ABSTRACT
ABSTRACT Objective The insulin tolerance test (ITT) has been accepted as the gold standard test for assessing the integrity of the growth hormone (GH) - insulin-like growth factor (IGF-1) axis and the hypothalamic-pituitary-adrenal (HPA) axis. The goal of the test is to achieve clinical and biochemical hypoglycemia at a blood glucose level ≤ 40 mg/dL to effectively and correctly assess the HPA and GH-IGF-1 axes. In this study, the GH and cortisol responses of patients who achieved and failed to achieve biochemical hypoglycemia during an ITT were compared. Subjects and methods One hundred thirty-five patients with pituitary disorders were included in the study. Samples for blood glucose levels were obtained after clear symptoms of clinical hypoglycemia developed. The patients were enrolled in the hypoglycemic and nonhypoglycemic groups according to whether their plasma glucose level ≤ 40 mg/dL or > 40 mg/dL during an ITT, and the groups were compared in terms of their GH and cortisol responses. Results The mean age, body mass index and waist circumference of the two patient groups were found to be similar. The mean blood glucose level was significantly lower in the hypoglycemic group than in the nonhypoglycemic group (19.3 and 52.0 mg/dL, respectively). When the two groups were compared in terms of peak cortisol and GH responses, no statistically significant differences were found. Conclusion The data presented suggest that clinically symptomatic hypoglycemia is as effective as biochemically confirmed hypoglycemia during an ITT. Arch Endocrinol Metab. 2020;64(1):82-8
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Insulin-Like Growth Factor I/analysis , Hydrocortisone/blood , Human Growth Hormone/blood , Glucose Tolerance Test/methods , Hypoglycemia/blood , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Pituitary-Adrenal System/metabolism , Blood Glucose Self-Monitoring , Retrospective Studies , Glucose Tolerance Test/adverse effects , Hypoglycemia/diagnosis , Hypoglycemia/metabolism , Hypothalamo-Hypophyseal System/metabolismABSTRACT
ABSTRACT Objective The oral glucose tolerance test (OGTT) is used in the screening of gestational diabetes, in diagnosis of type 2 diabetes in conjunction with fasting blood glucose and glycated hemoglobin. The aim of this study was to examine the incidence and risk factors of adverse effects of OGTT in patients who underwent bariatric surgery, in addition to proposing standardization for ordering the OGTT in these patients. Subjects and methods This study assessed the incidence of adverse effects in 128 post-bariatric surgery patients who underwent the OGTT. Descriptive and logistic regression analysis were performed, the dependent variables were defined as the presence of signs (tremor, profuse sweating, tachycardia), symptoms (nausea, diarrhea, dizziness, weakness), and hypoglycemia (blood glucose ≤ 50 mg/dL). Results One hundred and seventeen participants (91.4%) were female; 38 (29.7%) participants were pregnant. High incidence (64.8%) of adverse effects was observed: nausea (38.4%), dizziness (30.5%), weakness (25.8%), diarrhea (23.4%), hypoglycemia (14.8%), tachycardia (14.1%), tremor (13.3%), profuse sweating (12.5%) and one case of severe hypoglycemia (24 mg/dL). The presence of signs was associated with hypoglycemia (OR = 8.1, CI 95% 2.6-25.1). The arterial hypertension persisted as a risk factor for the incidence of signs (OR = 3.6, CI 95% 1.2-11.3). Fasting glucose below 75 mg/dL increased the risk of hypoglycemia during the test (OR = 9.5, CI 95% 2.6-35.1). Conclusion In this study, high incidence of adverse effects during the OGTT was observed in post-bariatric surgery patients. If these results are confirmed by further studies, the indication and regulation of the OGTT procedure must be reviewed for these patients.
