The association of hyperglycemia with the development of infectious complications in adult Filipino patients with acute lymphoblastic leukemia

Abstract Introduction Hyperglycemia occurs in Acute Lymphoblastic Leukemia (ALL) due to chemotherapeutic agents and may be stress-induced. Given the potential impact of hyperglycemia on the clinical outcomes of ALL patients, we sought to determine the association of hyperglycemia with the development of infectious complications. Methods This is a retrospective cohort involving adult Filipino ALL patients admitted at a tertiary referral center. Patients were stratified according to blood glucose levels and infections were classified into microbiologically and clinically defined infections. Logistic regression was performed to determine whether hyperglycemia was associated with the development of infectious complications. Results Of the 174 patients admitted for ALL, only 76 patients (44%) underwent blood glucose monitoring and were thus included in this study. Hyperglycemia was observed in 64 patients (84.21%). Infectious complications were seen in 56 patients (73.68%), of whom 37 patients (48.68%) had microbiologically defined infections and 19 (25%) had clinically defined infections. The respiratory tract was the most common site of infection and gram-negative bacteria were the predominant isolates. Hyperglycemia significantly increased the likelihood of infectious complications, particularly at blood glucose levels ≥ 200 mg/dL. Conclusion Hyperglycemia is associated with an increased likelihood of infectious complications in Filipino ALL patients. With sepsis being one of the main causes of mortality in this population, our study provides compelling evidence for us to consider routine blood glucose monitoring in order to manage and potentially decrease the occurrence of infections in these patients.

Efeito da dieta hipocalórica na pressão arterial e demais cofatores da síndrome metabólica / Effect of hypocaloric diet on blood pressure and other cofactors of metabolic syndrome

Introdução: a hipertensão arterial sistêmica (HAS) está associada a fatores de risco metabólicos e pode ser definida como uma doença crônica multifatorial, com valores persistentes de pressão arterial sistólica (PAS) e (ou) pressão arterial diastólica (PAD) maiores ou iguais a 140 mmHg x 90 mmHg, respectivamente. A HAS é um dos fatores que compõem a síndrome metabólica (SM) juntamente com a hiperglicemia, dislipidemia e (ou) obesidade central. Modificações no estilo de vida, como a alimentação e perda de peso, demonstraram melhorar os parâmetros cardiometabólicos nos pacientes com HAS e SM. Objetivo: verificar o efeito de uma dieta hipocalórica na antropometria, na pressão arterial e em outros cofatores da síndrome metabólica. Metodologia: trata-se de um ensaio clínico não randomizado, retrospectivo, com dados secundários, em que o mesmo grupo foi de "intervenção" e "comparador", e cujos dados foram coletados antes (baseline) e após a intervenção. A pesquisa foi realizada com 84 pacientes, adultos, com síndrome metabólica, de ambos os sexos. Os pacientes seguiram dieta com restrição calórica de 200 a 500kcal/dia, com cálculo energético em torno de 20kcal/kg de peso, valor energético total não inferior a 1200kcal, durante um período de dois meses. Foi utilizada estatística descritiva e o teste t pareado ou Wilcoxon-Sign-Rank intragrupo para analisar as variações ao longo do tempo (p < 0,05). Resultado:houve uma redução na antropometria (índice de massa corporal, circunferência da cintura, circunferência do braço e circunferência do quadril), PAS e PAD, glicemia de jejum e triglicerídeos com p< 0,05 dos pacientes após a intervenção, mas não houve melhora no HDL (p > 0,05). Conclusão: a dieta hipocalórica reduziu as medidas antropométricas, a pressão arterial e os demais cofatores da SM nos pacientes avaliados após o acompanhamento de dois meses.

