Factors Associated With Mild Cognitive Impairment in Patients With Type 2 Diabetes: A Cohort Study.

Background Cognitive dysfunction is increasingly recognized as an important comorbidity of diabetes mellitus (DM). Objective The purpose of this study was to determine the prevalence and predictors of cognitive decline in individuals with type 2 diabetes mellitus (T2DM). Methods This cohort study included patients with type 2 diabetes mellitus aged between 40 and 75 years and with a duration of the evolution of diabetes that is greater than five years admitted in endocrinology consultation of the Sheikh Khalifa ibn Zaid Hospital in Casablanca, Morocco. For each patient, we collected clinical characteristics and biological assessments. All subjects provided screening test results as defined by the Mini-Mental State Examination (MMSE). Results We included a total of 100 patients with diabetes between May and September 2021. The median age of the patients was 65 years (interquartile range (IQR): 59-70 years), 65% were males, and the median duration of diabetes was 15 years (IQR: 9-20 years). The most common cardiovascular risk factors (CVRFs) were hypertension (72.7%) and dyslipidemia (53%). The most common complications of diabetes were peripheral neuropathy (50%), diabetic retinopathy (DR) (39%), peripheral artery disease (33%), and coronary artery disease (27%). Cognitive impairment was present in 47.5% of our patients. For the multivariate analysis, we found that the decrease in the MMSE score is associated with the increase in age (p-value = 0.004) and the occurrence of diabetic retinopathy (p-value < 0.001), dyslipidemia (p-value = 0.006), and elevated creatinine (p-value < 0.001). Conclusion It is necessary to consider the cognitive decline of patients with diabetes as one of the most important complications of this disease because of its impact on the evolution and compliance of these patients.

Ramadan and Diabetes: What About Non-Fasting Patients with Diabetes?

Background: The management of diabetes during Ramadan is well codified. International guidelines recommend avoiding fasting for patients with the risk of complications. However, during Ramadan drastic changes occur in lifestyles habits. Our study aims to evaluate the impact of the month of Ramadan on the lifestyle habits and metabolic profile of non-fasting patients with diabetes. Patients and Methods: This observational cross-sectional study was carried out during 3 months of Ramadan in 2018, Ramadan 2019, and Ramadan 2021. We conducted 3 consultations (before, during, and after Ramadan). Before Ramadan, we collected anthropometric and metabolic parameters, and we assessed physical activity level and dietary intake. During Ramadan, we evaluated the occurrence of complications such as hyperglycemia and hypoglycemia, as well as we assessed physical activity level, dietary intake, and the number of meals. After Ramadan re-evaluate anthropometric and metabolic parameters. Results: We included 155 patients, 93.5% had type 2 diabetes and 6.5% had type 1 diabetes. We found that glycated hemoglobin, LDL cholesterol, and Triglyceride increased significantly after Ramadan (p-value <0.001). We also found that weight, body mass index, waist circumference. Caloric intake increased significantly during Ramadan (p-value <0.001); this increase concerned 61.3% of patients. In terms of metabolic parameters, diabetes was unbalanced in 52.6% of patients, hypoglycemia occurs in 20.9% of patients, and hyperglycemia was experienced by 37% of patients during Ramadan. We found that LDL cholesterol increased in 48.4% of patients, triglycerides increased in 60.6% of patients and serum level of total cholesterol increased in 55% of patients. Conclusion: Our study showed that during Ramadan risk of complications in patients with diabetes is not only related to fasting.

Predicting poor glycemic control during Ramadan among non-fasting patients with diabetes using artificial intelligence based machine learning models.

AIMS: This study aims to predict poor glycemic control during Ramadan among non-fasting patients with diabetes using machine learning models. METHODS: First, we conducted three consultations, before, during, and after Ramadan to assess demographics, diabetes history, caloric intake, anthropometric and metabolic parameters. Second, machine learning techniques (Logistic Regression, Support Vector Machine, Naive Bayes, K-nearest neighbor, Decision Tree, Random Forest, Extra Trees Classifier and Catboost) were trained using the data to predict poor glycemic control among patients. Then, we conducted several simulations with the best performing machine learning model using variables that were found as main predictors of poor glycemic control. RESULTS: The prevalence of poor glycemic control among patients was 52.6%. Extra tree Classifier was the best performing model for glycemic deterioration (accuracy = 0.87, AUC = 0,87). Caloric intake evolution, gender, baseline caloric intake, baseline weight, BMI variation, waist circumference evolution and Total Cholesterol serum level after Ramadan were selected as the most significant for the prediction of poor glycemic control. We determined thresholds for each predicting factor among which this risk is present. CONCLUSIONS: The clinical use of our findings may help to improve glycemic control during Ramadan among patients who do not fast by targeting risk factors of poor glycemic control.