Subject(s)
Humans , Male , Female , Pregnancy , Adult , Middle Aged , Bariatric Surgery/adverse effects , Glucose Tolerance Test/adverse effects , Hypoglycemia/etiology , Hypoglycemia/epidemiology , Time Factors , Blood Glucose/analysis , Brazil/epidemiology , Logistic Models , Multivariate Analysis , Risk Factors , Fasting/blood , Diabetes, Gestational/diagnosis , Depression/etiology , Depression/epidemiology , Diabetes Mellitus, Type 2/diagnosis , Dyslipidemias/etiology , Dyslipidemias/epidemiology , Hypertension/etiology , Hypertension/epidemiologySubject(s)
Humans , Female , Pregnancy , Pregnancy in Diabetics/metabolism , Diabetes Mellitus/diagnosis , Bariatric Surgery , Glucose Tolerance Test/adverse effects , Pregnancy Complications/etiology , Pregnancy Complications/metabolism , Blood Glucose/analysis , Blood Glucose/metabolism , Body Mass Index , Risk Factors , Diabetes Mellitus/metabolism , Hypoglycemia/metabolismABSTRACT
Introducción: el comienzo de la diabetes mellitus tipo 2 precede en varios años el diagnóstico clínico, y está relacionado con algunos factores de riesgo aterogénicos y con la historia familiar de la enfermedad. Objetivo: identificar la presencia y evolución de dichos factores y las alteraciones del metabolismo glucídico en familiares de pacientes diabéticos. Métodos: estudio de cohorte en 113 sujetos, familiares de primer y de segundo grado de pacientes que padecen diabetes tipo 2 y que no presentaban alteraciones conocidas del metabolismo glucídico. Se midió semestralmente la tensión arterial, índice de masa corporal, lipidograma, glucemias (ayunas y posprandial), insulinemia e insulinorresistencia.Resultados: se encontraron valores medios elevados de índice de masa corporal, tensión arterial y lípidos, los cuales se incrementaron de forma evolutiva. Se diagnosticaron 90 nuevos pacientes con alteraciones de este metabolismo y se observó un deterioro progresivo del metabolismo glucídico, la insulinorresistencia y la insulinosecreción. Conclusiones: los familiares de primer y de segundo grado de pacientes diabéticos tipo 2 tienen una alta prevalencia de factores de riesgo aterogénicos, y evolucionan hacia el deterioro progresivo de estos y de la homeostasis glucídica(AU)
Introduction: the onset of type-2 diabetes mellitus proceeds several years from the clinical diagnosis and it is associated with atherogenic risk factors and family history of this disease. Objective: to identify the presence and evolution of such factors, and carbohydrate metabolism disorders in relatives of diabetic patients. Methods: a cohort study in 113 subjects, first-and second-degree relatives of patients who have type-2 diabetes and who had no known disorders of glucose metabolism. Twice a year, blood pressure, body mass index, lipid profile, blood glucose (fasting and postprandial), insulin and insulin resistance were measured. Results: high mean values were found for body mass index, blood pressure and lipids, which increased in an evolutionary form. 90 new patients were diagnosed with disorders of this metabolism and a progressive deterioration of glucose metabolism; insulin resistance and insulin secretion were showed. Conclusions: the first-and second-degree relatives of patients with type-2 diabetes have a high prevalence of atherogenic risk factors, and they evolve into progressive deterioration of these factors and glucose homeostasis(AU)
Subject(s)
Humans , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Risk Factors , Insulin Resistance , Glucose Tolerance Test/adverse effects , Cohort StudiesABSTRACT
Introducción: la obesidad se considera actualmente una epidemia en aumento a escala mundial. El fenómeno afecta a niños y adultos, y se asocia con la aparición precoz de enfermedades crónicas no trasmisibles que antes parecían exclusivas de los adultos, pero que se pueden presentar, incluso, en edades tempranas de la vida. Objetivo: identificar alteraciones clínicas y metabólicas en pacientes obesos y su asociación con la acantosis nigricans. Métodos: se realizó un estudio longitudinal prospectivo con 60 pacientes diagnosticados con obesidad exógena, con o sin acantosis nigricans, en el período comprendido de enero de 2009 a enero de 2010 en el servicio de endocrinología del Hospital Docente William Soler . Se les realizó, además de anamnesis y examen físico, prueba de tolerancia a la glucosa, con determinación de glucemia e insulinemia en ayunas y a las 2 horas, determinación de colesterol, triglicéridos y ultrasonido del hígado. Resultados: el 55 por ciento de los pacientes estudiados presentaban acantosis nigricans. La hipertensión arterial (18,2 por ciento), así como el hiperinsulinismo (21,2 por ciento), predominaron en este grupo de pacientes. La prueba de tolerancia a la glucosa alterada (6 por ciento), las alteraciones de los lípidos (27,2 por ciento) y la esteatosis hepática (39 por ciento) predominaron en los pacientes obesos con acantosis nigricans. Conclusiones: la obesidad en edad pediátrica puede constituir un riesgo elevado de sufrir complicaciones metabólicas, sobre todo, en el obeso con acantosis nigricans(AU)
