scholarly journals Diagnosis and Treatment of Subclinical Hypercortisolism

2011 ◽  
Vol 96 (5) ◽  
pp. 1223-1236 ◽  
Author(s):  
Iacopo Chiodini
Keyword(s):  
Diabetes Mellitus ◽  
Evidence Synthesis ◽  
Adult Population ◽  
Randomized Study ◽  
Diagnostic Procedures ◽  
Adrenal Incidentalomas ◽  
Subclinical Hypercortisolism ◽  
Chronic Complications ◽  
Patients With Diabetes ◽  
Pubmed Search

Context: Subclinical hypercortisolism (SH) is a condition of biochemical cortisol excess without the classical signs or symptoms of overt hypercortisolism. It is thought to be present in the 5–30% of patients with incidentally discovered adrenal mass (adrenal incidentalomas), which in turn are found in 4–7% of the adult population. Therefore, SH has been suggested to be present in 0.2–2.0% of the adult population. Some studies suggested that this condition is present in 1–10% of patients with diabetes or established osteoporosis. The present manuscript reviews the literature on diagnostic procedures and the metabolic effect of the recovery from SH. Evidence Acquisition: A PubMed search was used to identify the available studies. The most relevant studies from 1992 to November 2010 have been included in the review. Evidence Synthesis: The available data suggest that SH may be associated with chronic complications, such as hypertension, diabetes mellitus, overweight/obesity, and osteoporosis. The available intervention studies suggest that the recovery from SH may lead to the improvement of hypertension and diabetes mellitus. A retrospective study suggests that this beneficial effect could be predicted before surgery. Conclusions: SH is suggested to be associated with some chronic complications of overt cortisol excess. Recovery from this condition seems to improve these complications. However, a large, prospective, randomized study is needed to confirm this hypothesis and to establish the best diagnostic approach to identify patients with adrenal incidentalomas who can benefit from surgery.

Hypoglycaemia in the treatment of diabetes mellitus

2011 ◽  
pp. 1849-1861
Author(s):  
Pratik Choudhary ◽  
Stephanie A. Amiel
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Blood Glucose Concentration ◽  
Cerebral Metabolism ◽  
Chronic Complications ◽  
Glucose Levels ◽  
Patients With Diabetes ◽  
Treatment Of Diabetes ◽  
Clinically Significant ◽  
The Brain

Hypoglycaemia (low blood glucose concentration) is the most important acute complication of the pharmacological treatment of diabetes mellitus. Low blood glucose impairs brain (and, potentially, cardiac) function. The brain has minimal endogenous stores of energy, with small amounts of glycogen in astroglial cells. The brain is therefore largely dependent on circulating glucose as the substrate to fuel cerebral metabolism and support cognitive performance. If blood glucose levels fall sufficiently, cognitive dysfunction is inevitable. In health, efficient glucose sensing and counterregulatory mechanisms exist to prevent clinically significant hypoglycaemia. These are impaired by diabetes and by its therapies. Patients with diabetes rank fear of hypoglycaemia as highly as fear of chronic complications such as nephropathy or retinopathy (1). Fear of hypoglycaemia, hypoglycaemia itself and attempts to avoid hypoglycaemia limit the degree to which glycaemic control can be intensified to reduce the risk of chronic complications of diabetes both for type 1 and type 2 diabetes.

scholarly journals Lifestyle Parameters in Patients with Diabetes Mellitus and in the General Adult Population—Trends over Five Years: Results of the Austrian National Health Interview Series

2021 ◽  
Vol 18 (18) ◽  
pp. 9910
Author(s):  
Thomas Ernst Dorner ◽  
Christian Lackinger ◽  
Sandra Haider ◽  
Katharina Viktoria Stein
Keyword(s):  
Diabetes Mellitus ◽  
Adult Population ◽  
Lifestyle Factors ◽  
Fruit And Vegetables ◽  
Related Factors ◽  
Logistic Regression Models ◽  
Muscle Strengthening ◽  
Health Interview ◽  
Patients With Diabetes ◽  
Austrian Population

Background: Not smoking, performing >150 min of aerobic physical activity (PA) and muscle strengthening exercises/week, and consuming >5 portions of fruit and vegetables/day are lifestyle recommendations for both the general population and people with diabetes mellitus (DM). Methods: A total of 15,771 and 15,461 persons from the Austrian Health Interview Surveys 2014 and 2019, respectively, including 4.9% and 6.0% of people with DM, were analysed in terms of their smoking, PA, and nutritional behaviours. Logistic regression models were performed for the lifestyle factors, adjusted for socio-demographic and health-related factors. Adjusted interactions between the survey year and DM on the lifestyle factors were computed. Results: The proportions of smokers were 23.9% and 20.2%, of people complying with the PA recommendations were 24.9% and 21.4%, and with fruit and vegetables recommendations were 7.1% and 5.5%, respectively, with significantly lower proportions of smokers and persons complying with the PA recommendations among people with DM. The fully adjusted odds ratios (95% confidence interval) for people with DM were 1.09 (0.94–1.26), 1.44 (1.23–1.69), and 0.90 (0.71–1.13) for smoking, not complying with PA recommendations, and not complying with fruit and vegetables recommendations, respectively. The proportion of people complying with PA recommendations decreased to a greater extent (p < 0.001) in people with DM (16.5% to 8.3%) compared to people without DM (25.3% to 22.3%). Conclusion: Diabetogenic lifestyle behaviours increased in the general Austrian population in recent years, which was especially true for people with DM regarding PA.

