Evaluation of association between time in range, a continuous glucose monitoring metric, and cardiac autonomic neuropathy in type 2 diabetes patients.

Introduction: Time in range (TIR), a metric of continuous glucose monitoring (CGM) provides better information regarding the individual's glycemic variability than a static measure like glycated hemoglobin (HbA1c). TIR is emerging as an independent risk factor for diabetic complications, both microvascular and macrovascular complications independent of HbA1c. Hence, this study evaluates the association between TIR and cardiac autonomic neuropathy (CAN) in type 2 diabetic patients. Materials and Methods: A total of 42 patients with type 2 diabetes mellitus were enrolled in this study and underwent a 3-day CGM using the "FreeStyle Libre Pro Flash Glucose Monitoring System Sensor" along with tests for CAN within the 3 days of attaching the CGM. Results: Out of 42 patients, 36 patients (85.7%) were diagnosed with CAN (early CAN 57.1% and definite CAN 28.6%) and the mean TIR was 64.4% ±23.5%. Out of those with TIR <70%, 42.9% were affected with definite CAN compared to only 14.3% among those with TIR >70%. Patients with more severe CAN were found to have a lower TIR (P = 0.115). Conclusion: The study found a high prevalence of cardiac autonomic neuropathy (CAN) of around 85.7% in type 2 diabetes patients. Lower TIR values were associated with a higher incidence of definite CAN (42.9% vs. 14.3% in TIR <70% vs. >70% groups). The findings suggest TIR is inversely associated with the presence and severity of cardiac autonomic neuropathy in type 2 diabetic patients and also a potential link between TIR and CAN severity.

Résumé Introduction: Le temps dans l'intervalle (TIR), une mesure de la surveillance continue du glucose (SGC), fournit de meilleures informations sur l'état de santé de l'individu. variabilité glycémique qu'une mesure statique comme l'hémoglobine glyquée (HbA1c). Le TIR est en train de devenir un facteur de risque indépendant pour les diabétiques complications microvasculaires et macrovasculaires indépendantes de l'HbA1c. Par conséquent, cette étude évalue l'association entre le TIR et la neuropathie autonome cardiaque (CAN) chez les patients diabétiques de type 2. Matériel et méthodes: Un total de 42 patients atteints de diabète sucré de type 2 ont été inclus dans cette étude et ont subi une SGC de 3 jours à l'aide du " FreeStyle Libre Pro Flash Glucose Monitoring System Sensor " ainsi que des tests de CAN dans les 3 jours suivant la fixation de la CGM. Résultats: Sur 42 patients, 36 patients (85,7 %) ont reçu un diagnostic de CAN (CAN précoce 57.1 % et CAN définitif 28.6 %) et le TIR moyen était de 64.4 % ±23.5 %). Parmi ceux qui ont un TIR, 70 %. Les patients atteints d'une CAN plus sévère présentaient un TIR plus faible (p = 0,115).Conclusion: L'étude a révélé une prévalence élevée de neuropathie autonome cardiaque (CAN) d'environ 85.7 % dans le diabète de type 2 patient. Des valeurs de TIR plus faibles étaient associées à une incidence plus élevée de CAN défini (42.9 % contre 14.3 % dans les groupes TIR <70 % contre >70 %). Le Les résultats suggèrent que le TIR est inversement associé à la présence et à la gravité de la neuropathie autonome cardiaque chez les patients diabétiques de type 2 et Il existe également un lien potentiel entre la gravité du TIR et celle du CAN. Mots-clés: Neuropathie autonome cardiaque, surveillance continue de la glycémie, temps au-dessus de la plage, temps en dessous de la plage, temps dans la plage, type 2 diabète sucré.

Hypophysitis in granulomatosis with polyangiitis: rare presentation of a multisystem disease.

Granulomatosis with polyangiitis (GPA) is a type of granulomatous vasculitis that can involve any organ in the body. The pituitary gland is one of the uncommon sites to be involved in this condition, with only a few cases reported in the literature. Our patient initially presented with central diabetes insipidus, epistaxis and haematuria. Diagnosis was established by antineutrophil cytoplasmic antibodies (cANCA) positivity against a background of typical clinical features and a bulky pituitary on magnetic resonance imaging (MRI) scan. Patient was started on steroids and methotrexate which were later changed to mycophenolate mofetil due to intolerance. Due to the refractory nature of the disease the patient was treated with one course of rituximab. Since then she has not had epistaxis, joint pains or haematuria. She continues to have diabetes insipidus although the requirement of desmopressin has come down. We thus report a case of GPA with hypophysitis which is one of the rare manifestations of the disease.