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1.
Curr Diabetes Rev ; 16(2): 171-180, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31250764

RESUMO

BACKGROUND: Glycemic variability (GV) is an alternative diabetes-related parameter that has been associated with mortality and longer hospitalization periods. There is no ideal method for calculating GV. In this study, we used standard deviation and coefficient of variation due to their suitability for this sample and ease of use in daily clinical practice. OBJECTIVE: This study aimed to investigate the association between GV, hypoglycemia, and the 90-day mortality and length of hospital stay (LOS) among non-critically ill hospitalized elderly patients. METHODS: The medical records of 2,237 elderly patients admitted to the Zilda Arns Elderly Hospital over a 2.5-year period were reviewed. Hypoglycemia was defined as a glucose level <70 mg/dL (hypoglycemia alert value) and represented by the proportion of days in which the patient presented with this condition relative to the LOS. The Charlson comorbidity index was used to evaluate prognosis. Data were analyzed using multiple linear and logistic multivariate regression analyses. RESULTS: Adjusted analysis of 687 patients (305 men [44.4%] and 382 women [55.6%], mean age of 77.86±9.25 years) revealed that GV was associated with a longer LOS (p=0.048). Mortality was associated with hypoglycemia (p=0.005) and mean patient-day blood glucose level (p=0.036). Variables such as age (p<0.001), Charlson score (p<0.001), enteral diet (p<0.001), and corticosteroid use (p=0.007) were also independently associated with 90-day mortality. CONCLUSION: Increased GV during hospitalization is independently associated with a longer LOS and hypoglycemia in non-critically ill elderly patients, while the mean patient-day blood glucose is associated with increased mortality.


Assuntos
Glicemia/análise , Complicações do Diabetes/sangue , Hospitalização/estatística & dados numéricos , Hipoglicemia/sangue , Hipoglicemia/mortalidade , Tempo de Internação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Humanos , Hipoglicemia/diagnóstico , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco
2.
Biochem Med (Zagreb) ; 30(1): 010802, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31839727

RESUMO

Introduction: Hypoglycaemia has been reported as an unusual complication of tramadol use and in a few cases of tramadol poisoning, but the exact mechanism is not known. Case description: An ambulance crew was dispatched to an unconscious 46-year old man. A glucometer point-of-care measurement revealed a profound hypoglycaemia (1.9 mmol/L). Treatment with intravenous glucose was started and the patient was transported to the hospital. The patient had several episodes of pulseless electrical activity requiring cardiopulmonary resuscitation in the ambulance and upon arrival in the hospital. Despite continuous glucose infusion the hypoglycaemia was difficult to correct during the next few hours and the patient developed hypokalaemia. Further investigation to identify the cause of hypoglycaemia revealed that insulin and C-peptide were inappropriately raised. A toxicological investigation revealed the presence of tramadol and its metabolites in lethal concentrations. Also acetaminophen, ibuprofen and lormetazepam were present. Ethanol screening was negative (< 0.1 g/L) and no sulfonylurea were detected. The patient developed multiple organ failure, but eventually recovered. What happened: The hypoglycaemia was caused by inappropriate stimulation of insulin secretion in a patient intoxicated with tramadol. The sudden hypokalaemia was caused by a massive intracellular shift of potassium in response to the hyperinsulinemia, triggered by the intravenous administration of glucose. Main lesson: To our knowledge, we are the first to document a significant rise in endogenous insulin production in a hypoglycaemic patient presenting with tramadol intoxication. Our observation suggests that hyperinsulinemia could be the cause of the hypoglycaemia associated with tramadol use.


Assuntos
Analgésicos Opioides/efeitos adversos , Hipoglicemia/diagnóstico , Tramadol/efeitos adversos , Analgésicos Opioides/uso terapêutico , Glicemia/análise , Peptídeo C/sangue , Glucose/administração & dosagem , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/etiologia , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Tramadol/uso terapêutico
3.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(9): 534-539, nov. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-184375

