Effects of Exogenous Insulin Therapy on Thyroid Nodule Size in Patients with Type 2 Diabetes Mellitus

Objectives: Recent evidence suggests that insulin resistance and endogenous hyperinsulinaemia are related to thyroid nodule growth and development, but the effect of exogenous insulin therapy on thyroid nodules is unknown. The objectives of this study are to investigate the effects of exogenous insulin on thyroid nodule size in diabetic patients.Methods: retrospective analysis of patients with nodular thyroid disease and type 2 diabetes mellitus receiving metformin alone or insulin-and-metformin. Thyroid ultrasonography was used to monitor changes in nodule size: ≥2 mm and ≥20% being statistically significant.Results: 34 insulin-treated (73 nodules) and 53 metformin-only (135 nodules) patients were followed for 5.9-67.9 months (mean 24.5±1.8). Nodule size ranged from 0.17-5.25 cm (mean 1.29±0.08). There were no signifi cant differences in serum TSH, free-T4 or Vitamin D between the two groups, but haemoglobin A1C was higher in insulin-treated patients at baseline and during follow-up (8.75±0.12% vs. 6.48±0.08%; P-value &lt;0.001). In insulin-treated patients, the number of nodules with no change, increase or decrease in size were 49/73 (67.12%), 13/73 (17.81%) and 11/73 (15.07%) at the end of follow-up. The respective number of nodules in the metformin-only group were 105/135 (77.78%), 20/135 (14.81%) and 10/135 (7.41%). Chi-square test for type of treatment and changes in nodule size was not significant (P-value 0.15).</p

Clinical and Biochemical Characteristics of Diabetes Ketoacidosis in a Tertiary Hospital in Riyadh

Diabetes is the fifth leading cause of death worldwide. Diabetic ketoacidosis (DKA) is a life-threatening acute complication of diabetes. The aim of this study is to investigate the clinical and biochemical characteristics of DKA among 400 patients admitted to hospital, most of whom had type 1 diabetes ( n = 372; 93%). Vomiting ( n = 319; 79.8%), nausea ( n = 282; 70.5%), and abdominal pain ( n = 303; 75.8%) were the presenting symptoms most commonly experienced by the patients. Tachycardia was the most common clinical sign noted in the patients on admission ( n = 243; 61.8%). The predominant precipitating cause of DKA was noncompliance to an insulin regimen ( n = 215; 54.2%). Recurrent DKA admissions in type 1 diabetes patients was higher than those with type 2 diabetes ( n = 232 versus n = 9, respectively; P = 0.002). Recurrent DKA admissions in female patients were higher than in male patients ( n = 167 versus n = 74, respectively; P = 0.002). Continued diabetic education (given to n = 384; 94%) and counseling on the importance of adhering to the recommended medical regime, addressing the social and cultural barriers that precipitate DKA, as well as the provision of timely medical attention may greatly reduce DKA episodes and their associated complications

Glycemic control and pregnancy outcomes in patients with diabetes in pregnancy: A retrospective study

Context: Diabetes in pregnancy (DIP) is either pregestational or gestational. Aims: To determine the relationship between glycemic control and pregnancy outcomes in a cohort of DIP patients. Settings and Design: In this 12-month retrospective study, a total of 325 Saudi women with DIP who attended the outpatient clinics at a tertiary center Riyadh, Saudi Arabia, were included. Subjects and Methods: The patients were divided into two groups, those with glycated hemoglobin (HbA1c) ≤6.5% (48 mmol/mol) and those with glycated hemoglobin (HbA1c) above 6.5%. The two groups were compared for differences in maternal and fetal outcomes. Statistical Analysis Used: Independent Student's t-test and analysis of variance were performed for comparison of continuous variables and Chi-square test for frequencies. Odds ratio and 95% confidence intervals were calculated using logistic regression. Results: Patients with higher HbA1c were older (P = 0.0077), had significantly higher blood pressure, proteinuria (P < 0.0001), and were multiparous (P = 0.0269). They had significantly shorter gestational periods (P = 0.0002), more preterm labor (P < 0.0001), more perineal tears (P = 0.0406), more miscarriages (P < 0.0001), and more operative deliveries (P < 0.0001). Their babies were significantly of greater weight, had more Neonatal Intensive Care Unit (NICU) admissions, hypoglycemia, and macrosomia. Conclusions: Poor glycemic control during pregnancy is associated with adverse maternal and fetal outcomes (shortened gestational period, greater risk of miscarriage, increased likelihood of operative delivery, hypoglycemia, macrosomia, and increased NICU admission). Especially at risk are those with preexisting diabetes, who would benefit from earlier diabetes consultation and tighter glycemic control before conception