Introduction: systemic arterial hypertension (SAH) is associated with metabolic risk factors and can be defined as a multifactorial chronic disease, with persistent values of systolic blood pressure (SBP) and (or) diastolic blood pressure (DBP) greater than or equal to 140 mmHg x 90 mmHg, respectively. SAH is one of the factors that make up the metabolic syndrome (MS) along with hyperglycemia, dyslipidemia and (or) central obesity. Lifestyle modifications, such as diet and weight loss, have been shown to improve cardiometabolic parameters in patients with SAH and MS. Objective: to verify the effect of a hypocaloric diet on anthropometry, blood pressure and other cofactors of the metabolic syndrome. Methodology: this is a non-randomized, retrospective clinical trial, with secondary data, in which the same group was "intervention" and "comparator", and whose data were collected before (baseline) and after the intervention. Research was carried out with 84 patients, adults, with metabolic syndrome, of both sexes. Patients followed a calorie-restricted diet of 200 to 500kcal/day, with energy calculation around 20kcal/kg of weight, total energy value not less than 1200kcal, during a period of two months. Descriptive statistics and the paired t test or intragroup Wilcoxon-Sign-Rank were used to analyze variations over time (p < 0.05). Result: there was a reduction in anthropometry (body mass index, waist circumference, arm circumference and hip circumference), SBP and DBP, fasting glucose and triglycerides with p<0.05 of patients after the intervention, but there was no improvement in HDL (p > 0.05). Conclusion: the hypocaloric diet reduced anthropometric measurements, blood pressure and other MS cofactors in the patients evaluated after a two-month follow-up.

Mecanismos bioquímicos en el pronóstico grave de pacientes con diabetes mellitus infectados por el virus SARS-CoV-2: revisión de la literatura / Biochemical mechanisms in the severe prognosis of patients with diabetes mellitus infected by SARS-CoV-2 virus: literature review

Resumen La diabetes mellitus (DM) es una enfermedad metabólica caracterizada principalmente por signos y síntomas derivados del aumento de glucosa sérica o hiperglucemia. La pandemia por la enfermedad del coronavirus 2019 (COVID- 19) afectó a todo el mundo con informes de pronóstico grave en pacientes diabéticos infectados por el virus del síndrome respiratorio agudo severo por coronavirus 2 (SARS-CoV-2) y elevada admisión hospitalaria en la unidad de cuidados intensivos (UCI) en comparación con pacientes no diabéticos. El objetivo del trabajo de revisión bibliográfica fue evaluar y describir algunos de los mecanismos bioquímicos que conducen al pronóstico grave en pacientes con DM infectados por el virus SARS-CoV-2 mediante la búsqueda sistemática de información en diferentes bases de datos. Los resultados mostraron que la elevada admisión a UCI con un pronóstico grave de pacientes diabéticos infectados por el virus fue por presentar inflamación excesiva que ocasiona síndrome de distrés respiratorio agudo, tormenta de citoquinas, neumonía severa, inmunidad deteriorada e hiperglucemia. El virus ingresa a la célula principalmente por la vía endocítica y no endosómica; los receptores celulares centrales implícitos en los mecanismos son receptores de insulina (RI), transportador de glucosa tipo 2 (GLUT-2), dipeptidil-peptidasa-4 (DPP4), transportador de glucosa tipo 4 (GLUT-4), enzima convertidora de angiotensina 2 (ECA2) y el correceptor proteasa transmembrana de serina 2 (TMPRSS2) esencial para la propagación viral. La mayor susceptibilidad a desarrollar COVID- 19 en pacientes diabéticos se debe a la sobreexpresión de ECA2 y las complicaciones graves se incrementan a niveles micro y macrovascular como nefropatías, neuropatías y enfermedades cardiovasculares.