RESUMO

Objetivo: Menos de un tercio de los pacientes con diabetes tipo 1 (DT1) consiguen el objetivo de punto de corte establecido como control metabólico óptimo (HbA1c < 7%). Sin embargo, reducciones porcentuales de HbA1c y la prevención de hipoglucemias graves (HG) han demostrado beneficios clínicamente relevantes. Por ello, el objetivo de este estudio ha sido evaluar la efectividad de la terapia con infusión subcutánea continua de insulina (ISCI) a los 5 años de seguimiento en una cohorte de pacientes de una unidad especializada mediante objetivos combinados de descenso de HbA1c y ausencia de HG. Material y métodos: Estudio observacional retrospectivo que incluye a 178 pacientes que iniciaron terapia ISCI de manera consecutiva entre los años 2003 y 2008. Se han analizado las características basales de los individuos, la HbA1c inicial y a los 5 años de tratamiento con ISCI y la presencia o no de HG. Se calcularon las variables combinadas: a) descenso de al menos 0,5 puntos de HbA1c y ausencia de HG en los últimos 2 años; b) HbA1c a los 5 años < 7,5% sin HG en los últimos 2 años; c) HbA1c < 8,5% sin HG en los últimos 2 años, y d) descenso ≥ 0,5 puntos y/o HbA1c < 7,5% a los 5 años sin presencia de HG en los 2 últimos años de seguimiento. Resultados: Veintisiete de los 178 pacientes fueron excluidos debido a pérdida del seguimiento o abandono de la terapia ISCI. Se analizó a 151 pacientes (edad 37,4 ± 10,5 años, 64% mujeres, 19,2 ± 10,7 años de evolución de la DT1). Las 2 indicaciones principales para el inicio de ISCI fueron: control metabólico subóptimo (60,9%) e HG o hipoglucemia desapercibida (28,5%). Las HbA1c de la cohorte total y de control metabólico subóptimo fueron de 8,0 ± 1,2 y 8,4 ± 1,1% al inicio de la terapia ISCI y de 7,8 ± 1,2 y 8,0 ± 1,3% a los 5 años (p = 0,104 y p = 0,016), respectivamente. En la cohorte global un 55,5% de los pacientes alcanzaron a los 5 años el objetivo combinado HbA1c < 7,5% y/o un descenso ≥ 0,5% sin HG. Conclusiones: Tras 5 años de terapia ISCI más de la mitad de nuestros pacientes consiguen el objetivo combinado de reducción significativa de HbA1c y ausencia de HG. La utilización de objetivos combinados nos ofrece la posibilidad de evaluar la efectividad de las terapias en la DT1 desde un punto de vista más cercano a su significado clínico


Objective: Less than one third of patients with type 1 diabetes mellitus (T1DM) achieve the cut-off value proposed as good metabolic control by most guidelines, HbA1c < 7%. However, HbA1c reductions and prevention of severe hypoglycemia (SH) have shown clinically relevant benefits. The study objective therefore was to assess the effectiveness of continuous subcutaneous insulin infusion (CSII) therapy at 5 years of follow-up in a cohort of patients attending a specialized unit using HbA1c reduction and abscence of SH as combined goals. Methods: A retrospective, observational study on 178 patients with T1DM who started CSII treatment at Hospital Clinic of Barcelona between 2003 and 2008. HbA1c levels at baseline and after 5 years of treatment with CSII and presence or absence of SH were recorded. The combined variables calculated included: a) HbA1c reduction by ≥ 0.5 points and absence of SH in the last 2 years; b) HbA1c at 5 years < 7.5% and no SH in the last 2 years; c) HbA1c < 8.5% and no HG in the last 2 years, and d) HbA1c reduction by ≥ 0.5 points and/or HbA1c < 7.5% at 5 years with no SH in the last 2 years of follow-up. Results: Twenty-seven of the 178 patients were excluded due to loss to follow-up or CSII discontinuation. A total of 151 patients (aged 37.4 ± 10.5 years, 64% women, diabetes duration of 19.2 ± 10.7 years) were therefore analyzed. The 2 main reasons for starting CSII were suboptimal metabolic control (60.9%) and severe hypoglycemia/hypoglycemia unawareness (28.5%). HbA1c levels in the total cohort and in patients with suboptimal metabolic control were 8.0 ± 1.2 and 8.4 ± 1.1% at CSII start and 7.8 ± 1.2 and 8.0 ± 1.3% at 5 years of treatment (P = .104 and P = .016) respectively. In the overall cohort, 55.5% of patients achieved at 5 years the combined goal of HbA1c < 7.5% and/or HbA1c reductions ≥ 0.5% without SH. Conclusions: After 5 years of CSII therapy, more than half of the patients achieved the combined goal of significant HbA1c reduction and absence of SH. The use of combined goals offers the opportunity to assess the effectiveness of T1DM treatment from a clinically more meaningful point of view


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Resultado do Tratamento , Insulina/administração & dosagem , Sistemas de Infusão de Insulina , Hipoglicemia/diagnóstico , Hipoglicemiantes/administração & dosagem , Hipoglicemia/tratamento farmacológico , Estudos Retrospectivos
4.
Ann Saudi Med ; 39(5): 359-361, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31580708

RESUMO

Hypoglycemia is a clinically significant disorder with a wide variety of underlying causes. We report an unusual case of hypoglycemic episodes caused by an iatrogenic infection in a 17-year-old white female who presented to our emergency department complaining of 2-3 episodes of syncope per week in the previous year, which started after an appendectomy in 2016. She was hypoglycemic and a vague painless abdominal mass was found upon palpation. An abdominal CT revealed a large, well-defined heterogeneous lesion. The excised mass was surrounded by pieces of gauze that had remained in her abdomen since the appendectomy. An asymptomatic infection was the cause of her hypoglycemic episodes. After antibiotic therapy, the abdominal symptoms resolved within the first week and at follow up at 6 months after surgery, her glucose level was back to normal. This is the first reported case of iatrogenic occult infection with episodic hypoglycemia as a cardinal feature. This case illustrates that infection should remain in the differential diagnosis although cardinal signs are absent. SIMILAR CASES PUBLISHED: 0.


