Diabetes & Endocrine Associates

Type 2 diabetes (T2D), along with other co-morbidities (hypertension, hyperlipidemia, etc.), causes vascular complications and atherosclerosis, leading to heart or kidney damage. The timely detection of cardiovascular disease (CVD) and chronic kidney disease (CKD) risk helps in targeted treatment, thereby reducing hospitalization/death in people with T2D. The vascular complications of T2D, including the onset of CVD or CKD, have been widely studied. However, a clear understanding of the concurrent inter-relatability of diabetes-kidney-heart or diabetes-heart-kidney continuum would further assist the clinicians in preventing morbidity and mortality. The narrative review sought to outline the stages (“prevent,” “regress,” and “retard”), pathophysiological mechanism, and management of the continuum with defined patient profiles and associated risk factors. Pharmacotherapies with a focus on managing both cardiac and renal vascular changes (e.g., sodium-glucose transporter-2 inhibitors {SGLT-2is}, glucagon-like peptide-1 receptor agonists {GLP-1RA}, dipeptidyl peptidase-4 inhibitors {DPP-4is}, lipid-lowering therapy, and renin-angiotensin-aldosterone system {RAAS} blockers) have been discussed. In addition, new diagnostic approaches such as levels of B‐type natriuretic peptide (BNP), N‐terminal prohormone, cardiac troponin, cystatin C, and single-cell transcriptome sequencing, with proven accuracy for detecting vascular complications in the heart and kidney, have been summarized. The review underscores the importance of the early detection of the vascular complications in T2D with individual risk stratification for the initiation/continuation/switching of therapies, to enhance treatment adherence and outcomes.

GDM is an intermediate phase in a woman's life that certainly poses a high risk of type 2 diabetes. Maternal health affects the health of offspring, a precursor of the vicious cycle of diabetes that continues through generations. Knowing the causative factors of GDM is important to breaking this cycle. To study the risk factors of GDM in Indian women. The observational study database records from 2022 to 2023 from 11 different centres across India. We included pregnant women diagnosed with GDM with any OGTT criteria and excluded women with pre-existing diabetes. A total of 431 women with GDM were included in the study. 166 women were diagnosed with GDM in the 3rd trimester, followed by 235 women in the 2nd trimester, and 30 women in the 1st trimester of pregnancy. Those detected with GDM during the 1st trimester had a BMI of 27.9kg/m2, followed by 28.3 and 29.3kg/m2 in 3rd trimester. Multigravida showed a positive correlation with a family history of T2D (0.04), previous history of GDM (p-value < 0.001), history of stillbirth (p-value < 0.001) and hypertension (p-value 0.03). Pre-pregnancy BMI and women's age at family planning are two important risk factors for the prevention of gestational diabetes.

A 9-year-old mixed breed cat with a history of recurrent ulcerated skin lesions was diagnosed with nocardiosis. Three months after initiating potentiated sulfonamide treatment, the cat developed goitrous hypothyroidism, characterized by palpable enlargement of both thyroid lobes, low serum concentrations of total thyroxine (T4) and free thyroxine (fT4), and high serum thyroid-stimulating hormone (TSH) concentration. Thyroid scintigraphy identified symmetrical enlargement of both thyroid lobes, with increased radionuclide (99mTc-pertechnetate) uptake. Upon discontinuation of trimethoprim-sulfa, serum concentrations of T4, fT4, and TSH returned to normal, confirming the diagnosis of iatrogenic, drug-induced thyroid dyshormonogenesis leading to hypothyroidism. A skin lesion was surgically removed, and microscopy disclosed branched filaments along with characteristic Gram-positive coccobacilli and Splendore-Hoeppli phenomenon. Using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), the clinical isolate was identified as Nocardia puris.

Accurate assessment of an individual’s diet is vital to study the effect of diet on health. Image-based methods, which use images as input, may improve the reliability of dietary assessment. We developed an iOS application that uses computer vision to identify food from images. This study aimed to assess the accuracy of energy intake (EIapp) estimates from the application by comparing them to estimated energy expenditure (EE) and to the EI estimates from a validated dietary assessment tool, the 24-h recall (EIrecall). Participants were recruited from a randomised controlled trial called He Rourou Whai Painga. Participants recorded all intake over 7 d using the application, which provided a mean daily EI; this was compared to the EI estimated by two 24-h recalls. The EI from the application and the recalls were compared to EE, estimated using indirect calorimetry and wrist-worn accelerometry. EI estimates from the application and the 24-h recalls were lower than EE, with a mean bias of -1814 kJ (95% CI -3012 to -615, p = 0.005) and -1715 kJ (95% CI -3237 to -193, p = 0.029), respectively. The mean bias between EI from the application and the 24-h recall was 783 kJ (95% CI -875 to 2441, p = 0.33). This suggests that the EI estimates from the application are comparable to the 24-h recall method, a validated and widely used tool in nutritional research.

Patients with hypertension are at an increased risk of cardiovascular disease and death. Resistant hypertension, or hypertension that is unsuccessfully treated with multiple antihypertensive medications, further exacerbates the complications and negative outcomes for patients. A new pathway, via aldosterone synthesis inhibition, is currently being studied as a method to reduce blood pressure values in patients who are currently taking other antihypertensive medications. This review presents and discusses the current pharmacokinetic, pharmacodynamic, and clinical and scientific evidence pertaining to baxdrostat, a novel aldosterone synthase inhibitor.

