Peculiarities of influence of risk factors and cardiometabolic disorders on the course of hypertension with comorbid complications

2021 ◽  
Author(s):  
A. O. Nesen ◽  
V. A. Chernyshov ◽  
O. V. Babenko ◽  
V. L. Shkapo ◽  
I. A. Valentynova
Keyword(s):  
Metabolic Disorders ◽  
Visceral Obesity ◽  
Functional Class ◽  
Strongly Correlated ◽  
Tyg Index ◽  
Type 2 Dm ◽  
Cardiometabolic Disorders ◽  
History Of ◽  
Disorders Of Lipid Metabolism

Objective — to determine the clinical features of the influence of risk factors and cardiometabolic disorders on the course of arterial hypertension (AH) with comorbid complications. Materials and methods. The study included the results of a survey of 580 patients (according to case histories) — 260 (44.8 %) female and 320 (55.2 %) male aged 20 to 88 years (mean age 59.34 ± 8.48) with AH stage II — III, who were examined and treated in the clinic of the State Institution «National Institute of Therapy. L. T. Malaya of National Academy of Medical Sciences of Ukraine” (Kharkiv). All patients had their blood pressure, body weight, height measured, fat and muscle tissue ratios evaluated, and physical activity was determined using pedometers. The indicators of distribution of adipose tissue were calculated: the percentage of fat deposits (PFD), body fat mass (BFM), fat mass index (FMI) according to known formulas. Indicators of carbohydrate, lipid and purine metabolism were evaluated. Results. The severity of the AH was associated with a lower percentage of alcohol consumption (p = 0.012), higher blood pressure levels (p < 0.001), higher functional class of chronic heart failure (CHF) (p < 0.001), more frequent detection of fasting hyperglycemia in patients (p < 0.001), the development of type 2 DM (p < 0.001) and diabetic nephropathy (p < 0.001). The markers of visceral obesity (PBF, BFM and FMI) correlated significantly with a low level of daily physical activity (p ≤ 0.002), a higher degree of AH (p ≤ 0.001), a higher functional class of CHF (p ≤ 0.001), with the presence of left ventricular hypertrophy (p < 0.001), the development of concomitant type 2 DM (p ≤ 0.001). It should be noted that in contrast to BMI, higher rates of PBF, BFM and FMI were more likely to correlate with older age, history of smoking and excessive alcohol consumption as well as the presence of concomitant thyroid pathology. Assessment of the lipid profile showed a significant correlation between BMI, BFM, FMI and the level of triglycerides (TG), very low­density lipoprotein cholesterol and with high­density lipoprotein cholesterol (HDL­C). The presence of visceral obesity was strongly correlated with triglyceride­glucose index (TyG index) (p ≤ 0,001). According to the results of the factor analysis, the severity of AH in the examined patients is primarily due to metabolic disorders associated with disorders of lipid metabolism and the development of varying degrees of insulin resistance, which in male is most strongly correlated with TG levels (r = 0.899), atherogenic index of plasma (r = 0.872), TyG index (r = 0.788), in female — with HDL­C (r = –0.770), atherogenic coefficient (r = 0.768), TG (r = 0.749). In contrast to the population of female, for male with AH there is the additional most important component of the indicators was estimated that characterizes the presence of comorbid chronic diseases of the pancreas (r = 0.754) on the background of a history of alcohol abuse (r = 0.627) and/or comorbid non­alcoholic fatty liver disease (r = 0.558). Conclusions. The severity of GC in the examined patients is primarily due to metabolic disorders associated with disorders of lipid metabolism and the development of varying degrees of insulin resistance on the background of visceral obesity.  

scholarly journals AB0420 RISK OF DEVELOPING TYPE 2 DIABETES MELLITUS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1510.2-1510
Author(s):  
L. Kondrateva ◽  
T. Popkova ◽  
E. Nasonov ◽  
A. Lila
Keyword(s):  
Abdominal Obesity ◽  
Lupus Erythematosus ◽  
Antihypertensive Drugs ◽  
Control Group ◽  
Systemic Lupus ◽  
Type 2 Dm ◽  
History Of ◽  
Systemic Rheumatic Diseases ◽  
Very High