Abstract Diabetes mellitus (DM) is a metabolic disease characterised mainly by signs and symptoms derived from increased serum glucose or hyperglycemia. The coronavirus disease 2019 (COVID-19) pandemic affected the entire world continenwith reports of severe prognosis in diabetic patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and high hospital admissions in the intensive care unit (ICU) compared to non-diabetic patients. The objective of the bibliographic review was to evaluate and describe some of the biochemical mechanisms that lead to severe prognosis in patients with DM infected by the SARSCoV- 2 virus through a systematic search for information in different databases. The results showed that the high ICU admission with a severe prognosis of diabetic patients infected by the virus was due to excessive inflammation that causes acute respiratory distress syndrome, cytokine storm, severe pneumonia, impaired immunity, and hyperglycemia. The virus enters the cell mainly through the endocytic and non-endosomal pathway; the central cellular receptors involved in the mechanisms are insulin receptors (IR), glucose transporter type 2 (GLUT-2), dipeptidyl peptidase-4 (DPP4), glucose transporter type 4 (GLUT-4), glucose converting enzyme angiotensin 2 (ACE2), and the serine transmembrane protease co-receptor 2 (TMPRSS2) essential for viral propagation. The increased susceptibility to developing COVID-19 in diabetic patients is due to the overexpression of ACE2, and serious complications are increased at the microvascular and macrovascular levels, such as nephropathies, neuropathies, and cardiovascular diseases.

Resumo O diabetes mellitus (DM) é uma doença metabólica caracterizada principalmente por sinais e sintomas decorrentes do aumento de glicose sérica ou hiperglicemia. A pandemia pela doença do coronavírus 2019 (COVID-19) afetou o mundo inteiro com relatos de prognóstico grave em pacientes diabéticos infectados pelo vírus da síndrome respiratória aguda grave por coronavírus 2 (SARS-CoV-2) e altas internações hospitalares na unidade de terapia intensiva (UTI) em comparação com pacientes não diabéticos. O objetivo do trabalho de revisão bibliográfica foi avaliar e descrever alguns dos mecanismos bioquímicos que levam ao prognóstico grave em pacientes com DM infectados pelo vírus SARS-CoV-2 por meio da busca sistemática de informações em diferentes bancos de dados. Os resultados mostraram que a alta admissão na UTI com prognóstico grave de pacientes diabéticos infectados pelo vírus foi devido à inflamação excessiva que apresentavam e que causa síndrome de desconforto respiratório agudo, tempestade de citocinas, pneumonia grave, imunidade prejudicada e hiperglicemia. O vírus entra na célula principalmente pela via endocítica e não endossômica; os receptores celulares centrais envolvidos nos mecanismos são os receptores de insulina (IR), transportador de glicose tipo 2 (GLUT-2), dipeptidil peptidase-4 (DPP4), transportador de glicose tipo 4 (GLUT-4), enzima conversora de angiotensina 2 (ACE2), e o co-receptor protease transmembrana de serina 2 (TMPRSS2) essencial para a propagação viral. A maior suscetibilidade ao desenvolvimento de COVID-19 em pacientes diabéticos deve-se à superexpressão de ECA2, e complicações graves aumentam nos níveis micro e macrovascular, como nefropatias, neuropatias e doenças cardiovasculares.

Resistencia a Insulina: Revisión de literatura / Insulin Resistance: Literature Review

La resistencia a la insulina es una condición patológica de expresión variable asociada a riesgo cardiovascular, diabetes mellitus tipo 2, hígado graso de etiología no alcohólica, lipodistrofias, síndrome de ovario poliquístico y algunos cánceres. El propósito de esta revisión bibliográfica es brindar información actualizada al lector sobre algunos de los avances actuales de la resistencia a la insulina. Se realizó una búsqueda de literatura en PUBMED de enero 2014-octubre 2021, obteniéndose 1,354 referencias, seleccionando 39 publicaciones. Aunque continúe la discusión sobre la definición clínica y laboratorial, se ha determinado que el manejo terapéutico y preventivo para casos de resistencia a la insulina se debe basar en cambios de estilo de vida con apoyo farmacológico individualizado. El impacto actual y potencial en el futuro inmediato de la epidemiología de la resistencia a la insulina está en los estudios clínico-terapéuticos en curso y en las políticas públicas dirigidas a fomentar el estilo de vida saludable...(AU)

