Insight into the impact of diabetes mellitus on the increased risk of hepatocellular carcinoma: mini-review

Exposure to untreated gestational diabetes mellitus (GDM) in utero increases the risk of obesity and type 2 diabetes in adulthood, and increased adiposity in GDM-exposed infants is suggested as a plausible mediator of this increased risk of later-life metabolic disorders. Evidence is equivocal regarding the impact of good glycaemic control in GDM mothers on infant adiposity at birth. We systematically reviewed studies reporting fat mass (FM), percent fat mass (%FM) and skinfold thicknesses (SFT) at birth in infants of mothers with GDM controlled with therapeutic interventions (IGDMtr). While treating GDM lowered FM in newborns compared to no treatment, there was no difference in FM and SFT according to the type of treatment (insulin, metformin, glyburide). IGDMtr had higher overall adiposity (mean difference, 95% confidence interval) measured with FM (68.46 g, 29.91 to 107.01) and %FM (1.98%, 0.54 to 3.42) but similar subcutaneous adiposity measured with SFT, compared to infants exposed to normal glucose tolerance (INGT). This suggests that IGDMtr may be characterised by excess fat accrual in internal adipose tissue. Given that intra-abdominal adiposity is a major risk factor for metabolic disorders, future studies should distinguish adipose tissue distribution of IGDMtr and INGT.

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495 THE IMPACT OF DIABETES MELLITUS ON THE DEVELOPMENT OF HEPATOCELLULAR CARCINOMA AMONG PATIENTS WITH ALCOHOLIC LIVER CIRRHOSIS AND DIABETES MELLITUS

Journal of Hepatology ◽

10.1016/s0168-8278(11)60497-2 ◽

2011 ◽

Vol 54 ◽

pp. S202-S203

Author(s):

H.C. Kim ◽

E.Y. Cho ◽

J.Y. Lee ◽

T.H. Kim

Keyword(s):

Diabetes Mellitus ◽

Hepatocellular Carcinoma ◽

Liver Cirrhosis ◽

Alcoholic Liver Cirrhosis ◽

The Impact

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Pregnancy After Simultaneous Pancreas-Kidney Transplantation in Treatment of End-Stage Diabetes Mellitus: a Review

Zeitschrift für Geburtshilfe und Neonatologie ◽

10.1055/a-1710-4097 ◽

2021 ◽

Author(s):

Zana Stanic ◽

Marko Vulic ◽

Zlatko Hrgovic ◽

Rajko Fureš ◽

Milvija Plazibat ◽

...

Keyword(s):

Diabetes Mellitus ◽

Kidney Transplantation ◽

Graft Function ◽

Insulin Dependent Diabetes Mellitus ◽

Organ Damage ◽

Multiple Organ ◽

Dependent Diabetes Mellitus ◽

Increased Risk ◽

Simultaneous Pancreas Kidney ◽

The Impact

AbstractThe majority of patients with simultaneous pancreas and kidney transplant (SPKT) required transplantation owing to a long-standing history of insulin-dependent diabetes mellitus (IDDM). The disease causes multiple organ damage, impairs fertility, and affects quality of life. A successful kidney and pancreas transplant can improve health, ameliorate the consequences of pre-existent diabetes, and restore fertility. Good graft function, without any sign of rejection, and stable doses of immunosuppressant drugs are of utmost importance prior to the planned pregnancy. SPKT recipients who become pregnant may be at an increased risk for an adverse outcome and require meticulous multidisciplinary surveillance. We present experiences with SPKT pregnancies, traditional approaches, and recent considerations. In light of complex interactions between new anatomic relations and the impact of developing pregnancy and immunosuppressive medications, special stress is put on the risk of graft rejection, development of pregnancy complications, and potential harmful effects on fetal development. Recent recommendations in management of SPKT recipients who wish to commence pregnancy are presented as well. Key words: transplantation, pregnancy, pancreas, kidney, simultaneous pancreas and kidney transplantation (SPKT)

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Impact of Individual Components of the Metabolic Syndrome on the Outcome of Patients with Advanced Hepatocellular Carcinoma Treated with Sorafenib

Digestive Diseases ◽

10.1159/000477578 ◽

2017 ◽

Vol 36 (1) ◽

pp. 78-88 ◽

Cited By ~ 4

Author(s):

Christian Labenz ◽

Vera Prenosil ◽

Sandra Koch ◽

Yvonne Huber ◽

Jens U. Marquardt ◽

...