Diabetic Ketoacidosis With Acute Metabolic Pancreatitis: Two Serious Cases.

Hypertriglyceridemia is a rare cause of acute pancreatitis (AP), occupying approximately 7% of cases. The triad of acute pancreatitis, hypertriglyceridemia, and diabetes is a rare event, with a higher death rate. We describe two cases of severe acute metabolic pancreatitis discovered in diabetic ketoacidosis. For both patients, all other causes of AP were excluded (including gallstones, hypercalcemia, drugs, and alcohol). A laboratory workup revealed elevated lipasemia (more than three times the normal) and hypertriglyceridemia. Abdominal computed tomography confirmed the diagnosis of severe acute pancreatitis. Fasting, fluid resuscitation, and insulin therapy were initiated in the intensive care unit with good clinical results and progressive improvement in metabolic disorders.

Treatment of Graves' Disease Associated With Severe Neutropenia.

Severe neutropenia in newly diagnosed hyperthyroidism is a diagnostic and therapeutic dilemma since antithyroid drugs (ATDs) cannot be started if the absolute neutrophil count (ANC) is <1 x 109/L. We report the case of a patient followed for hyperthyroidism associated with severe neutropenia treated with dexamethasone and ATD. The patient was 51 years old and was hospitalized for hyperthyroidism with a thyroid stimulating hormone (TSH) level <0.005 (0.4-4) mUI/L, T4 at 415 (9.3-17.1) ng/L and T3 at 148 (2-4.4) pg/mL on Graves' disease (GD) confirmed by the TSH receptor antibodies at 38 IU/mL and scintigraphy, associated with neutropenia, with ANC at 0.4 x 109/L. He was put on prednisolone 60 mg/day and propranolol 60 mg/day for three weeks without improvement. Faced with the association of hyperthyroidism and severe neutropenia, we could not start the ATD for fear of agranulocytosis; we put the patient on propranolol 60 mg and dexamethasone 6 mg with progressive degression resulting in a spectacular increase of ANC from 0.4 x 109/L to 7.1 x 109/L, which allowed us to start the ATD (carbimazole) at a dose of 30 mg, and then 50 mg, with monitoring of ANC and transaminases every 48 hours. Euthyroidism was achieved after 15 days. A curative treatment with radioactive iodine ablation was administered. Our patient did not respond to prednisolone but responded dramatically to dexamethasone; this leads us to consider using dexamethasone for the rapid preparation for radical treatment of patients with GD.

Unusual Cutaneous Location of Langheransian Histiocytosis: A Case Report.

Langheransian cell histiocytosis (LCH) is a rare pathology characterized by the proliferation of CD1+ and Langerin+ cells. It can affect all ages, with an estimated prevalence of one to two cases/100,000 habitants. The involvement is often multi-visceral; however, isolated cutaneous involvement can be found in 40% of cases with very variable manifestations. We report the case of 45-year-old women followed for non-insulin-dependent diabetes and primary hyperparathyroidism suffering from isolated and refractory cutaneous histiocytosis.

Diabetes During the Fasting Month of Ramadan: Is Telemedicine as Efficient as Conventional Follow-Up? Results from a Moroccan Comparative Study.

AIM: During the COVID-19 pandemic, access to health care was affected by the lockdown period. To overcome this situation, telemedicine is an alternative to conventional follow-up for patients with diabetes during the fasting month of Ramadan. The aim of this study is to compare the effectiveness of telemedicine consultation of diabetic patients during Ramadan compared with conventional follow-up. METHODS: This comparative cross-sectional study conducted in the Sheikh Khalifa Ibn Zaid Hospital of Casablanca, Morocco, included diabetic patients followed up by conventional consultation in 2019 Ramadan and by telemedicine in 2020 Ramadan. For each patient and in both Ramadans (2019 and 2020), we have conducted a pre-Ramadan assessment, screening for acute diabetic complications during Ramadan and an evaluation of weight and glycated hemoglobin of patients, after Ramadan. We compared the occurrence of acute complications and the variation of metabolic parameters of patients in Ramadan 2020 with their results in Ramadan 2019. RESULTS: In this study, we included 61 patients. In Ramadan 2020, compared with Ramadan 2019, there was no significant difference in terms of hypoglycemia (18.03% versus 32.78%, p = 0.09), minor hyperglycemia (13.1% versus 11.47%, p = 0.35) and major hyperglycemia or ketoacidosis (3.27% versus 6.55%, p = 0.19). Fasting was interrupted in 8.19% versus 11.47% (p = 0.012). There were no significant variations of weight (+0.62 versus -0.77; p = 0.09). In term of variation of glycated hemoglobin, there was a significant different between Ramadan 2020 and Ramadan 2019 (-0.36 versus -0.61 in 2019, p<0.05). CONCLUSION: Despite comparable results in terms of weight change and hypoglycemia, our study showed that telemedicine follow-up in patients with diabetes during Ramadan did not provide as effective glycemic control as conventional monitoring.

