Association of vitamin D and insulin resistance among the adults with newly detected prediabetes attending in a tertiary care hospital of Bangladesh

Several studies have found an inverse association between vitamin D level and insulin resistance (IR) causing prediabetes and diabetes. So the current study was done to find out the association between serum vitamin D level and IR among adults with prediabetes. This cross-sectional study was carried out in 140 newly detected adults with prediabetes according to ADA 2018 criteria. The 25(OH) D cutoffs to define deficiency and insufficiency were used according to Endocrine Society (USA) criteria, measurement of vitamin D & insulin (fasting) was done by chemiluminescent microparticle immunoassay (CMIA). Data were analyzed using SPSS (version 22.0) and presented as table and figure. P-value ≤0.05 was considered significant. In this study, most of the population was 30 years and above (73%). The Male-female ratio was 1:7, the majority of participants came from urban areas (81%) and it was observed that there was an increasing trend of insulin resistance across increasing severity of vitamin D deficiency though it was not statistically significant (p= 0.74). In conclusion, vitamin-D deficiency/insuffi- ciency is common among individuals with prediabetes in our country, but there were no associ- ation had been found between vitamin D and insulin resistance in individuals with prediabetes BSMMU J 2021; 14(4): 157-16

Role of antimullarian hormone in the diagnosis of sonographically inconclusive polycystic ovary syndrome

Antimullarian hormone (AMH) is found to be a vital tool for the diagnosis of polycystic ovary syndrome (PCOS). AMH may help in the diagnosis of sonographically inconclusive cases of PCOS. This study measured the AMH level in PCOS to assess its impacts on the diagnosis of the syndrome. This cross-sectional study included 160 newly diagnosed females with PCOS who were diagnosed using a modified revised Rotterdam criteria. Fasting blood was collected to measure AMH by enzyme-linked immunosorbent assay and other hormones [total testosterone, luteinizing hormone and follicle-stimulating hormone] were measured by chemiluminescent microparticle immunoassay. Ovarian USG was done in the follicular phase of the menstrual cycle. Serum AMH≥ 3.5 ng/mL and ovarian volume >10 mL was considered as a combined marker of polycystic ovary (PCO). USG-PCO criteria could detect 84.38% PCO, whereas AMH-PCO criteria 67.5%. There was a lack of agreement between USG-PCO and AMH-PCO criteria [κ=-0.004] in PCOS. AMH-PCO criteria identified 68% of PCO patients undiagnosed by USG-PCO criteria [17/25]. Age [β=-0.172, p=0.040], systolic [β =-0.213, p=0.037] and diastolic blood pressure [β=0.301, p=0.004] had significant predictive associations with AMH by linear regression. AMH had a fair discriminating index for combined-PCO [AUC=0.824] in PCOS patients. In conclusion, AMH assessment can help detect PCOS patients who are inconclusively diagnosed by USG-PCO criteria. BSMMU J 2022; 15(2): 65-6

Spectrum of thyroid dysfunctions among hospitalized patients with non-critically ill coronavirus disease 2019: A cross-sectional study

Background: Patients with coronavirus disease 2019 (COVID-19) particularly critically ill ones may present with different types of thyroid abnormalities. However, data regarding thyroid function tests (TFTs) among noncritical patients with COVID-19 are scarce. This study aimed to assess thyroid functions and their associations with the severity of illness among non-critically ill hospitalized patients with COVID-19. Methods: This cross-sectional study assessed TFTs in 87 (aged 18-65 years) RT-PCR-confirmed COVID-19 patients admitted to a tertiary-care hospital in Bangladesh. Diagnosis of non–critical illness and severity (mild, moderate, and severe) were defined by WHO’s interim guidance. Patients having known thyroid dysfunctions or taking drugs that may affect thyroid functions were excluded from the study. Serum TSH, FT4, and FT3 were measured by chemiluminescent immunoassay. Results: Majority of the patients (72%) had normal thyroid function. Among the abnormalities, the highest frequency was isolated hyperthyroxinemia (12.6%) and the rest were subclinical hypothyroidism (6.9%), subclinical thyrotoxicosis (4.6%), thyrotoxicosis (2.3%), isolated tri-iodothyroninemia (1.1%), and hypothyroidism (1.1%).  Serum TSH, FT4, and FT3 levels were similar across the spectrum of noncritical illness. No significant correlation was found between the inflammatory markers (C-reactive protein, ferritin, and D-dimer) and TSH levels. Conclusions: More than one-fourth of non-critically ill hospitalized patients with COVID-19 presented with a spectrum of thyroid abnormalities with isolated hyperthyroxinemia being the most common. However, TFTs had no significant associations with the severity of illness among noncritically ill patients with COVID-19. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(2): 81-86

