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PURPOSE OF REVIEW: Postprandial hyperglycemia, or elevated blood glucose after meals, is associated with the development and progression of various diabetes-related complications. Prandial insulins are designed to replicate the natural insulin release after meals and are highly effective in managing post-meal glucose spikes. Currently, different types of prandial insulins are available such as human regular insulin, rapid-acting analogs, ultra-rapid-acting analogs, and inhaled insulins. Knowledge about diverse landscape of prandial insulin will optimize glycemic management. RECENT FINDINGS: Human regular insulin, identical to insulin produced by the human pancreas, has a slower onset and extended duration, potentially leading to post-meal hyperglycemia and later hypoglycemia. In contrast, rapid-acting analogs, such as lispro, aspart, and glulisine, are new insulin types with amino acid modifications that enhance their subcutaneous absorption, resulting in a faster onset and shorter action duration. Ultra-rapid analogs, like faster aspart and ultra-rapid lispro, offer even shorter onset of action, providing better meal-time flexibility. The Technosphere insulin offers an inhaled route for prandial insulin delivery. The prandial insulins can be incorporated into basal-bolus, basal plus, or prandial-only regimens or delivered through insulin pumps. Human regular insulin, aspart, lispro, and faster aspart are recommended for management of hyperglycemia during pregnancy. Ongoing research is focused on refining prandial insulin replacement and exploring newer delivery methods. The article provides a comprehensive overview of various prandial insulin options and their clinical applications in the management of diabetes.
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Hipoglucemiantes , Humanos , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/uso terapéutico , Insulina/administración & dosificación , Insulina/uso terapéutico , Periodo Posprandial , Hiperglucemia/tratamiento farmacológico , Femenino , Glucemia/efectos de los fármacos , Glucemia/análisis , Diabetes Mellitus/tratamiento farmacológico , EmbarazoRESUMEN
Peripheral neuropathy (PN) often remains undiagnosed (~80%). Earlier diagnosis of PN may reduce morbidity and enable earlier risk factor reduction to limit disease progression. Diabetic peripheral neuropathy (DPN) is the most common PN and the 10 g monofilament is endorsed as an inexpensive and easily performed test for DPN. However, it only detects patients with advanced neuropathy at high risk of foot ulceration. There are many validated questionnaires to diagnose PN, but they can be time-consuming and have complex scoring systems. Primary care physicians (PCPs) have busy clinics and lack access to a readily available screening method to diagnose PN. They would prefer a short, simple, and accurate tool to screen for PN. Involving the patient in the screening process would not only reduce the time a physician requires to make a diagnosis but would also empower the patient. Following an expert meeting of diabetologists and neurologists from the Middle East, South East Asia and Latin America, a consensus was formulated to help improve the diagnosis of PN in primary care using a simple tool for patients to screen themselves for PN followed by a consultation with the physician to confirm the diagnosis.
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Neuropatías Diabéticas , Humanos , Neuropatías Diabéticas/diagnóstico , Factores de Riesgo , Atención Primaria de SaludRESUMEN
BACKGROUND: Lung biopsy remains the gold standard in the diagnosis of fibrotic interstitial lung disease (F-ILD), but there is a growing appreciation of the role of pathogenic gene variants in telomere and surfactant protein genes, especially in familial pulmonary fibrosis (FPF). Pleuroparenchymal fibroelastosis (PPFE) is a rare disease that can coexist with different patterns of F-ILD, including FPF. It can be progressive and often leads to respiratory failure and death. This study tested the hypothesis that genetic testing goes beyond radiological and histological findings in PPFE and other F-ILD further informing clinical decision-making for patients and affected family members by identifying pathological gene variants in telomere and surfactant protein genes. METHODS: This is a retrospective review of 70 patients with F-ILD in the setting of FPF or premature lung fibrosis. Six out of 70 patients were diagnosed with PPFE based on radiological or histological characteristics. All patients underwent telomere length evaluation in peripheral blood by Flow-FISH or genetic testing using a customized exome-based panel that included telomere and surfactant protein genes associated with lung fibrosis. RESULTS: Herein, we identified six individuals where radiographic or histopathological analyses of PPFE were linked with telomere biology disorders (TBD) or variants in surfactant protein genes. Each case involved individuals with either personal early-onset lung fibrosis or a family history of the disease. Assessments of telomere length and genetic testing offered insights beyond traditional radiological and histopathological evaluations. CONCLUSION: Detecting anomalies in TBD-related or surfactant protein genes can significantly refine the diagnosis and treatment strategies for individuals with PPFE and other F-ILD.
