Medical Nutrition Therapy for Special Groups with Diabetes Mellitus

The prevalence of diabetes mellitus (DM) is increasing worldwide. Medical nutrition therapy increases the success of diabetes treatment and provides an appropriate glycemic control that decreases diabetes complications. The requirement of energy and nutritional elements may differ according to specific conditions including age, the presence of pregnancy, or comorbidities. Therefore, these specific conditions should be taken into account in the planning of medical nutrition therapy. Ensuring continuity of children and young growth and development, providing requirements based on comorbidities and physiological alterations in older adults, and protection of fetal development and maternal glycemic and nutrient balance in pregnancy should be aimed in the determination of energy and nutritional elements requirements. Here, we will discuss the medical nutrition therapy in special groups with diabetes mellitus

The value of routine measurement of serum calcitonin on insufficient, indeterminate, and suspicious thyroid nodule cytology

Routine calcitonin measurement in patients with nodular thyroid disease is rather controversial. The aim of this study was to evaluate the contribution of serum calcitonin measurement in the diagnostic evaluation of thyroid nodules with insufficient, indeterminate, or suspicious cytology. Out of 1668 patients who underwent thyroidectomy with the diagnosis of nodular thyroid disease and were screened, 873 patients with insufficient, indeterminate, or suspicious fine needle aspiration biopsy results were included in the study. From the total number of patients in this study, 10 (1.1%) were diagnosed as medullary thyroid cancer (MTC) using histopathology. The calcitonin level was detected to be above the assay-specific cut-off in 23 (2.6%) patients ranging between 6.5 - 4450 pg/mL. While hypercalcitoninemia was detected in all 10 MTC patients, a false positive elevation of serum calcitonin was detected in 13 patients (1.5%). Of the MTC group, 7 patients had cytology results that were suspicious for malignancy (Bethesda V), one patient’s cytology showed atypia of undetermined significance (Bethesda III) and two patient’s cytology results were suspicious for follicular neoplasm (Bethesda IV). Among the cases with non-diagnostic cytology (Bethesda I), none of the patients were diagnosed with MTC. In conclusion, routine serum calcitonin measurement can be performed in selected cases rather than in all nodular thyroid patients. While it is reasonable to perform routine calcitonin measurement in patients with Bethesda IV and Bethesda V, this measurement was not useful in Bethesda I patients. In Bethesda III patients, patient-based decisions can be made according to their calcitonin measurement.

Maternal genetic contribution to pre-pregnancy obesity, gestational weight gain, and gestational diabetes mellitus

Abstract Introduction Pre-pregnancy obesity, gestational diabetes mellitus (GDM), and gestational weight gain (GWG) are associated with each other. This is the first study to investigate whether genetic variants were associated with having GDM, and whether genetic variants-related GDM were associated with adiposity including pre-pregnancy obesity and excessive GWG in Turkish women. Patients and methods Women with GDM (n = 160) and without GDM (n = 145) were included in case-controlled study. Genotyping of the HNF1A gene (p.I27L rs1169288, p.98V rs1800574, p.S487N rs2464196), the VDR gene (p.BsmI rs1544410, p.ApaI rs7975232, p.TaqI rs731236, p.FokI rs2228570), and FTO gene (rs9939609) SNPs were performed by using RT-PCR. Results The FTO AA genotype was associated with an increased risk of having GDM (AA vs. AT + TT, 24.4% vs. 12.4%, OR = 2.27, 95% CI [1.23–4.19], p = 0.007). The HNF1A p.I27L GT/TT genotype was associated with increased GDM risk (GT + TT vs. GG-wild, 79.4% vs. 65.5%, OR = 2.02, 95% CI 1.21–3.38], p = 0.007). However, all VDR gene SNPs and the HNF1A p.A98V, p.S487N were not associated with having GDM (p > 0.05). The FTO AA genotype was associated with an increased risk for pre-pregnancy overweight/obesity (OR = 1.43, 95% CI [1.25–3.4], p = 0.035), but not associated with excessive GWG after adjusting for pre-pregnancy weight (p > 0.05). Pre-pregnancy weight, weight at delivery, and GWG did not differ in both VDR and HNF1A gene carriers (p > 0.05). HOMA-IR and HbA1c were increased in both p.I27L TT and FTO AA genotype carriers (p < 0.05). Conclusion The adiposity-related gene FTO is associated with GDM by the effect of FTO on pre-pregnancy obesity. The diabetes-related p.I27L gene is associated with GDM by increasing insulin resistance

Components of the Complete Blood Count in Type 2 Diabetes Mellitus with Inadequate Glycemic Control