Assuntos
Corpos Estranhos/complicações , Hipoglicemia/etiologia , /diagnóstico , Adolescente , Apendicectomia/efeitos adversos , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Hipoglicemia/diagnóstico , Doença Iatrogênica , /etiologia
5.
J Stroke Cerebrovasc Dis ; 28(12): 104346, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31548085

RESUMO

BACKGROUND: In patients with acute ischemic stroke, current guidelines recommend maintaining blood glucose levels in a range of 140-180 mg/dL and closely monitoring to prevent hypoglycemia (<60 mg/dL). We aimed to assess glucose variability by continuous glucose monitoring (CGM) and to demonstrate the risk of acute ischemic stroke patients with glucose levels outside of the glucose management recommendations. METHODS: Patients with ischemic stroke admitted within 7 days after onset were prospectively enrolled, and their blood glucose levels were monitored every 15 minutes for 72-hour period using the FreeStyle Libre Pro. Multivariate logistic regression analyses were used to analyze potential predictors for hyperglycemic (>180 mg/dL) and hypoglycemic (<60 mg/dL) events. RESULTS: A total of 39 acute ischemic stroke patients (mean age 75.9 ± 11.5 years) were enrolled, and CGM was started from 58.6 ± 41.9 hours after stroke onset. CGM showed hypoglycemic events in 19 patients and hyperglycemic events in 21 patients, and the frequencies of hypo- and hyperglycemic events during CGM were 10.1 ± 15.7% and 11.9 ± 22.5%, respectively. Hypoglycemic events were mainly observed in the night-time in patients with normoglycemia at admission. Logistic regression analyses demonstrated significant associations between the blood glucose level at admission and hypo- and hyperglycemic events on CGM. CONCLUSIONS: This study of CGM found that many stroke patients have blood glucose levels outside the recommended guideline range in the acute phase. Blood glucose level on admission may be used as a predictor for hypo- and hyperglycemic events after admission.


Assuntos
Glicemia/metabolismo , Isquemia Encefálica/sangue , Hiperglicemia/sangue , Hipoglicemia/sangue , Monitorização Fisiológica , Acidente Vascular Cerebral/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Feminino , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/terapia , Hipoglicemia/diagnóstico , Hipoglicemia/terapia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , Admissão do Paciente , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Fatores de Tempo
6.
Ann Biol Clin (Paris) ; 77(4): 439-445, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31418706

RESUMO

A 67 years old woman with a Waldenström disease was admitted in the intensive care unit for dyspnea and fever. During hospitalization, episodes of undetectable glycemia were observed without any hypoglycemia symptoms. Plasma glucose was determined with the hexokinase method (recommended). From this observation, a literature review on PubMed was performed to investigate similar cases. In patients with protides in excess (e.g. immunoproliferative syndrome), absorption measurements could be disrupted by the precipitation of excess protein (IgM in most cases). Other parameters could be affected: bilirubin, phosphate, HDL cholesterol, GGT, CRP and calcemia. In our case, the main difficulty was to identify the cause of the interference and then correct it. Using a series of dilution, we prevented protide precipitation allowing correct glucose determination. Those interferences are rare, but present a real analytical difficulty. Biologists should be aware of those interferences because of dramatics consequences.


Assuntos
Análise Química do Sangue/métodos , Glicemia/análise , Hexoquinase/metabolismo , Hipoglicemia/diagnóstico , Paraproteínas/efeitos adversos , Macroglobulinemia de Waldenstrom/sangue , Idoso , Artefatos , Análise Química do Sangue/normas , Glicemia/metabolismo , Diagnóstico Diferencial , Dispneia/sangue , Dispneia/diagnóstico , Dispneia/etiologia , Reações Falso-Positivas , Feminino , Febre/sangue , Febre/diagnóstico , Febre/etiologia , Hexoquinase/química , Humanos , Hipoglicemia/sangue , Paraproteínas/metabolismo , Hemorragia Retiniana/sangue , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/etiologia , Macroglobulinemia de Waldenstrom/complicações , Macroglobulinemia de Waldenstrom/diagnóstico
7.
BMC Endocr Disord ; 19(1): 91, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464602