Background:Patients with systemic lupus erythematosus (SLE) have higher than in general population prevalence of diabetes mellitus (DM). Hyperinsulinemia is a predictor of developing type 2 DM, however routine measurement of insulin levels for DM risk assessment is uncomfortable in daily clinical practice. International Diabetes Federation recommends the use of patient questionnaires to quickly identify people who may be at a higher risk of DM development.Objectives:To determine the 10-years risk of developing type 2 DM in SLE patients using dedicated questionnaire - Finnish Type 2 Diabetes Risk Assessment Form (FINDRISK) data.Methods:The study included 92 SLE patients without DM (83 women, 9 men, 39 [34; 47] years old). The median disease duration was 6 [2,14] years, SLEDAI-2K was 4[2;8]. SLE pts were treated with glucocorticoids (GC) (89%) and hydroxychloroquine (78%), immunosuppressive drugs (28%) and biological agents (10%). The control group consisted of 88 subjects without systemic rheumatic diseases, inflammatory arthritis or DM, matched by age and sex with SLE patients. Eight items of FINDRISK questionnaire (age, overweight, abdominal obesity, family history of diabetes, physical inactivity, eating habits, history of antihypertensive drugs treatment, history of hyperglycemia) were taken into account to calculate the total risk score (TS). The risk of developing DM within following 10 years is regarded as low (1%) or slightly elevated (4%) with TS ≤11 points, as moderate (17%), high (33%) or very high (50%) with TS ≥12 points.Results:The risk of developing DM was low or slightly elevated in 65 (71%) SLE pts and moderate, high or very high in 27 (29%) pts. The difference was significant compared with the control group, in which 76 (86%) subjects had a low or slightly elevated risk and 12 (14%) had a moderate, high or very high risk (p=0,01). The number of risk factors (4[2;5]) and the median TS of SLE pts (9[5;12] points) were higher than values in control subjects (3[2,4] factors and 6[3;9] points, respectively) (p<0,01 for both). DM risk factors profiles were similar in two groups, except for higher prevalence of abdominal obesity (66% vs 41%, p<0,01) and history of antihypertensive drugs treatment (57% vs 17%, p<0,01) in SLE. There were positive correlations between TS and CRP levels (r=0,25, p=0,02), SLICC (r=0,36, p<0,01), HAQ (r=0,29, p<0,01), and negative correlations between TS and SLEDAI-2K (r= -0,32, p<0,01), glomerular filtration rate by CKD-EPI (r=-0,23, p=0,03). Current GC use had no influence on TS values in SLE.Conclusion:Patients with SLE were more likely than individuals without systemic rheumatic diseases to have a moderate, high and very high risk of developing DM, and therefore, required interventions to prevent the metabolic disease. Increased risk of developing DM was associated with most common traditional factors, especially by abdominal obesity and regular use of antihypertensive drugs that can be considered a kind of equivalent to the presence of hypertension. Curtain contribution of inflammation, lupus activity and irreversible damage index can’t be ignored. Clarification of SLE-specific phenomena in DM pathogenesis requires further research.Disclosure of Interests: :None declared

scholarly journals Alcohol consumption and risk of type 2 diabetes mellitus among males in The Manggis Area, Karangasem, Bali

2018 ◽  
Vol 6 (1) ◽  
pp. 31
Author(s):  
I Gusti Ayu Mirah Adhi ◽  
Ni Luh Putu Suariyani ◽  
I Wayan Weta ◽  
Anak Agung Sagung Sawitri
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Alcohol Consumption ◽  
Sugar Alcohol ◽  
Sweetened Beverages ◽  
Type 2 Dm ◽  
Frequent Consumption ◽  
History Of ◽  
History Of Obesity

AbstractBackground and purpose: Diabetes mellitus (DM) is a serious health problem worldwide. Local alcohol consumption is one of Balinese’s traditions considered to be associated with the high incidence of DM. This study aims to determine the pattern of alcohol consumption and risk of type 2 DM in Manggis Subdistrict, Karangasem, Bali.Methods A case control study was conducted in 55 men with type 2 DM as cases and 55 non-diabetic men as controls. Non-diabetic men were defined with fasting glucose level (GDP) <100 mg/dl and without clinical symptoms of DM. Cases were recruited from the patient's register at the public health centre (PHC) in Manggis Sub-District and controls were recruited from similar neighborhood with the cases and matched by age. Data were collected over May-July 2017 by households’ interview using structured questionnaires. Multivariate analysis was employed using logistic regression to identify the risk factors of type 2 DM.Results: The characteristics of cases and controls were similar in terms of age, education and physical activity, but there was a significant difference in employment. Multivariate analysis showed that heavy alcohol consumption (AOR=7.84; 95%CI: 1.46-42.28), frequent consumption of high sugar alcohol drinks (AOR=3.45; 95%CI: 1.16-10.22), history of obesity (AOR=8.82; 95% CI: 2.43-32.01), employed (AOR=5.98; 95%CI: 1.89-18.93) and frequent consumption of sweetened beverages (AOR=39,57; 95%CI: 4.00-391,8) were significantly associated with the incidence of type 2 DM. No significant association was found between the duration of alcohol consumption and the incidence of type 2 DM.Conclusions: Alcohol consumption, a history of obesity, consumption of high sugar alcohol drinks, retirement/unemployment and consumption of sweetened beverages are associated with the incidence of type 2 DM. Education regarding those risk factors should be enhanced to reduce the incidence of type 2 DM.