Abstract M. Umapathysivam: None. A. Vincent: None. J. Tan: None. A. Ashagre: None. D. Jesudason: None. G. Wittert: Consulting Fee; Self; I-Nova. Grant Recipient; Self; Bayer, Inc., Eli Lilly &amp; Company, Weight Watchers, Lawley Pharmaceutical. Speaker; Self; Besin Health Care, Bayer, Inc., Amgen Inc. Background: Obesity causes reduction in serum testosterone concentration (T) and low T is an independent risk for the development of type 2 diabetes (T2D). The relationship between T and diabetes risk across the range of T remains unclear, as does the interaction between T and age, waist circumference (WC) and baseline glycemia. Aim: To determine the relationship between T and incident T2D risk across the range of T and to examine interactions between T and WC, age, and baseline glycemia on incident T2D risk in middle aged and older men. Methods: Men without diabetes, cancer, testosterone treatment, and both baseline and 5-yr follow-up assessments in the MAILES Cohort were included. The MAILES cohort comprises 2563 North West Adelaide, community dwelling men aged 35-85 years at enrolment. Multivariate logistic regressions assessed the association between baseline T and incident T2D risk with/out pairwise interactions and non-linear associations (splines). The covariates adjusted for were baseline age, WC, HbA1c, family history, smoking, alcohol intake, self-reported physical activity and medication affecting T2D risk. Incident diabetes was assessed 5 years after baseline assessment and was defined as HbA1c ≥6.5%, medication to lower blood glucose, or self-reported diagnosis of T2D.Results: 1315 men met the inclusion criteria. There were 110 cases of incident T2D (8.4%). T at recruitment was an independent risk factor for incident T2D (OR=0.93, 95%CI=[0.89, 0.98], p=0.003). There was no detectable interactions between T and WC (p = 0.72), WC and baseline HbA1c (p=0.38). There was an interaction between T and age (p = 0.001), with a T effect in men &amp;lt;65 years (OR=0.85, 95%CI=[0.81, 0.92], p&amp;lt;0.001) and not in men &amp;gt;65 years (OR=1.03, 95%CI=[0.95, 1.11], p=0.51). In both the entire cohort and in men &amp;lt;65 years there was no evidence of non-linearity on the logit scale, with higher T being associated with lower T2D risk across the spectrum of T. Conclusions: Higher baseline T was protective against incident diabetes independent of traditional risk factors at all levels of T in men aged ≤65. This is consistent with the recent observation that, treatment with exogenous testosterone of individual with normal T, reduces risk of incident T2D. We were unable to detect effects of baseline T concentration on incident diabetes in older individuals (&amp;gt;65 years). Saturday, June 1, 2024

Ventricular arrhythmias are commonly associated with hypertrophic cardiomyopathy with and without midventricular obstruction. Although the overall prognosis is relatively good with an annual mortality rate <1%, the propensity to potentially fatal ventricular arrhythmias (ventricular tachycardia) is the most feared complication. Electrical storms are a severe manifestation of ventricular arrhythmias, with poor outcomes. In this report, we present a case of a young patient with non-obstructive hypertrophic cardiomyopathy who presents after a syncopal episode and is found to have an electric storm that is refractory to medical therapy.

Obesity, prediabetes, and type 2 diabetes mellitus (T2DM) pose a triple burden in India. Almost two-thirds of people with diabetes (PWD) in India are found to have suboptimal glycemic, blood pressure, and lipid control. Medical nutrition therapy (MNT) in diabetes has emphasized on the amount and type of carbohydrates for years. However, protein, an important macronutrient in diabetes management, needs to be focused upon, especially in India, where the consumption is found to be lower than the recommendations provided by most guidelines. An expert committee attempted to review the role of dietary protein in the management of T2DM, arrive at a consensus on the significance of increasing dietary protein for various benefits, and offer practical guidance on ways to improve protein intake among Indians. A total of 10 endocrinologists and diabetologists, one nephrologist, and three registered dietitians representing four zones of India formed the expert committee. An in-depth review of literature in the Indian context was carried out, and the draft document was shared with the expert committee, and their views were incorporated into the same. The expert committee then assembled virtually to deliberate on various aspects of the role of protein in T2DM management. The experts from various specialties gave their valuable inputs and suggestions from their extensive personal clinical experience and research work, which helped to reach a consensus on the role and significance of protein in the management of T2DM and its complications in India. There is abundant evidence that MNT is essential for the prevention and management of T2DM and its complications. Experts agreed that increasing protein intake offers myriad health benefits, namely reducing glycemic variability, improving glycemic control, increasing insulin sensitivity, improvement in lipid profile and immunity, and helping in weight management and preservation of muscle mass in PWD. The expert committee suggested aiming for an increase in protein intake by at least 5-10% of the current intake in lieu of carbohydrates in PWD. Experts also highlighted the need for more data quantifying the unmet protein needs in the Indian PWD, especially among vegetarians. Randomized controlled trials to study the effect of protein in diabetes complications such as cardiovascular disease (CVD) and diabetic kidney disease (DKD) and comorbid conditions such as sarcopenia among the Indian population are also warranted. Increasing protein quantity and quality in the diets of Indian PWD could significantly contribute to positive health outcomes. Increased protein intake, preferably through dietary sources to meet the requirements and, when required using diabetes-specific protein supplements (DSPS), is recommended in the prevention and control of T2DM.