Effect of Prosopis ruscifolia on incretin and insulin secretion in alloxan-induced hyperglycemic rats / Efecto de Prosopis ruscifolia sobre la secreción de incretina e insulina de ratas hiperglicémicas por aloxano

Background: Diabetes mellitus treatment is based on oral hypoglycemic agents or insulin. Medicinal plants constitute an option, and the leaves of Prosopis ruscifolia (Pr) were shown to be effective in reducing glycemia in hyperglycemic animals. Objective: In this paper, we report the effect of P. rusciofolia (Pr) on insulin and incretin secretion in alloxan-induced hyperglycemic rats. Methodology: The effective dose was selected, and four groups (n=10) of Wistar rats were used. Two groups with normal glycemia received water or Pr (75 mg/Kg, per os, p.o.), and two groups with hyperglycemia induced by alloxan (intraperitoneal, ip), received water or Pr (75 mg/Kg, p.o.) for 2 weeks. Oral glucose tolerance test, and incretin and insulin levels were measured at the end of the experimental period. Results: The results showed that extract promotes better tolerance to oral glucose overload, in addition to a statistically significant (p<0.001) increase in blood levels of incretin and insulin, compared to the hyperglycemic rats. Conclusion: It is concluded that the ethanolic extract of P. ruscifolialeaves has a hypoglycemic effect in hyperglycemic animals by a mechanism that involves the incretin-insulin system

Antecedentes: la diabetes mellitus es una enfermedad metabólica cuyo tratamiento se basa en el uso de agentes hipoglicemiantes orales o insulina. Una opción al tratamiento son las plantas medicinales y en ese sentido, estudios previos en animales con hojas de Prosopis ruscifolia (Pr) han demostrado efecto hipoglicemiante. Objetivo: en este trabajo se reporta el efecto de P. rusciofolia (Pr) en la secreción de insulina e incretina, en ratas hiperglicémicas por aloxano. Metodología: se emplearon cuatro grupos de ratas Wistar (n=10). Dos grupos con glicemia normal que fueron tratadas con agua Pr (75 mg/Kg, per os, p.o.) y dos grupos con hiperglicemia inducida por la inyección intraperitoneal de aloxano recibieron agua Pr (75 mg/Kg, per os, p.o.) durante dos semanas. Se midieron la tolerancia oral a la glucosa, y los niveles de incretina e insulina al final del periodo de experimentación. Resultados: se encontró que el extracto promueve una mayor tolerancia a la sobrecarga de glucosa, y además un incremento significativo (p<0.001) de los niveles de incretina e insulina en sangre, comparados al grupo de ratas hiperglicémicas. Conclusión: se concluye que e l estracto etanólico de las hojas de P. ruscifolia tienen efecto hipoglicemiante en animales hiperglicémicos por un mecanismo que incluye al sistema incretina-insulina

O aluno com diabetes: avaliação dos pais sobre o ambiente escolar / The student with diabetes: parental assessment of the school environment

Introdução: O diabetes mellitus tipo 1 (DM1) é uma das doenças crônicas mais comuns da infância. O adequado controle do DM1 engloba uma ação multidisciplinar e envolve ambientes nos quais as crianças passam grande parte do tempo do seu dia, as escolas. Objetivos: Identificar a realidade vivenciada pelo aluno com diabetes no ambiente escolar sob a visão dos pais ou responsáveis. Métodos: Aplicado um questionário a 200 pais ou responsáveis por alunos com diabetes matriculados na educação infantil, nos ensinos fundamental e médio de escolas públicas e privadas de Belo Horizonte, compreendidos entre a faixa etária dos quatro aos dezoito anos. Resultados: A escolha da escola pelos pais foi influenciada pelo fato da criança ter diabetes em 16,5% dos casos. Houve negação inicial de matrícula. Foram necessárias explicações sobre o DM1 para os professores em 67,5% dos casos. Para 74,5% dos pais, os professores das escolas envolvidas não possuem o conhecimento necessário sobre diabetes. A maioria das crianças tem a permissão para realizar a glicemia capilar em sala de aula. Cerca de 54,5% dos alunos com diabetes fazem o uso de insulina na escola, entretanto, grande parte delas não oferecem um local específico para tal procedimento. A merenda escolar foi considerada inadequada. Houve relato de bullying. Alguns foram impedidos de participarem de excursões e até mesmo da educação física. Conclusão: Os alunos com DM1 vivenciam uma realidade inadequada no ambiente escolar. A maioria das escolas não está preparada do ponto de vista técnico e estrutural para receber estas crianças.