RESUMO

OBJECTIVE AND BACKGROUND: In 2015 approximately 5.0 million people were estimated to have died from diabetes. Poor glycemic control is the most determinant of diabetes-related complication and death. The percentage of patients whose blood glucose level are not well controlled remains high yet. The aim of this study is to identify the determinants of poor glycemic control at the diabetes clinic of the Jimma University Medical Center from April 01 to June 30/2017. METHODS: Facility-based case-control study design was conducted on patients with type 2 diabetes mellitus on follow-up at the diabetes clinic of Jimma University medical center. The consecutive sampling technique was employed and data were collected from April to June 2017. The data were entered using Epidata manager version 4.0.2 and exported to SPSS Version 21 for analysis. Logistic regression analysis was performed and variables with the p-value of less than 0.05 were considered as statistically significant determinants of poor glycemic control. RESULT: The study was conducted on 410 patients, of which 228 males and 182 females. The determinants of poor glycemic control were comorbidities [Adjusted odd ratio(AOR) = 2.56, 95%CI = 1.10-5.96], lack of self-monitoring blood glucose [AOR = 3.44,95%CI = 1.33-8.94], total cholesterol level of 200 mg/dl or more [AOR = 3.62, 95%CI = 1.46-8.97], diabetes duration of greater than 7 years [AOR = 3.08, 95%CI = 1.33-7.16], physical activity of three or less than three days [AOR = 4.79, 95%CI = 1.70-13.53], waist to hip ratio of 0.9 or greater for male and 0.85 or greater for female [AOR = 3.52, 95%CI = 1.23-10.11], being on metformin plus insulin [AOR = 9.22, 95%CI = 2.90-29.35] and being on insulin [AOR = 4.48, 95%CI = 1.52-13.16]. CONCLUSION: Lack of Self-monitoring blood glucose, presence of comorbidities, duration of diabetes mellitus, physical activity of three or less than three days, total cholesterol of 200 mg/dl or more, waist to hip ratio of 0.9 or greater for male and 0.85 or greater for female, and types of antidiabetic medication were the independent predictors of poor glycemic control. Effort should be made towards reducing these factors by the concerned body.


Assuntos
Biomarcadores/análise , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hiperglicemia/epidemiologia , Hipoglicemia/epidemiologia , Hipoglicemiantes/efeitos adversos , Adulto , Idoso , Glicemia/análise , Estudos de Casos e Controles , Estudos Transversais , Etiópia/epidemiologia , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/induzido quimicamente , Hiperglicemia/diagnóstico , Hipoglicemia/induzido quimicamente , Hipoglicemia/diagnóstico , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco
8.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451477

RESUMO

Thyroid storm (accelerated hyperthyroidism) is an uncommon life-threatening emergency. The diagnosis is difficult and at times delayed owing to atypical presentation. Early diagnosis is the key to its successful management. We came across a patient who had presentations of acute abdomen but later diagnosed in thyroid storm. Multiorgan involvement leads all resuscitative measures futile and prevented us to salvage the patient.


Assuntos
Dor Abdominal , Hipoglicemia , Enteropatias/diagnóstico , Icterícia , Insuficiência de Múltiplos Órgãos , Crise Tireóidea , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Deterioração Clínica , Tratamento Conservador/métodos , Cuidados Críticos/métodos , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Hipoglicemia/diagnóstico , Hipoglicemia/etiologia , Icterícia/diagnóstico , Icterícia/etiologia , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapia , Crise Tireóidea/sangue , Crise Tireóidea/complicações , Crise Tireóidea/diagnóstico , Crise Tireóidea/terapia , Torsades de Pointes/diagnóstico , Torsades de Pointes/etiologia
10.
BMJ Case Rep ; 12(8)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466960

RESUMO

Cancer immunotherapy has been used in several malignancies with clinical benefit. Despite the clinical success, immune-related adverse events are frequent and endocrinopathies can be particularly severe. We report a 55-year-old male patient with stage IV pulmonary carcinoma treated with nivolumab who presented with thyroid dysfunction after the sixth administration of the drug. One year after thyroid dysfunction, the patient complained of severe fatigue, asthenia and weight loss. Laboratory testing showed low morning cortisol with undetected adrenocorticotropic hormone; other pituitary hormones were normal and MRI showed homogeneous enhancement of the pituitary gland and no space-occupying lesions. The diagnosis of nivolumab-induced hypophysitis was made and replacement treatment with hydrocortisone was started with clinical improvement. This case demonstrates that patients under immunotherapy are at risk for a large spectrum of endocrine dysfunctions that may worsen their prognosis. Close monitoring of these patients is warranted.


Assuntos
Hormônio Adrenocorticotrópico/deficiência , Antineoplásicos Imunológicos/efeitos adversos , Doenças do Sistema Endócrino/etiologia , Doenças Genéticas Inatas/etiologia , Hipoglicemia/etiologia , Hipotireoidismo/induzido quimicamente , Neoplasias Pulmonares/tratamento farmacológico , Nivolumabe/efeitos adversos , Hormônio Adrenocorticotrópico/sangue , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Carcinoma , Doenças do Sistema Endócrino/sangue , Doenças do Sistema Endócrino/diagnóstico , Doenças Genéticas Inatas/sangue , Doenças Genéticas Inatas/diagnóstico , Humanos , Hidrocortisona/administração & dosagem , Hidrocortisona/uso terapêutico , Hipoglicemia/sangue , Hipoglicemia/diagnóstico , Hipofisite/induzido quimicamente , Hipofisite/diagnóstico por imagem , Hipofisite/tratamento farmacológico , Hipotireoidismo/complicações , Neoplasias Pulmonares/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Nivolumabe/uso terapêutico , Resultado do Tratamento
11.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31439558

RESUMO

The increased use of immune checkpoint inhibitors (ICIs) has led to the observation of a variety of immune-related adverse events (irAEs). These irAEs occur usually within the first months after ICIs onset and can involve theorically all organs. We describe two rare irAEs occurring in a 70-year-old caucasian man who was treated with nivolumab for an advanced urothelial cancer of the left kidney. He developed an isolated adrenocorticotropic hormone deficiency that was diagnosed at week 19 and a neurological complication that appeared at week 79 and initially confounded with a lumbar spinal stenosis. Diagnosis of Guillain-Barré syndrome was finally confirmed with the complete resolution of symptoms after 5 days of intravenous immunoglobulin and corticosteroids. We highlight the importance of quickly recognising these potential life-threatening irAEs such as cortisol insufficiency and neurologic adverse events whose initially presentation could be non-specific.