Keyword(s):

Diabetes Mellitus ◽

Hepatocellular Carcinoma ◽

Metabolic Syndrome ◽

Group Performance ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Advanced Hepatocellular Carcinoma ◽

Advanced Hcc ◽

The Metabolic Syndrome ◽

The Impact

Background/Aim: Individual components of the metabolic syndrome (MS) such as obesity or diabetes mellitus impair the prognosis of patients with hepatocellular carcinoma (HCC) following curative treatment approaches or transarterial therapies. The aim of this retrospective study was to assess the impact of these factors on the overall survival (OS) of patients with advanced HCC treated with sorafenib. Methods: Univariate and multivariate analyses were performed to assess the impact of individual components of the MS on the OS of 152 consecutive patients with advanced HCC treated with sorafenib. Results: The presence of overweight/obesity, type 2 diabetes mellitus, hypertension, dyslipidemia, and of the MS itself did not impair the median OS. Multivariate analysis showed that Eastern Cooperative Oncology Group Performance Status ≥1 (hazards ratio [HR] 2.03), presence of macrovascular invasion (HR 1.71), Child-Pugh score B/C (HR 2.19), tumor grading G3 (HR 2.17), no prior HCC treatment (HR 2.34), and the presence of 2 or more out of 5 individual components of the MS (HR 0.65) were independent prognostic factors regarding the median OS. Conclusions: Our investigations do not confirm a negative prognostic role of individual components of the MS or the MS itself for patients with advanced HCC treated with sorafenib.

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The impact of prenatal parental tobacco smoking on risk of diabetes mellitus in middle-aged women

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174415000045 ◽

2015 ◽

Vol 6 (3) ◽

pp. 242-249 ◽

Cited By ~ 17

Author(s):

M. A. La Merrill ◽

P. M. Cirillo ◽

N. Y. Krigbaum ◽

B. A. Cohn

Keyword(s):

Diabetes Mellitus ◽

Birth Weight ◽

Confidence Intervals ◽

Tobacco Smoking ◽

Maternal Smoking ◽

Parental Smoking ◽

Diabetes Diagnosis ◽

Environmental Chemical ◽

Increased Risk ◽

The Impact

Growing evidence indicates that parental smoking is associated with risk of offspring obesity. The purpose of this study was to identify whether parental tobacco smoking during gestation was associated with risk of diabetes mellitus. This is a prospective study of 44- to 54-year-old daughters (n=1801) born in the Child Health and Development Studies pregnancy cohort between 1959 and 1967. Their mothers resided near Oakland California, were members of the Kaiser Foundation Health Plan and reported parental tobacco smoking during an early pregnancy interview. Daughters reported physician diagnoses of diabetes mellitus and provided blood samples for hemoglobin A1C measurement. Prenatal maternal smoking had a stronger association with daughters’ diabetes mellitus risk than prenatal paternal smoking, and the former persisted after adjustment for parental race, diabetes and employment (aRR=2.4 [95% confidence intervals 1.4–4.1] P<0.01 and aRR=1.7 [95% confidence intervals 1.0–3.0] P=0.05, respectively). Estimates of the effect of parental smoking were unchanged when further adjusted by daughters’ birth weight or current body mass index (BMI). Maternal smoking was also significantly associated with self-reported type 2 diabetes diagnosis (2.3 [95% confidence intervals 1.0–5.0] P<0.05). Having parents who smoked during pregnancy was associated with an increased risk of diabetes mellitus among adult daughters, independent of known risk factors, providing further evidence that prenatal environmental chemical exposures independent of birth weight and current BMI may contribute to adult diabetes mellitus. While other studies seek to confirm our results, caution toward tobacco smoking by or proximal to pregnant women is warranted in diabetes mellitus prevention efforts.

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Risk of diabetes mellitus associated with disease-modifying antirheumatic drugs and statins in rheumatoid arthritis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2016-209954 ◽

2016 ◽

Vol 76 (5) ◽

pp. 848-854 ◽

Cited By ~ 31

Author(s):

Gulsen Ozen ◽

Sofia Pedro ◽

Marie E Holmqvist ◽

Michael Avery ◽

Frederick Wolfe ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Diabetes Mellitus ◽

Adult Population ◽

Data Bank ◽

Self Report ◽

Increased Risk ◽

Cox Proportional Hazard Models ◽

Synthetic Dmards ◽

Disease Modifying ◽

The Impact

ObjectiveTo investigate the rate of incident diabetes mellitus (DM) in patients with rheumatoid arthritis (RA) and the impact of disease-modifying antirheumatic drug (DMARD) and statin treatments.MethodsWe studied patients with RA and ≥1 year participation in the National Data Bank for Rheumatic Diseases without baseline DM from 2000 through 2014. DM was determined by self-report or initiating DM medication. DMARDs were categorised into four mutually exclusive groups: (1) methotrexate monotherapy (reference); (2) any abatacept with or without synthetic DMARDs (3) any other DMARDs with methotrexate; (4) all other DMARDs without methotrexate; along with separate statin, glucocorticoid and hydroxychloroquine (yes/no) variables. Time-varying Cox proportional hazard models were used to adjust for age, sex, socioeconomic status, comorbidities, body mass index and RA severity measures.ResultsDuring a median (IQR) 4.6 (2.5–8.8) years of follow-up in 13 669 patients with RA, 1139 incident DM cases were observed. The standardised incidence ratio (95% CI) of DM in patients with RA (1.37, (1.29 to 1.45)) was increased compared with US adult population. Adjusted HR (95% CI) for DM were 0.67 (0.57 to 0.80) for hydroxychloroquine, 0.52 (0.31 to 0.89) for abatacept (compared with methotrexate monotherapy), 1.31 (1.15 to 1.49) for glucocorticoids and 1.56 (1.36 to 1.78) for statins. Other synthetic/biological DMARDs were not associated with any risk change. Concomitant use of glucocorticoids did not alter DM risk reduction with hydroxychloroquine (HR 0.69 (0.51 to 0.93)).ConclusionsIn RA, incidence of DM is increased. Hydroxychloroquine and abatacept were associated with decreased risk of DM, and glucocorticoids and statins with increased risk.

