Endocrinology, Diabetes, and Metabolism Commons^™

Implication Of Melanocortin Receptor Genes In The Familial Comorbidity Of Type 2 Diabetes And Depression., Mutaz Amin, Jurg Ott, Rongling Wu, Teodor T Postolache, Claudia Gragnoli

Division of Endocrinology, Diabetes and Metabolic Diseases Faculty Papers

The melanocortin receptors are G-protein-coupled receptors, which are essential components of the hypothalamic–pituitary–adrenal axis, and they mediate the actions of melanocortins (melanocyte-stimulating hormones: α-MSH, β-MSH, and γ-MSH) as well as the adrenocorticotropin hormone (ACTH) in skin pigmentation, adrenal steroidogenesis, and stress response. Three melanocortin receptor genes (MC1R, MC2R, and MC5R) contribute to the risk of major depressive disorder (MDD), and one melanocortin receptor gene (MC4R) contributes to the risk of type 2 diabetes (T2D). MDD increases T2D risk in drug-naïve patients; thus, MDD and T2D commonly coexist. The five melanocortin receptor genes might confer risk for both disorders. However, they …

Improving Cancer Care Through Digital Health Coaching, Jennifer Nguyen, Pharmd, Vittorio Maio, Pharmd, Ms, Msph, Nathan Handley, Md, Mba

College of Population Health Faculty Papers

No abstract provided.

Functional (Psychogenic) Seizures Are Associated With Thyroid Disorders, Ali A. Asadi-Pooya, Mohsen Farazdaghi

Department of Neurology Faculty Papers

Objective: We investigated medical comorbidities in patients with functional seizures (FS) and those with epilepsy (idiopathic generalized epilepsies [IGEs] or temporal lobe epilepsy [TLE]). We hypothesized that the nature of medical comorbidities differs between these three groups. This might be helpful to postulate on the pathophysiology of FS. Materials and Methods: In a retrospective study, all adult patients with a diagnosis of IGE, TLE, or FS were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Iran, from 2008 until 2020. The three groups of patients were matched with regard to their age. Age, sex, and medical …

Diabetic Care Pathway, Shalini Bansal, Kayla Brockmeyer, Nick Kieran

Physician Executive Leadership-Plus (PEL-Plus)

Presentation Outline

• The Impact of Diabetes
• Problem Statement
• Solution
• Looking to the Future

Flash Glucose Monitoring In Type 2 Diabetes Managed With Basal Insulin In The Usa: A Retrospective Real-World Chart Review Study And Meta-Analysis., Anders L Carlson, Timothy Dilon Daniel, Andrea Desantis, Serge Jabbour, Esra Karslioglu French, Davida Kruger, Eden Miller, Kerem Ozer, Tom Elliott

Division of Endocrinology, Diabetes and Metabolic Diseases Faculty Papers

INTRODUCTION: Evidence supporting use of continuous glucose monitoring in type 2 diabetes treated with basal insulin is unclear. This real-world study aimed to assess the impact on glycated hemoglobin (HbA1c) of flash glucose monitoring use in adults with type 2 diabetes managed with basal insulin.

RESEARCH DESIGN AND METHODS: Medical records were reviewed for adult individuals with type 2 diabetes using basal insulin for ≥1 year with or without additional antihyperglycemic medication, HbA1c 8.0%-12.0% prior to FreeStyle Libre Flash Glucose Monitoring use for ≥90 days and an HbA1c measurement recorded between 90 and 194 days after device use. Exclusion criteria …

Abdominal Paraganglioma In A Patient With Fever Of Unknown Origin, Samantha Sokoloff, Barbara Simon

Department of Medicine Faculty Papers

Reaxys Chemistry database information SciVal Topics Funding details

Abstract

Introduction: Paragangliomas have a wide range of clinical presentations. A significant portion of these tumors are discovered as abdominal masses on imaging or palpation in patients without typical symptoms of catecholamine excess [1]. This case reports a 28-year-old female who presented with fever of unknown origin and was found to have an abdominal mass on CT imaging. This mass was biopsied prior to a complete evaluation and confirmed to be a paraganglioma. Case report: We discuss the case of a 28 year-old-female who presented to the Endocrinology office after she was …