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Enfermedades Pulmonares Intersticiales , Fibrosis Pulmonar , Humanos , Fibrosis Pulmonar/diagnóstico por imagen , Fibrosis Pulmonar/genética , Fibrosis Pulmonar/complicaciones , Tomografía Computarizada por Rayos X/métodos , Enfermedades Pulmonares Intersticiales/diagnóstico , Fibrosis , Pruebas Genéticas , Tensoactivos , Pulmón/diagnóstico por imagen , Pulmón/patologíaRESUMEN
The effect of hydration in modulating metabolic disease risk is a comparatively recent concept. Diabetic patients are at increased risk of dehydration due to osmotic diuresis. Undiagnosed or undertreated hyperglycemia may lead to electrolyte imbalance and elevated renal burden of glucose excretion, which may alter fluid reabsorption in the kidney. Also, the presence of one or more contributory factors, such as inadequate fluid intake, strenuous exercise, high temperatures, alcohol consumption, diarrhea, acute illnesses, fever, nausea, and vomiting, may put diabetic patients at increased risk of dehydration and electrolyte imbalance. Certain antidiabetic agents used by diabetic patients may cause fluid retention/deficits and/or electrolyte abnormalities in a few patients. Thus, drinking ample amounts of water and fluids with appropriate electrolyte composition is important to prevent dehydration. Successful management of dehydration in patients with diabetes is an unmet need and can best be accomplished by maintaining adequate hydration status.
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Deshidratación , Fluidoterapia , Desequilibrio Hidroelectrolítico , Humanos , Fluidoterapia/métodos , Deshidratación/etiología , Desequilibrio Hidroelectrolítico/etiología , Desequilibrio Hidroelectrolítico/terapia , Diabetes Mellitus , Hipoglucemiantes/uso terapéutico , Complicaciones de la DiabetesRESUMEN
Dehydration, often unnoticed, can occur in adults due to heat-related illnesses, viral infections, and upper respiratory tract infections, leading to deficits in fluids, electrolytes, and energy (FEE), even without diarrhea. This fluid deficit, in turn, impairs immunity at cellular and molecular levels. Physiologically, the immune system rapidly reacts to threats by adjusting its structural permeability, allowing water and small solutes to be passed, facilitated by proteins like aquaporins (AQPs). These AQPs are also essential for immune cell communication and adjustments of the cytoskeleton for functions like chemotaxis and phagocytosis. Apart from hydration, maintaining an optimal intake of essential micronutrients, including vitamins C and E, copper, zinc, and selenium, is also critical for supporting immune function and acting as antioxidants. Transient alterations in immune function caused by acute stressors or nondiarrheal conditions heighten vulnerability to coexisting illnesses, particularly cold and upper respiratory tract infections, while also elevating the likelihood of recurrent health issues. Supplementing fluids with known FEE content according to quality standards and enhanced taste is recommended during acute illness and until complete recovery. Thus, dehydration, caused by various acute conditions, can impair immunity and delay recovery. Prioritizing hydration and nutrition in healthcare and general settings is imperative, even when diarrhea is absent.
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Deshidratación , Micronutrientes , Humanos , Fluidoterapia/métodosRESUMEN
Dehydration is a well-known problem worldwide, and its assessment can be challenging due to confusing physical signs. The most effective way to assess hydration status is through the costly stable isotope methodology, but this approach has practical limitations. More commonly accepted and utilized indicators of hydration status are hematological and urinary parameters. However, hematological markers require invasive methods, and urinary markers have varying degrees of success in tracking hydration changes. While alterations in body weight can serve as a means of promptly evaluating hydration status, various factors such as food consumption, fluid intake, fecal losses, and urine production can impact these changes. Researchers have turned their attention to saliva as a potential marker and point-of-care (POC) testing to address the limitations of existing biomarkers. Saliva is appealing due to its easy collection process and similarities to extracellular fluid in terms of water and ion concentrations. Recent studies have shown that saliva flow rate, osmolarity/osmolality, and total protein concentration can effectively monitor changes in body mass during acute dehydration. Misdiagnosing dehydration can have severe clinical consequences, leading to morbidity and even mortality. This narrative review focuses on recognizing the significance of hydration assessment, monitoring, and the potential of salivary osmolarity (SOSM) as an assessment tool. Healthcare professionals can improve their practices and interventions to optimize hydration and promote overall wellness using such tools.
