História familiar de Diabetes Tipo 2 está associada com Síndrome Metabólica em indivíduos obesos do sexo feminino

The aim of this study was to evaluate the association between the family history (FH) of type 2 diabetes and metabolic syndrome (MetS) in a group of non-diabetic obese female subjects. A cross-sectional study was conducted in 239 female patients with obesity, regularly attending the Internal Medicine Division’s outpatient clinic (Hospital de Clínicas de Porto Alegre, Brazil). The inclusion criteria were patients with body mass index /30 kg/m2 and absence of type 2 diabetes. The FH was considered positive if a first degree relative had a diagnosis of diabetes. Seventy-four of 239 patients evaluated (30%) had a positive FH for type 2 diabetes. Patients with positive FH had higher waist/hip ratio and MetS more often than patients with negative FH. FH of type 2 diabetes was associated with MetS in this sample of nondiabetic obese female patients. Waist/hip ratio and fasting plasma glucose, markers of insulin resistance, were also associated with FH of type 2 diabetes. The simple question: “Do you have a FH of type 2 diabetes?” may help to identify the obese patients that should be better evaluated and intensively treated with the objective of preventing type 2 diabetes.O objetivo deste estudo foi avaliar a associação entre história familiar (HF) de diabetes melito tipo 2 (DM2) e síndrome metabólica (SM) em um grupo de mulheres obesas não-diabéticas. Conduzimos um estudo transversal com 239 mulheres com obesidade, regularmente atendidas no ambulatório de medicina interrna do Hospital de Clínicas de Porto Alegre, Brasil. Os critérios de inclusão foram pacientes com índice de massa corporal /30 kg/m2 e ausência de DM2. A HF de DM2 foi considerada positiva se um familiar de primeiro grau tivesse o diagnóstico de diabetes. Setenta e quatro das 239 pacientes avaliadas (30%) tiveram uma HF positiva de DM2. Pacientes com HF positiva tiveram maior razão cintura/quadril e mais frequentemente a presença de SM que as pacientes com HF negativa. A HF de DM2 foi associada com SM nesta amostra de pacientes femininas obesas não-diabéticas. A razão cintura/quadril e a glicemia de jejum, ambos marcadores de resistência à ação da insulina, foram também associadas com HF de DM2. A simples pergunta: “Você tem uma HF de DM2”? pode ajudar a identificar pacientes obesos que devem ser mais bem avaliados e intensamente tratados com o objetivo de prevenção do DM2

Association of Subjective Global Assessment and adductor pollicis muscle thickness with the Sarcopenia in older patients with type 2 diabetes

Background and Aim: Sarcopenia is prevalent in older patients and increases the risk for negative outcomes during hospitalization and after hospital discharge. In patients with type 2 diabetes (T2D) this association may be even worse. Upon hospital admission, it is often difficult to identify sarcopenia, so the objective of this study was to assess whether the subjective global assessment (SGA), the European Society for Clinical Nutrition and Metabolism (ESPEN) and Global Leadership Initiative on Malnutrition (GLIM) criteria and/or usual anthropometric measures can predict sarcopenia. A secondary objective, to evaluate the accuracy of variables in the prediction of sarcopenia. Methodology: Patients 60 years old and with T2D were included. Malnutrition was evaluated in accordance with the guidelines of ESPEN and GLIM, and SGA. Anthropometric measurements were performed by Mid-arm circumference (MAC), mid-upper arm muscle circumference (MUAMC), and adductor pollicis muscle thickness (APMT) was performed. The sarcopenia was evaluated by handgrip strength, timed Up and Go (TUG) test and muscle mass by measuring the calf circumference (CC). Logistic regression was performed to assess the association of variables with Sarcopenia. Results: A total of 311 patients were included. The prevalence of malnutrition in accordance to ESPEN, GLIM and SGA was 18 (5.8%), 65 (21%) and 15 (4%), respectively. The MAC and MUAMC showed a negative relationship with sarcopenia (HR: 0.92 CI95% 0.85-0.99). However, patients with overweight had a 66% reduction in the risk of sarcopenia (HR: 0.34 CI95% 0.19-0.59). After adjustments, malnourished patients according to the SGA had a risk of HR: 5.65 (CI95% 1.64-19.38) of sarcopenia, similarly to patients with APMT <5 th HR: 2.81 (CI95% 1.53-5.13), ESPEN and GLIM criteria presented HR:3.10 (CI95%1.12-8.22) and HR:2.94 (CI95%1.64-5.27), respectively. The interaction between SGA and APMT after adjusting the model has been significant (HR: 7.23 CI95% 2.98-17.67). In the area under the curve (ROC), only SGA and APMT showed greater accuracy in the prediction of sarcopenia (AUC: 0.713 CI95% 0.650-0.803). Conclusion: In our sample, it was possible to predict sarcopenia through the malnutrition criteria of ESPEN and GLIM, SGA, MAC and APMT. Measures such as APMT associated with the SGA tool seem to better predict sarcopenia in older patients with T2D