Assuntos
Hormônio Adrenocorticotrópico/deficiência , Antineoplásicos Imunológicos/efeitos adversos , Doenças do Sistema Endócrino/diagnóstico , Doenças Genéticas Inatas/diagnóstico , Síndrome de Guillain-Barré/diagnóstico , Hipoglicemia/diagnóstico , Nivolumabe/efeitos adversos , Hormônio Adrenocorticotrópico/sangue , Idoso , Diagnóstico Diferencial , Doenças do Sistema Endócrino/sangue , Doenças do Sistema Endócrino/induzido quimicamente , Doenças Genéticas Inatas/sangue , Doenças Genéticas Inatas/induzido quimicamente , Síndrome de Guillain-Barré/induzido quimicamente , Síndrome de Guillain-Barré/complicações , Síndrome de Guillain-Barré/fisiopatologia , Humanos , Hipoglicemia/sangue , Hipoglicemia/induzido quimicamente , Masculino , Neoplasias Uretrais/tratamento farmacológico , Neoplasias Uretrais/cirurgia
12.
Endokrynol Pol ; 70(3): 277-297, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31290559

RESUMO

Hypoglycemia is a decrease in blood glucose concentration below the physiological level. It occurs in healthy people and in people with various diseases with inadequate secretion of insulin by ß cells, or deficiency of counterregulatory hormones secreted at the moment of hypoglycemia. Hypoglycemia is also associated with diabetes therapy, regardless of whether behavioral therapy, oral hypoglycemic agents, or insulin are used. Distinguishing the causes of hypoglycemia is the basis for taking appropriate therapeutic actions that protect patients against subsequent episodes of lowering blood glucose and complications caused by hypoglycemia.


Assuntos
Doenças do Sistema Endócrino/complicações , Hipoglicemia/diagnóstico , Hipoglicemiantes/efeitos adversos , Diagnóstico Diferencial , Feminino , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/tratamento farmacológico , Hipoglicemia/etiologia , Masculino , Guias de Prática Clínica como Assunto
13.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352401

RESUMO

Hypoglycaemia in infants and children is caused by a number of endocrine and metabolic defects, some of which are unique to this age group. Growth hormone deficiency (GHD) has been rarely reported as a cause of recurrent fasting hypoglycaemia in children. An 18-month-old male child presented to us for evaluation of neuroglycopenic symptoms caused by recurrent episodes of fasting hypoglycaemia. Laboratory evaluation revealed ketotic hypoinsulinaemic hypoglycaemia. The child was diagnosed to have GHD on the basis of two failed stimulation tests. A detailed work-up for metabolic and other hormonal causes of hypoglycaemia was negative. We present the case for its rarity and to highlight the importance of a detailed metabolic and hormonal assessment in evaluation of childhood hypoglycaemia.


Assuntos
Carboidratos da Dieta/uso terapêutico , Nanismo Hipofisário/diagnóstico , Jejum/efeitos adversos , Hormônio do Crescimento Humano/uso terapêutico , Hipoglicemia/diagnóstico , Aconselhamento Diretivo , Nanismo Hipofisário/complicações , Nanismo Hipofisário/fisiopatologia , Humanos , Hipoglicemia/etiologia , Hipoglicemia/fisiopatologia , Hipoglicemia/terapia , Lactente , Masculino , Recidiva , Resultado do Tratamento
14.
Diabetes Res Clin Pract ; 154: 75-81, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31271810

RESUMO

AIMS: To evaluate the impact of a prepregnancy care (PPC) programme, beyond HbA1c, on hypoglycaemia awareness and glycaemic variability (GV). METHODS: Prospective pilot study. We selected women with Type 1 diabetes who initiated a PPC programme with normal hypoglycaemia awareness (n = 24). Hypoglycaemia awareness, hypoglycaemic events and GV derived from masked-continuous glucose monitoring were evaluated in the first visit and within 2 weeks after pregnancy confirmation. RESULTS: The duration was 16.5 ±â€¯13.0 months. HbA1c significantly decreased (-0.8 ±â€¯0.7; p < 0.001). The Clarke score increased (0[0-1] vs. 1[0-2] points, p = 0.164), 2 out of 24 were reclassified as having impaired awareness of hypoglycaemia and 2 presented severe hypoglycaemia. GV decreased: standard deviation (p = 0.008), coefficient of variation (p = 0.021), mean amplitude of glycaemic excursions (p = 0.007), average daily risk range (p < 0.001), J-index (p = 0.010), high blood glucose index (HBGI) (p = 0.004), continuous overall net glycaemic action (CONGA) (p = 0.018), mean of daily differences (p = 0.045) and glycaemic risk assessment diabetes equation (p = 0.012). Final HbA1c was associated with baseline J-index, CONGA and HBGI (ß = 0.535, ß = 0.466, ß = 0.534, respectively; p < 0.05). CONCLUSIONS: A PPC programme improved HbA1c as well as GV with no significant impact on hypoglycaemia awareness. Moreover, GV could help to identify women less likely to achieve glycaemic targets. Larger studies are needed to confirm these results.


