Endocrinology, Diabetes, and Metabolism Commons^™

Is It T3 Thyrotoxicosis? A Case Of Falsely Elevated Tri-Iodothyronine (T3) Levels Leading To A Diagnosis Of Multiple Myeloma, Nanik Ram, Saira Furqan, Sibtain Ahmed

Section of Diabetes, Endocrinology and Metabolism

We are presenting a case of falsely elevated T3 levels in a patient due to interference from monoclonal immunoglobulins. A 56-year-old, clinically euthyroid man referred to the endocrinology clinic of the Aga Khan university, Karachi Pakistan, for possible T3 thyrotoxicosis after thyroid function tests revealed total T3 >12.32 nmol/L (reference range 0.6-2.79), normal TSH, and total T4 level. There was a mismatch in clinical and laboratory parameters and preliminary laboratory results were suggestive of thyroid binding globulin abnormalities. Further evaluation in this context unmasked multiple myeloma. The presence of monoclonal immunoglobulins can lead to assay interference and spurious results. To …

Sex Differences In 10-Year Ischemic Cardiovascular Disease Risk Prediction In Chinese Patients With Prediabetes And Type 2 Diabetes., Lihong Yang, Anne Fish, Yuanyuan Zhu, Xiaodan Yuan, Jianing Li, Xiaoyun Wang, Li Yuan, Zhumin Jia, Chao Liu, Yunchen Xu, Qingqing Lou

Nursing Faculty Works

No abstract provided.

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 …

Increase Postpartum Gestational Diabetes Screening, Kari Ayala, Angela Bonin, Rachael Baker, Susan Chin, Brian Drake, Joseph Kaempf, Christina Malango, Judy Marvin, Shelly Johnson

Articles, Abstracts, and Reports

Introduction:

Diabetic women did not get follow up screening after delivery. Nurses are finding a way to screen more women.

Antepartum Screening Alignment, Shelly Johnson, Silvia Moreno-Aguilar, Joanna Sullivan, Dennis Tan

Articles, Abstracts, and Reports

No abstract provided.

Diabetes Prevention, Shelly Johnson, Miles Hassell, Heidi Davis, Caroline Garrett, Joseph Kaempf

Articles, Abstracts, and Reports

Introduction:

Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. If not treated properly, medicine is recommended = A2GDM. Both are preventable.

Maternal Characteristics And Outcomes Affected By Hypothyroidism During Pregnancy (Maternal Hypothyroidism On Pregnancy Outcomes, Mhpo-1), Zareen Kiran, Aisha Sheikh, Sarwar Malik, Areeba Meraj, Maha Masood, Safana Ismail, Owais Rashid, Quratulain Shaikh, Numan Majeed, Lumaan Sheikh, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Background: Hypothyroidism in pregnancy is an arena of ongoing research, with international conflicts regarding screening, management, and outcomes. Various studies have described the outcomes depending on geographical and international diagnostic criteria. No study has been conducted in this regard from the region of Pakistan. Therefore, we aim to report the clinical features and maternal outcomes of hypothyroid pregnancies and compare the maternal outcomes between uncontrolled and controlled TSH levels in the preconception as well as the gestational period.
Methods: We conducted a cross-sectional retrospective study on 718 cases in the Aga Khan University Hospital after ethical approval. We collected information …

Hypothyroidism, Sex And Age Predict Future Thromboembolic Events Among Younger People, Supplementary Table 1, Jay A. Martinez, Fares Qeadan, Mark R. Burge

Clinical and Translational Science Center Scholarly Output

This is Supplementary Table 1 for a forthcoming publication in the Journal of Clinical Endocrinology and Metabolism, entitled "Hypothyroidism, Sex and Age Predict Future Thromboembolic Events Among Younger People," by Authors Jay A. Martinez, Fares Qeadan, PhD, and Mark R. Burge, MD

Supplement Table 1: ICD-9 and ICD-10 codes employed in this study for inclusion and exclusion purposes.

Elevated Glucose Acts Directly On Osteocytes To Increase Sclerostin Expression In Diabetes, Donna M. Pacicca, Tammy Brown, Dara Watkins, Karen Kover, Yun Yan, Matthew Prideaux, Lynda Bonewald

Manuscripts, Articles, Book Chapters and Other Papers

© 2019, The Author(s).

Bone quality in diabetic patients is compromised, leading to weaker bones and increased fracture risk. However, the mechanism by which this occurs in diabetic bone remains to be fully elucidated. We hypothesized that elevated glucose and glucose variation would affect the function of osteocytes, essential regulators of bone homeostasis and quality. To first test this hypothesis, we used the IDG-SW3 osteocyte-like cell line to examine the effects of glucose levels on osteocyte function and viability in vitro. We confirmed our in vitro findings using the in vivo streptozotocin-induced (STZ) diabetic rat model and ex-vivo cultured osteocytes …

Adapting The Diabetes Prevention Program For Low And Middle-Income Countries: Protocol For A Cluster Randomised Trial To Evaluate 'Lifestyle Africa'., Delwyn Catley, Thandi Puoane, Lungiswa Tsolekile, Ken Resnicow, Kandace Fleming, Emily A. Hurley, Joshua M. