Maximum body mass index before onset of type 2 diabetes is independently associated with advanced diabetic complications

IntroductionThe maximum body mass index (BMI) before onset of type 2 diabetes (MBBO) might be used to estimate a patient’s insulin secretion capacity. There have been few factors that can predict future diabetic complications at the time of diagnosis of diabetes mellitus. This study aimed to clarify the clinical usefulness of MBBO for predicting the development of advanced diabetic microvascular complications.Research design and methodsThis was a cross-sectional observational study. Of 1304 consecutively admitted patients with type 2 diabetes, we enrolled 435 patients for whom we could confirm their MBBO. Univariate and multivariate logistic regression analyses were performed to examine whether MBBO or BMI on admission was associated with advanced diabetic retinopathy or nephropathy. To evaluate the predictive performance of these indexes, we performed cross-validation in various models with MBBO or BMI and evaluated the areas under the curve (AUCs) yielded by these analyses.ResultsUnivariate analyses suggested that MBBO was associated with advanced retinopathy and nephropathy, while BMI on admission was associated only with advanced nephropathy. In multivariate analyses, MBBO was significantly associated with advanced complications, while BMI on admission was not. For advanced diabetic retinopathy, the AUCs were 0.70–0.72, and for advanced nephropathy, the AUCs were 0.81–0.83. When comparing the AUCs among models, the models with MBBO sustained high predictive performance for diabetic complications.ConclusionsMBBO was independently associated with advanced diabetic complications, while BMI on admission was not. Diabetic microvascular complications in patients with high MBBO could progress more rapidly. At the time of the diagnosis of diabetes mellitus, MBBO would enable us to predict the progress of diabetic complications.

Prevalence and risk factors for primary angle-closure disease spectrum: The Colombian glaucoma study

Purpose To estimate the prevalence and risk factors associated with the primary angle-closure disease spectrum in participants of the Colombian Glaucoma Study. Methods A cross-sectional study in subjects older than 50 years with a diagnosis of diabetes mellitus or/and systemic hypertension was conducted in Colombia to estimate glaucoma prevalence. This study included 1749 patients and classified them using gonioscopy into either open-angle or primary angle-closure disease spectrum groups. The patients in the primary angle-closure disease spectrum group were then subdivided into the following categories: primary angle-closure suspect, primary angle-closure, and primary angle-closure glaucoma. A logistic regression model was carried out to identify factors related to the primary angle-closure disease spectrum, including age, sex, height, and refraction. Results The prevalence of primary angle-closure disease spectrum was 19.3% (338) (95% CI: 17.5–21.2). The prevalence of primary angle-closure suspect, primary angle-closure, and primary angle-closure glaucoma was 8.0% (140) (95% CI: 6.8–9.4), 10.1% (176) (95% CI: 8.7–11.6), and 1.2% (22) (95% CI: 0.8–1.9), respectively. In the multivariate analysis, advanced age (+80 years), female sex, and high hyperopia ( p = 0.000, 0.021, and 0.001, respectively) were identified as independent factors related to the primary angle-closure disease spectrum. Conclusion A high prevalence of primary angle-closure disease spectrum was found in Colombian patients with a diagnosis of diabetes mellitus or/and systemic hypertension, especially primary angle-closure and primary angle-closure glaucoma. Age, female sex, and high hyperopia were identified as risk factors for the primary angle-closure disease spectrum.