Vitamin D supplementation on prediabetic adults with vitamin D deficiency: a double-blind placebo-controlled randomized clinical trial

Hypovitaminosis D (<20 ng/mL) is thought to increase insulin resistance and meta-inflammation contributing to the pathogenesis of diabetes mellitus (DM). Correcting vitamin D deficiency in people with prediabetes might halt its progression to DM. The aim of this study was to examine the effect of vitamin D supplementation on insulin resistance, glycemic status, and inflammation in prediabetic adults with vitamin D deficiency. This doubleblind randomized placebo-controlled trial was done among 27 newly detected prediabetic adults with hypovitaminosis D randomly assigned to 60,000 IU of vitamin D weekly for eight weeks followed by monthly for the next four months or placebo along with lifestyle modification in both groups [vitamin D (n= 14) vs. Placebo (n=13). They were comparable in terms of sex, age and borlymass index. Glycemic status, fasting plasma glucose (FPG) and Hemoglobin A1C (HbA1C), insulin resistance (homeostasis model assessment of insulin resistance (HOMA-IR) and inflammatory marker high sensitivity C reactive protein (hs-CRP) were measured at baseline and after six months of intervention. Vitamin D levels (ng/mL) increased in both groups from baseline (vitamin D vs. placebo: 12.2±5.9 vs. 3.9±3.5, mean±SD). FPG (mmol/L) significantly decreased in the Vitamin D group (before vs. after: 5.9±0.6 vs. 5.5±0.7, P=0.016, mean±SD), whereas HbA1C (%) and hs- CRP (mg/L) significantly increased in the placebo group (before vs. after- HbA1C: 5.8±0.3 vs. 6.0±0.4, P<0.001; hs-CRP: 5.0±4.4 vs. 5.6±4.9, P=0.039, mean±SD). Percent changes in glycemic status, HOMA-IR, and hs-CRP were statistically similar between the groups. Our study failed to demonstrate the positive effects of vitamin D supplementation on reducing glucose, insulin resistance, or inflammatory marker in prediabetic adult patients with hypovitaminosis D. BSMMU J 2022; 15(3): 167-17

Short-term and low-dose liraglutide plus metformin decreased body mass index and insulin resistance more than metformin alone in obese women with polycystic ovary syndrome: An open-label randomized controlled study

Background and objectives: Reduction of weight improves different manifestations of polycystic ovary syndrome (PCOS). This study compared the effects of liraglutide plus metformin versus metformin alone on weight loss and metabolic profiles in obese women with PCOS. Methods: This open-label randomized controlled clinical trial consecutively recruited newly-diagnosed PCOS patients of reproductive age with obesity (body mass index ≥ 27.5 kg/m2). Following randomization into two equal groups, Group-1 received treatment with metformin 1000 mg daily alone while Group-2 was given metformin 1000 mg plus subcutaneous (SC) liraglutide 1.2 mg daily for 12 weeks. Anthropometric, biochemical and hormonal data and ovarian morphology were assessed at baseline and after 12 weeks. Clinical information and side effects were recorded every four weeks after initiation of the treatment. Glucose, lipids, and all hormones were analyzed by glucose oxidase, precipitation method, and chemiluminescent microparticle immunoassay respectively. Insulin resistance was measured by homeostatic model assessment (HOMA-IR). Results: Study included 30 participants comprising 15 for each group. Among 15 participants, 5 dropped out from the Group-1 and 1 dropped out from the Group-2. The final analysis was done among 24 participants (Gr-1: 10 and Gr-2: 14). Waist and hip circumference (WC, HC) significantly (p <0.05) decreased in patients treated with only metformin. Menstrual irregularity, BMI (body mass index), HC, systolic blood pressure (BP), 2h-OGTT glucose, fasting insulin, and HOMA-IR significantly (p < 0.05) decreased in the patients of Group-2 after 12 weeks compared to baseline status. Percentage changes of weight, BMI and HOMA-IR improved significantly (p < 0.05) in cases of Group-2 than those in Group-1. Side effects were though numerically higher in the Group-2 patients, but reduced with time. Conclusions: Addition of liraglutide with metformin was superior to metformin alone for lowering of BMI and insulin resistance among obese PCOS women with acceptable side effects. IMC J Med Sci. 2024; 18(1):002. DOI: https://doi.org/10.55010/imcjms.18.002 *Correspondence: Muhammad Abul Hasanat, Room# 1524, Level-15, Block-D, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka-1000, Bangladesh. ORCID iD: orcid.org/0000-0001-8151-9792; Email: [email protected]