Glycosaminoglycans As Biomarkers For Mucopolysaccharidoses And Other Disorders, Paige Amendum, Shaukat Khan, Seiji Yamaguchi, Hironori Kobayashi, Yasuhiko Ago, Yasuyuki Suzuki, Betul Celik, Estera Rintz, Jobayer Hossain, Wendi Xiao, Shunji Tomatsu

Department of Pediatrics Faculty Papers

Glycosaminoglycans (GAGs) are present in proteoglycans, which play critical physiological roles in various tissues. They are known to be elevated in mucopolysaccharidoses (MPS), a group of rare inherited metabolic diseases in which the lysosomal enzyme required to break down one or more GAG is deficient. In a previous study, we found elevation of GAGs in a subset of patients without MPS. In the current study, we aim to investigate serum GAG levels in patients with conditions beyond MPS. In our investigated samples, the largest group of patients had a clinical diagnosis of viral or non-viral encephalopathy. Clinical diagnoses and conditions …

Medical Nutrition Therapy For Diabetes, Cheryl Marco, Rd, Cde

Department of Family & Community Medicine Presentations and Grand Rounds

No abstract provided.

Decreasing Post Insulin Hypoglycemia Incidence In End Stage Renal Disease (Esrd) Patients, Anna Lo, Md, Rachana Mundada, Md, Eric Shiffrin, Md, Jenny Wang, Md

Health Equity and Quality Improvement (HEQI) Summit

ESRD patients are vulnerable to hypoglycemia due to impaired insulin clearance, glucose metabolism changes, and effects of dialysis. Hypoglycemic events lead to serious and life-threatening complications.

Aims for Improvement:

To decrease the rate of hypoglycemic events amongst ESRD patients receiving insulin for hyperkalemia treatment.

Computational Identification Of Gene Networks As A Biomarker Of Neuroblastoma Risk, Lidan Sun, Libo Jiang, Christa N Grant, Hong-Gang Wang, Claudia Gragnoli, Zhenqiu Liu, Rongling Wu

Division of Endocrinology, Diabetes and Metabolic Diseases Faculty Papers

Neuroblastoma is a common cancer in children, affected by a number of genes that interact with each other through intricate but coordinated networks. Traditional approaches can only reconstruct a single regulatory network that is topologically not informative enough to explain the complexity of neuroblastoma risk. We implemented and modified an advanced model for recovering informative, omnidirectional, dynamic, and personalized networks (idopNetworks) from static gene expression data for neuroblastoma risk. We analyzed 3439 immune genes of neuroblastoma for 217 high-risk patients and 30 low-risk patients by which to reconstruct large patient-specific idopNetworks. By converting these networks into risk-specific representations, we found …

Prediction Of Neonatal Birthweight Associated With Maternal Obesity And Diabetes, Laura Gleason, Rebekah Mccurdy, Md, Mph

Phase 1

Introduction: To design a model that will predict neonatal birth weight within obese mothers by diabetic status.

Methods: A secondary data analysis of an RCT (NCT 02909582) was utilized to create a neonatal birth weight prediction model. Women (n=325) with a BMI > 35 kg/m2 from a tertiary academic institution, 2016 – 2019, were included to estimate the risk of large for gestational age (LGA) infants and neonatal birth weight based on maternal prepregnancy BMI and diabetic status. LGA was defined as an infant birth weight > 90th percentile. Analysis included Chi-square, t-test, multivariate logistic and linear regression.