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Deshidratación , Saliva , Humanos , Saliva/química , Concentración Osmolar , Deshidratación/diagnóstico , Biomarcadores/análisis , Sistemas de Atención de Punto , Estado de Hidratación del Organismo/fisiología , Pruebas en el Punto de AtenciónRESUMEN
This communication defines and describes the novel concept of endocrine entropy. The authors share insights regarding the various facets of entropy in endocrine epidemiology, physiology, clinical presentation and management. The discussion opens up a new way of approaching endocrinology. Recent advances in artificial intelligence, assessment and addressal of entropy may become integral part of endocrine diagnostics and therapeutics.
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Enfermedades del Sistema Endocrino , Entropía , Humanos , Enfermedades del Sistema Endocrino/terapia , Enfermedades del Sistema Endocrino/diagnóstico , Endocrinología , Inteligencia ArtificialRESUMEN
This communication defines and describes the novel concept of endocrine entropy. The authors share insights regarding the various facets of entropy in endocrine epidemiology, physiology, clinical presentation and management. The discussion opens up a new way of approaching endocrinology. Recent advances in artificial intelligence, assessment and addressal of entropy may become integral part of endocrine diagnostics and therapeutics.
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Enfermedades del Sistema Endocrino , Entropía , Humanos , Enfermedades del Sistema Endocrino/terapia , Enfermedades del Sistema Endocrino/diagnóstico , Endocrinología , Inteligencia ArtificialRESUMEN
Menopause is the transition period in female life cycle. Resultant hormonal changes lead to adverse health effects. Women may seek treatment due to significant impairment in quality of life. Vitamin D deficiency is a globally prevalent problem. Vitamin D deficiency in menopausal women may aggravate the adverse health risks associated with menopause. In this article, the authors discuss endocrinology and clinical features of menopause, Vitamin D and its links with menopause, and the potential role of Vitamin D supplementation to combat detrimental multi-organ system effects of menopause.
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Suplementos Dietéticos , Menopausia , Deficiencia de Vitamina D , Vitamina D , Femenino , Humanos , Menopausia/efectos de los fármacos , Menopausia/fisiología , Deficiencia de Vitamina D/epidemiología , Deficiencia de Vitamina D/complicaciones , Vitaminas/uso terapéuticoRESUMEN
Psychological well-being is essential for the maintenance of good metabolic health. Modern management of most chronic metabolic disorders rightly focusses on improving the health-related quality of life of persons living with disease. In this brief communication we describe the bidirectional association between muscle function and mood (psychological health), explore the various pathways that link these aspects of health, and underscore their clinical implications. This paper emphasizes the importance of maintaining good mental health through exercise and vice a versa.
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Sarcopenia , Humanos , Calidad de Vida , Encéfalo/diagnóstico por imagen , Músculo Esquelético/fisiología , Ejercicio Físico/fisiologíaRESUMEN
Diabetes gastroparesis is a common manifestation of autonomic neuropathy in persons with long-standing, uncontrolled diabetes. Most discussion about its management revolves around the mitigation of symptoms. Here, we share tips on choosing the right glucose-lowering medication, based upon predominant symptomatology of gastroparesis. We highlight about insulin preparations, and their timing of administration, can be tailored according to need. We also emphasize the need to choose oral glucose lowering drugs with care.
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Diabetes Mellitus , Neuropatías Diabéticas , Gastroparesia , Humanos , Gastroparesia/etiología , Gastroparesia/terapia , Gastroparesia/diagnóstico , Neuropatías Diabéticas/complicaciones , Neuropatías Diabéticas/tratamiento farmacológico , Glucosa , Insulina/uso terapéutico , Diabetes Mellitus/tratamiento farmacológicoRESUMEN
This communication defines and describes the Barocene era, as that phase of human development which is characterized by a major impact of overweight and obesity. We use this term to highlight the fact that overweight and obesity need to be prevented and managed on an urgent footing. If not checked, these endocrine diseases will retard our growth and reduce our well being.
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Obesidad , Sobrepeso , Humanos , Sobrepeso/prevención & control , Obesidad/epidemiología , Obesidad/prevención & controlRESUMEN
Obesity has multiple causes and correlates. Usually studied as a metabolic and endocrine disease, with mechanical and musculoskeletal comorbidities, obesity also has a communicable angle to it. Obesity can be considered a communicable disease from the conventional point of view, as it is associated with viral etiology in animal and human models. It is also associated with increased prevalence and worse prognosis of infectious diseases. Not only that, obesity is a 'socially communicable' disease, as it 'spreads' amongst people living in similar environments.