Objective: Inadequate control of glycemia in diabetic patients is the primary cause of both micro- and macrovascular complications. Several components of complete blood count were investigated and have found to be higher in diabetic patients. We aimed to evaluate white blood cell (WBC), neutrophil, lymphocyte and platelet counts and, red cell distribution width (RDW), mean platelet volume (MPV) and platelet distribution width (PDW) in type 2 diabetes mellitus (T2DM) patients with inappropriorate glycemic management (HbAlc >7%) despite using insulin therapy. Methods: 135 type 2 diabetic patients with inappropriorate blood glucose management (HbAlc value >7 %) despite using insulin therapy for at least 3-month period (only insulin or insulin plus oral hypoglycemic agents) and 121 healthy subjects were included in the study. Demographic, anthropometric and laboratory data were recorded. Results: WBC, neutrophil, lymphocyte and monocyte counts were higher in DM group (p<0.0001). WBC counts were positively correlated with diastolic blood pressure (DBP), body mass index (BMI), waist circumference (WC) and high-sensitive C- reactive protein (hsCRP), fasting plasma glucose (FPG), post-prandial glucose (PPG), HbA1c and triglyceride levels (p<0.05). Neutrophil counts were positively correlated with hsCRP, FPG, HbA1c, BMI, PPG, LDL-Cholesterol (LDL-C) and microalbumin levels (p<0.05). Lymphocyte counts were positively correlated with systolic blood pressure (SBP), DBP, BMI, WC and FPG, HbA1c, LDL-C and triglyceride levels (p<0.05). WBC, neutrophil and lymphocyte counts were negatively correlated with HDL-Cholesterol (HDL-C) levels (p<0.05). PDW was higher in DM group (16.65±0.59 to 16.51±0.51, p:0.043). PDW was positively correlated with age, DBP, FPG, PPG, HbA1c, LDL-C and triglyceride levels (p<0.05). Monocyte to HDL-C ratio was higher in DM group (13.50 ± 5.34 to 10.54 ± 4.29, p<0.0001). Conclusions: In this study white blood cell, neutrophil and lymphocyte counts and PDW were higher in type 2 diabetic patients with inappropriorate glycemic management despite insulin therapy and they were correlated wıth cardio-metabolic risk factors. Leukocyte subtypes and PDW may be used as a marker for cardiovascular diseases in these patients

Screening for celiac disease in poorly controlled type 2 diabetes mellitus: worth it or not?

Abstract Background Recent studies have demonstrated that immune factors might have a role in the pathophysiology of insulin resistance and type 2 diabetes mellitus (T2DM). Inappropriate glycemic control in patients with T2DM is an important risk factor for the occurrence of diabetes complications. The prevalence of celiac disease (CD) is high in type 1 diabetes mellitus however, there are scarce data about its prevalence in T2DM. Our aim was to investigate the prevalence of celiac disease among insulin-using type 2 diabetes patients with inappropriate glycemic control. Methods IgA tissue transglutaminase antibodies (tTGA IgA) test was performed as a screening test. A total of 135 patients with T2DM whose control of glycemia is inappropriate (HbAlc value >7%) in spite of using insulin treatment for at least 3-months (only insulin or insulin with oral antidiabetic drugs) and 115 healthy controls were enrolled in the study. Upper gastrointestinal endoscopy with duodenal biopsy was performed to all patients with raised tTGA IgA or selective lgA deficiency. Results Gender, age, body mass index (BMI) and tTGA IgA, kreatinin, calcium, LDL-cholesterol (LDL-C), total cholesterol, 25-OH vitamin D3 levels were similar between groups. Systolic and diastolic blood pressure, waist circumference, fasting plasma glucose, postprandial plasma glucose, urea, sodium, HbA1c, LDL-C, triglyceride, vitamin B12 levels were significantly higher in DM group (p < 0.0001). BMI, high-sensitive CRP, microalbuminuria, and AST, ALT, potassium, phosphorus levels were significantly higher in the T2DM group (p < 0.05). HDL-cholesterol and parathormone levels were significantly lower in the T2DM group (p < 0.05). Two of the 135 patients with T2DM were diagnosed with CD (1.45%). Conclusions The prevalence of celiac disease among patients with type 2 diabetes, with poor glycemic control despite insulin therapy, is slightly higher than the actual CD prevalence in general population. Type 2 diabetic patients with inappropriate control of glycemia in spite of insulin treatment might be additionally tested for Celiac disease especially if they have low C-peptide levels

INCREASED CHITOTRIOSIDASE ACTIVITIES IN PATIENTS WITH RHEUMATOID ARTHRITIS: A POSSIBLE NOVEL MARKER?