Assuntos
Automonitorização da Glicemia/normas , Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Conhecimentos, Atitudes e Prática em Saúde , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Cuidado Pré-Concepcional/métodos , Adulto , Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 1/tratamento farmacológico , Feminino , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/sangue , Hiperglicemia/induzido quimicamente , Hiperglicemia/diagnóstico , Hipoglicemia/sangue , Hipoglicemia/induzido quimicamente , Hipoglicemia/diagnóstico , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Projetos Piloto , Prognóstico , Estudos Prospectivos
15.
Medicine (Baltimore) ; 98(28): e16407, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305453

RESUMO

RATIONALE: The misdiagnosis of hypopituitarism is common due to its rarity and its nonspecific clinical manifestations. Our case report highlights the importance of critical evaluation regarding hypopituitarism as a cause of recurrent hypoglycemia, hyponatremia, and gastrointestinal symptoms in patients with T1DM, as misdiagnosis might be fatal to the patient. PATIENT CONCERNS: We herein report the case of 35-year-old female patient who presented with 18 years of history of well-controlled type 1 diabetes mellitus and a 6-month history of recurrent nausea and vomiting, generalized weakness, hyponatremia, and severe hypoglycemia, despite a reduction in the dose of insulin. She was considered as having "type 1 diabetes and gastroparesis." Four months later, she was diagnosed with hypothyroidism, and 25 µg/d of levothyroxine was prescribed. However, the levothyroxine had to be discontinued 1 week later because of frequent vomiting by the patient. DIAGNOSIS: Further evaluation in our hospital revealed low-normal adrenocorticotropic hormone, low-normal serum cortisol, and low 24-hours urinary cortisol excretion. Secondary hypothyroidism and hypogonadotropic hypogonadism were also demonstrated. Based on the endocrinological findings, she was diagnosed with hypopituitarism possibly due to lymphocytic hypophysitis. Diabetic nephropathy was another diagnosis made after kidney biopsy. INTERVENTIONS: The patient was treated with 100 mg/d of hydrocortisone intravenously for 2 weeks. After that, she continued on 15 mg/d of prednisone, and then 25 µg/d of levothyroxine was administered. OUTCOMES: The patient's insulin requirement increased to a premorbid level, the severe hypoglycemia resolved, the physical discomforts were alleviated, and blood electrolytes returned to normal. LESSONS: This uncommon case reinforced the significance of a timely diagnosis and appropriate treatment of hypopituitarism. We recommend that physicians focus their awareness on this potentially life-threatening disease, as it is a condition potentially fatal to the patient if not recognized and treated.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Hipoglicemia/etiologia , Hiponatremia/etiologia , Hipopituitarismo/complicações , Adulto , Nefropatias Diabéticas/complicações , Diagnóstico Diferencial , Feminino , Humanos , Hipoglicemia/diagnóstico , Hipoglicemia/tratamento farmacológico , Hiponatremia/diagnóstico , Hiponatremia/tratamento farmacológico , Hipopituitarismo/diagnóstico , Hipopituitarismo/tratamento farmacológico
16.
J Pediatr Endocrinol Metab ; 32(7): 767-774, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31211689

RESUMO

Background Persistent hypoglycemia (PH) beyond 3 days of life warrants investigation which includes a critical sample. We report our case series of five neonates who presented with PH as the first sign of congenital hypopituitarism. Design This is a case series. Methods/Results This is a case series of five neonates evaluated at our academic institution in a 3-year period (2013-2016), who presented with persistent severe hypoglycemia and were subsequently diagnosed with congenital hypopituitarism. All neonates were full term (mean gestational age 39.8 ± 1.4 weeks) born by caesarian section with a mean weight of 3.5 ± 0.16 kg and a mean length of 51.2 ± 1.2 cm at birth. All five neonates had PH beyond 3 days with an average blood glucose (BG) <35 mg/dL at presentation, requiring a mean glucose infusion rate (GIR) of 7.22 ± 1.98 mg/kg/min. The average BG during the critical sample was 42 ± 0.16 mg/dL (three patients). The mean duration of requirement of the glucose infusion was 6.2 ± 3 days during the immediate neonatal period. Diagnosis of the hypopituitarism took 2-52 days from the initial presentation of hypoglycemia. Besides growth hormone (GH) deficiency, cortisol deficiency was diagnosed in all the five neonates. Neuroimaging findings in all the neonates were consistent with pituitary stalk interruption syndrome (hypoplastic anterior pituitary, ectopic posterior pituitary [EPP] and interrupted pituitary stalk). Conclusions Hypoglycemia is a common metabolic complication affecting an infant in the immediate neonatal period. Delay in the diagnosis of hypopituitarism presenting as hypoglycemia is the result of the lack of awareness among neonatologists and/or pediatricians. We propose that providers be cognizant that PH can be the only presentation of hypopituitarism in the neonatal period. Therefore, having a high index of suspicion about this condition can avoid a delay in the evaluation, diagnosis and treatment of hypopituitarism.