Enhancing Cushing’s disease diagnosis: exploring the impact of desmopressin on ACTH gradient during BIPSS

IntroductionThe differential diagnosis between Cushing’s disease (CD) and ectopic ACTH syndrome (EAS) is complex, and bilateral inferior petrosal sinus sampling (BIPSS) is considered the gold-standard test. However, BIPSS with corticotropin-releasing hormone (CRH) stimulation is rarely available.ObjectiveThis retrospective cohort study aimed to assess the accuracy of the inferior petrosal sinus to peripheral ACTH gradient (IPS:P) before and after desmopressin stimulation for the differential diagnosis of ACTH-dependent Cushing’s syndrome (CS), applying different cutoff values.MethodsA total of 50 patients (48 with CD and 2 with EAS) who underwent BIPSS were included in this study. The sensitivity and specificity of IPS:P in BIPSS before and after desmopressin stimulation were evaluated. Various cutoff values for IPS:P were examined to determine their diagnostic accuracy.ResultsUsing the traditional IPS:P cutoff, the sensitivity was 85.1% before stimulation, 89.6% after stimulation, and a combined sensitivity of 91.7%. Applying cutoff values of IPS:P &gt;1.4 before and &gt;2.8 after stimulation, the sensitivity was 87.2% and 89.6%, respectively, with a combined sensitivity of 91.7%. Receiver operating characteristic (ROC) curve analysis determined optimal cutoff values of 1.2 before stimulation and 1.57 after stimulation, resulting in a sensitivity of 93.6% and 93.8%, respectively, with a combined sensitivity of 97.9%. Specificity remained at 100% throughout all analyses. Among the 43 patients who responded positively to stimulation, 42 (97.7%) did so within the first three minutes, and all 43 (100%) did so within the first five minutes. None of the assessed clinical variables predicted the ACTH response to stimulation in BIPSS with statistical significance.DiscussionACTH stimulation with desmopressin during BIPSS improves the accuracy of IPS:P, making it a valuable tool for investigating ACTH-dependent Cushing’s syndrome. Considering the low risk of complications, we recommend the use of desmopressin stimulation during BIPSS for the differential diagnosis of ACTH-dependent CS

Evaluation of evening versus morning levothyroxine intake in elderly (MONIALE)

Background: The aging population is associated with increased multimorbidity and polypharmacy. Older adults are at a higher risk of adverse events and reduced therapeutic response. This phenomenon is partially explained by drug interactions and treatment adherence. Most randomized clinical trials have found no significant differences between morning and evening levothyroxine (LT4) administration in young adults, but there is little evidence regarding alternative LT4 regimens in older populations. Thus, the MONIALE trial aims to test an alternative schedule for LT4 administration in older adults. Methods/design: This randomized crossover clinical trial will include participants aged 60 years or older with primary hypothyroidism. The trial groups will consist of morning LT4 intake (60 min before breakfast) or evening LT4 intake (60 min after supper). The primary outcome will be variation in serum thyrotropin (TSH) levels after 24 weeks of the LT4 protocol. The secondary outcomes will be the prevalence of drugs that potentially interact with LT4 and hypothyroidism control according to interaction status. The sample size was calculated to detect a minimum mean difference of 1 mUI/L in serum TSH level between the groups with 80% power and a 5% probability of type I error, resulting in 91 patients per group. The project was approved by the Hospital de Clínicas de Porto Alegre Ethics Committee. Discussion: Considering the aging population, the increased prevalence of multimorbidity and polypharmacy, as well as potential drug interactions and treatment adherence difficulties, an alternative LT4 protocol could be useful for hypothyroidism treatment in the elderly. Prior studies comparing alternative LT4 administration protocols have mainly included young adult populations and have not addressed potential drug interactions