Results: Mean birthweight did …

Spectrum Of Renal Biopsy Findings In Trident Cohort, Casey Jackson, Shira Blady, Shatakshee Chatarjee, Phd, Matthew Palmer, Md, Phd, Katalin Susztak, Md, Phd

Phase 1

Introduction: Diabetic kidney disease is the most common cause of chronic end stage renal failure in the USA. Kidney biopsy is the gold standard diagnostic criteria; however, it is an invasive procedure; not everyone undergoes diagnostic biopsy. The relationship between histological and clinical parameters and prognosis in DKD is incompletely understood. TRIDENT, (Transformative research in diabetic nephropathy) plans to enroll 400 diabetic subjects undergoing clinically indicated renal biopsies and performs multi-omics characterization of subjects to identify pathways associated with kidney function decline. Genetic studies indicated that podocytes influence albuminuria and diabetic kidney disease development. We seek to understand whether …

Nighttime Melatonin Administration And Insulin Sensitivity, Albert Mchugh, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Previous studies have shown melatonin effects on insulin sensitivity, but with conflicting results. The inconsistency between these studies may be due to differences in melatonin dosage and subject age. Low melatonin dosages, generally <5 mg, have been used in prior research. We studied the effect of melatonin 9 mg for 6 weeks on insulin resistance, peripheral microvascular function, and sleep in non-diabetic, non-hypertensive middle-aged and geriatric patients.

Methods: Subjects with a history of hypertension or diabetes were excluded from the study. The geriatric cohort included 5 subjects 60-80 years old while the younger cohort was comprised of 14 subjects age 27-45 years old. Fifteen subjects were randomized to the melatonin treatment group and took 9 mg of controlled-release melatonin by mouth 30 minutes before bedtime for 6 weeks; the four subjects in …

Effects Of Medications On Cognitive Function And Falls In Older African Americans With Diabetes, Diana Alnemri, Robin J. Casten

Phase 1

Introduction: Potentially-inappropriate medications (PIMs) are medications that have increased rates of adverse drug events in older adults. Medications with anticholinergic activity are classified as PIMs since they can lead to cognitive dysfunction and increased fall risk. PIM use is higher among African Americans (AA) than Whites.

Methods: This study explored relationships among cognitive function, falls, and PIMs in AAs with diabetes. This study recruited AAs with diabetes (n=99, age ≥60yrs) who were seen in the Emergency Department (ED), and were enrolled in a trial of a behavioral intervention to improve diabetes management. PIMs were based on the Beer’s criteria …

Clinical Significance Of Obstructive Sleep Apnea In Patients With Acute Coronary Syndrome In Relation To Diabetes Status., Xiao Wang, Jingyao Fan, Yunhui Du, Changsheng Ma, Xin-Liang Ma, Shaoping Nie, Yongxiang Wei

Department of Emergency Medicine Faculty Papers

Objective: The prognostic significance of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS) according to diabetes mellitus (DM) status remains unclear. We aimed to elucidate the association of OSA with subsequent cardiovascular events in patients with ACS with or without DM.

Research design and methods: In this prospective cohort study, consecutive eligible patients with ACS underwent cardiorespiratory polygraphy between June 2015 and May 2017. OSA was defined as an Apnea Hypopnea Index ≥15 events/hour. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for …

Shared Learning Meeting Launch – November 8, 2019

Know Diabetes by Heart and Diabetes INSIDE Shared Learning

No abstract provided.

Improving Diabetic Retinopathy Screening In A Large Ambulatory Practice, Erica Li, Md, Rebecca Simon, Md, Michael Weissberger, Md, Jennifer Moyer, Md, Rachel Ehrman-Dupre, Md, Andrew Rabovsky, Md, Simon Newsom, Md, Pooja Padgaonkar, Md, Julita Mienko, Md, Sarah Hirsh, Md, Geoffrey Mills, Md, Phd

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Aim 1: To increase the percentage of JFMA diabetic patients with up-to-date retinopathy screening to 60% by April 1, 2019.

Aim 2: To increase the utilization of an in-office portable retinal scanner by identifying current barriers to its use and developing a standardized workflow to overcome these barriers.

