Is Uric Acid elevation a random finding or a causative agent of diabetic nephropathy?

SUMMARY OBJECTIVE In this study, we aimed to analyze the relationship between serum uric acid (UA) and microalbuminuria as a marker of renal injury in type 2 diabetes mellitus. METHODS A total of 100 patients with type 2 diabetes mellitus were enrolled in the study. Participants were divided into two groups according to the urinary microalbumin/creatinine ratio: diabetic nephropathy and non-nephropathy group. UA and microalbuminuria were compared between the study groups. RESULTS Serum UA levels of diabetic nephropathy patients were significantly higher than those in the non-nephropathy group (UA in patients with diabetic nephropathy groups: 6.3 (1.82) mg/dl, UA in patients of the non-nephropathic group: 4.85 (1.92) mg/dl) (p<0.001). There was a correlation between microalbuminuria and UA (r=0.238). This correlation was statistically significant (p=0.017). CONCLUSION UA levels may be an important predictor of nephropathy in diabetic patients.

RESUMO OBJETIVO O objetivo deste estudo foi analisar a relação entre o ácido úrico sérico e a microalbuminúria como marcador de lesão renal no diabetes mellitus tipo 2. MÉTODOS Um total de 100 pacientes com diabetes mellitus tipo 2 foram inscritos no estudo. Os grupos de estudo foram divididos em dois, de acordo com a relação microalbumina/creatinina na urina: nefropatia diabética e grupo não nefropático. UA e microalbuminúria foram comparados entre os grupos de estudo. RESULTADOS Os níveis séricos de AU de pacientes com nefropatia diabética foram significativamente maiores do que o grupo sem nefropatia (AU em pacientes com grupos de nefropatia diabética: 6,3 (1,82) mg/dl, AU em pacientes com grupos não nefropáticos: 4,85 (1,92) mg/dl ) (p<0,001). Houve correlação entre microalbuminúria e AU (r=0,238). Essa correlação foi estatisticamente significativa (p=0,017). CONCLUSÃO Os níveis de AU podem ser um importante preditor de nefropatia em pacientes diabéticos.

Diabetic regulation of subjects with type 2 diabetes mellitus is associated with serum vitamin D levels

SUMMARY OBJECTIVE Vitamin D deficiency is not only associated with bone metabolism but also with diabetes mellitus. We aimed to study the possible association between serum vitamin D concentration and HbA1c level in patients with type 2 diabetes mellitus (T2DM) in this retrospective report. METHODS Patients with T2DM were enrolled to the study either in regulated or non-regulated T2DM groups, according to HbA1c levels. An HbA1c level of <8% was considered as relatively controlled and others were considered as poorly controlled T2DM. RESULTS Serum vitamin D levels in poorly controlled T2DM subjects (9.4 (4.9-34) ng/ml) were significantly lower than that of the relatively well regulated T2DM patients (13.5 (3.4-36) ng/ml) (p=0.03). Vitamin D was strongly and inversely correlated with HbA1c levels (r= -0.295, p=0.005). CONCLUSION Whatever the cause or result of the diabetes mellitus, it is clear that lower vitamin D is strongly associated with worse diabetic regulation in T2DM subjects. Randomized controlled larger studies, which research the relation between diabetic regulation and vitamin D status, are needed to claim whether it could be a therapeutic target in future in diabetic subjects.

RESUMO CONTEXTO E OBJETIVO A deficiência de vitamina D não é apenas associada ao metabolismo ósseo, mas também ao diabetes mellitus. Procurou-se estudar a possível associação entre os níveis de concentração do soro de vitamina D e de HbA1c em pacientes com diabetes mellitus tipo 2 neste relatório retrospectivo. MÉTODOS Os pacientes com diabetes mellitus tipo 2 foram inscritos no estudo em regulada ou não regulada de acordo com os grupos de níveis de HbA1c DM2. HbA1c nível de <8% caracterizava DM2 controlada e HbA1c > 8% DM2 descontrolada. RESULTADOS Os níveis de vitamina D no soro em indivíduos com DM2 mal regulados (9,4 (4,9 a 34) ng/ml) foram significativamente menores do que o do bem regulado em doentes DM2 (13,5 (3,4-36) ng/ml) (p = 0,03). A vitamina D foi forte e inversamente correlacionada com os níveis de HbA1c (p = 0,005). CONCLUSÃO Seja qual for a causa ou o resultado do diabetes mellitus, é claro que níveis baixos de vitamina D são fortemente associados com pior regulação em indivíduos diabéticos com DM2. Maiores estudos randomizados e controlados que pesquisam a relação entre o status de vitamina D e a regulação em diabéticos são necessários para molusco se é, no futuro, poderia ser um alvo terapêutico em indivíduos diabéticos.