Introduction: Type 1 diabetes mellitus (DM1) is one of the most common chronic diseases in childhood. Proper control of DM1 encompasses a multidisciplinary action and involves environments in which children spend much of their day, such as schools. Objectives: To identify the reality experienced by students with diabetes in the school environment from the perspective of parents or guardians. Methods: A questionnaire was applied for 200 parents or guardians of students with diabetes enrolled in early childhood education, in the elementary and high schools of public and private schools in Belo Horizonte, in the age group of four to eighteen years. Results: The parents' choice of school was influenced by the fact that the child had diabetes in 16.5% of cases. There was an initial denial of registration on school. Explanations about DM1 were needed for teachers in 67.5% of cases. For 74.5% of parents, school teachers do not have the necessary knowledge about diabetes. Most children are allowed to take capillary blood glucose in the classroom. About 54.5% of students with diabetes use insulin at school, however, in most of them there are not a specific place for such procedure. The school meal was considered inadequate. There was a bullying relationship. Some students were prevented from getting involved in extracurricular activities such as excursions and in physical education. Conclusion: Students with DM1 experience an inadequate reality in the school environment. Most schools are not technically and structurally prepared to receive these children.

Extrações dentárias em pacientes com diabetes mellitus: estudo retrospectivo / Dental extractions in patients with diabetes mellitus: Retrospective study

Introdução: A literatura científica médica traz evidências que suportam a hipótese de que a hiperglicemia e o diabetes mellitus (DM) aumentam o risco de infecção e atraso na cicatrização da ferida após procedimentos cirúrgicos de grande porte. Muitos autores extrapolaram esse conceito para cirurgia menores, como as extrações dentárias. Estudos prospectivos têm sugerido que a taxa de complicações após exodontias é semelhante em pessoas com e sem DM. Objetivo: Comparar a frequência e o tipo de complicações após exodontias em pacientes com DM1 e DM2. Além disso, observar se há relação entre complicações pós-operatórias infecciosas e inflamatórias e a prescrição de antibióticos. Material e Métodos: Do total de 718 prontuários de pacientes com DM atendidos entre um período de 27 anos, 311 foram incluídos na pesquisa, uma vez que esses pacientes foram submetidos a pelo menos uma exodontia. Foram coletados dados demográficos, história médica pregressa e atual, dados relativos à(s) exodontia(s) realizada(s), complicações transoperatórias e pós-operatórias e antibioticoterapia. Resultados: A maioria dos pacientes eram do sexo masculino (164/311; 52,7%), cor de pele branca (230/311; 73,9%) e com média de idade de 51 anos. Sessenta e oito (21,9%) pacientes tinham DM1 e 243 (78,1%) DM2. Duzentos e vinte e sete (73,0%) tinham comorbidades associadas ao DM, sendo as doenças cardiovasculares as mais prevalentes (208/311; 66,9%). Nos 311 prontuários, havia registro de 895 intervenções de exodontias, das quais 192 (21,5%) foram realizadas em pacientes com DM1 e 703 (78,5%) em pacientes com DM2, elas foram adiadas em 29 prontuários (29/895; 3,2%). Complicações transoperatórias estavam registradas em 08 prontuários (08/895; 0,9%), sendo a hemorragia transoperatória a complicação mais frequente, em 3 dos 8 registros. Das 895 intervenções, encontramos 25 registros de complicações após as exodontias. Pacientes com DM1 exibiram 11 (11/192; 5,7%) registros de complicações após as exodontias, sendo eles: registro de edema (1), trismo (1), abscesso (1), atrasos na epitelização (2), sequestro de espícula óssea (3), alergia a medicamento (1) e alveolite (2). Nos pacientes com DM2, computamos 14 (14/703; 2%) registros de complicações, sendo eles: registros de dor (7), parestesia (1), abcesso (1), sequestro de espícula óssea (3) e alveolite (2). Os pacientes com DM1 exibiram mais complicações após exodontias que os pacientes com DM2 (5,7% versus 2%; p=0,011). Houve prescrição antibiótica para 26% dos pacientes com DM1 (50/192) e para 15% dos pacientes com DM2 (105/703). Não foi observada associação entre complicações pós-operatórias inflamatórias e infecciosas e a prescrição de antibiótico profilático. Conclusão: A prevalência de complicações após exodontias foi baixa e semelhante entre os pacientes com DM1 e DM2. É possível afirmar que o DM não aumenta o risco de complicações infecciosas e inflamatórias após exodontias.

