Hepatocellular Glycogen Accumulation in the Setting of Poorly Controlled Type 1 Diabetes Mellitus: Case Report and Review of the Literature

Glycogenic hepatopathy (GH) is the accumulation of glycogen in the hepatocytes and represents a rare complication in patients with diabetes mellitus (DM), most commonly type 1 DM. We present a case of a 23-year-old woman with a medical history of poorly controlled type 1 DM and gastroesophageal reflux disease (GERD) who presented with progressively worsening right-sided abdominal pain. Diagnostic workup resulted in a liver biopsy with hepatocytes that stained heavily for glycogen with no evidence of fibrosis or steatohepatitis. A diagnosis of glycogenic hepatopathy was made, and an aggressive glucose control regimen was implemented leading to resolution of symptoms and improvement in AST, ALT, and ALP. In addition to presenting this rare case, we offer a review of literature and draw important distinctions between glycogenic hepatopathy and other differential diagnoses with the aim of assisting providers in the diagnostic workup and treatment of glycogenic hepatopathy.

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A literature review and meta-analysis of safety profiles of SGLT2 inhibitors in Japanese patients with diabetes mellitus

Scientific Reports ◽

10.1038/s41598-021-92925-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Junichi Mukai ◽

Shinya Kanno ◽

Rie Kubota

Keyword(s):

Diabetes Mellitus ◽

Meta Analysis ◽

Japanese Patients ◽

Sglt2 Inhibitors ◽

Patients With Diabetes ◽

Language Restriction ◽

Calculated Risk ◽

Favorable Safety ◽

Type 1 Dm

AbstractThe safety profiles of sodium-glucose co-transporter 2 (SGLT2) inhibitors may depend on races/ethnicities. We aimed to assess the safety profiles of SGLT2 inhibitors in Japanese patients with diabetes mellitus (DM). The electronic databases MEDLINE, CENTRAL, and Ichushi-web were searched for studies with no language restriction from their inception to August 2019. Trials were included in the analysis if they were randomized controlled trials (RCTs) comparing the effects of SGLT2 inhibitors with a placebo in Japanese patients with DM > 18 years and reporting HbA1c and at least 1 adverse event. We calculated risk ratios with 95% CIs and used a random-effects model. Of the 22 RCTs included in our review, only 1 included patients with type 1 DM. The durations of RCTs ranged between 4 and 24 weeks. In comparison with a placebo, SGLT2 inhibitors were associated with similar risks of hypoglycemia, urinary tract infection, genital infection, hypovolemia, and fracture. The outcomes of treatment with SGLT2 inhibitors among Japanese patients with DM suggest favorable safety profiles. However, further evidence from studies with a longer duration, involving more diverse populations, such as patients with different types of DM, or including individual SGLT2 inhibitors is needed to resolve the limitations of the present study.

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Novel Molecular Evidence Related to COVID-19 in Patients with Diabetes Mellitus

Journal of Clinical Medicine ◽

10.3390/jcm9123962 ◽

2020 ◽

Vol 9 (12) ◽

pp. 3962

Author(s):

Yu-Huang Liao ◽

Jing-Quan Zheng ◽

Cai-Mei Zheng ◽

Kuo-Cheng Lu ◽

You-Chen Chao

Keyword(s):