Outcome measure: The percentage of adult diabetic patients with a JFMA provider listed as the PCP who have been seen in the Jefferson health system within the last 24 months, who had retinopathy screening once in the last 24 months.

Process measure: The number of retinal scans completed each week.

Pth1r-Casr Cross Talk: New Treatment Options For Breast Cancer Osteolytic Bone Metastases., Yanmei Yang, Bin Wang

Department of Medicine Faculty Papers

Metastatic breast cancer (BrCa) is currently incurable despite great improvements in treatment of primary BrCa. The incidence of skeletal metastases in advanced BrCa occurs up to 70%. Recent findings have established that the distribution of BrCa metastases to the skeleton is not a random process but due to the favorable microenvironment for tumor invasion and growth. The complex interplay among BrCa cells, stromal/osteoblastic cells, and osteoclasts in the osseous microenvironment creates a bone-tumor vicious cycle (a feed-forward loop) that results in excessive bone destruction and progressive tumor growth. Both the type 1 PTH receptor (PTH1R) and extracellular calcium-sensing receptor (CaSR) …

The Effect Of Diabetes Self-Management Education On Hba1c And Quality Of Life In African-Americans: A Systematic Review And Meta-Analysis., Amy T. Cunningham, Denine R. Crittendon, Neva White, Geoffrey D. Mills, Victor Diaz, Marianna Lanoue

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Type 2 diabetes presents a major morbidity and mortality burden in the United States. Diabetes self-management education (DSME) is an intervention associated with improved hemoglobin A1c(HbA1c) and quality of life(QOL), and is recommended for all individuals with type 2 diabetes. African-Americans have disproportionate type 2 diabetes morbidity and mortality, yet no prior meta-analyses have examined DSME outcomes exclusively in this population. This systematic review and meta-analysis examined the impact of DSME on HbA1c and QOL in African-Americans compared to usual care.

METHODS: Randomized controlled trials, cluster-randomized trials, and quasi-experimental interventions were included. 352 citations were retrieved; 279 abstracts were …

Systematic In Vivo Evaluation Of The Time-Dependent Inflammatory Response To Steel And Teflon Insulin Infusion Catheters., Jasmin R. Hauzenberger, Julia Münzker, Petra Kotzbeck, Martin Asslaber, Vladimir Bubalo, Jeffrey I. Joseph, Thomas R. Pieber

Department of Anesthesiology Faculty Papers

Continuous subcutaneous insulin infusion (CSII) catheters are considered the weak link of insulin pump therapy. Wear-time considerably varies between patients and the choice of catheter material is based on personal preferences rather than scientific facts. Therefore, we systematically assessed and quantified the inflammatory tissue response to steel versus Teflon CSII catheters over a maximum wear-time of 7 days in swine. Tissue surrounding catheters was analysed using histopathology and quantitative real-time PCR. The area of inflammation increased significantly over time independent of material which was confirmed by an increase in CD68 expression and an increase in mononuclear and neutrophil cell infiltrate …

Sex Differences In Outcomes After Stroke In Patients With Diabetes In Ontario, Canada., Mandip S. Dhamoon, John W. Liang, Limei Zhou, Melissa Stamplecoski, Moira K. Kapral, Baiju R. Shah

Department of Neurology Faculty Papers

BACKGROUND: Outcomes after stroke in those with diabetes are not well characterized, especially by sex and age. We sought to calculate the sex- and age-specific risk of cardiovascular outcomes after ischemic stroke among those with diabetes.

METHODS: Using population-based demographic and administrative health-care databases in Ontario, Canada, all patients with diabetes hospitalized with index ischemic stroke between April 1, 2002, and March 31, 2012, were followed for death, stroke, and myocardial infarction (MI). The Kaplan-Meier survival analysis and Fine-Gray competing risk models estimated hazards of outcomes by sex and age, unadjusted and adjusted for demographics and vascular risk factors.