Blood glucose related adverse drug reaction of antitumor monoclonal antibodies: a retrospective analysis using Vigibase

Abstract On the increasing prevalence of using mAbs (monoclonal antibodies) in cancer therapy and the severe risk of hyperglycemia, we aimed to analyze the main clinical ADRs of mAbs, with a focus on adverse hyperglycemic events associated with currently clinically used mAbs. mAbs as well as target information were selected from Martinadale book and published articles. Drug approving information was collected from each government website, and ADR statistic data were collected from VigibaseR, comparing with Adverse Event Reporting System of US FDA. Top 10 mAbs were classified within listing in total ADR records, ADRs per year, hyperglycemic ADR records. Vigibase data were updated onto 15 Feb 2019. 20 mAbs were analyzed with 263217 ADR reports, wherein 16751 records on Metabolism and nutrition disorders and 1444 records on Glucose metabolism disorders. The geographic, age, gender distributions and annual ADR report numbers were listed respectively. Of the top 10, Rituximab, Bevacizumab and Nivolumab were on the top 3 in total ADR record and hyperglycemic record. Top 3 record results were similar in Vigibase and FDA database. It is of increasing importance for clinicians to be aware of early detection, patient management, or drug selection strategies when using mAbs, particularly within the high glycemic risk-reported mAbs, to improve the efficacy and tolerability of mAbs regiment and optimize patient outcomes.

Fisiopatología y alteraciones clínicas de la diabetes mellitus tipo 2: revisión de literatura / Physiopathology and clinical alterations of diabetes mellitus 2: literature review

Resumen La diabetes mellitus tipo 2 constituye una condición clínica debilitante, degenerativa y multifacética de alta prevalencia a nivel mundial. Dada la complejidad de su fisiopatología y las variadas opciones terapéuticas que existen esta enfermedad presenta un desafío para el médico general, se hace imperativo describir comprensiblemente esta patología para mejorar la resolutividad de ésta en atención primaria. Tras una búsqueda bibliográfica exhaustiva de 103 estudios publicados hasta el año 2010, se identificaron los aspectos más importantes tanto de la fisiología, fisiopatología, complicaciones y terapéuticas de esta patología. La resistencia a la insulina (RI) es una condición metabólica central en la etiopatogenia de esta patología donde se logra reconocer de manera clásica tanto la pérdida de la acción periférica de la insulina por parte de los diferentes tejidos, así como defectos en la secreción de insulina conllevando estados de hiperglucemia constantes asociados tanto a complicaciones agudas como crónicas caracterizadas por provocar disfunción y fallo en diferentes órganos. Es de conocimiento general que parte importante de los resultados en el manejo de esta patología se logran con cambios en el estilo de vida que van desde modificaciones en la dieta a cambios en el patrón de actividad física con pérdida de peso corporal. No obstante, existe a su vez una amplia gama de terapias farmacológicas orientadas a controlar estados hiperglucémicos ante la falla de la terapia no farmacológica. Dentro de este mismo contexto varias son las dianas y objetivos terapéuticos en el tratamiento del diabético tipo 2, sin embargo, todas confluyen en el control metabólico de los estados de hiperglucemia y la prevención de sus complicaciones.