Diabetes Mellitus ◽

Viral Entry ◽

Cell Injury ◽

Molecular Evidence ◽

Protective Effects ◽

Cytosolic Ph ◽

S Protein ◽

Patients With Diabetes ◽

Type 1 Dm

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly evolved into a global pandemic. The hyperglycemia in patients with diabetes mellitus (DM) substantially compromises their innate immune system. SARS-CoV-2 uses human angiotensin-converting enzyme 2 (ACE2) receptors to enter the affected cell. Uncontrolled hyperglycemia-induced glycosylation of ACE2 and the S protein of SARS-CoV-2 could facilitate the binding of S protein to ACE2, enabling viral entry. Downregulation of ACE2 activity secondary to SARS-CoV-2 infection, with consequent accumulation of angiotensin II and metabolites, eventually leads to poor outcomes. The altered binding of ACE2 with SARS-CoV-2 and the compromised innate immunity of patients with DM increase their susceptibility to COVID-19; COVID-19 induces pancreatic β-cell injury and poor glycemic control, which further compromises the immune response and aggravates hyperglycemia and COVID-19 progression, forming a vicious cycle. Sequential cleavage of viral S protein by furin and transmembrane serine protease 2 (TMPRSS2) triggers viral entry to release the viral genome into the target cell. Hence, TMPRSS2 and furin are possible drug targets. As type 1 DM exhibits a Th1-driven autoimmune process, the relatively lower mortality of COVID-19 in type 1 DM compared to type 2 DM might be attributed to an imbalance between Th1 and Th2 immunity. The anti-inflammatory effects of dipeptidyl peptidase-4 inhibitor may benefit patients with DM and COVID-19. The potential protective effects of sodium–glucose cotransporter-2 inhibitor (SGLT2i), including reduction in lactate level, prevention of lowering of cytosolic pH and reduction in pro-inflammatory cytokine levels may justify the provision of SGLT2i to patients with DM and mild or asymptomatic COVID-19. For patients with DM and COVID-19 who require hospitalization, insulin-based treatment is recommended with cessation of metformin and SGLT2i. Further evidence from randomized or case–control clinical trials is necessary to elucidate the effectiveness and pitfalls of different types of medication for DM.

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Comparative characteristics of the fetoplacental complex in women with type 1 diabetes and in pregnant women with gestational diabetes

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2019-23(4)-16 ◽

2019 ◽

Vol 23 (4) ◽

pp. 652-658

Author(s):

A.P. Dnistryanska ◽

O.S. Musienko ◽

L.V. Yaremchuk

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Gestational Diabetes ◽

Pregnant Women ◽

Termination Of Pregnancy ◽

Fetoplacental Complex ◽

Biophysical Profile ◽

Patients With Diabetes ◽

History Of

Annotation. In the structure of causes of maternal mortality, extragenital pathology accounts for 25%. Among them, endocrine pathology is 6%, diabetes accounts for 31.9%. 1% of women of childbearing age suffer from type 1 diabetes, and 2–17% has gestational diabetes (GD). The aim is to compare the condition of the fetoplacental complex in the third trimester of pregnancy in 9 pregnant women with type 1 diabetes (group 1) and in 12 women with GD (group 2) who were observed at “Vinnitsa City Clinical Hospital and child” for 2016–2019. The control group included 10 patients with physiological pregnancy. Women with diabetes had a history of gynecological diseases: colpitis (8 patients (88.8%)), cervical erosion (2 (22.2%)), chronic adnexitis (5 (55.5%)). Among the complications of previous pregnancies in the group of patients with diabetes mellitus (5 births) were unauthorized miscarriages (1 (11.1%)), the risk of termination of pregnancy (5 (55%)). In women with a history of GD, colpitis was observed in 3 (24.9%), which is significantly less than in women with type 1 diabetes. There were 2 pregnant women with GD: preterm births (16.6%). Among the complications of pregnancy in 1 patient was the threat of abortion in previous cases. Changes in the indexes of hemodynamics of the uterine-placental complex were evaluated on the basis of cardiotocography, ultrasound on ultrasound machine “Logic-5” with 2D measurement, Doppler, evaluation of the biophysical profile of the fetus (BPF). Statistical data processing was performed by calculating Student coefficients (+) using the Microsoft Excel program. It was established that in the 1st trimester of pregnancy, 5 (55.5%) women with type 1 diabetes were diagnosed with a threat of termination of pregnancy (TTP), and in the 1st (11.1%), they had a retroplacental hematoma. Two (22.2%) women with GD were diagnosed with TTF. In the 2nd trimester, 2 women with GD remained symptomatic of TTF. Six (66.7%) women with type 1 diabetes have symptoms of TTF. In the 1 pregnant woman developed pyelonephritis. Childbirth in 8 (88.8%) women with type 1 diabetes ended through natural birth canal, in 1 woman — a caesarean section. The weight of the child was 4435±2 g. In women with GD the weight of the child was 3756±12. In 7 (77.8%) patients, fetal weight exceeded 4000 g. BPF in the group of patients with diabetes was significantly different from the group with GD at 37–38 weeks of pregnancy. BPF in the 1st group — 7.6±0.2, in the 2nd group — 8.7±0.2, resistance index (RI): 1st group — 0.61±0.01, 2-ha group — 0.57±0.01, CO/K: in the 1st group — 3.2±0.1, in the 2nd group — 3.1±0.1. The correlation between the level of GD compensation and pathological changes in the fetoplacental complex has been established. The data obtained indicate that early screening of this pathology and appropriate compensation for carbohydrate metabolism in the presence of diabetes mellitus should be noted as one of the methods for the prevention of the development of complications in GD.

