Highlights of the 11th Emirates Diabetes and Endocrine (Virtual) Congress, March 4–6, 2021

<b><i>Backgrounds:</i></b> The Eleventh Diabetes and Endocrine Virtual Congress (EDEC 2021) was held on March 4–6, 2021, due to the COVID pandemic. <b><i>Objectives:</i></b> We aimed to present highlights of the congress proceedings. <b><i>Materials and Methods:</i></b> The journal appointed 3 rapporteurs to prepare this congress report. They prepared assigned sections and reviewed the rest of the manuscript, and approved its final version. <b><i>Results:</i></b> The conference contents over 3 days included a wide range of lectures by world-class experts and key opinion leaders on various topical subjects, endocrinology, diabetes care, and metabolism, in addition to original data from submitted abstracts. The clinical approach to managing a pituitary mass, contemporary management of acromegaly, and the relationship between growth hormone and neoplasia were discussed. The virtual EDEC 2021 provided a comprehensive review of topical issues concerning clinical practice and research in diabetes, endocrinology, and metabolism. Predictably, the thyroid took the scene’s center, spanning many subjects from hypothyroidism, pregnancy care, thyroid nodules, and cancer management. Rational approaches to pituitary disease and acromegaly were valuable for practicing endocrinologists. Recent advances in adrenal disease were valuable, practical, and futuristic. The reviews on bone metabolism and calcium homeostasis at large and during the COVID-19 pandemic were fascinating. On the diabetes side, emphasis on the cardiovascular outcomes, the use of newer agents when compelling indications exist, and the role of technology were precious contributions. Some of the classical questions were addressed and revisited, such as endocrinology of thalassemia, precocious puberty, and testosterone replacement. The newer and future lipid-modifying therapies were stimulating, mainly when high-risk patients are considered. Imaging, immunology, and molecular biology took their share in various presentations. <b><i>Conclusions:</i></b> The virtual EDEC 2021 provided a comprehensive review of topical issues concerning clinical practice and research in diabetes, endocrinology, and metabolism. Many new concepts were introduced in diabetes care and endocrinology, bringing the audience to the forefront of research and world-class clinical practice.

The Study of the Association of Serum Parathyroid Hormone Level with Obesity in Patients Admitted to a Tertiary Care Center in Basrah

<b><i>Background:</i></b> Parathyroid hormone (PTH) has been reported to have a positive correlation with insulin resistance and the development of the metabolic syndrome. This study aims to evaluate if there is an association between obesity and serum PTH levels. <b><i>Methods:</i></b> This case-control study was conducted at the Faiha Specialized Diabetes Endocrine and Metabolism Center in Basrah (Southern Iraq) from September 2018 to July 2019. A total of 230 patients were recruited for this study (103 male and 127 female), divided into 2 groups according to the BMI: &#x3c;30 kg/m² were considered as the control group (83 persons) and ≥30 kg/m² were considered as obese persons (147 persons). The study groups were also subdivided into 3 groups according to the serum level of PTH: &#x3c;40 pg/mL, 40–65 pg/mL, and &#x3e;65 pg/mL. <b><i>Results:</i></b> The mean age of the obese and control groups was 44.39 ± 10.64 and 30.12 ± 8.95 years, respectively. About 46.25% of obese were men and 53.75% were women, while 42% of the control group were men and 58% were women. Serum PTH level was significantly higher (<i>p</i> &#x3c; 0.001) among obese persons with a mean level of 53.21 ± 19.58 pg/mL for obese and 37.63 ± 21.8 pg/mL for control. Vitamin D deficiency was seen in 84.4% of the obese group while in 71.1% of the control group (<i>p</i> value 0.04). Females turned to have higher PTH levels than males in both the obese and the control group (<i>p</i> value &#x3c;0.001). However, age and the presence of diabetes mellitus were not associated with higher PTH levels (<i>p</i> value 0.155 and 0.6, respectively). <b><i>Conclusion:</i></b> Obesity was associated with a higher serum PTH level related to the severity of vitamin D deficiency.