scholarly journals General Practitioners’ Autonomy in the Management of Non-Communicable Diseases (NCDs) in the JKN Era: Is It Feasible?

2019 ◽  
Vol 2 (3) ◽  
pp. 89
Author(s):  
Nur Afrainin Syah
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Heart Attack ◽  
Metabolic Disorders ◽  
Communicable Diseases ◽  
Increase Life Expectancy ◽  
Non Communicable Diseases ◽  
Indonesian Population ◽  
Type 2 Dm

Demographic, epidemiological, and nutritional transitions increase life expectancy, changes in lifestyles and behaviors of Indonesian people. These changes are resulting in a growing contribution of non-communicable diseases (NCDs) to morbidity and mortality, especially metabolic disorders, such as type 2 diabetes mellitus (DM), hypertension, and dyslipidemia. Approximately 10.9% of the Indonesian population above 15 years old suffers from type 2 DM (21.2 million) and 34.1% have hypertension (66.3 million) in 2018. These figures increase significantly from 2013 figure; 6.9% and 25.8% respectively1. The metabolic disorders, which in turn, are responsible for vascular problems such as renal failure, stroke, and heart attack. Not surprisingly, then, 60% of Indonesian national health insurance (JKN) funds are spent on the NCDs. This condition causes a deficit and threatens the sustainability of the JKN program.

scholarly journals THE ROLE OF MYOKINES INTERSTITIAL INTERACTION AND REGULATION OF METABOLISM: A REVIEW OF LITERATURE

2016 ◽  
Vol 19 (1) ◽  
pp. 28-34
Author(s):  
T T Tsoriev ◽  
Zh E White ◽  
L Ya Rozhinskaya
Keyword(s):  
Skeletal Muscles ◽  
Metabolic Disorders ◽  
Visceral Obesity ◽  
Signal Pathways ◽  
Review Of Literature ◽  
Glucose And Lipid Metabolism ◽  
Regulation Of Metabolism ◽  
Skin Mucosa

Myokines are hormone-like acting molecules produced in skeletal muscles during and immediately after exercise. They affect both paracrine (inside the muscles themselves) and endocrine manner (in adipose tissue, liver, endothelium, skin, mucosa etc.) implementing different effects on target tissues, mainly through regulation of metabolic processes (such as glucose and lipid metabolism, growth and division of neurons and endothelial cells and others). The examination of myokines is of great interest for researchers of different medicine departments, particularly for endocrinologists, because of myokines’ involvement in pathogenesis of abdominal and visceral obesity, diabetes mellitus type 2 and cardiovascular diseases that are all the components of metabolic syndrome. The most important issue for clinicians is a possibility of future therapeutic implication of the myokine’s signal pathways in treatment of widespread metabolic disorders.

scholarly journals Alcohol consumption and risk of type 2 diabetes mellitus among males in The Manggis Area, Karangasem, Bali

2018 ◽  
Vol 6 (1) ◽  
pp. 1
Author(s):  
I Gusti Ayu Mirah Adhi ◽  
Ni Luh Putu Suariyani ◽  
I Wayan Weta ◽  
Anak Agung Sagung Sawitri
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Alcohol Consumption ◽  
Sugar Alcohol ◽  
Sweetened Beverages ◽  
Type 2 Dm ◽  
Frequent Consumption ◽  
History Of ◽  
History Of Obesity