RESULTS: …

Effect Of Oral Semaglutide Compared With Placebo And Subcutaneous Semaglutide On Glycemic Control In Patients With Type 2 Diabetes: A Randomized Clinical Trial., Melanie Davies, Thomas R. Pieber, Marie-Louise Hartoft-Nielsen, Oluf K.H. Hansen, Serge Jabbour, Julio Rosenstock

Department of Medicine Faculty Papers

Importance: Glucagon-like peptide-1 (GLP-1) receptor agonists are effective therapies for the treatment of type 2 diabetes and are all currently available as an injection.

Objectives: To compare the effects of oral semaglutide with placebo (primary) and open-label subcutaneous semaglutide (secondary) on glycemic control in patients with type 2 diabetes.

Design, Setting, and Patients: Phase 2, randomized, parallel-group, dosage-finding, 26-week trial with 5-week follow-up at 100 sites (hospital clinics, general practices, and clinical research centers) in 14 countries conducted between December 2013 and December 2014. Of 1106 participants assessed, 632 with type 2 diabetes and insufficient glycemic control using diet and …

A Case Of Severe Insulin Resistance In A Diabetic Patient Being Treated For Acute Promyelocytic Leukemia With Arsenic And Glucocorticoids, Eric Shiffrin, Md, Intekhab Ahmed, Md, Serge Jabbour, Md, Facp, Face, Kevin Furlong, Do

Division of Endocrinology, Diabetes and Metabolic Diseases Posters

Objective:

To present a case of severe insulin resistance in a patient with a new diagnosis of acute promyelocytic leukemia (APML) treated with all-trans retinoic acid (ATRA), arsenic, and high-dose glucocorticoids.

Poster presented at Thomas Jefferson University House Staff Quality and Safety conference.

Text Messaging In The Patient-Centered Medical Home To Improve Glucose Control And Retinopathy Screening., Janice M Miller, Ann G. Phalen, Albert Crawford, Anthony Frisby, Barry S. Ziring

College of Nursing Faculty Papers & Presentations

Purpose: To evaluate the effectiveness of a text messaging program (TMP) to improve glucose control, retinopathy screening (RS) rates, and self-care behaviors in patients with uncontrolled type 2 diabetes.

Methods: A single-group design with a quasi-systematic random sample (n=20) received educational/exhortational text messages on their cellular phones for 3 months. Subjects, 12 of whom identified as a minority ethnicity, were mostly male, aged 27-73 years.

Results: Glucose control and RS rates improved significantly. Subjects (>70%) reported changes in self-care behaviors.

Conclusion: Leveraging ubiquitous technology, a TMP for patients with limited access to healthcare education, holds promise

Mechanisms Of Progranulin Action And Regulation In Genitourinary Cancers., Ryuta Tanimoto, Kuojung G Lu, Shi-Qiong Xu, Simone Buraschi, Antonino Belfiore, Renato V. Iozzo, Andrea Morrione

Department of Urology Faculty Papers

The growth factor progranulin has emerged in recent years as a critical regulator of transformation in several cancer models, including breast cancer, glioblastomas, leukemias, and hepatocellular carcinomas. Several laboratories, including ours, have also demonstrated an important role of progranulin in several genitourinary cancers, including ovarian, endometrial, cervical, prostate, and bladder tumors, where progranulin acts as an autocrine growth factor thereby modulating motility and invasion of transformed cells. In this review, we will focus on the mechanisms of action and regulation of progranulin signaling in genitourinary cancers with a special emphasis on prostate and bladder tumors.

Bilateral Adrenal Hemorrhage In A Patient With Antiphospholipid Syndrome, Silpa Yalamanchili, Md

The Medicine Forum

INTRODUCTION

Bilateral adrenal hemorrhage is relatively uncommon, with a reported incidence in the United States of 0.3-1.8% in hospital post-mortems1.Clinical manifestations of adrenal hemorrhage are widely variable, making diagnosis a challenge. Left undiagnosed and untreated, bilateral adrenal hemorrhage may lead to cardiovascular collapse and/or death. Here we present a rare case of bilateral adrenal hemorrhage in a patient with antiphospholipid syndrome; the aim of this case, and the corresponding literature review, is to highlight risk factors for and management of this condition.