Introduction: nowadays, obesity is considered a worldwide increasing epidemic. This phenomenon involves children and adults and it is associated with the early appearance of non-communicable chronic diseases that in the past were exclusive of adults, but that may be present in early ages of life. Objective: to identify the clinical and metabolic alterations in obese patients and its association with acanthosis nigricans. Methods: a prospective and longitudinal study was conducted in 60 patients diagnosed with exogenous obesity with or without acanthosis nigricans from January, 2009 to January, 2010 in the endocrinology services of the William Soler Teaching Children Hospital. Authors also carried out anamnesis and physical examination, glucose tolerance test, with fasting glycemia and insulinemia determination and at two hours, cholesterol determination, triglycerides and liver ultrasound. Results: the 55 percent of study patients had acanthosis nigricans. In this group of patients there was predominance of high blood pressure (18.2 percent), as well as the hyperinsulinism (21.2 percent). Altered glucose tolerance test (6 percent), lipid alterations (27.2 percent) and hepatic steatosis predominated in the obese patients presenting with acanthosis nigricans. Conclusions: obesity in pediatric age may be a high risk to suffer metabolic complications, mainly in the obese patient with acanthosis nigricans(AU)
Subject(s)
Humans , Child , Adolescent , Pediatric Obesity/diagnosis , Acanthosis Nigricans/complications , Glucose Tolerance Test/adverse effects , Data Interpretation, Statistical , Prospective Studies , Longitudinal StudiesABSTRACT
Se considera la prediabetes en niños cuando los valores de glucemia no son normales, pero tampoco lo suficientemente elevados como para que sean criterios diagnósticos de diabetes mellitus (DM). El concepto actual se basa en criterios bioquímicos, sin embargo en el caso de la diabetes tipo 1 y la diabetes autoinmune de progresión lenta (LADA), creemos importante tomar en cuenta los marcadores de autoinmunidad pancreática que reflejen el deterioro temprano de la célula beta en individuos supuestamente sanos (prediabetes). Dada su envergadura como condición de riesgo, algunos investigadores consideran esta condición como una enfermedad; en cambio, nosotros creemos que no es más que un estadio preclínico de la diabetes..(AU)
Subject(s)
Humans , Child , Adolescent , Prediabetic State/diagnosis , Risk Factors , Diabetes Mellitus, Type 1/epidemiology , Glucose Tolerance Test/adverse effects , Diabetes Mellitus, Type 2/diagnosis , Medical History Taking/methodsABSTRACT
Actualmente se define la PD como la situación de riesgo de padecer DM 2 y complicaciones vasculares en las personas con tolerancia a la glucosa alterada (TGA) o glicemia en ayunas alterada (GAA). Se conoce que en la progresión de la PD hacia la DM 2 ocurren paralelamente cambios de la TG, de la sensibilidad a la insulina, modificaciones de los patrones de secreción de esta hormona ante los cambios de los niveles de la glucosa en el plasma, trastornos tisulares y fenómenos aterogénicos y trombogénicos, que dependen de estos trastornos. Las intervenciones para la prevención de la DM no deben dirigirse solamente a las personas con hiperglucemia en ayunas o posprandial, pues la heterogeneidad del cuadro clínico y metabólico de esta etapa obliga a ampliar la exploración a toda la población con factores personales o antecedentes familiares que potencialmente lo colocan en una situación de riesgo
Subject(s)
Humans , Risk Factors , Diabetes Mellitus, Type 2/prevention & control , Glucose Tolerance Test/adverse effects , Prediabetic State/physiopathology , Cardiovascular Diseases/epidemiology , Metabolic Syndrome/etiology , Diabetes Mellitus, Type 2/complicationsABSTRACT
Objetivo: reportar la morbi-mortalidad perinatal y materna de este grado de intolerancia a la glucosa detectada durante el embarazo y que conjuntamente con el diagnóstico de Tolerancia a la Glucosa Alterada (TGA), se ha calificado de Prediabetes. Métodos: se estudiaron los resultados maternos y perinatales en 9 pacientes con resultado de la 2da. hora de la PTGo no patológica (menos de 7,8 mmo/L-140 mg/dL), pero que sí reunían criterios de Glucemia alterada en ayunas (GAA) según la OMS (6,1 a 6,9 mmol/L-110 a 125 mg/dL), en más de una ocasión. Resultados: en 4 de las pacientes fue necesario tratamiento con insulina regular humana Novonordisk a dosis que fluctuaron de 0,5 Ud/kg de peso corporal ideal a 1,6 Ud. El 50 por ciento de los RN presentaron exceso de peso corporal neonatal y 1 de ellos resultó superior a los 4 000 g, el cual desarrolló una hipoglucemia sintomática. Se detecta una anomalía congénita (Hidrocefalia), y 2 amenazas de parto pretérmino con necesidad de tratamiento anticálcico. Conclusión: la Glucemia alterada en ayunas (GAA) según nuestros resultados repercute severamente en la morbilidad materna y perinatal.
