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Bilateral adrenal hemorrhage is a rare cause of primary adrenal insufficiency, and bilateral adrenal hemorrhage due to anticoagulant use is even rarer. We describe the case of a 62-year-old woman receiving post total knee arthroplasty anticoagulant therapy who presented fever, vomitting, stomachache, and severe fatigue on the 8th day. It was until 4 months later that the patient was finally diagnosed with adrenal insufficiency resuting from bilateral adrenal hemorrhage, her symptoms were relieved by glucocorticoid replacement therapy. In order to promote the awareness, diagnosis, and mangement of post-surgery anticoagulants induced bilateral adrenal hemorrhage, the clinical characteristics of the reported cases were summarized and analyzed.
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Parathyroid hormone plays an important role in maintaining the homeostasis of calcium and phosphorus metabolism via acting on bone, kidney, and intestine. However, little is known about the effects of parathyroid diseases on the reproductive system. This article describes the association of parathyroid diseases with reproductive function and health.
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Islet β cell protection is one of the key strategies for diabetes treatment. The new antidiabetic drug sodium-glucose cotransporter 2(SGLT2)inhibitor decreases blood glucose by inhibiting glucose reabsorption in the renal tubule, independent of insulin. Various clinical studies have shown that SGLT2 inhibitors improve β cell function. Furthermore, animal experiments have indicated that SGLT2 inhibitors increase β cell mass. SGLT2 inhibitors promote islet regeneration through stimulating β cell proliferation, inhibiting β cell apoptosis and dedifferentiation, enhancing transdifferentiation of α cells to β cells, and initiating progenitor-derived β cell neogenisis. Indirect effects of metabolic improvement(i.e.lowering glucose, losing weight, improving lipid metabolism), inhibiting inflammatory reaction, inducing glucagon-like peptide-1 secreted from α cells, and regulating gene changes might be involved in the β cell protection of SGLT2 inhibitors.
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BACKGROUND@#Cardiovascular (CV) disease is the leading cause of morbidity and mortality in adults with type 2 diabetes (T2D). The aim of this study was to determine the CV risk in Chinese patients with T2D based on the 2019 European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD) guidelines on diabetes, pre-diabetes, and CV diseases.@*METHODS@#A total of 25,411 patients with T2D, who participated in the study of China Cardiometabolic Registries 3B study, were included in our analysis. We assessed the proportions of patients in each CV risk category according to 2019 ESC/EASD guidelines.@*RESULTS@#Based on the 2019 ESC/EASD guidelines, 16,663 (65.6%), 1895 (7.5%), and 152 (0.6%) of patients were included in "very high risk," "high risk," and "moderate risk" categories, respectively. The proportions of patients in each category varied based on age, sex, body mass index, and duration. While 58.7% (9786/16,663) of elderly patients were classified to "very high risk" group, 89.6% (3732/4165) of patients with obesity were divided into "very high risk" group. Almost all patients with a duration of diabetes >10 years had "very high risk" or "high risk." However, 6701 (26.4%) of Chinese T2D patients, who had shorter duration, and one or two risk factors, could not be included in any category (the "unclear risk" category).@*CONCLUSIONS@#In China, most patients with T2D have "very high" or "high" CV risk based on 2019 ESC/EASD guidelines. However, the risk of patients in "unclear risk" group needs to be further classified.