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Thyroid dysfunction in patients with diabetes mellitus at Puducherry, India: a retrospective study

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20182445 ◽

2018 ◽

Vol 5 (4) ◽

pp. 822

Author(s):

K. Shaik Anwar Hussain

Keyword(s):

Diabetes Mellitus ◽

Retrospective Study ◽

Thyroid Dysfunction ◽

Diabetic Patients ◽

Type Ii ◽

Patients With Diabetes ◽

Study Participants ◽

Type 1 Dm

Background: There is a complex interrelationship in the co-existence of thyroid dysfunction among diabetic patients and may be related to the development of cardiovascular diseases and other complications of long term metabolic derangements. The prevalence of thyroid dysfunction varies from 10 to 24% among diabetic patients. The objective of the present study was to determine the prevalence of thyroid dysfunction among the patients with diabetes mellitus in a tertiary care hospital at Puducherry, India.Methods: This retrospective study was conducted during June 2018 analysing the records of diabetes patients attending to the diabetes OPD, Department of General Medicine in the past one year and their association with thyroid dysfunction was studied.Results: Among the study participants (n=200), 14.5% (n=29) were Type I diabetics and 85.5% (n=171) were type II Diabetes patients. The prevalence of Thyroid Dysfunction (TD) among the study participants was 28.5% (n=57). The proportion of TD was higher among type 1 DM compared to type 2 (p<0.001). The prevalence of subclinical hypothyroidism was more (n=7, 24.1%) among type 1DM compared to type II DM patients (p=0.05).Conclusions: There was a higher prevalence of TD among the diabetics. TD was more frequent among type 1 DM compared to Type 2 DM patients and the most frequent TD associated with diabetes was subclinical hypothyroidism.

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A mathematical model for stratification of LADA risk groups

Diabetes Mellitus ◽

10.14341/dm2014115-20 ◽

2014 ◽

Vol 17 (1) ◽

pp. 15-20

Author(s):

Tatiana M. Tikhonova

Keyword(s):

Diabetes Mellitus ◽

Discriminant Analysis ◽

Clinical Characteristics ◽

Risk Groups ◽

Early Evidence ◽

Progressive Loss ◽

Patients With Diabetes ◽

History Of

Aim. To stratify risk groups via discriminant analysis based on the most clinically relevant indications of LADA onset derived from medical history.Materials and Methods. Present study included 141 patients with diabetes mellitus (DM) of whom 65 had preliminary diagnosis of LADA, 40 patients were diagnosed with type 1 diabetes mellitus (T1DM) and 36 ? with type 2 diabetes mellitus (T2DM). Discriminant analysis was performed to evaluate the differences between the clinical onsets in study groups.Results. Aside from torpid onset with early evidence for insulin resistance, clinical characteristics of LADA included diagnosis during random examination, progressive loss of body mass, hyperglycemia greater than 14 mmol/L at the diagnosis and, possibly, ketonuria without history of acute ketoacidosis.Conclusion. Discriminant analysis is beneficial in stratifying risk groups for the development of LADA.

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UNCONTROLLED TYPE 1 DIABETES MELLITUS WITH TUBERCULOMA IN INFERIOR LOBE LEFT LUNG AND BILATERAL HYDRONEPHROSIS IN CHILD

Medical and Health Science Journal ◽

10.33086/mhsj.v3i2.1155 ◽

2019 ◽

Vol 3 (2) ◽

pp. 5

Author(s):

Anggia Rarasati Wardhana ◽

Sukartini Sukartini ◽

Annisa Muhyi

Keyword(s):

Diabetes Mellitus ◽

Clinical Symptoms ◽

Previous History ◽

Left Lung ◽

Laboratory Findings ◽

Bilateral Hydronephrosis ◽

Increased Risk ◽

History Of ◽

Type 1 Dm

Diabetes Mellitus (DM) is an important risk factor for the development of active tuberculosis (TB). It is chronic and will weaken the immune system causing the patient have increased risk of tuberculosis by three-fold.We present a case of 13-year-old girl with chest pain and cough. She has a previous history of type 1 DM. Laboratory findings showed hyperglycemic state. Thoracic CT showed tuberculoma of inferoposterior lobe left lung, while abdominal CT showed bilateral hydronephrosis. He was then administered TB treatment of 2HRZE/10RH, corticosteroid, and insulin regiments with strict monitoring of blood glucoses. Clinical symptoms and blood glucose level were significantly improved after treatment.