PSYCHOEMOTIONAL FEATURES OF PATIENTS WITH DIABETES MELLITUS

В наше время сахарный диабет является одним из наиболее распространенных хронических заболеваний. Он существенно влияет на качество жизни пациента. По данным литературы известно, что в лечении сахарного диабета акцент ставится на коррекцию соматического состояния пациентов. Психологический статус пациентов остается недостаточно изученным. У больных с сахарным диабетом часто выявляются изменения в психоэмоциональном состоянии. На фоне метаболических расстройств такие пациенты более подвержены воздействию стрессовых ситуаций, эмоциональному перенапряжению и негативным компонентам внешней среды, что существенно влияет на снижение ресурсов организма. Психоэмоциональные проблемы могут сыграть большую роль в течении и исходе данного заболевания. Поэтому можно утверждать, что изучение эмоционального и психического состояния пациентов с диагнозом «сахарный диабет» является важным аспектом в работе врача, т.к. от этого зависит успешность адаптации больного к условиям жизни, связанным с болезнью. In our time, diabetes is one of the most common chronic diseases. It significantly affects the quality of life of the patient. According to the literature, it is known that in the treatment of diabetes mellitus, the emphasis is placed on the correction of the somatic state of patients. The psychological status of patients remains poorly understood. In patients with diabetes mellitus, changes in the psychoemotional state are often detected. Against the background of metabolic disorders, such patients are more susceptible to stressful situations, emotional overstrain and negative components of the external environment, which significantly affects the reduction of the body's resources. Psychoemotional problems can play a big role in the course and outcome of this disease. Therefore, it can be argued that the study of the emotional and mental state of patients with a diagnosis of diabetes mellitus is an important aspect in the work of a doctor, since The success of the patient's adaptation to the living conditions associated with the disease depends on this.

Biomarker Glycated Hemoglobin (HbA1c) in Diabetes Mellitus Type II

Early diagnosis of diabetes is clinically important in reducing health complications worldwide. In this respect HbA1c has become an accurate biomarker for the diagnosis of Diabetes Mellitus (DM) and its complication [1]. In the present study HbA1c measured in subject of age <20,21-30,31-40 yrs and the level found to show high risk for DM in youngsters. Hence counselling at least once a month is warranted. To be most effective to reduce or prevent the prevalence in youngsters the importance of controlling HbA1c and keeping it at low level can be achieved by including in the curriculum right from school ageing. It will reduce the financial burden on state and central government authorities. Key words: HbA1c, Diabetes Mellitus 2.

Alpelisib-Induced Diabetic Ketoacidosis- A Case Report

Background: Alpelisib, in combination with Fulvestrant, was approved in 2019 by the Food and Drug Administration for treatment of HR+, HER2- advanced or metastatic breast cancer in patients with PIK3CA mutation. a This combination is currently on phase III of study. One of the most common side effects is hyperglycemia. Rarely, this can be severe enough to induce diabetes ketoacidosis, which is an indication for interrupting Alpelisib treatment. Clinical Case: A 78 year old female presented to our emergency department with altered mentation. Her past medical history is significant for metastatic breast cancer, with known PIK3CA mutation, started on alpelisib three months prior. Concomitantly, despite not carrying a diagnosis of diabetes mellitus, the patient was started on metformin, due to the known side effect of hyperglycemia. Upon admission, the patient was found to be tachycardic and otherwise hemodynamically stable. Pertinent laboratory studies revealed an initial serum glucose of 600 (nl 70–100) mg/dL, potassium of 5.4 (nl 3.5–5.1) mmol/L, serum carbon dioxide of 8 (nl 21–32) mmol/L, calculated anion gap of 25 (nl &lt;12) mEq/L, and a serum beta-hydroxybutyrate &gt; 4.50(nl 0.02–0.27) mmol/l. ABG revealed a pH of 7.11, PaO2 of 102, pCO2 of 11, and a lactate of 4.0 mmol/L. Glycated hemoglobin was 10.7% (nl &lt;6.5%). EKG revealed sinus tachycardia with PACs, abnormal anterolateral T wave inversion, and a QTc of 519 msec. Initial troponin was elevated at 0.15 with a max troponin at 1.40 ng/mL. Urinalysis revealed glucosuria. Chest x-ray showed no acute cardiopulmonary process. Blood cultures were negative to completion. Patient was admitted for diabetic ketoacidosis and was started on DKA protocol which included aggressive hydration with sodium chloride and insulin drip. Alpelisib was discontinued immediately. Upon resolution of the anion gap metabolic acidosis, the patient’s encephalopathy significantly improved. She was transitioned to subcutaneous insulin. During the same hospitalization, the patient’s serum glucose rapidly normalized and she did not require insulin at the time of discharge. Conclusion: Diabetic ketoacidosis is an unusual but life-threatening side effect of Alpelisib, even in patients without an underlying diagnosis of diabetes mellitus. This case suggests that such patients should have a close monitoring of glycemic control and intensification of their anti-diabetic medications if required, to prevent hyperglycemic crises.