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Adult , Aged , Humans , Cardiovascular Diseases/epidemiology , Cross-Sectional Studies , Diabetes Mellitus, Type 2 , Heart Disease Risk Factors , Risk FactorsABSTRACT
Bone turnover is balanced with coupling of bone formation and resorption at various rates leading to continuous remodeling of bone.Osteoporosis diagnosis, which is nowadays generally made based on bone mineral density(BMD)measurements, suffers from certain limitations.Bone turnover markers (BTMs)can help improve osteoporosis detection.BTMs can provide information that is useful for the management of patients with osteoporosis,for assessing the possible causes of secondary osteoporosis and the correct dosage;they are also potentially useful as surrogate biomarkers for fracture.(Chin J Lab Med,2018, 41:333-336)
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The discovery and development of incretin effect has changed the landscape of diabetes treatment over past decades. Nowadays, incretin-based agents, such as glucagon-like peptide-1 ( GLP-1) receptor agonists and dipeptidyl peptidase-4 ( DPP-4) inhibitors have been wildly used in the therapy of type 2 diabetes. These agents show the beneficial effects on the multiple pathophysiological defects of type 2 diabetes, and provide a safe approach for achieving glycemic control with low risk of hypoglycemia and weight gain. Moreover, incretin-based therapies are still in development. Novel incretin-related therapies, such as fixed-dose combinations of GLP-1 receptor agonists and basal insulins, oral GLP-1 receptor agonists, and GLP-1 secretagogues, will be available in clinical practice in the near future.
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To investigate the association between hemoglobin ( Hb ) and thyroid-stimulating hormone ( TSH) levels in different trimester pregnant women with subclinical hypothyroidism (SCH). 62 pregnant women, who were diagnosed as SCH when they had their first antenatal care and eventually delivered in the Affiliated Quanzhou First Hospital of Fujian Medical University from March 2013 to December 2014, were enrolled in this study. These subjects were divided into three groups according to weeks of gestation when they had their first prenatal care:including first trimester (n＝24), second trimester (n＝17), and third trimester (n＝21) groups. All SCH pregnant women were treated with levothyroxine ( L-T4). The clinical and laboratory data in the first antenatal care and antepartum period were collected. Association of Hb level with other clinical and laboratory data were analyzed. Compared to baseline, the levels of TSH, γ-glutamyl transpeptidase, alanine aminotransferase, and total cholesterol were lower (all P<0.05), and the levels of Hb were higher (P<0.05), after treated with L-T4in three groups. Pearson correlation analysis showed that the level of Hb was negativly correlated with TSH in all pregnancies or in third trimester groups (r＝－0.394,－0.308,－0.537 and－0.453 respectivly, all P<0.05). Multivariate regression analysis indicated that the level of Hb was independently associated with TSH and body mass index in pregnant women with SCH. In pregnant women with SCH, the higher TSH and body mass index levels are correlated with increased risk of anemia. L-T4treatment may ameliorate anemia during pregnancy.
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Whether levothyroxine ( LT4 ) treatment improves outcomes following in vitro fertilization and embryo transfer ( IVF-ET) in euthyroid women who have tested positive for thyroid autoantibodies remains unclear. In Pregnancy Outcome Study in enthyroid women with Thyroid Autoimmunity after Levothyroxine ( POSTAL) trial, which was a randomized controlled study involving 600 euthyroid women undergoing IVF-ET who were tested positive for thyroperoxidase antibodies, the miscarriage rate, clinical pregnancy rate and live-birth rate were not significantly different between the LT4 intervention group and control group. Therefore, LT4 treatment did not appear to improve pregnancy outcomes among women with thyroid autoantibodies undergoing IVF-ET.
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American Diabetes Association (ADA)has been working on standards of medical csare in diabetes for a long time.Based on the latest evidence of clinical studies,the Standards of Medical Care in Diabetes updated annually by ADA has become one of the most important guidelines for medical professionals.The new version of Standards of Medical Care in Diabetes was published as supplement form on Diabetes Care in January 2018.The statement of ADA on diagnosis,management and assessment in diabetes are recommended for clinicians,researchers and patients.This interpretation will focus on the updates of importance.
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Glucagon regulates glucolipid metabolism and body weight through binding to and activating glucagon receptor ( GCGR ), which is predominantly expressed in liver and pancreas. In the diabetic state, inappropriately increased glucagon secretion leads to elevated hepatic glucose output, while GCGR blockage restores blood glucose homeostasis. Various approaches including GCGR monoclonal antibodies ( mAbs ), antagonists, antisense oligonucleotides, and gene knockout can block GCGR signaling. It has shown that GCGR mAbs improve hyperglycemia in diabetic mice and humans without severe adverse effects, since they can specifically antagonize the action of glucagon. Therefore, GCGR signaling plays a critical role in the pathophysiology of diabetes and GCGR mAbs represent innovative approaches in the management of diabetes.