Assuntos
Hipoglicemia/etiologia , Hipopituitarismo/congênito , Hipopituitarismo/complicações , Doenças do Recém-Nascido/etiologia , Índice de Gravidade de Doença , Biomarcadores/análise , Feminino , Humanos , Hipoglicemia/diagnóstico , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Masculino , Gravidez , Prognóstico
17.
Diabetes Res Clin Pract ; 154: 27-34, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31238060

RESUMO

AIMS: To evaluate the natural history of gastric emptying in type 2 diabetes. METHODS: 12 patients with type 2 diabetes (7 female; age 65.6 ±â€¯1.2 years; duration of known diabetes 22.9 ±â€¯1.5 years) were invited to return for repeat measurements of gastric emptying using the same dual-labelled solid and liquid meal, a mean of 14.0 ±â€¯0.5 years after their initial study. Blood glucose levels, glycated haemoglobin, upper gastrointestinal symptoms and autonomic nerve function at baseline and follow up were also compared. RESULTS: Gastric emptying of solids was more rapid at follow up than at baseline (period effect P < 0.05), while emptying of liquids was comparable at baseline and follow up (period effect P = 0.2). Gastric emptying of the solid component was abnormally slow (based on T100min) in 6 subjects at baseline and 1 subject at follow up. Liquid emptying was abnormally slow in 6 subjects at baseline, and 5 subjects at follow up. Two patients were insulin treated at baseline, and 6 at follow up. HbA1c was higher at follow up (P < 0.05); however, fasting blood glucose (P = 0.6), postprandial blood glucose excursions (P = 0.07), autonomic nerve function (P > 0.999), and total upper gastrointestinal symptom score (P = 0.1) did not differ. CONCLUSIONS: In patients with long-term type 2 diabetes, gastric emptying of solids and liquids does not usually become more delayed over time, and abnormally slow gastric emptying of solids may improve.


Assuntos
Complicações do Diabetes/etiologia , Diabetes Mellitus Tipo 2/complicações , Neuropatias Diabéticas/etiologia , Esvaziamento Gástrico , Gastroenteropatias/etiologia , Hiperglicemia/etiologia , Hipoglicemia/etiologia , Idoso , Glicemia/análise , Complicações do Diabetes/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatologia , Neuropatias Diabéticas/diagnóstico , Feminino , Gastroenteropatias/diagnóstico , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/diagnóstico , Hipoglicemia/diagnóstico , Insulina/análise , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico
18.
Diabetes Res Clin Pract ; 154: 138-145, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31150723

RESUMO

AIM: To evaluate the predictive factors of glycemic control in children and adolescents with type 1 diabetes mellitus (T1DM). METHODS: Cross-sectional study at a referral service in Rio de Janeiro, Brazil. Sociodemographic, anthropometric, clinical, and dietary factors were evaluated. Food consumption was evaluated by 24 h dietary recall and the NOVA system was adopted for classifying the foods according to the extent and purpose of industrial processing. The predictive factors were evaluated by multivariate linear regression, adopting p < 0.05. RESULTS: One hundred and twenty children and adolescents participated, with a mean age of 11.74 years (±2.88) and HbA1c of 8.13% (±1.26). The mean diabetes duration was 6.68 years (±3.33) and the insulin used was 1.05 units per kilogram of ideal weight (IU/kg of ideal weight; ±0.46) About 80% (n = 96) used carbohydrate counting and it was verified that 24.27% (±17.89) of the participants' total calories came from ultraprocessed foods. For each year of diagnosis with T1DM and for each IU/kg of weight used, HbA1c increased by 0.087% (ß = 0.087, p = 0.007) and 0.651%, respectively (ß = 0.651; p = <0.001). Use of carbohydrate counting was associated with a 1.058% reduction in HbA1c (ß = -1.058; p = 0.001). CONCLUSION: Disease duration and insulin dose were directly reflected in HbA1c concentrations, while carbohydrate counting showed an inverse association.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hemoglobina A Glicada/análise , Hiperglicemia/diagnóstico , Hipoglicemia/diagnóstico , Insulina/administração & dosagem , Encaminhamento e Consulta , Adolescente , Peso Corporal , Brasil/epidemiologia , Criança , Estudos Transversais , Diabetes Mellitus Tipo 1/fisiopatologia , Ingestão de Energia , Feminino , Humanos , Hiperglicemia/epidemiologia , Hiperglicemia/prevenção & controle , Hipoglicemia/epidemiologia , Hipoglicemia/prevenção & controle , Masculino , Valor Preditivo dos Testes , Prevalência
19.
BMC Endocr Disord ; 19(1): 57, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170961