Tumour-Not So Sweet, Tumour-Induced Hypoglycemia: A Rare Case of Refractory Hypoglycemia in a Toddler

Tumour-induced hypoglycaemia is a rare complication/condition mainly seen in adults. It is caused due to increased production of insulin or insulin-like growth factor (IGF) 2 tumour cells. We present a 3-year-old paediatric patient with non-islet cell tumour induced hypoglycaemia (NICTH) secondary to rhabdomyosarcoma. She presented with abdominal mass and refractory hypoglycaemia, requiring high glucose infusion and steroids. Critical sample analysis during hypoglycaemia showed suppression of insulin, IGF-1, C-peptide, growth hormone, and ketones, with a high cortisol level. CT scan of abdomen and pelvis showed a huge retroperitoneal mass, later diagnosed as rhabdomyosarcoma. In a resource-limited setting, where IGF-2 is not possible, low serum insulin and IGF-1 levels during hypoglycaemia aids in diagnosis of NICTH. This is one of the first few reported paediatric cases with NICTH from India, and we believe that reporting this case would add more information to the existing literature. Thus, NICTH should be suspected in all malignancies presenting with intractable hypoglycaemia irrespective of their age.

Evaluation of the Effects of Bariatric Surgery in Terms of Weight Loss and Diabetes Remission in the Indian Population

<b><i>Objectives:</i></b> The growing prevalence of obesity rates worldwide is associated with an upsurge in its comorbidities, particularly type 2 diabetes mellitus (T2DM). Bariatric surgery is a proven treatment modality for producing sustained weight loss and resolution of associated T2DM providing marked improvement in quality of life with rapid recovery. This study aims to investigate the effects of laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and mini-gastric bypass (MGB) on obese patients suffering from T2DM in the Indian population and their long-term association with regard to diabetes remission, resolution of comorbidities, and percentage EWL. <b><i>Methods:</i></b> Retrospective data of obese patients with T2DM (preoperative BMI 45.37 ± 8.1) who underwent bariatric surgery (RYGB, LSG, and MGB) were analyzed in this study over a period of 9 years. The mean follow-up period was 2.2 years. Following surgery, the clinical outcome on BMI, resolution of percentage weight loss, and T2DM were studied. The predictive factors of diabetic remission after surgery were determined. Student’s <i>t</i> test and ANOVA and McNemar’s test were applied. <b><i>Results:</i></b> Out of a total of 274 patients, complete remission of T2DM was achieved in 52.9% (<i>n</i> = 145) with mean fasting blood glucose and glycated hemoglobin values being 6.1 ± 0.769 (<i>p</i> = 0.00) at 1 year after surgery. The independent predictive factors of remission were age, gender, BMI, preoperative comorbidities, and % EWL. Gender had no correlation with the chance of achieving disease remission. <b><i>Conclusion:</i></b> Based on our results, bariatric surgery proves to be a successful treatment option resulting in sustained weight loss in obese patients suffering from T2DM. It is found to be beneficial for the long-term resolution of T2DM and improving comorbidities such as hypertension and dyslipidemia. The outcome of the different surgical methods is found to be similar for all patients irrespective of the independent predictors of complete remission.

Prevalence of Macroprolactinemia in Patients with Hyperprolactinemia Using Roche Elecsys Platform in a Large Tertiary Referral Center in UAE