Amiodarone-Induced Thyrotoxicosis And Ventricular Arrhythmias: Case Report And Review Of The Literature, Ashish Shah, Md

The Medicine Forum

INTRODUCTION

Amiodarone is a common drug used to treat arrhythmias and its side effects are diverse. An important adverse effect is amiodarone-induced thyrotoxicosis (AIT), which can potentially lead to a pro-arrythmogenic state. There have been limited studies on the pathogenesis of how thyrotoxicosis increases the risk of ventricular arrhythmias, which causes providers to face a therapeutic challenge in patients who require this medication for the prevention of life threatening arrhythmias. This case report will present a patient with a left ventricular assist device (LVAD) who had recurrent ventricular arrhythmias on chronic amiodarone therapy in the setting of AIT.

Treatment-Induced Changes In Plasma Adiponectin Do Not Reduce Urinary Albumin Excretion In The Diabetes Prevention Program Cohort., Kieren J Mather, Qing Pan, William C Knowler, Tohru Funahashi, George A Bray, Richard Arakaki, Bonita Falkner, Kumar Sharma, Barry J. Goldstein

Department of Medicine Faculty Papers

BACKGROUND AND OBJECTIVES: Molecular data suggests that adiponectin may directly regulate urinary albumin excretion. In the Diabetes Prevention Program (DPP) we measured adiponectin and albuminuria before and after intervention, and we previously reported increases in adiponectin with interventions. Here we have used the DPP dataset to test the hypothesis that treatment-related increases in adiponectin may reduce albuminuria in obesity.

DESIGN, SETTING, PARTICIPANTS AND METHODS: We evaluated cross-sectional correlations between plasma adiponectin and urinary albumin excretion at baseline, and the relationship of treatment-related changes in adiponectin and albuminuria. Baseline and follow-up urine albumin to creatinine ratios (ACR (albumin to creatinine ratio)) …

Ovarian Leydig Cell Hyperplasia: An Unusual Case Of Virilization In A Postmenopausal Woman., Jaya M Mehta, Jeffery L. Miller, Anthony J. Cannon, Stacey K. Mardekian, Lawrence C. Kenyon, Serge A. Jabbour

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Objective. To report an unusual case of ovarian Leydig cell hyperplasia resulting in virilization in a postmenopausal woman. Methods. Patient's medical history and pertinent literature were reviewed. Results. A 64-year-old woman presented with virilization with worsening hirsutism, deepening of her voice, male musculature, and male pattern alopecia. Her pertinent past medical history included type 1 diabetes, hyperlipidemia, and hypertension. Her pertinent past surgical history included hysterectomy due to fibroids. On further work-up, her serum total testosterone was 506 ng/dL (nl range: 2-45) and free testosterone was 40 pg/mL (nl range: 0.1-6.4). After ruling out adrenal causes, the patient underwent an …

The Emerging Role Of Oxylipins In Thrombosis And Diabetes., Benjamin E Tourdot, Intekhab Ahmed, Michael Holinstat

Division of Endocrinology, Diabetes and Metabolic Diseases Faculty Papers

The prevalence of cardiovascular disease (CVD), the leading cause of death in the US, is predicted to increase due to the shift in age of the general population and increase in CVD risk factors such as obesity and diabetes. New therapies are required to decrease the prevalence of CVD risk factors (obesity and diabetes) as well as reduce atherothrombosis, the major cause of CVD related mortality. Oxylipins, bioactive metabolites derived from the oxygenation of polyunsaturated fatty acids, play a role in the progression of CVD risk factors and thrombosis. Aspirin, a cyclooxygenase-1 inhibitor, decreases atherothrombotic associated mortality by 25%. These …