Cardiovascular Risk Factors and the Severity of COVID-19 Disease.

Background and objective Several cardiovascular risk factors have emerged as important determinants of severe illness and death among coronavirus disease 2019 (COVID-19) patients. However, the full impact of these cardiovascular risk factors is still under investigation. This study aimed to investigate the association between patients' level of cardiovascular risk and the severity of COVID-19. Materials and methods This observational study included all adult patients with COVID-19 hospitalized at Sheikh Khalifa Ibn Zaid International University Hospital from March 20 to May 10, 2020. The cardiovascular risk level was assessed by the doctor responsible for each patient based on the 2019 European Society of Cardiology (ESC), the European Atherosclerosis Society (EAS), and the European Association for the Study of Diabetes (EASD) guidelines. We examined the association between the patients' level of cardiovascular risk and their severity of COVID-19 disease by using a logistic regression model. Results Among 133 patients with confirmed COVID-19, 46.6% had a low cardiovascular risk level, 19.5% had a moderate risk level, 15.8% had a high risk level, and 18.1% was found to have a very high risk level. Patients with different cardiovascular risk levels had significantly different rates of complications including secondary infection (p-value: <0.001), acute respiratory distress syndrome (ARDS) (p-value = 0.017), intensive care unit (ICU) admission (p-value: <0.001), and death (p-value: <0.001). A patient's very high cardiovascular risk level versus low, moderate, or high cardiovascular risk level was independently associated with ICU admission [OR = 6.42, 95% CI: (1.45-28.30)]. Conclusion Based on our findings, an increased level of cardiovascular risk among patients was strongly associated with the severity of COVID-19. This study also highlights the need for assessing cardiovascular risk factors in all patients with COVID-19.

Obesity and Disease Severity Among Patients With COVID-19.

Background Obesity can be associated with one or more co-morbidities that worsen the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Studies demonstrated that severe forms of coronavirus disease (COVID-19) have occurred in elderly patients and patients with co-morbidities such as diabetes, hypertension, and cardiovascular diseases. Objective This study investigated the impact of obesity on COVID-19 severity, irrespective of other individual factors. Methods This retrospective observational study included all adult patients with confirmed COVID-19 infection, who were admitted to Sheikh Khalifa Ibn Zaid International University Hospital between March 20 and May 10, 2020. First, we compared patients with and those without obesity in terms of demographic characteristics, co-morbidities, clinical symptoms, and outcomes. Further, using logistic regression models, we analyzed the association between obesity and intensive care unit (ICU) admission. Also, we examined whether the association between obesity and ICU admission was also consistent among overweight patients. Results The study population included 107 patients with confirmed COVID-19 infection. Obese patients have been admitted in ICU more than patients without obesity (P-value = 0.035). While adjusting for other risk factors for ICU admission, we found that obesity was an independent risk factor for ICU admission (OR = 5.04, 95% CI (1.14-22.37)). When we examined the association of both obesity and overweight with ICU admission, we found that only obesity was significantly associated with ICU admission (OR = 9.11, 95% CI (1.49-55.84)). Conclusion Our study found that obesity was strongly associated with severity of COVID-19. The risk of ICU admission is greater in the presence of obesity. Physicians should be awarded to the need of specific and early management of obese patients with COVID-19 disease.

Pituitary Apoplexy in Geriatric Patients: A Report of Four Cases.