Diabetes control could through platelet-to-lymphocyte ratio in hemograms / O controle diabético poderia ser predicado por Platelet para a relação de linfócitos no hemograma

SUMMARY OBJECTIVE Association between type 2 diabetes mellitus and inflammation is well-established. We aimed to study platelet-to-lymphocyte ratio (PLR), a novel inflammatory index derived from hemogram, in diabetic patients in comparison to those in healthy volunteers. METHODS Medical data of type 2 diabetics that showed up in general outpatient medical clinics of our institution between February 2017 and August 2017 were recorded and analyzed. RESULTS Median PLR of type 2 diabetic patients was significantly higher than the PLR of healthy controls (p=0.001). Moreover, PLR was significantly and positively correlated with HbA1c (p<0.001, r=0.58), fasting plasma glucose (p<0.001, r=0.49), and c-reactive protein (p=0.003, r=0.30) levels. Type 2 diabetic subjects with proteinuria had significantly higher PLR levels than that of diabetic subjects without proteinuria. CONCLUSION As an inexpensive and easy to use index, PLR may be useful in predicting the development and control levels of type 2 diabetes mellitus. However, its correlation with HbA1c needs to be validated by larger prospective studies.

RESUMO OBJETIVO A associação entre diabetes mellitus tipo 2 e inflamação está bem estabelecida. Pretendemos estudar a relação plaquetária com linfócitos (PLR), um novo índice inflamatório derivado do hemograma, em pacientes diabéticos e comparar com aqueles em voluntários saudáveis. MÉTODOS Foram registrados e analisados dados médicos de diabéticos de tipo 2 que apareceram em clínicas ambulatoriais de medicina geral de nossa instituição entre fevereiro de 2017 e agosto de 2017. RESULTADOS A PLR mediana dos pacientes com diabetes tipo 2 foi significativamente maior que a PLR de controles saudáveis (p=0,001). Além disso, a PLR foi correlacionada de forma significativa e positiva com os níveis de glicemia de jejum (p<0,001, r=0,49) e níveis de proteína c-reativa (p=0,003, r=0,30) com HbA1c (p<0,001, r=0,58). Os indivíduos diabéticos de tipo 2 com proteinúria aumentaram significativamente os níveis de PLR do que os indivíduos diabéticos sem proteinúria. CONCLUSÃO Como um índice barato e fácil de usar, a PLR pode ser útil para prever o desenvolvimento e controle do nível de diabetes mellitus tipo 2. No entanto, sua correlação com HbA1c precisa ser validada por estudos prospectivos maiores.

Prolonged hypoglycemia due to sulfonylurea in an elderly woman

Overuse of antidiabetic medications is the most common cause of hypoglycemia in diabetic subjects. Here, we report a case of hypoglycemia associated with sulfonylurea administration. An 83-year-old female patient was admitted to the emergency department with complaints of loss of consciousness and fainting. The patient's blood glucose level was of 33 mg/dL, and she received emergency treatment with an intravenous 10% dextrose solution. In conclusion, sulfonylureas in combination with antidiabetic therapy increase the risk of hypoglycemic events in elderly patients with renal failure. Therefore, we suggest that physicians should closely monitor these patients for hypoglycemia and, preferably, use drugs that have less hypoglycemia side effects

Elevated neutrophil-to-lymphocyte ratio in the diagnosis of Hashimoto's thyroiditis

Summary Objective: Hashimoto's thyroiditis (HT) is an autoimmune inflammatory disorder. The purpose of this study was to determine the neutrophil-to-lymphocyte ratio (NLR), a novel marker of inflammation, in patients with HT and to compare these values with those from healthy subjects. Method: A total of 154 participants were included in the study, 90 HT patients and 64 healthy volunteers. Retrospectively, demographic and laboratory data of the subjects were obtained from our institution's database. Patients with active infection, diabetes mellitus, malignancy, other chronic inflammatory diseases, hematologic disorders and patients on aspirin or steroid treatment were excluded from the study. Values for complete blood count (CBC) and serum laboratory parameters of HT patients were the baseline values obtained at the time of HT diagnosis. Control subjects consisted of healthy volunteers who visited our institution for a routine check-up. Results: Age, gender and CBC parameters were not different between the HT group and the control group; however, the NLR of HT group (2.1 [1.3-5.8]) was significantly higher than the control group (1.9 [0.6-3.3]), p=0.04. Conclusion: Increased NLR may be useful as an indicator of the presence of HT, especially in complicated cases. NLR is inexpensive and easy to determine. Larger, prospective studies are required to determine its usefulness in assessing diagnostic potential and treatment outcomes in HT patients.