Objective: to report the perinatal and maternal morbimortality corresponding to this degree of glucose intolerance detected during pregnancy and that together with the diagnosis of Impaired Glucose Tolerance (IGT) has been classified as Prediabetes. Methods: the maternal and perinatal results were studied in 9 patients with non-pathological respond at the second hour of the OGTT ( 7.8 mmol/L-140 mg/dL), but who fulfilled the criteria of impaired fasting glycaemia (IFG) according to the World Health Organization (6.1 to 6.9 mmol/L-110 to 125 mg/dL) more than once. RESULTS: in 4 of the patients it was necessary the treatment with Novonordisk human regular insulin at doses ranging from 0.5 Ud/kg of ideal body weight to 1.6 Ud. 50 percent of the newborn infants presented excess of neonatal body weight. One of them with a weight over 4 000 g developed a symptomatic hypoglycaemia. A congenital anomaly (hydrocepaly) and two menaces of pretem delivery with need of anticalcic treatment were detected. Conclusion: Impaired fasting glycaemia according to our results has a severe impact on maternal and perinatal morbidity.
Subject(s)
Humans , Female , Pregnancy , Maternal Mortality , Perinatal Mortality , Glucose Tolerance Test/adverse effects , Case ReportsABSTRACT
Objetivo: reportar la morbi-mortalidad perinatal y materna de este grado de intolerancia a la glucosa detectada durante el embarazo y que conjuntamente con el diagnóstico de Tolerancia a la Glucosa Alterada (TGA), se ha calificado de Prediabetes. Métodos: se estudiaron los resultados maternos y perinatales en 9 pacientes con resultado de la 2da. hora de la PTGo no patológica (menos de 7,8 mmo/L-140 mg/dL), pero que sí reunían criterios de Glucemia alterada en ayunas (GAA) según la OMS (6,1 a 6,9 mmol/L-110 a 125 mg/dL), en más de una ocasión. Resultados: en 4 de las pacientes fue necesario tratamiento con insulina regular humana Novonordisk a dosis que fluctuaron de 0,5 Ud/kg de peso corporal ideal a 1,6 Ud. El 50 por ciento de los RN presentaron exceso de peso corporal neonatal y 1 de ellos resultó superior a los 4 000 g, el cual desarrolló una hipoglucemia sintomática. Se detecta una anomalía congénita (Hidrocefalia), y 2 amenazas de parto pretérmino con necesidad de tratamiento anticálcico. Conclusión: la Glucemia alterada en ayunas (GAA) según nuestros resultados repercute severamente en la morbilidad materna y perinatal(AU)
Objective: to report the perinatal and maternal morbimortality corresponding to this degree of glucose intolerance detected during pregnancy and that together with the diagnosis of Impaired Glucose Tolerance (IGT) has been classified as Prediabetes. Methods: the maternal and perinatal results were studied in 9 patients with non-pathological respond at the second hour of the OGTT ( 7.8 mmol/L-140 mg/dL), but who fulfilled the criteria of impaired fasting glycaemia (IFG) according to the World Health Organization (6.1 to 6.9 mmol/L-110 to 125 mg/dL) more than once. RESULTS: in 4 of the patients it was necessary the treatment with Novonordisk human regular insulin at doses ranging from 0.5 Ud/kg of ideal body weight to 1.6 Ud. 50 percent of the newborn infants presented excess of neonatal body weight. One of them with a weight over 4 000 g developed a symptomatic hypoglycaemia. A congenital anomaly (hydrocepaly) and two menaces of pretem delivery with need of anticalcic treatment were detected. Conclusion: Impaired fasting glycaemia according to our results has a severe impact on maternal and perinatal morbidity(AU)