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Osteoporosis(OS)is a systemic skeletal disorder characterized by low bone mass and increased risk of fracture.Bone mineral density(BMD)is a gold standard in the diagnosis of OS,but is not sensitive enough for detecting the earlier bone loss.Bone metabolic markers have high sensitivity and specificity.Therefore,they are able to reflect the early changes of bone mass and can be used to monitor the efficacy of anti-OS agents.This article summarizes the research advance in both traditional and newly identified bone metabolic markers.
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Both dipeptidyl peptidase-4(DPP-4)inhibitor and sodium-glucose cotransporter-2(SGLT-2) inhibitor have been approved for the treatment of type 2 diabetes mellitus(T2DM). In preclinical or clinical studies, DPP-4 inhibitor shows a potential beneficial effect on renal architecture damage,whereas SGLT-2 inhibitor has a role in renoprotection by improving renal hemodynamics. Therefore,the combination therapies with DPP-4 inhibitor and SGLT-2 inhibitor not only improve metabolic control, but also may have a synergistic or complementary effect in protecting renal structure and function in patients with T2DM. This combination therapy provides a novel option for raising the comprehensive management level in patients with T2DM.
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Objective To compare the efficacy and safety of insulin aspart (IAsp) versus regular human insulin (RHI) used in basal bolus (BB) or continuous subcutaneous insulin infusion (CSII) regimen in patients with diabetes mellitus in Chinese population.Methods We searched MEDLINE (via OVID),the Cochrane Library,Embase,PubMed,CBM,China National Knowledge Infrastructure (CNKI),and Wanfang databases from the beginning of the databases to November,2015.The randomized controlled trials comparing IAsp and RHI in DM were searched.The meta-analysis in newly diagnosed DM and treated DM was performed by RevMan 5.3.Results A total of 40 trials were included in this study,with 1087 newly diagnosed and 2395 treated DM patients.In both groups,IAsp was better in lowering 2 hours postprandial plasma glucose (2 hPG) after breakfast,lunch and dinner (For newly diagnosed population MD=-1.22,-1.70,-1.44;95%CI:-1.79~-0.64,-2.77~-0.63,-2.12~-0.75;for treated population MD=-1.19,-1.14,-1.03;95%CI:-1.39~-0.98,-1.27~-1.02,-1.25~-0.81) and fasting plasma glucose (For newly diagnosed population MD=-0.55,95%CI:-0.97~-0.12;for treated population MD=-0.24,95%CI:-0.44~-0.03) when compared with RHI.IAsp could shorten the time to achieve blood glucose target(For newly diagnosed population MD=-1.58,95%CI:-1.74~-1.42;for treated population MD=-1.73,95%CI:-2.10~-1.36) and reduce the risk of hypoglycaemia compared with RHI (For newly diagnosed population RR=0.33,95%CI:0.19~0.56;for treated population RR=0.44,95%CI:0.32~0.61) (P<0.05).Moreover,the total daily insulin dose was lower in IAsp therapy than in RHI therapy when using CSII regimen.Conclusion In Chinese DM patients,IAsp shows advantages in controlling 2 hPG,shortening the time to achieve blood glucose target and lowering the risk of hypoglycaemia when compared with RHI.