scholarly journals Urinary N-Acetyl-β-d-glucosaminidase (uNAG) as an Indicative Biomarker of Early Diabetic Nephropathy in Patients with Diabetes Mellitus (T1DM, T2DM): A Systematic Review and Meta-Analysis

Diabetology ◽  
2021 ◽  
Vol 2 (4) ◽  
pp. 272-285
Author(s):  
Arlinda R. Driza ◽  
Georgia V. Kapoula ◽  
Pantelis G. Bagos
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Diabetic Nephropathy ◽  
Meta Analysis ◽  
Area Under The Curve ◽  
Diabetic Patients ◽  
Pool Data ◽  
Patients With Diabetes ◽  
Pubmed Search ◽  
Renal Tubular

Diabetic nephropathy (DN) is the main cause of chronic kidney disease in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Renal tubular lysosomal enzyme activities like N-acetyl-β-d-glucosaminidase (NAG) have been shown to increase in patients developing DN. The aim of this systematic review and meta-analysis is to evaluate the diagnostic accuracy of NAG, as a preventional biomarker in the early stages of DN in patients with diabetes mellitus. Two impartial reviewers conducted a complete PubMed search until July 2021. A 2 × 2 contingency table was created for each trial and sensitivity and specificity were estimated using a bivariate random effects model. To pool data and estimate the area under the curve (AUC), the hierarchical summary ROC (hsROC) approach was utilized. Deek’s test was used to estimate publication bias. The meta-analysis included 21 studies that evaluated 2783 patients with T1DM and T2DM, as well as 673 healthy individuals. The AUC of urinary NAG (uNAG) ranged from 0.69 (95% CI: 0.65–0.73) to 0.89 (95% CI: 0.86–0.92). According to the results, NAG in urine can be considered as a potential and effective biomarker for predicting DN in diabetic patients (T1DM, T2DM).

scholarly journals Characteristics of bone mineral density in elderly patients with diabetes mellitus

2017 ◽  
Vol 95 (3) ◽  
pp. 228-232
Author(s):  
V. V. Sergeeva ◽  
S. E. Dymnova ◽  
V. A. Bobylev
Keyword(s):  
Diabetes Mellitus ◽  
Bone Mineral Density ◽  
Literature Review ◽  
Elderly Patients ◽  
Bone Tissue ◽  
Social Problem ◽  
Mineral Density ◽  
Chronic Complications ◽  
Patients With Diabetes ◽  
Mechanisms Of Development

Diabetes mellitus is a most important medical and social problem in Russia. Osteoarthropathy, osteopenia and osteoporosis are chronic complications of diabetes. There is no consensus on the pathogenetic mechanisms of development of changes of the bone tissue in this pathology. The present literature review outlines the problem.

scholarly journals Prevalence and Incidence Rate of Diabetes, Pre-diabetes, Uncontrolled Diabetes, and Their Predictors in the Adult Population in Southeastern Iran: Findings From KERCADR Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Hamid Najafipour ◽  
Maryam Farjami ◽  
Mojgan Sanjari ◽  
Raheleh Amirzadeh ◽  
Mitra Shadkam Farokhi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Incidence Rate ◽  
Diabetes Management ◽  
Disease Risk ◽  
Phase 1 ◽  
Adult Population ◽  
Household Survey ◽  
Logistic Regression Models ◽  
Patients With Diabetes ◽  
Artery Disease

Background: Diabetes mellitus is among the most serious health challenges worldwide. We assessed the prevalence of pre-diabetes (pre-DM) and diabetes (DM), the effectiveness of diabetes management, the 5-year incidence rate, and associated variables in the adult population in southeastern Iran.Methods: In a random cluster household survey (2014–2018), 9,959 adult individuals aged 15–80 years were assessed for coronary artery disease risk factors, including diabetes mellitus in Kerman (KERCADRS, phase 2). Among these people, 2,820 persons had also participated in phase 1 of the study 5 years earlier (2009–2011). Univariable and multivariable survey logistic regression models were used to identify the potential predictors of diabetes and pre-diabetes.Results: The prevalence of pre-DM was 12% (males 13.2% vs. females 11.1%), steadily increasing from 7.1% in the 15–24 years group to 18.4% in the 55–64 years group. The prevalence of DM was 10.2% (male and female, 7.9 and 10.8%, respectively), of which 1.9% were undiagnosed. DM was diagnosed in 10.6% of educated and 15.1% of illiterate people. The prevalence of diagnosed DM was lower in smokers (5.2 vs. 8.7%) and dependent opium users (5.4 vs. 8.8%). The prevalence of uncontrolled DM (HbA1c &gt; 7%) was 48.8%, increasing with age. The frequency of uncontrolled DM among people without and with treatment was 32 and 55.9%, respectively. Illiterate people had worse uncontrolled DM (55.6 vs. 39.6%). The 5-year incidence rate (persons/100 person-years) was 1.5 for pre-DM and 1.2 for DM, respectively. The lowest and the highest incidence rate of DM belonged to the 15–34 years old group (0.5) and dependent opium users (2.4). The incidence rate was found to have a direct relationship with BMI and a reverse relationship with physical activity.Conclusion: Pre-DM and DM affected 22.2% of the population. One-third of patients with diabetes had undiagnosed DM, and in 55.9% of people with diagnosed DM, treatment had been ineffective. Appropriate health interventions are needed to reduce the prevalence and health consequences of diabetes in the region.

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