Abstract Type 2 diabetes mellitus is a debilitating, degenerative and multifaceted clinical condition with a high prevalence worldwide. Given the complexity of its pathophysiology and the various therapeutic options that exist, this disease presents a challenge for the general practitioner, it is imperative to understand this pathology to improve its resolution in primary care. After an exhaustive bibliographic search of 103 studies published up to 2010, the most important aspects of both the physiology, pathophysiology, complications, and therapeutics of this pathology were identified. Insulin resistance (IR) is a central metabolic condition in the etiopathogenesis of this pathology. Classically it is possible to recognize both the loss of the peripheral action of insulin by the different tissues as well as defects in the secretion of insulin that leads to constant hyperglycemic states associated with both acute and chronic complications characterized by causing dysfunction and failure in different organs. It is generally known that an important part of the results in the management of this pathology are achieved with changes in lifestyle that range from modifications in diet to changes in the pattern of physical activity with loss of body weight. However, there also is a wide range of pharmacological therapies aimed at controlling hyperglycemic states in the event of the failure of non-pharmacological therapy. Within this same context, there are several therapeutic targets and objectives in the treatment of type 2 diabetics, however, they all converge in the metabolic control of hyperglycemic states and the prevention of their complications

Hiperglicemia y diabetes inducidas por esteroides / Hyperglycemia and steroid-induced diabetes

La hiperglicemia y/o diabetes inducida por esteroides, se define como la elevación de la glicemia, causada por la acción de los fármacos glucocorticoideos, sobre el metabolismo de los carbohidratos, y presenta una prevalencia entre un 20% al 50%, en pacientes sin diabetes previa, existiendo mayor riesgo para esta patología en pacientes con diabetes pre-existente, obesidad, uso crónico de esteroides o en dosis altas, entre otros. El diagnóstico se rige por los criterios para diabetes en la mayoría de los casos. No obstante, existen casos en donde la hiperglicemia por esteroides es sub-diagnosticada. Su manejo se basa en el tratamiento farmacológico (antidiabéticos orales, subcutáneos e insulina) y no farmacológico (dieta y ejercicio), tomando en cuenta, el patrón glicémico, peso, edad, co-morbilidades, dosis, tipo y tiempo de uso de los esteroides. La relevancia de conocer como diagnosticar y tratar dicha patología, se debe al riesgo de ingreso hospitalario, de infección, de mala cicatrización y de mortalidad en casos no tratados. En vista del aumento del uso de glucocorticoides en la actualidad, se hace una revisión del abordaje terapéutico de la hiperglicemia y diabetes inducida por esteroides.

Hyperglycemia and Steroid-induced Diabetes is defined as the elevation of glycemia caused by the action of glucocorticoid drugs on carbohydrate metabolism, with a prevalence between 20% and 50% in patients without Diabetes. Though, there is a greater risk of this pathology in patients with pre-existing Diabetes, Obesity, chronic use of steroids or in high doses, among others. In most cases, the diagnosis is governed by the criteria of Diabetes; however, there are cases where hyperglycemia Steroid-induced is under-diagnosed. Its management is based on pharmacological treatment (oral and subcutaneous hypoglycemic agents and insulin) and non-pharmacological treatment (diet and exercise), in accordance with the glycemic pattern, weight, age, co-morbidities, dose, type and the duration of the use of steroid. The relevance of knowing how to diagnose and treat this pathology is the risk of hospital admission, infection, poor healing and mortality in untreated cases. In view of the increased use of glucocorticoids nowadays, a review is made about the therapeutic approach to hyperglycemia and steroid-induced Diabetes.