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Objective To investigate the efficacy and safety of domestic exenatide injection versus imported exenatide injection in type 2 diabetic patients with inadequate glycemic control on monotherapy or combination therapy of metformin and insulin secretagogues. Methods A multicenter, randomized, parallel-controlled, and non-inferiority trial was carried out. A total of 240 subjects were randomized at a 1:1 ratio to add domestic exenatide injection (trial group) or imported exenatide injection (control group) on the background therapies. The primary endpoint of efficacy was HbA1C change from baseline to week 16. The secondary endpoints of efficacy were the proportion of HbA1C0.05). The changes in FPG, 2hPG, 7P-SMBG and body weight from baseline to week 16 were comparable between the two groups (all P>0.05). Moreover, the incidences of hypoglycemia and adverse events were similar between the two groups (both P>0.05). Conclusion In type 2 diabetic patients inadequately controlled by monotherapy or combination therapy of metformin and insulin secretagogues, the efficacy of cotreatment with domestic exenatide injection is not inferior to that of imported product ones, with a similar safety profile.
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Proinsulin is the precursor of mature insulin.Proinsulin to insulin ratio reflects the degree of pancreatic β-cell dysfunction and the progression of type 2 diabetes, and may predict the risk of diabetes development.Some variants in susceptibility genes of diabetes are associated with the elevation of proinsulin to insulin ratio.Moreover, several antidiabetic drugs are able to decrease the proinsulin to insulin ratio in patients with type 2 diabetes.Therefore, the proinsulin to insulin ratio may act as a simple and useful indicator in the etiological study, risk prediction, disease progression and therapeutical evaluation in type 2 diabetes.
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Standards of Medical Care in Diabetes released by American Diabetes Association (ADA) is one of the most important guidelines for clinicians. Based on the latest evidence of clinical studies,the Standards of Medical Care in Diabetes is annually updated by ADA. The statement of ADA on diagnosis,assessment and management in diabetes are recommended for clinicians,patients and researchers. The latest edition of Standards of Medical Care in Diabetes was published as supplement form on Diabetes Care in January 2017. This interpretation will focus on the updated contents and their best evidence and clinical importance in this guideline.
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A 39-year-old female with central diabetes insipidus complained of polydipsia and polyuria and was found to be accompanied by lung lesions. The diagnosis of IgG4-related disease was confirmed by laboratory and pathological results. It should be alert to consider the possibility of IgG4-related disease in a patient with central diabetes insipidus coexisting with the signs of multisystem lesions such as lung disease.
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The prevalence of non-alcoholic fatty liver disease (NAFLD) keeps rising worldwide along with the increasing prevalence of metabolic diseases such as obesity, type 2 diabetes, and dyslipidemia. Although most NAFLD patients present with simple steatosis of hepatocytes, some patients progress to non-alcoholic steatohepatitis, liver cirrhosis, and even cancer. In the Western world, NAFLD is the most common cause of elevated liver enzymes, and hence there has been a growing interest in this disease. Given that fat deposition in the liver is the hallmark of NAFLD, we review the roles and the underlying mechanism of disturbed lipid metabolism in the development of NAFLD and suggest that more insights into the pathogenesis of NAFLD will help develop targeted strategies for the prevention and treatment of this disease.
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[Summary] Glucagon-like peptide-1 ( GLP-1 ) agents play important roles in glycemic control in type 2 diabetes. Moreover, these agents also show various protective effects on cardiovascular system. GLP-1 agents improve vascular endothelial function, ameliorate the risk factors of cardiovascular disease including obesity, hyperglycemia, dyslipidemia and hypertension, delay the occurrence and progression of atherosclerosis, and protect against cardiac ischemia-reperfusion injury and heart failure. Therefore, GLP-1 agents may have beneficial effects on cardiovascular diseases at different stages and in multiple aspects.
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Recent studies have demonstrated an association of glucagon-like peptide-1 (GLP-1) signaling defect with non-alcoholic fatty liver disease (NAFLD).Native GLP-1 and GLP-1-based agents may directly act on hepatocytes through activation of GLP-1 receptors in hepatocytes,resulting in the regulation of gene expression associated with insulin resistance and lipid metabolism,and the suppression of oxidative stress in liver cells.Moreover,GLP-1-based agents have been reported to be effective in improving hepatic endpoints in patients with NAFLD.