AbstractBackground and purpose: Diabetes mellitus (DM) is a serious health problem worldwide. Local alcohol consumption is one of Balinese’s traditions considered to be associated with the high incidence of DM. This study aims to determine the pattern of alcohol consumption and risk of type 2 DM in Manggis Subdistrict, Karangasem, Bali.Methods A case control study was conducted in 55 men with type 2 DM as cases and 55 non-diabetic men as controls. Non-diabetic men were defined with fasting glucose level (GDP) <100 mg/dl and without clinical symptoms of DM. Cases were recruited from the patient's register at the public health centre (PHC) in Manggis Sub-District and controls were recruited from similar neighborhood with the cases and matched by age. Data were collected over May-July 2017 by households’ interview using structured questionnaires. Multivariate analysis was employed using logistic regression to identify the risk factors of type 2 DM.Results: The characteristics of cases and controls were similar in terms of age, education and physical activity, but there was a significant difference in employment. Multivariate analysis showed that heavy alcohol consumption (AOR=7.84; 95%CI: 1.46-42.28), frequent consumption of high sugar alcohol drinks (AOR=3.45; 95%CI: 1.16-10.22), history of obesity (AOR=8.82; 95% CI: 2.43-32.01), employed (AOR=5.98; 95%CI: 1.89-18.93) and frequent consumption of sweetened beverages (AOR=39,57; 95%CI: 4.00-391,8) were significantly associated with the incidence of type 2 DM. No significant association was found between the duration of alcohol consumption and the incidence of type 2 DM.Conclusions: Alcohol consumption, a history of obesity, consumption of high sugar alcohol drinks, retirement/unemployment and consumption of sweetened beverages are associated with the incidence of type 2 DM. Education regarding those risk factors should be enhanced to reduce the incidence of type 2 DM.

Hypoglycemic and Hypolipemic Effects of a New Lecithin Formulation of Bergamot Polyphenolic Fraction: A Double Blind, Randomized, Placebo- Controlled Study

2019 ◽  
Vol 19 (2) ◽  
pp. 136-143 ◽  
Author(s):  
Vincenzo Mollace ◽  
Miriam Scicchitano ◽  
Sara Paone ◽  
Francesca Casale ◽  
Carla Calandruccio ◽  
...  
Keyword(s):  
Hdl Cholesterol ◽  
Fold Increase ◽  
Natural Antioxidants ◽  
Pharmacokinetic Profile ◽  
Controlled Study ◽  
Double Blind ◽  
Ldl Particles ◽  
Type 2 Dm ◽  
Cardiometabolic Disorders

Objective: Hyperlipemia represents an independent risk factor in the development of atherosclerosis in patients undergoing type 2 diabetes mellitus (DM). Moreover, the pharmacological treatment of dyslipemia in patients undergoing type 2 DM (e.g. by means of statins), is accompanied by relevant side effects and oral supplementation with natural antioxidants, such as Citrus polyphenols, has recently been suggested to improve cardioprotection in such patients. However, due to the poor gastrointestinal absorption of polyphenols, novel formulations have recently been developed for getting a better bioavailability of polyphenolic rich fractions of citrus species extract rich in polyphenols. Methods: Here, we investigated the effect of standard bergamot polyphenolic fraction (BPF®) as well as of its phytosomal formulation (BPF Phyto), in patients with type 2 DM and hyperlipemia. A randomized, double blind, placebo-controlled study was carried out in 60 patients suffering from type 2 DM and mixed hyperlipemia. </P><P> Patients were divided into three groups: one receiving placebo, the second receiving standard BPF and the third BPF Phyto. Results: In the groups receiving BPF and BPF Phyto, a significant reduction of fasting plasma glucose, serum LDL cholesterol and triglycerides accompanied by increased HDL cholesterol was observed. This effect was associated with significant reduction of small dense atherogenic LDL particles, as detected by means of proton NMR Spectroscopy, thus confirming the hypolipemic and hypoglycemic effect of bergamot extract both when using standard formulation as well as BPF Phyto. No differences were seen in the therapeutic response among groups receiving BPF and BPF Phyto, thus suggesting a substantial bioequivalence in their hypoglycemic and hypolipemic profile. However, when comparing the pharmacokinetic profile of naringin (the major component of BPF) and its metabolites, in patients treated with BPF Phyto, an at least 2,5 fold increase in its absorption was found, confirming in human studies the better profile of BPF Phyto compared to standard BPF. Conclusion: These data suggest that better absorption and tissue distribution of BPF Phyto formulation represents an innovative approach in supplementation treatments of cardiometabolic disorders.

scholarly journals Role of CHA2DS2-VASc score in predicting new-onset atrial fibrillation in patients with type 2 diabetes mellitus with and without hyperosmolar hyperglycaemic state: real-world data from a nationwide cohort

