertility which affects one in ten women in the United Kingdom. Women with PCOS are typified by insulin resistance, gestational diabetes and obesity. Therefore, a close association between reproductive function and nutrition is postulated. However, regulatory pathways common to energy and reproductive function have received little attention. Recent research shows rapid amelioration of infertility, PCOS and type 2 diabetes following Roux-en-Y bariatric surgery (RYGB). This occurs prior to weight loss suggesting involvement of gut derived factors. Therefore, gut hormones emerge as key players in the regulation of both energy homeostasis and possibly reproductive function. Alteration of gut peptide levels including GLP-1, GIP, PYY, ghrelin, NPY and neurotensin post-bariatric surgery suggest a plausible mechanism behind beneficial effects of RYGB. Furthermore, expression of gut peptide receptors within the reproductive axis strengthen the idea of involvement of these hormones in the remission of fertility post-surgery. The present commentary discusses the role of these important gut peptides and their receptors in the regulation of female reproductive system in the light of a recent article published by our laboratory. Understanding the functional relationship between the gut and reproductive axis will help us to identify novel and less invasive alternatives to bariatric surgeries for reproductive and related metabolic disorders.

View / Download Pdf

Aurelio Lo Buglio, Francesco Bellanti, Gianluigi Vendemiale*

Centre for Aging Research - Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy

Malnutrition is associated to poor clinical outcomes, especially in hospitalized patients. High prevalence of low-grade chronic inflammation, low skeletal muscle mass, and insulin resistance are often found in malnourished patients. Increasing evidence shows how these effects can be partially reverted through an adequate intake of food or using specific dietary supplementation. In this scenario, Mediterranean Diet (MD) demonstrated positive effects on the nutritional status, with important clinical finding in hospitalized patients such as low rate of length of stay and in-hospital mortality.

The aim of this review is the summary of the main evidence about the role of Mediterranean diet on health and clinical outcomes in hospitalized elderly patients.

View / Download Pdf

Santosh Ramakrishnan1*, Mohammed Yousuf Khan1, Anantharaman Ramakrishnan2, Shanmugasundar Gopal3, Rohit Warrier4

1Consultant Endocrinologist & Diabetologist, Magna centres for Obesity, Diabetes & Endocrinology, Hyderabad, India

2Consultant Endocrinologist & Diabetologist, Magna centres for Obesity, Diabetes & Endocrinology, Bangalore, India

3Consultant Endocrinologist & Diabetologist, Magna centres for Obesity, Diabetes & Endocrinology, Chennai, India

4Consultant Diabetologist, Magna centres for Obesity, Diabetes & Endocrinology, Bangalore, India

Psoriasis is an immune mediated chronic skin disease associated with components of metabolic syndrome like obesity and type-2 diabetes. Previously, anti-diabetic drugs especially insulin sensitizers (metformin and pioglitazone) have shown positive outcomes in subjects with psoriasis1. Recently, many case series and longitudinal observational studies previously have demonstrated improvement in psoriasis with GLP1 agonist therapy when followed up for 8-12 weeks2,3. We report a patient with psoriasis and Type2 DM in whom a marked improvement in psoriasis was seen with liraglutide therapy, even with a short course of therapy for 4 weeks, which has not been previously recorded, to the best of our knowledge. This could be due to our subject possibly being a better GLP-1 responder based on baseline characteristics of relatively higher BMI and HbA1c4.

View / Download Pdf

Catherine E. Kerr1*, Sarah D. Hackman2, Gary L. Francis1

1Department of Pediatrics1, Endocrinology and Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

2Department of Pathology and Laboratory Medicine2, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

View / Download Pdf

Santosh Ramakrishnan1*, Anantharaman Ramakrishnan2, Rohit Warrier3, Shanmugasundar Gopal4

1Consultant Endocrinologist & Diabetologist, Magna centres Clinics for Obesity, Diabetes & Endocrinology, Hyderabad, India

2Consultant Endocrinologist & Diabetologist, Magna centres Clinics for Obesity, Diabetes & Endocrinology, Bangalore, India

3Consultant Diabetologist, Magna centres Clinics for Obesity, Diabetes & Endocrinology, Bangalore, India

4Consultant Endocrinologist & Diabetologist, Magna centres Clinics for Obesity, Diabetes & Endocrinology, Chennai, India

We describe a case where we effectively managed chronic, uncontrolled type 2 diabetes with hydroxychloroquine (HCQS) as an add on therapy, wherein the patient was on multiple oral hypoglycemic agents along with a combination of injectable incretin/insulin therapy prior to HCQS initiation. Six months into combination therapy with HCQS, the target HbA1c was achieved for the first time in the patient’s recent history at a much lower daily insulin dose (56% requirement drop), which has never been documented before. This combination also resulted in significant weight loss. We make a case for advocating the use of HCQS to the available routine diabetes therapeutic agents, especially if the blood sugars fail to achieve target levels in spite of being on intensive management with insulin and for the obese phenotype.

View / Download Pdf

Paolo Lissoni1*, Antonio Bastone1, Arianna Lissoni1, Franco Rovelli1, Giuseppe Di Fede1

1Institute of Biological Medicine, Milan, Italy

Several clinical studies have shown that blood pressure (BP) declines during the night in the healthy subjects, and that BP circadian rhythm tends to disappear with age. The mechanisms responsible for BP circadian rhythm and its aging-dependent loss need to be further understood. At present, it is already known that the two main hormones provided by hypotensive activity, consisting of the cardiac hormone atrial natriuretic peptide (ANP) and the pineal indole hormone melatonin (MLT), are mainly produced during the night, whereas hypertensive hormones, such as cortisol, are mainly produced during the early period of light phase. Then, the circadian variations of BP would be the consequence of changes in the neuroendocrine system. On this basis, a preliminary study was performed to establish which relation may exist among BP, ANP and MLT rhythms in the healthy subjects. The study included 20 65-year younger, and 20 65-year older healthy subjects. In 65-year younger subjects, both systolic and diastolic BP mean values significantly decreased during the night, whereas no significant difference occurred in the 65-older ones, because of BP values decreased in the night only in 13/20 (65) subjects. In addition, within the 65-year older group, both ANP and MLT night mean values were significantly higher in subjects with BP rhythm than in those, who had no BP daily variations. These preliminary results would suggest that age-dependent loss in the circadian rhythm of BP may be caused by the concomitant loss in the circadian secretion of at least two major hypotensive hormones, such as ANP and MLT.

View / Download Pdf