Diabetes mellitus type 2: Exploratory data analysis based on clinical reading

Diabetes mellitus type 2 (DMT2) is a severe and complex health problem. It is the most common type of diabetes. DMT2 is a chronic metabolic disorder that affects the way your body metabolizes sugar. With DMT2, your body either resists the effects of insulin or does not produce sufficient insulin to continue normal glucose levels. DMT2 is a disease that requires a multifactorial approach of controlling that includes lifestyle change and pharmacotherapy. Less than ideal management increases the risk of developing complications and comorbidities such as cardiovascular disease and numerous social and economic penalties. That is why the studies dedicated to the pathophysiological mechanisms and the treatment of DMT2 are extremely numerous and diverse. In this study, exploratory data analysis approaches are applied for the treatment of clinical and anthropometric readings of patients with DMT2. Since multivariate statistics is a well-known method for classification, modeling and interpretation of large collections of data, the major aim of the present study was to reveal latent relations between the objects of the investigation (group of patients and control group) and the variables describing the objects (clinical and anthropometric parameters). In the proposed method by the application of hierarchical cluster analysis and principal component analysis it is possible to identify reduced number of parameters which appear to be the most significant discriminant parameters to distinguish between four patterns of patients with DMT2. However, there is still lack of multivariate statistical studies using DMT2 data sets to assess different aspects of the problem like optimal rapid monitoring of the patients or specific separation of patients into patterns of similarity related to their health status which could be of help in preparation of data bases for DMT2 patients. The outcome from the study could be of custom for the selection of significant tests for rapid monitoring of patients and more detailed approach to the health status of DMT2 patients

Levoketoconazole improves clinical signs and symptoms and patient-reported outcomes in patients with Cushing’s syndrome

Purpose: The efficacy of levoketoconazole in treating hypercortisolism was demonstrated in an open-label phase 3 study (SONICS) of adults with endogenous Cushing’s syndrome (CS) and baseline mean urinary free cortisol (mUFC) ≥ 1.5× ULN. Clinical signs and symptoms and patient-reported outcomes from the SONICS trial were evaluated in the current manuscript. Methods: Patients titrated to an individualized therapeutic dose entered a 6-month maintenance phase. Secondary endpoints included investigator-graded clinical signs and symptoms of CS during the maintenance phase, and patient-reported quality of life (CushingQoL questionnaire) and depression symptoms (Beck Depression Inventory II [BDI-II]). Results: Of 94 enrolled patients, 77 entered the maintenance phase following individualized dose titration. Significant mean improvements from baseline were noted at end of maintenance (Month 6) for acne, hirsutism (females only), and peripheral edema. These improvements were observed as early as Day 1 of maintenance for hirsutism (mean baseline score, 7.8; ∆ − 1.9; P < 0.0001), end of Month 1 for acne (mean baseline score, 2.8; ∆ − 1.2; P = 0.0481), and Month 4 for peripheral edema (mean baseline score, 1.0; ∆ − 0.5; P = 0.0052). Significant mean improvements from baseline were observed by Month 3 of maintenance for CushingQoL (mean baseline score, 44.3; ∆ + 6.9; P = 0.0018) and at Month 6 for BDI-II (mean baseline score, 17.1; ∆ − 4.3; P = 0.0043) scores. No significant mean improvement was identified in a composite score of 7 other clinical signs and symptoms. Conclusions: Treatment with levoketoconazole was associated with sustained, meaningful improvements in QoL, depression, and certain clinical signs and symptoms characteristic of CS. ClinialTrials.gov identifier: NCT01838551

Corticotroph tumor progression after bilateral adrenalectomy (Nelson’s syndrome):systematic review and expert consensus recommendations

Corticotroph tumor progression (CTP) leading to Nelson's syndrome (NS) is a severe and difficult-to-treat complication subsequent to bilateral adrenalectomy (BADX) for Cushing's disease. Its characteristics are not well described, and consensus recommendations for diagnosis and treatment are missing

Time to diagnosis in Cushing’s syndrome: A meta-analysis based on 5367 patients

The time from first symptom to diagnosis of Cushing's syndrome is considered relevant for the severity of phenotype at presentation and long-term outcome. We therefore performed a systematic literature search to investigate relevant factors associated with a short time to diagnosis. The meta-analysis of 45 studies with 5560 patients showed significant differences for adrenal Cushing’s syndrome, Cushing’s disease and the ectopic Cushing’s syndrome. We did not find difference for gender, age or time of publication

C-peptide levels and glycemic indices in COVID-19 patients

AbstractType 2 diabetes (T2DM) is a common comorbidity in COVID-19 patients, which could favor disease progression. Our study aimed to evaluate the impact of some glycemic biomarkers on characteristic features of COVID-19. Electronic medical records of patients consecutively admitted to a COVID-19 ward were analyzed. Demographic and anthropometric as well as clinical and laboratory parameters were obtained. T2DM was present in 47% of the patients, with 22.58% of diabetic patients being newly diagnosed at admission. The most important predictors of severe COVID-19 were age (OR 1.214 [1.078-1.366], p = 0.001), creatinine levels (OR 1.018 [1.003-1.034], p = 0.017), glucose above 7.0 mmol/L at admission (OR 7.800 [2.232-27.255], p = 0.001) and HbA1c ≥ 6.5% (OR 4.840 [1.428-16.405], p = 0.011) irrespective of the presence of DM. C-peptide levels correlated positively with age, creatinine level, the severity of hypoxia and ferritin levels of patients (p < 0.05 for all) and appeared to be a significant predictor of leukocytosis. Suboptimal glycemic indices and impaired kidney function might predict COVID-19 disease worsening. Early detection of DM and optimization of glycemic control in diabetic patients should be among the priorities of the public health systems during COVID-19 pandemics

Macroprolactinemia in a Patient with Invasive Macroprolactinoma: A Case Report and Minireview

Background. Macroprolactin, the high-molecular prolactin isoform, is considered to be an inactive in vivo product with extrapituitary origin. Patients with macroprolactinemia are usually asymptomatic, with negative pituitary imaging. Based on these data, most authors do not recommend treatment and long-term followup in subjects with macroprolactinemia. However, there is evidence for overlapping clinical features among subjects with hyperprolactinemia due to monomeric or “big big” PRL isoform. Case Presentation. We present a 35-year-old female patient with secondary amenorrhea, mild obesity, hirsutism, headache and blurred vision. Hormonal evaluation revealed an extreme hyperprolactinemia (PRL = 10 610 mIU/L) almost exclusively due to macroprolactin isoform (MPRL = 10 107 mIU/L; recovery after PEG precipitation 4.7%) and hypogonadotropic hypogonadism. An invasive pituitary macroadenoma was visualized on MRI, and cabergoline therapy was initiated. Disappearance of clinical signs and symptoms, normalization of gonadotropin levels, and restoration of regular ovulatory menstrual cycles after 1 year of treatment are arguments in favor of preserved-macroprolactin bioactivity in this case. The significant decrease in MPRL levels and tumor volume in response to dopamine agonist therapy is suggestive for the tumoral origin of this isoform. Conclusions. Although macroprolactinemia is considered to be a benign condition, pituitary imaging, dopamine agonist treatment, and prolonged followup should be recommended in some particular cases