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Obesidad , Humanos , Obesidad/epidemiología , Enfermedades Transmisibles/epidemiología , PrevalenciaRESUMEN
Oneirotherapy is a form of psychotherapy that is based on visual imagery and symbolism. In this communication. We discuss the role of oneirotherapy, or using vivid imagery, as adjuvant therapy in obesity care. Oneirotherapy can be used to promote acceptance of, and adherence to, prescribed therapy. It may also help improve quality of life and enhance self-esteem. However, oneirotherapy alone, without following a healthy lifestyle and or taking antiobesity medication, will help manage weight only in one's dreams.
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Obesidad , Sobrepeso , Humanos , Obesidad/terapia , Obesidad/psicología , Sobrepeso/terapia , Calidad de Vida , AutoimagenRESUMEN
This review delves into relatively less discussed role of alkaline phosphatase (ALP) as an accessible alternative to intact parathyroid hormone (iPTH) in the context of bone health assessment, particularly focussing on its potential boon for underprivileged individuals with chronic kidney disease (CKD) in South Asia. The financial constraints faced by this demographic often hinder regular monitoring of iPTH levels. ALP emerges as a promising surrogate, offering a cost-effective and practical solution for bone health evaluation in resource-constrained settings.
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Fosfatasa Alcalina , Hormona Paratiroidea , Humanos , Fosfatasa Alcalina/sangre , Hormona Paratiroidea/sangre , Insuficiencia Renal Crónica/sangre , Biomarcadores/sangre , Densidad ÓseaRESUMEN
The term KgA1c paradox is used to describe the unwanted rise in weight that occurs when HbA1c is controlled using conventional therapy. We highlight facets of pathophysiology, prevention, pharmacology, person centred care, and epidemiology, which correspond to the concept of KgA1c paradox. We suggest a novel index, KgA1c product [(BMI) x (HbA1c)], which can be used to evaluate efficacy of drugs, and assess metabolic control in persons with diabetes.
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Hemoglobina Glucada , Hipoglucemiantes , Humanos , Hemoglobina Glucada/metabolismo , Hipoglucemiantes/uso terapéutico , Índice de Masa Corporal , Diabetes Mellitus Tipo 2 , Aumento de Peso/fisiología , Diabetes Mellitus/epidemiologíaRESUMEN
The increasing pandemic of metabolic disease has spurred us to focus on promotion of health and prevention of disease. Simple public health messaging is required to inform and motivate the public to follow evidence-based interventions which can help prevent metabolic illnesses and their complications. We present a catchy 6E framework which enjoins individuals to Eat well, Exercise well, Eliminate unhealthy behaviours/habits, Ensure adequate Entertainment, relaxation and sleep, practice Emotional control, and Eschew/avoid extremes. This message can be used at individual, family as well as public health levels, to spread awareness about healthy behaviours and lifestyle.
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Ejercicio Físico , Promoción de la Salud , Humanos , Promoción de la Salud/métodos , Conductas Relacionadas con la Salud , Estilo de Vida SaludableRESUMEN
Glucokathexis is a clinical state characterized by low plasma glucose levels, in the presence of adequate glucose precursor stores. We conceive and construct this rubric to initiate interest and inspire insight into this field of metabolic medicine. We list various conditions that can cause true as well as pseudo-glucokathexis.
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Glucemia , Humanos , Glucemia/metabolismoRESUMEN
This communication conceptualizes and characterizes the phenomenon of dialysis distress, commonly encountered in persons living with end stage kidney disease on dialysis. Dialysis distress can be defined as an emotional state, marked by extreme apprehension, anxiety, despair and/or dejection, due to a perceived inability to cope with the challenges and demands of living with dialysis. This concept can be extrapolated to persons who undergo renal replacement therapy such as renal transplant. Dialysis distress should be identified in a timely manner, and managed using appropriate support, counselling and education, delivered in an empathic manner.
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Fallo Renal Crónico , Diálisis Renal , Humanos , Diálisis Renal/psicología , Fallo Renal Crónico/terapia , Fallo Renal Crónico/psicología , Estrés Psicológico/psicología , Distrés Psicológico , Adaptación Psicológica , Ansiedad/psicologíaRESUMEN
Chronic diseases require long term commitment from both the patient and the treating physician for improving their clinical outcomes. This journey can be made more easier if a proper communication bridge can be made between both of them. This paper describes an alliterative C-based flow-chart to describe a Collaborative Conversation Map for chronic disease care. It crafts a map which serves as a checklist for chronic health care providers, especially those dealing with obesity and diabetes. This conversation map is concordant with the WATER (welcome warmly, ask and assess, tell truthfully, explain with empathy, reassure and return) conversation approach described earlier.