Dietary fatty acids and cardiovascular disease: A review

Fatty acids (FAs) can be classified into saturated (SFA), unsaturated (poly- or monounsaturated) and trans FA. Recent studies have found that both the quantity and quality of dietary FAs may influence their role in metabolic pathways. Due to their chemical composition, some FAs play a major role in the development and progression of cardiovascular disease. This is especially true for SFA and n-3 polyunsaturated fatty acids, which include marine eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The proinflammatory effects of high SFA intake may increase the risk of atherosclerosis. On the other hand, dietary n-3 intake may reduce the risk of cardiovascular disease by decreasing atherosclerosis, inflammation, and thrombotic processes. The goal of this study was to review the current literature on the role of FA intake in the prevention and risk of cardiovascular disease

Newest diabetes related technologies for pediatric type 1 diabetes and its impact on routine care : a narrative synthesis of the literature

Purpose of Review This review aims to address the actual state of the most advanced diabetes devices, as follows: continuous subcutaneous insulin infusions (CSII), continuous glucose monitoring systems (CGM), hybrid-closed loop (HCL) systems, and “Do-it-yourself” Artifcial Pancreas Systems (DIYAPS) in children, adolescents, and young adults. This review has also the objective to assess the use of telemedicine for diabetes care across three diferent areas: education, social media, and daily care. Recent Findings Recent advances in diabetes technology after integration of CSII with CGM have increased the popularity of this treatment modality in pediatric age and shifted the standard diabetes management in many countries. We found an impressive transition from the use of CSII and/or CGM only to integrative devices with automated delivery systems. Although much has changed over the past 5 years, including a pandemic period that precipitated a broader use of telemedicine in diabetes care, some advances in technology may still be an additional burden of care for providers, patients, and caregivers. The extent of a higher rate of “auto-mode” use in diabetes devices while using the HCL/DIYAPS is essential to reduce the burden of diabetes treatment. Summary More studies including higher-risk populations are needed, and eforts should be taken to ensure proper access to cost-efective advanced technology on diabetes care

Hemochromatosis and Diabetes Mellitus : case report and literature review

Introdução: A hemocromatose é uma desordem caracterizada por armazenamento alterado de ferro. A forma adquirida da doença pode ser ocasionada por sobrecarga de ferro, alcoolismo, infecção pelo vírus da hepatite C, hepatite não-alcoólica e doença hepática crônica. A forma hereditária pode ser causada por diferentes mutações, sendo a C282Y e a H63D as mais freqüentes. A hemocromatose é uma patologia que pode acometer diferentes órgãos, entre eles: coração, articulações, fígado, hipotálamo, hipófise, gônadas e pâncreas. Objetivo: O objetivo deste estudo foi relatar um caso de hemocromatose e revisar a literatura, com especial atenção para a associação de hemocromatose e diabetes melito. Resultados: Paciente 53 anos, masculino apresentou-se ao clínico geral com artralgias metacarpofalangeanas, tornozelos, joelhos, coxofemoral direita, lombar e cervical e queixas de astenia e emagrecimento. Entre 3 irmãos, um deles tinha diagnóstico de Hemocromatose Hereditária, com PCR demonstrando homozigose para C282Y. Trazia exames: TGO 128 U/l, TGP 231 U/l, fosfatase alcalina 258 U/l; ecografia abdominal com hepatomegalia e baço no limite superior da normalidade. Biópsia hepática demonstrou alargamento fibroso portal com hemossiderose intensa. Foi feito também o diagnóstico de diabetes melito A pesquisa da mutação confirmou a mesma mutação familiar: homozigose para C282Y.Background: Hemochromatosis is a disorder characterized by iron storage amended. The acquired form of the disease can be caused by iron overload, alcoholism, infection by C virus hepatitis, non-alcoholic hepatitis and chronic liver disease. The hereditary form can be caused by different mutations, being the C282Y and H63D the most frequent, 83% of cases are homozigotous for C282Y and 4% are compound heterozygous (C282Y/H63D). Hemochromatosis is a condition that can affect several organs, including: heart, joints, liver, hypothalamus, pituitary, pancreas and gonads. Objective: This study was to report a case of hemochromatosis and review the literature, with special attention to the association of hemochromatosis and diabetes mellitus. Results: Patient 53 years, male presented to the doctor with arthralgia metacarpophalangeal, ankles, knees, coxofemoral right, and cervical and lumbar, complaints of fatigue and weight loss. Between 3 brothers, one of them had a diagnosis of hereditary hemochromatosis, with PCR demonstrating homozygous for C282Y. Labs: GOT 128 U/l, ALT 231 U/l, alkaline phosphatase 258 U/l, abdominal ultrasound with hepatomegaly and spleen at the upper limit of normal. Liver biopsy demonstrated portal fibrosis extension with hemosiderosis intense. It also made the diagnosis of diabetes mellitus. The research confirmed the same mutation of the changing family: homozygous for C282Y