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Sensory processing disorders in premature infants

Praxis medica ◽

10.5937/pramed2102019t ◽

2021 ◽

Vol 50 (1-2) ◽

pp. 19-23

Author(s):

Jelena Todorović ◽

Mirjana Petrović-Lazić

Keyword(s):

Preterm Infants ◽

Premature Infants ◽

Sensory Processing ◽

Relevant Literature ◽

Sensory System ◽

Neonatal Unit ◽

Increased Risk ◽

Sensory Processing Disorders ◽

The Impact ◽

Insight Into

Introduction. Children born prematurely have an increased risk of immediate medical complications, as well as socioemotional, cognitive, linguistic and sensory processing disorders later in life. Studies have examined the effects of prematurity on developmental outcomes, such as cognition, however, there is a need for a more detailed examination of sensory processing disorders in preterm infants. Not only is prenatal neurosensory development interrupted in utero, but these children may also experience intense stimulation in the neonatal unit, which can further alter the development and function of the sensory system. Objective. The paper presents an overview of research on sensory processing disorders in premature infants, with special emphasis on the impact of the environment of the neonatal unit. Method. Insight into the relevant literature was performed by specialized search engines on the Internet and insight into the electronic database. Results. Sensory processing disorders affect 39% to 52% of newborns born prematurely, with some evidence to suggest that children born before 32 weeks are most at risk. The literature to date has consistently reported difficulties in sensory modulation of preterm infants, within the tactile, vestibular, auditory, oral, and visual domains. Conclusion. Sensory processing disorders in preterm infants appear to occur as a result of their immature neurological and biological system and being in the environment of a neonatal intensive care unit, which is unable to meet the sensory needs of preterm infants. Altered sensory experiences, during periods of neurodevelopmental vulnerability and fragility, can result in sensory processing disorders, which may include enhanced responses or less response to stimuli (hyper or hyposensitivity).

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Hospital Frailty Risk Score Is Independently Associated with Mortality and Encephalopathy in Hospitalized Patients with Hepatocellular Carcinoma

Biomedicines ◽

10.3390/biomedicines9111693 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1693

Author(s):

Daryl Ramai ◽

Khoi P. Dang-Ho ◽

Anjali Kewalramani ◽

Praneeth Bandaru ◽

Rodolfo Sacco ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatic Encephalopathy ◽

Length Of Stay ◽

Risk Score ◽

Cox Regression ◽

Surrogate Marker ◽

Hospital Length Of Stay ◽

Frail Patients ◽

Increased Risk ◽

The Impact

Frailty represents a state of vulnerability to multiple internal physiologic factors, as well as external pressures, and has been associated with clinical outcomes. We aim to understand the impact of frailty on patients admitted with hepatocellular carcinoma (HCC) by using the validated Hospital Frailty Risk Score, which is implemented in several hospitals worldwide. We conducted a nation-wide retrospective cohort study to determine the effect of frailty on the risk of in-patient mortality, hepatic encephalopathy, length of stay and cost. Frailty was associated with a 4.5-fold increased risk of mortality and a 2.3-fold increased risk of hepatic encephalopathy. Adjusted Cox regression showed that frailty was correlated with increased risk of in-patient mortality (hazard ratio: 2.3, 95% CI 1.9–2.8, p < 0.001). Frail HCC patients had longer hospital stay (median 5 days) vs. non-frail HCC patients (median 3 days). Additionally, frail patients had higher total costs of hospitalization ($40,875) compared with non-frail patients ($31,667). Frailty is an independent predictor of hepatic encephalopathy and in-patient mortality. Frailty is a surrogate marker of hospital length of stay and cost.

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Impact of the UK COVID-19 pandemic on HbA1c testing and its implications for diabetes diagnosis and management

10.22541/au.160770263.30907582/v1 ◽

2020 ◽

Author(s):

David Holland ◽

Adrian Heald ◽

Mike Stedman ◽

Lewis Green ◽

Jonathan Scargill ◽

...

Keyword(s):

Diabetes Mellitus ◽

Diabetes Diagnosis ◽

Long Term Conditions ◽

Diagnosis And Management ◽

Increased Risk ◽

Poor Outcomes ◽

The Uk ◽

The Impact

Our findings illustrate the widespread collateral impact of implementing measures to mitigate the impact of COVID-19 in people with, or being investigated for diabetes mellitus (DM). Ironically, failure to focus of the wider implications for people with DM and other groups with long-term conditions, may place them at increased risk of poor outcomes from SARS-CoV-2 infection itself, irrespective of the implications for their longer-term health prospects.

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