Hypoglycemia-associated autonomic failure in diabetes

Hypoglycemia is the limiting factor in the glycemic management of diabetes. The concept of hypoglycemia-associated autonomic failure (HAAF) in diabetes posits that recent antecedent iatrogenic hypoglycemia causes both defective glucose counterregulation (by reducing the epinephrine response to falling glucose levels in the setting of an absent glucagon response) and hypoglycemia unawareness (by reducing the autonomic and the resulting neurogenic symptom responses) and thus a vicious cycle of recurrent hypoglycemia. Perhaps the most compelling support for HAAF is the finding that as little as 2–3 wk of scrupulous avoidance of hypoglycemia reverses hypoglycemia unawareness and improves the reduced epinephrine component of defective glucose counterregulation in most affected individuals. Insight into this pathophysiology has led to a broader view of the clinical risk factors for hypoglycemia to include indexes of compromised glucose counterregulation and provided a framework for the study of the mechanisms of iatrogenic hypoglycemia and, ultimately, its elimination from the lives of people with diabetes.

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To Predict the Requirement of Pharmacotherapy by OGTT Glucose Levels in Women with GDM Classified by the IADPSG Criteria

Journal of Diabetes Research ◽

10.1155/2018/3243754 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Gülen Yerlikaya ◽

Veronica Falcone ◽

Tina Stopp ◽

Martina Mittlböck ◽

Andrea Tura ◽

...

Keyword(s):

Risk Factors ◽

Random Forest ◽

Risk Stratification ◽

Predictive Accuracy ◽

Lifestyle Modification ◽

Clinical Risk Factors ◽

Random Forest Analysis ◽

Glucose Levels ◽

Clinical Risk ◽

Iadpsg Criteria

The aim of this study was to assess the association between OGTT glucose levels and requirement of pharmacotherapy in GDM patients classified by the IADPSG criteria. This study included 203 GDM patients (108 managed with lifestyle modification and 95 requiring pharmacotherapy). Clinical risk factors and OGTT glucose concentrations at 0 (G0), 60 (G60), and 120 min (G120) were collected. OGTT glucose levels were significantly associated with the later requirement of pharmacotherapy (ROC-AUC: 71.1, 95% CI: 63.8–78.3). Also, the combination of clinical risk factors (age, BMI, parity, and pharmacotherapy in previous gestation) showed an acceptable predictive accuracy (ROC-AUC: 72.1, 95% CI: 65.0–79.2), which was further improved when glycemic parameters were added (ROC-AUC: 77.5, 95% CI: 71.5–83.9). Random forest analysis revealed the highest variable importance for G0, G60, and age. OGTT glucose measures in addition to clinical risk factors showed promising properties for risk stratification in GDM patients classified by the recently established IADPSG criteria.

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Recurrent hypoglycemia alters hypothalamic expression of the regulatory proteins FosB and synaptophysin

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.90511.2008 ◽

2008 ◽

Vol 295 (5) ◽

pp. R1446-R1454 ◽

Cited By ~ 16

Author(s):

Salwa Al-Noori ◽

Nicole M. Sanders ◽

Gerald J. Taborsky ◽

Charles W. Wilkinson ◽

Aryana Zavosh ◽

...

Keyword(s):