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020065 ◽  
Author(s):  
Wei-Syun Hu ◽  
Cheng-Li Lin
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Predictive Ability ◽  
Type 2 Dm ◽  
History Of ◽  
New Onset

PurposeThe objective of the current study was to explore the role of CHA2DS2-VASc score in predicting incidence of atrial fibrillation (AF) in patients with type 2 diabetes mellitus (DM). Furthermore, the use of the CHA2DS2-VASc score for stratifying new-onset AF risk in patients with DM and with/without hyperosmolar hyperglycaemic state (HHS) was also compared.MethodsThe study subjects were identified from Longitudinal Health Insurance Database provided by the National Health Research Institutes. The patients with DM were divided into two groups based on a history of HHS or not. The predictive ability of CHA2DS2-VASc score for stratifying new-onset AF risk in the two groups was calculated using the area under the curve of receiver-operating characteristic (AUROC).ResultsThe present study involved a total of 69 530 patients with type 2 DM. Among them, 1558 patients had a history of HHS, whereas 67 972 patients did not. The AUROC of the CHA2DS2-VASc score as a predictor of incident AF in patients with DM and with/without HHS was 0.67 (95% CI 0.59 to 0.75) and 0.71 (95% CI 0.70 to 0.72), respectively.ConclusionsTo conclude, we reported for the first time on the assessment of CHA2DS2-VASc score for incident AF risk discrimination in patients with type 2 DM. We further found that the predictive ability of the CHA2DS2-VASc score was attenuated in patients with type 2 DM and with HHS in comparison with those without HHS.

scholarly journals Prevalence and risk factors of type-2 diabetes mellitus in Ethiopia: systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Melkamu A. Zeru ◽  
Endalamaw Tesfa ◽  
Aweke A. Mitiku ◽  
Awoke Seyoum ◽  
Tesfaye Abera Bokoro
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Systematic Review ◽  
Family History ◽  
Physical Inactivity ◽  
Meta Analysis ◽  
Type 2 Dm ◽  
Pooled Prevalence ◽  
History Of

AbstractDiabetes mellitus (DM) is a public health problem in developing as well as developed nations. DM leads to many complications that are associated with higher morbidity and mortality worldwide. Therefore, the current study was planned to assess the prevalence and risk factors of type-2 DM in Ethiopian population. Six electronic databases such as: PubMed, Scopus, Hinari, Web of science, Google Scholar, and African Journals Online were searched for studies published in English up December 30, 2020. Newcastle–Ottawa Scale was used for quality assessment of the included studies. The data was extracted by Microsoft excel and analyzed through Stata version 16 software. The random effect meta-regression analysis was computed at 95% CI to assess the pooled prevalence and risk factors of type-2 DM. Forty observational studies were included in this systematic review and meta-analysis. The pooled prevalence of DM in Ethiopia was 6.5% (95% CI (5.8, 7.3)). The sub-group analysis revealed that the highest prevalence of DM was found in Dire Dawa city administration (14%), and the lowest prevalence was observed in Tigray region (2%). The pooled prevalence of DM was higher (8%) in studies conducted in health facility. Factors like: Age ≥ 40 years ((Adjusted Odds Ratio (AOR): 1.91 (95% CI: 1.05, 3.49)), Illiterate (AOR: 2.74 (95% CI: 1.18, 6.34)), Cigarette smoking (AOR: 1.97 (95% CI: 1.17, 3.32)), Body mass index (BMI) ≥ 25 kg/m2 (AOR: 2.01 (95 CI: 1.46, 2.27)), family history of DM (AOR: 6.14 (95% CI: 2.80, 13.46)), history of hypertension (AOR: 3.00 (95% CI: 1.13, 7.95)) and physical inactivity (AOR: 5.79 (95% CI: 2.12, 15.77)) were significantly associated with type-2 DM in Ethiopian population. In this review, the prevalence of type-2 DM was high. Factors like: Older age, illiteracy, cigarette smoking, MBI ≥ 25, family history of DM, history of hypertension and physical inactivity were an identified risk factors of type-2 DM. Therefore, health education and promotion will be warranted. Further, large scale prospective studies will be recommended to address possible risk factors of type-2 DM in Ethiopian population.

scholarly journals Euglycemic DKA in Patients on SGLT2 Inhibitor and Potentially Ketotic State