RESUMO

BACKGROUND: Although exercise seems to be beneficial for type 2 diabetes mellitus (T2DM) patients, there is limited research elucidating the optimal accessible indices of adiposity and insulin resistance for identifying elderly T2DM patients with poor glycemic control, which could be improved by performing regular exercise. METHODS: A community-based, cross-sectional study was conducted with 918 Chinese elderly individuals with T2DM in Zhejiang. Relevant risk factors for poor glycemic control, as determined using glycated haemoglobin A1c (HbA1c) > 7%, were explored using logistic regression analyses and included body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), fasting blood glucose (FBG), triglycerides (TGs), total cholesterol (TC), the product of fasting triglycerides and glucose (TyG), visceral adiposity index (VAI), lipid accumulation product (LAP), TyG-BMI, and TyG-WC. Comparisons of the risk factors' ability to discriminate poor glycemic control as well as their optimal cutoff values were determined using receiver operating characteristic (ROC) analyses, and then the extent of poor glycemic control risk reduction through regular exercise was examined using multivariate logistic regression analyses. RESULTS: The overall poor glycemic control rate was 49.3%. The factors associated with poor glycemic control included FBG > 3.869, TyG > 8.73, TyG-BMI > 222.45, and TyG-WC > 713.48 in logistic regression analyses. The optimal cutoff points of FBG, TyG, TyG-WC, and TyG-BMI in discriminating poor glycemic control were 7.38, 9.22, 813.33, and 227.77, and their corresponding areas under the ROC curves were 0.864(0.840-0.886), 0.684(0.653-0.714), 0.604(0.571-0.635), and 0.574(0.541-0.606), respectively. Occasional and regular exercise reduced the odds ratios (95% confidence interval) of poor glycemic control to 0.187 (0.063-0.557) and 0.183 (0.059-0.571) for subjects with TyG-WC > 813.33 (p = 0.008), to 0.349 (0.156-0.782) and 0.284 (0.123-0.652) for subjects with TyG > 9.22 (p = 0.011), and to 0.390 (0.175-0.869) and 0.300(0.130-0.688) for subjects with TyG-BMI > 227.77 (p = 0.017), respectively, after adjusting for multiple confounding factors. CONCLUSION: Among elderly individuals with T2DM, poor glycemic control risk might be identified using indices calculated from FBG, TG, BMI, and WC measurements, which are indicative of adiposity and insulin resistance. TyG-WC seems to be an accessible and useful indicator to identify which elderly T2DM patients would benefit from performing regular exercise to achieve good glycemic control.


Assuntos
Automonitorização da Glicemia/estatística & dados numéricos , Diabetes Mellitus Tipo 2/fisiopatologia , Hiperglicemia/diagnóstico , Hipoglicemia/diagnóstico , Vida Independente/estatística & dados numéricos , Resistência à Insulina , Obesidade Abdominal/complicações , Adiposidade , Idoso , Biomarcadores/análise , China/epidemiologia , Estudos Transversais , Terapia por Exercício , Feminino , Seguimentos , Humanos , Hiperglicemia/epidemiologia , Hiperglicemia/prevenção & controle , Hipoglicemia/epidemiologia , Hipoglicemia/prevenção & controle , Masculino , Prognóstico , Curva ROC , Fatores de Risco
20.
Diabetes Res Clin Pract ; 152: 96-102, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31108139

RESUMO

AIMS: Hyperglycemia is the major factor underlying vascular complications of diabetes. Unfortunately, improved glycemia control is frequently accompanied by an increased risk of hypoglycemia. The aim of the study was to assess the relationship between hemoglobin A1c (HbA1c) and 1-week Continuous Glucose Monitoring (CGM) data in long-standing type 1 diabetes (T1DM). METHODS: We recruited 58 subjects with long-standing T1DM consecutively enrolled to the study. Each patient underwent a 1-week CGM and laboratory profile at baseline. Subjects were divided into three subgroups according to baseline HbA1c tertiles: T1 < 7.1%, T2 = 7.1-8.0%, and T3 > 8.0%. RESULTS: T1 patients were characterized by the longest time in range (66% of a week), whereas T3 patients experienced hyperglycemia in >50% time of the week. T1 patients were noted to have 25% of nighttime with glycemia <3.9 mmol/L (8% with glycemia <2.8 mmol/L). Most recent HbA1c closely reflected 10-years mean HbA1c values (R = 0.83; P < 0.0001). CONCLUSIONS: (1) Long-term diabetes control (10 years HbA1c mean) is a strong predictor of the current HbA1c levels. (2) Current and historical HbA1c levels are closely linked to CGM-derived glycemia. (3) Risk of clinically significant hypoglycemia negatively correlates with HbA1c. (4) HbA1c > 8.0% is associated with unsatisfactorily low (44%) time in range.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Hemoglobina A Glicada/metabolismo , Hipoglicemia/sangue , Adulto , Idoso , Glicemia/metabolismo , Automonitorização da Glicemia , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/patologia , Angiopatias Diabéticas/sangue , Testes Diagnósticos de Rotina , Progressão da Doença , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hipoglicemia/diagnóstico , Hipoglicemia/etiologia , Masculino , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente , Fatores de Risco , Fatores de Tempo
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