<b><i>Objectives:</i></b> Macroprolactin (macroPRL) excess is an important cause of hyperprolactinemia. Several prolactin assays have high reactivity to macroPRL. However, macroPRL screening is not routinely performed in many labs. This study aimed to evaluate the prevalence of macroprolactinemia (MP) in patients with elevated prolactin using the Roche Elecsys assay in a large tertiary center in UAE. <b><i>Materials and Methods:</i></b> Consecutive samples of patients with elevated prolactin presenting to Tawam Hospital from June to August 2018 were evaluated for MP. Polyethylene glycol (PEG) was used to precipitate macroPRL. Monomeric prolactin recovery cutoff ≤50% was used to determine the prevalence of MP. <b><i>Results:</i></b> A total of 180 patients with elevated prolactin were included in the study with a mean age of 33.1 ± 11.9 years. The majority were women (87.2%), and about 77.8% were newly diagnosed patients with hyperprolactinemia. The main indications for prolactin testing were menstrual irregularity (<i>n</i> = 121), infertility (<i>n</i> = 11), galactorrhea (<i>n</i> = 11), and sellar masses (<i>n</i> = 12). MP was present in 8.3% of the patients. The median (IQR) of total prolactin level was 740.5 (579–1,085) IU/m before PEG precipitation and was not significantly different between MP and true hyperprolactinemia cases. Three patients with MP had pituitary MRI evaluation, which was normal. Eight patients with MP were treated with cabergoline. <b><i>Conclusion:</i></b> One in 12 patients with hyperprolactinemia had MP on the Roche Elecsys assay defined as the cutoff recovery of ≤50% post-PEG precipitation. Physicians should be aware of the prolactin assay used in their labs, and we recommend routine macroPRL assessment in mild hyperprolactinemia samples in labs using the Roche Elecsys platform.

One-Year Course of Olanzapine-Induced Diabetic Ketoacidosis: A Case Report

Second-generation antipsychotics, despite being highly effective, are among the drugs known to cause insulin resistance and metabolic syndrome, eventually leading to diabetes mellitus and less commonly diabetic ketoacidosis (DKA). Here, we present the case of a 21-year-old male, who was not previously known to have any comorbid factors but presented with DKA 1 year and 9 months after beginning treatment with olanzapine for an unspecified psychotic disorder requiring hospital admission and the resolution of the same following discontinuation of the drug. Our case report emphasizes the need for regular screening of patients requiring diabetogenic drugs, so that early identification of possible side effects can be noted and averted.

Evaluation of the Association of CGM Metrics with Antihyperglycemic Drugs in Insulin-Treated Diabetics

<b><i>Introduction:</i></b> Intermittent flash glucose monitoring (FGM) and real-time continuous glucose monitoring (CGM) are used to monitor glycemic excursions for 14 days and can demonstrate time in range (TIR), time above range (TAR), and time below range (TBR). The utility of CGM metrics, such as TIR, TBR, and TAR, in diabetics treated with insulin combined with antihyperglycemic drugs is uncertain. <b><i>Methods:</i></b> In a cross-sectional and retrospective study, we investigated the relationship between target metrics from CGM/FGM and HbA1c or glucose variabilities in 80 type 1 and 2 diabetic patients receiving insulin treatment with ≥1 injections per day. The proportions of TIR, TAR, and TBR from FGM in relation to HbA1c and coefficient of variation (CV)% in types 1 and 2 diabetics were analyzed. Multivariable analyses were performed regarding the associations of TIR with biochemical factors and glycemic variabilities. TBR was also examined in relation to antidiabetic agents and diabetic type in multiple regression analyses. Finally, the association of retinopathy with FGM-CGM metrics was examined using a logistic analysis. <b><i>Results:</i></b> When patients were grouped by sex and diabetic type, significant differences in age, TIR, TBR, high-density lipoprotein cholesterol (HDLC), and insulin dose were detected using Kruskal-Wallis analyses. HbA1c significantly correlated with TIR (<i>p</i> &#x3c; 0.001) and TAR (<i>p</i> &#x3c; 0.001) using Pearson’s correlation analysis. TBR significantly correlated with CV% (<i>p</i> &#x3c; 0.001). Multivariable analysis of TIR showed a significant negative association with HbA1c (<i>p</i> = 0.02). Incretin combined with insulin therapy reduced the TBR proportion significantly according to the multivariate analysis. Retinopathy tended to be related to HbA1c (<i>p</i> = 0.059) and duration (<i>p</i> = 0.078) but not TIR (<i>p</i> = 0.891), according to the logistic analysis. <b><i>Conclusions:</i></b> These results demonstrate that CGM metrics reflect glucose control for 2 weeks using TIR. In addition, combined therapy with incretin and insulin therapy is superior for reducing hypoglycemia, based on TBR. Thus, TBR is also useful for monitoring hypoglycemia. However, FGM/CGM metrics do not predict retinopathy accurately.