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A382-A383
Author(s):  
Maram Khalifa ◽  
Hassaan Aftab ◽  
Vitaly Kantorovich
Keyword(s):  
Sglt2 Inhibitor ◽  
Sglt2 Inhibitors ◽  
Physical Exam ◽  
Anion Gap ◽  
Type 2 Dm ◽  
Antihyperglycemic Therapy ◽  
History Of ◽  
L 22 ◽  
Beta Hydroxybutyrate

Abstract Background: With mounting evidence demonstrating improved cardiovascular and renal outcomes with the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors, this class of newest antidiabetic agents is rapidly gaining favor. SGLT2 inhibition lowers the renal threshold for glucose excretion, resulting in renal glycosuria, a shift in substrate utilization from carbohydrate to fat oxidation and hyperglucagonemia and thus poses the risk of developing euglycemic DKA as a rare but serious adverse effect. Clinical Cases: the first case is A 36-year-old female was diagnosed with type 2 DM with an HbA1c of 10% and was started on multi-agent antihyperglycemic therapy including metformin 500 mg BID, extended release exenatide 2 mg once a week and empagliflozin 25 mg once daily which were all initiated simultaneously. 2 days after starting regimen, she complained of nausea, vomiting and was unable to tolerate oral diet and fluids by day 4 which potentially predisposed to starvation ketoacidosis. She presented to the ED with normal vitals, grossly normal physical exam and labs were significant for beta-hydroxybutyrate of over 7 mmol/L (ref range &lt;0.28), bicarbonate of 10 mmol/L (22 - 33), anion gap 25 (7 - 17), arterial pH 7.16 (7.33 - 7.43), serum glucose 111 (7.33 - 7.43). GAD-65 antibody titer was &lt;5 IU/mL (&lt; 5). She was diagnosed with euglycemic DKA, transferred to ICU and started on DKA protocol to which she responded very well. Second patient is A 65 Years old male with past medical history of CAD, HTN, HDL, history of PE/DVT and Type 2 DM was on insulin and jardiance, started ketodiet while continuing taking the jardiance and stopped taking his insulin because his sugars were controlled presented to the ED with abdominal pain, nausea and vomiting, had relatively normal vitals and benign physical exam, labs showed Bicarbonate of 9 mmol/L (22 - 33), anion gap of 31 (7 - 17), venous pH of 7.07 (7.33 - 7.43) glucose was 189 (7.33 - 7.43), beta-hydroxybutyrate of over 7.7 mmol/L (ref range &lt;0.28), patient was admitted to the ICU and started on insulin on DKA protocol Conclusion: SGLT2 inhibitors may be associated with DKA due to their ketogenic effects secondary to enhanced lipolysis and increased glucagon to insulin ratio. although not expected, euglycemic DKA could be much more present in cases where there is predisposition to increase ketones generation w/without appropriate clearance eg. starvation, ketotic diet, AKI, etc. These should be monitored for and the patient needs to be educated about accordingly to prevent both adverse outcomes and potential decrease in drug use if not strongly indicated. also,It would be prudent for prescribing clinicians to advise patients to withhold potentially harming medications temporarily if they cannot maintain adequate oral intake.

scholarly journals Gestational Diabetes – Metabolic Risks of Adult Women With Respect to Birth Weight

2015 ◽  
pp. S135-S145
Author(s):  
D. VEJRAZKOVA ◽  
P. LUKASOVA ◽  
M. VANKOVA ◽  
O. BRADNOVA ◽  
G. VACINOVA ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Gestational Diabetes ◽  
Metabolic Disorders ◽  
Liver Enzymes ◽  
High Birth Weight ◽  
Adult Women ◽  
History Of

Metabolic disorders such as obesity, insulin resistance and other components of metabolic syndrome (MetS) are connected with birth weight. Low and high birth weight is associated with a higher risk of developing type 2 diabetes mellitus, the mechanism is not clear. In this study, we evaluated the association between birth weight and anthropometric as well as biochemical components of MetS in women with a history of gestational diabetes mellitus (GDM) in comparison with control women. In part of the GDM group, we re-evaluated metabolic changes over 5-8 years. Anthropometry, blood pressure, glucose metabolism during the 3-h oGTT, lipid profile, uric acid, thyroid hormones, and liver enzymes were assessed. From the analyzed components of MetS in adult women we proved the association of low birth weight (birth weight <25th percentile) with glucose processing, in particular among women with a history of GDM. Low birth weight GDM women revealed significantly higher postchallenge insulin secretion and lower peripheral insulin sensitivity. Re-examinations indicate this association persists long after delivery.

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