Autonomic Failure ◽

Regulatory Proteins ◽

Early Gene ◽

Limiting Factor ◽

Dual Fluorescence ◽

Neuronal Populations ◽

Hypothalamic Nuclei ◽

Fluorescence Immunohistochemistry ◽

Recurrent Hypoglycemia ◽

Hypothalamic Activation

A limiting factor to the clinical management of diabetes is iatrogenic hypoglycemia. With multiple hypoglycemic episodes, the collective neuroendocrine response that restores euglycemia is impaired. In our animal model of recurrent hypoglycemia (RH), neuroendocrine deficits are accompanied by a decrease in medial hypothalamic activation. Here we tested the hypothesis that the medial hypothalamus may exhibit unique changes in the expression of regulatory proteins in response to RH. We report that expression of the immediate early gene FosB is increased in medial hypothalamic nuclei, anterior hypothalamus, and posterior paraventricular nucleus of the thalamus (THPVN) of the thalamus following RH. We identified the hypothalamic PVN, a key autonomic output site, among the regions expressing FosB. To identify the subtype(s) of neuronal populations that express FosB, we screened candidate neuropeptides of the PVN for coexpression using dual fluorescence immunohistochemistry. Among the neuropeptides analyzed [including oxytocin, vasopressin, thyrotropin-releasing hormone, and corticotropin-releasing factor (CRF)], FosB was only identified in CRF-positive neurons. Inhibitory γ-aminobutyric acid-positive processes appear to impinge on these FosB-expressing neurons. Finally, we observed a significant decrease in the presynaptic marker synaptophysin within the PVN of RH-treated vs. saline-treated rats, suggesting that rapid alterations of synaptic morphology may occur in association with RH. Collectively, these data suggest that RH stress triggers cellular changes that support synaptic plasticity, in specific neuroanatomical sites, which may contribute to the development of hypoglycemia-associated autonomic failure.

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438 Predictive impact of clinical risk factors and the inducibility of ventricular fibrillation in patients with an asymptomatic Brugada-type ECG

EP Europace ◽

10.1016/s1099-5129(05)80290-9 ◽

2005 ◽

Vol 7 ◽

pp. 98-98

Keyword(s):

Risk Factors ◽

Ventricular Fibrillation ◽

Clinical Risk Factors ◽

Clinical Risk

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The impact of standard clinical risk factors on determination of optimal mammographic density cutpoints

10.26226/morressier.5ade45fdd462b8029238e7dc ◽

2018 ◽

Author(s):

Sian Iles

Keyword(s):

Risk Factors ◽

Mammographic Density ◽

Clinical Risk Factors ◽

Clinical Risk ◽

The Impact

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Faculty Opinions recommendation of Molecular and clinical risk factors for recurrence of skull base chordomas: gain on chromosome 2p, expression of brachyury, and lack of irradiation negatively correlate with patient prognosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718084150.793526065 ◽

2016 ◽

Author(s):

Carlos Bagley

Keyword(s):

Risk Factors ◽

Skull Base ◽

Clinical Risk Factors ◽

Clinical Risk ◽

Risk Factors For Recurrence ◽

Skull Base Chordomas ◽

Patient Prognosis

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Long-Term Follow-Up of Patients With Isolated Side Branch Coronary Artery Disease

Angiology ◽

10.1177/00033197211028024 ◽

2021 ◽

pp. 000331972110280

Author(s):

Sukru Arslan ◽

Ahmet Yildiz ◽

Okay Abaci ◽

Urfan Jafarov ◽

Servet Batit ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Vessel Diameter ◽

Side Branch ◽

Clinical Risk Factors ◽

Clinical Risk ◽

Artery Disease

The data with respect to stable coronary artery disease (SCAD) are mainly confined to main vessel disease. However, there is a lack of information and long-term outcomes regarding isolated side branch disease. This study aimed to evaluate long-term major adverse cardiac and cerebrovascular events (MACCEs) in patients with isolated side branch coronary artery disease (CAD). A total of 437 patients with isolated side branch SCAD were included. After a median follow-up of 38 months, the overall MACCE and all-cause mortality rates were 14.6% and 5.9%, respectively. Among angiographic features, 68.2% of patients had diagonal artery and 82.2% had ostial lesions. In 28.8% of patients, the vessel diameter was ≥2.75 mm. According to the American College of Cardiology lesion classification, 84.2% of patients had either class B or C lesions. Age, ostial lesions, glycated hemoglobin A1c, and neutrophil levels were independent predictors of MACCE. On the other hand, side branch location, vessel diameter, and lesion complexity did not affect outcomes. Clinical risk factors seem to have a greater impact on MACCE rather than lesion morphology. Therefore, the treatment of clinical risk factors is of paramount importance in these patients.

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