Metabolic profile of people living with HIV in a treatment hub in Manila, Philippines: A Pre- and Post-Antiretroviral analysis / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#People living with HIV (PLHIV) are susceptible to develop dyslipidemia and hyperglycemia. This study aims to determine the prevalence of these metabolic derangements among Filipino PLHIV.@*Methodology@#We reviewed 635 medical records in a treatment hub in Manila, Philippines from January 2004 to July 2016. Logistic regression analysis was done to determine factors associated with dyslipidemia and hyperglycemia pre- and post-ART.@*Results@#Among 635 PLHIV, 97.3% were males with mean age of 30 years and median CD4 count of 207 cells/mm3. Pre-ART, prevalence of dyslipidemia was 65.4% and hyperglycemia was 10.4%. Risk factors for dyslipidemia include hyperglycemia (AOR 3.8, p 0.001) and >320 days delay in ART initiation from HIV confirmation (AOR 1.5, p 0.032), while dyslipidemia was associated with hyperglycemia (AOR 3.1, p 0.001). Post-ART, prevalence of dyslipidemia was 48.6% and hyperglycemia was 15.6%. Risk factors for post-ART dyslipidemia include being WHO stage 4 (AOR 2.1, p 0.021), hyperglycemia (AOR 16.1, p<0.001), >36 months ART duration (AOR 8.7, p<0.001) and efavirenz-based ART (AOR 2.8, p<0.001). Low CD4 count post-ART had a negative correlation with dyslipidemia (AOR 0.5, p 0.005). Post-ART hyperglycemia was associated with age >30 years (AOR 2.1, p 0.004), being overweight (AOR 1.8, p 0.023), dyslipidemia (AOR 17.8, p<0.001) and zidovudine-based ART (AOR 1.4, p 0.051).@*Conclusion@#Dyslipidemia and hyperglycemia prevalence was high in Filipino PLHIV. Traditional, HIV and treatment related factors contributed to its development. Intensive monitoring and initiation of appropriate treatment is recommended.

Technical Difficulties in the Implementation of the Continuous Glucose Monitoring System / 中国医疗器械杂志

The continuous glucose monitoring system (CGMS) has been clinically applied to monitor the dynamic change of the subcutaneous interstitial glucose concentration which is a function of the blood glucose level by glucose sensors. It can track blood glucose levels all day along, and thus provide comprehensive and reliable information about blood glucose dynamics. The clinical application of CGMS enables monitoring of blood glucose fluctuations and the discovery of hidden hyperglycemia and hypoglycemia that are difficult to be detected by traditional methods. As a CGMS needs to work subcutaneously for a long time, a series of factors such as biocompatibility, enzyme inactivation, oxygen deficiency, foreign body reaction, implant size, electrode flexibility, error correction, comfort, device toxicity, electrical safety, et al. should be considered beforehand. The study focused on the difficulties in the technology, and compared the products of Abbott, Medtronic and DexCom, then summarized their cutting-edge. Finally, this study expounded some key technologies in dynamic blood glucose monitoring and therefore can be utilized as a reference for the development of CGMS.

Hyperglycemic memory in diabetic cardiomyopathy / 医学前沿

Cardiovascular diseases account for approximately 80% of deaths among individuals with diabetes mellitus, with diabetic cardiomyopathy as the major diabetic cardiovascular complication. Hyperglycemia is a symptom that abnormally activates multiple downstream pathways and contributes to cardiac hypertrophy, fibrosis, apoptosis, and other pathophysiological changes. Although glycemic control has long been at the center of diabetes therapy, multicenter randomized clinical studies have revealed that intensive glycemic control fails to reduce heart failure-associated hospitalization and mortality in patients with diabetes. This finding indicates that hyperglycemic stress persists in the cardiovascular system of patients with diabetes even if blood glucose level is tightly controlled to the normal level. This process is now referred to as hyperglycemic memory (HGM) phenomenon. We briefly reviewed herein the current advances that have been achieved in research on the underlying mechanisms of HGM in diabetic cardiomyopathy.