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IMMUNOLOGICAL FEATURES OF THE DYNAMICS OF THE I DEGREE SEVERETY BACTERIAL KERATITES DEPENDING ON THE PRESENCE OF DIABETES MELLITUS

Kharkiv Surgical School ◽

10.37699/2308-7005.3.2021.12 ◽

2021 ◽

pp. 63-68

Author(s):

O. V. Zavoloka ◽

P. A. Bezditko ◽

L. P. Abramova ◽

V. O. Vekshyn

Keyword(s):

Diabetes Mellitus ◽

Enzyme Linked Immunosorbent Assay ◽

Observation Data ◽

Bacterial Keratitis ◽

Lacrimal Fluid ◽

Patients With Diabetes ◽

Contralateral Eye ◽

Instructions For Use ◽

Type 1 Dm

Summary. In patients with diabetes mellitus (DM) there are features of the dynamics of the I degree severity bacterial keratitis, leading to prolongation of the disease and worsening of its consequences. The aim was to identify immunological features of the dynamics of the I degree severity bacterial keratitis depending on the presence of type 1 DM. Materials and methods. The level of interleukins (IL) was analyzed, namely IL-1β, IL-6 and IL-10 in the lacrimal fluid of the sick and the contralateral eye of 6 patients with type 1 DM and the I degree severity bacterial keratitis and 6 nondiabetic patients with I degree severity bacterial keratitis on the 1st day, 10-14th day and 24th day of observation. Data from 14 healthy individuals of the appropriate age were used for comparison. The severity of bacterial keratitis was determined according to our scheme at a total score of ≤ 14. All patients were treated with instillations of ofloxacin, antiseptics, antioxidants, reparents, artificial tears, mydriatics, systemic anti-inflammatory therapy. The level of IL in the lacrimal fluid was determined by quantitative colorimetric enzyme-linked immunosorbent assay using ELISA kits by ANOGEN according to the instructions for use. Results and discussion. In patients with I degree severity bacterial keratitis, both DM and nondiabetic, on the 1st day of observation there was an increase in the level of IL-1β and IL-6 in the lacrimal fluid of the sick eye and IL-10 – of the contralateral eye compared to healthy persons, on the 10th-14th day — increase in the level of IL-1β and IL-6 of the sick and the contralateral eye, as well as IL-10 – of the contralateral eye (p<0.05). On the 24th day in nondiabetic patients with I degree severity bacterial keratitis normalization of interleukin levels in the lacrimal fluid of the sick and the contralateral eye was found, but in DM patients remained elevated levels of IL-1β, IL-6, both in the sick and in the contralateral eye (p<0.05). Conclusions. In DM patients there are immunological features of the dynamics of the I degree severity bacterial keratitis, namely a longer increase in the level of proinflammatory cytokines IL-1β, IL-6 in the lacrimal fluid of the sick and the contralateral eye.

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Nonketotic Hyperglycemic Chorea in a 10-Year-Old Asian Boy with Diabetes Mellitus

Journal of Pediatric Neurology ◽

10.1055/s-0040-1718553 ◽

2020 ◽

Author(s):

Julia Marian ◽

Firdous Rizvi ◽

Lily Q. Lew

Keyword(s):

Diabetes Mellitus ◽

Parietal Lobe ◽

Rare Complication ◽

Brain Magnetic Resonance Imaging ◽

Food Allergies ◽

Developmental Venous Anomaly ◽

Venous Anomaly ◽

Resonance Imaging ◽

Focal Lesions

AbstractNonketotic hyperglycemic chorea-ballism (NKHCB), also known as diabetic striato-pathy (DS) by some, is a rare complication of diabetes mellitus and uncommon in children. We report a case of a 10 11/12-year-old boy of Asian descent with uncontrolled type 1 diabetes mellitus (T1DM), Hashimoto's thyroiditis, and multiple food allergies presenting with bilateral chorea-ballism. His brain magnetic resonance imaging revealed developmental venous anomaly in right parietal lobe and right cerebellum, no focal lesions or abnormal enhancements. Choreiform movements resolved with correction of hyperglycemia. Children and adolescents with a movement disorder should be evaluated for diabetes mellitus, especially with increasing prevalence and insidious nature of T2DM associated with obesity.

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