Background: Chitotriosidase and YKL-40 are well-known in humans as Glyco_18 domain-containing proteins that are the common feature of mammalian chitinases and chitinase-like proteins. Previously, increased levels of YKL-40 were found correlated with the disease activity of rheumatoid arthritis. However, serum chitotriosidase activity in rheumatoid arthritis is not known yet. The aim of this study was to determine YKL-40 and chitotriosidase in patients with rheumatoid arthritis and to compare these markers with traditional ones such as C-reactive protein and erythrocyte sedimentation rate

The effect of disease activity on thyroid nodules in patients with acromegaly

Nodular thyroid disease is a very common disorder in patients with acromegaly. Insulin-like growth factor-1 (IGF-1) is a thyroid growth factor, and there is a correlation between IGF-1 levels and thyroid volume (TV) in patients with acromegaly. There is no study investigating the impact of somatostatin analog (SSA) treatment on thyroid nodule volume in patients with acromegaly. We aimed to assess thyroid nodule volume change with SSA treatment in patients with persistent acromegaly. We retrospectively analyzed data from 108 consecutive patients with acromegaly who were followed up by our clinic after undergoing surgery between 2002 and 2014. Patients who were cured after surgery were excluded. We only selected 43 patients (21 males, 22 females, mean age 52.8 ± 11.9 years) who did not meet the criteria of remission postoperatively, who were treated with SSA for at least six months and had normal thyroid function. Patients were divided into three groups (well-controlled, controlled, and active) according to their IGF-1 and growth hormone (GH) levels. All patients underwent an evaluation of TV and total thyroid nodule volume (TTNV) by ultrasound. TTNV decreased significantly in patients with well-controlled acromegaly (0.44 [0.75] to 0.23 [0.73], p < 0.001). TTNV did not change in controlled patients (0.18 [1.28] to 0.13 [1.54], p = 0.959); however TTNV increased in patients with active acromegaly (0.77 [1.46] to 1.03 [1.88], p = 0.028). Successful medical treatment of patients with active acromegaly decreases thyroid nodule volume. Sustained exposure to IGF-1 may cause an increase in thyroid nodule volume in patients with acromegaly

The effects of single high-dose or daily low-dosage oral colecalciferol treatment on vitamin D levels and muscle strength in postmenopausal women

Abstract Introduction Vitamin D deficiency is a common health problem. Vitamin D supplements are used to improve vitamin D status; however, there are contradictory data related to what doses to give and how often they should be given. Many studies have investigated the effects of vitamin D supplementation on muscle strength, but the results remain controversial. We aimed to compare the effects and safety of single high-dose with daily low-dose oral colecalciferol on 25(OH)D levels and muscle strength in postmenopausal women with vitamin D deficiency or insufficiency. Methods and design Sixty healthy postmenopausal women who had serum vitamin D levels  0.05). A significant increase in vitamin D levels was observed in both groups at 4 and 12 weeks after vitamin D3 treatment. The increase in the single-dose group was significantly higher than the daily low-dosage group at the 4th week (35.9 ± 9.6 ng/mL (89,6 ± 23,9 nmol/L), 16.9 ± 5.8 ng/mL (42,1 ± 14,4 nmol/L), p = 0.01). The increase in the single-dose group was significantly higher than in the daily low dosage group at the 12th week (23.4 ± 4.7 ng/mL (58,4 ± 11,7 nmol/L), 19.8 ± 7.2 ng/mL (49,4 ± 17,9 nmol/L), p = 0.049). The quadriceps muscle strength score increased significantly in the daily group at the 4th week (p = 0.038). The hamstring muscle strength score increased significantly in the daily group at the 12th week (p = 0.037). Conclusion Although daily administration routes are more effective in improving muscle strength, a single administration is more effective in increasing vitamin D levels. Trial registration number ISRCTN14226530 (04.07.2018), Name of the registry: ISRCTN registry, The study was retrospectively registered

The effect of disease activity on thyroid nodules in patients with acromegaly

Nodular thyroid disease is a very common disorder in patients with acromegaly. Insulin-like growth factor-1 (IGF-1) is a thyroid growth factor, and there is a correlation between IGF-1 levels and thyroid volume (TV) in patients with acromegaly. There is no study investigating the impact of somatostatin analog (SSA) treatment on thyroid nodule volume in patients with acromegaly. We aimed to assess thyroid nodule volume change with SSA treatment in patients with persistent acromegaly. We retrospectively analyzed data from 108 consecutive patients with acromegaly who were followed up by our clinic after undergoing surgery between 2002 and 2014. Patients who were cured after surgery were excluded. We only selected 43 patients (21 males, 22 females, mean age 52.8 +/- 11.9 years) who did not meet the criteria of remission postoperatively, who were treated with SSA for at least six months and had normal thyroid function. Patients were divided into three groups (well-controlled, controlled, and active) according to their IGF-1 and growth hormone (GH) levels. All patients underwent an evaluation of TV and total thyroid nodule volume (TTVN) by ultrasound. TTNV decreased significantly in patients with well-controlled acromegaly (0.44 {[}0.75] to 0.23 {[}0.73], p < 0.001). TTNV did not change in controlled patients (0.18 {[}1.28] to 0.13 {[}1.54], p = 0.959); however TTNV increased in patients with active acromegaly (0.77 {[}1.46] to 1.03 {[}1.88], p = 0.028). Successful medical treatment of patients with active acromegaly decreases thyroid nodule volume. Sustained exposure to IGF-1 may cause an increase in thyroid nodule volume in patients with acromegaly