Prevalence of Overweight and Obesity in Type 2 Diabetic Patients Visiting PHC in the Dubai Health Authority

<b><i>Background:</i></b> Diabetes is a highly prevalent global and local major health problem according to the International Diabetes Federation (IDF) and will double by 2045. A strong relationship between obesity and type 2 diabetes has been found. Both are leading causes of cardiovascular disease and death; thus, understanding the prevalence of obesity in type 2 diabetes is crucial for planning obesity management and preventing complications. <b><i>Objectives:</i></b> This study aimed to determine the prevalence of obesity and overweight among people with type 2 diabetes attending primary healthcare centers (PHC) in the Dubai Health Authority (DHA). <b><i>Methods:</i></b> The study sample consisted of type 2 diabetes mellitus patients who attended family medicine clinics in primary healthcare centers in DHA. All cases with type 2 diabetes attending family clinics for their periodic health checkup screening were included in the study. Patients &#x3c;18 years old, pregnant, and/or those with cancer and/or chronic kidney disease were excluded. <b><i>Results:</i></b> Our study sample had 9,198 type 2 diabetes mellitus cases with 51.6% males, 69.7% United Arab Emirates nationals, 7.9% who exercised regularly, and 1.8% who followed a healthy diet. Obesity and overweight cases were 49.5% and 35.5%, respectively. <b><i>Conclusion:</i></b> Without an aggressive obesity management approach, control of diabetes is difficult. The prevalence of obesity and overweight among people with type 2 diabetes is high. Obesity and overweight cases were 49.5% and 35.5%, respectively, among diabetic patients attending PHC. Over 50% (55%) of UAE nationals were obese, while 31.8% were overweight, suggesting that active interventions to control weight gain would be appropriate.

Long-Acting Glucagon-Like Peptide-1 Receptor Agonist-Induced Rheumatoid Arthritis in a Patient with Type 2 Diabetes Mellitus

<b><i>Case Presentation:</i></b> We report a case of a male patient with rheumatoid arthritis (RA) diagnosed during treatment with a long-acting glucagon-like peptide-1 (GLP-1) receptor agonist (once-weekly dulaglutide injection). At 3 months after dulaglutide initiation, he began experiencing left shoulder pain that continued despite treatment by an acupuncturist, indicating that the pain was not due to periarthritis scapulohumeralis. His HbA1c level was 7.3% at the 3-month follow-up. At the 6-month follow-up visit, the HbA1c level was 8.2%, the low-density lipoprotein cholesterol level was 132 mg/dL, and he expressed right shoulder pain. After 3 months, the HbA1c level was 9.0%, and his bilateral shoulder pain worsened, due to which he could not use his arms well. Routine laboratory testing revealed no other abnormalities at that time. However, several inflammatory and serological RA markers were detected, including an erythrocyte sedimentation rate of 73 (normal range, &#x3c;10) mm/h, a C-reactive protein level of 1.89 (normal range, 0.0–0.14) mg/dL, a rheumatoid factor level of 26 (normal range, 0–15) IU/mL, and an anti-cyclic citrullinated protein antibody level of 195 (normal range, &#x3c;4.5) U/mL. However, tests for antinuclear antibodies, anti-SS-A/Ro antibodies, and anti-RNP antibodies showed negative results. He was diagnosed with RA, and salazosulfapyridine (500 mg/day) was started. At 1 month after RA treatment initiation, his shoulder pain began showing improvement and improved HbA1c levels from 9.0% to 8.0%. <b><i>Discussion:</i></b> Thus, this case report suggests an association between RA and GLP-1. Based on a literature search in PubMed, we believe that this case report is the first to demonstrate that a patient with type 2 diabetes mellitus treated with a long-acting GLP-1 receptor agonist had RA. However, further research is needed to determine whether RA is one of the adverse effects of long-acting GLP-1 receptor agonists. <b><i>Conclusion:</i></b> During treatment with long-acting GLP-1 receptor agonists, it is necessary to consider the possibility of RA as a differential diagnosis when patients complain of persistent joint pain.