Pituitary apoplexy (PA) is a rare clinical syndrome related to abrupt hemorrhage and/or infarction of the pituitary gland, usually occurring in patients with preexisting pituitary disease. It is an endocrine emergency requiring rapid diagnosis and appropriate management. This is a literature review and a retrospective study reporting the observation of four patients that have suffered from pituitary macroadenomas. These observations illustrate the particularities of this pathology in the elderly. The symptoms may be truncated and lead to a late diagnosis with its repercussions on management, without forgetting the particularity of the fragile and multisystemic terrain, which may contraindicate the usual surgical treatment. A rapid diagnosis and appropriate management can limit the occurrence of irreversible complications.

[Management of diabetes during Ramadan fasting: applications of international recommendations in clinical practice]. / Prise en charge des patients diabétiques au cours du jeûne du Ramadan: application des recommandations internationales en pratique clinique.

Fasting is not without risk in diabetic patients. The aim of our study was to assess the impact of fasting on glycémic control in diabetic patients prepared for fasting as recommended by the American Diabetes Association (ADA) in 2010. We conducted a prospective cohort study in 2014, including diabetic patients wishing to fast during Ramadan, consenting to take part in this study. Were excluded patients considered at very high risk according to ADA classification. Patients included had a consultation before the month of Ramadan (D0) consisting of education and treatment adjustment. This was followed by a medical visit during Ramadan (J7), then at J30 and J60. Results analysis was done using SPSS Smartviewer15.0 Our study included 34 patients, of whom 60% were women, with a mean age of 50.4 years, an average 6.2-year diabetes history, and a mean body mass index of 27.83kg/m2. Therapeutic adjustments (D0) were: decrease dose of sulphonylurea (SH), gliptine add in patients at risk of hypoglycaemia, and a metformin dose distribution. During the first week (D7) two patients had a lower hypoglycemia 0.7g/l before breaking the fast and 38% of the sample showed hyperglycemia great than; 2g/l after breaking the fast. We noted dietary errors in 15% of patients. Adjusting at J7 was to modify the dose of SH or to add a gliptine. No patient showed major hyperglycemia, ketosis or severe hypoglycemia. One patient presented an atrial fibrillation on unknown ischemic cardiopathy with acease of fasting. Three patients gave up fasting between J15 and J20 due to an intense asthenia without hyperglycemia. Mean HbA1c in patients after the fasting was 7.10 versus 6.8% before fasting (p = 0.42). Factors significantly associated to poor glycemic control were mainly HbA1C rate at admission (p = 0.002), absence of self-monitoring (p = 0.01) and diabetes duration (p = 0.06). This study allowed us to show that a good evaluation of diabetic risk level, an education, a glycemia monitoring and an adjustment of the treatment by implementing international recommendations to allow fasting for Muslim diabetic patients with low risk of acute complications and metabolic disorders. A medical visit during the month of Ramadan (D7) would allow for correction of the dietetic mistakes and adjustment of oral agents if necessary.

Characteristics and outcomes of diabetic patients infected by the SARS-CoV-2.

Diabetes is considered a risk factor for complications due to COVID-19. In order to clarify this association, we are exploring the characteristics, the clinical signs, the outcomes and death in diabetic patients with COVID-19. In this retrospective observational study we are evaluating the demographic characteristics, the comorbidities of the patients, the clinical signs of the infection, the signs of clinical severity, the biological assessment at admission, the treatment, the outcomes and the deaths of 133 patients with COVID-19, of which 25 (19,4%) had diabetes. In the compared COVID-19 patients, with and without diabetes, the patients with diabetes were older, had higher blood pressure and more cardio-vascular diseases. Severe forms were more present in diabetic patients (56% versus 27.1%). Weight loss was higher in diabetic patients (6kg versus 3kg). Biologically, diabetic patients had higher levels of C-reactive protein (28 versus 5.8mg/l), procalcitonin (0.28 versus 0,13ng/l), ferritin (501 versus 140ng/ml), lactic dehydrogenase (268 versus 226IU/l) and of D. dimer (665 versus 444µg/l). Diabetic patients required more oxygen therapy (60% versus 26.9%), more mechanical ventilation (20% versus 8.3%) and more frequent admission to the intensive care unit (60% versus 27.8%). They presented more thromboembolic complications (12% versus 9%) but there were not significant differences in the other outcomes and in death rates. The excess of morbidity and mortality due to diabetes was still not fully clarified; the role of demographic factors, the interaction of mediations with ACE-2 receptors and the role of co-morbidities will all need to be studied in order to identify the patient at risk profile, i.e. who can develop severe forms of the diseases and more outcomes. The early identification of a possible hyper inflammation could be very valuable. More attention should be paid to patients with COVID-19 with diabetes because they are at a high risk of complications.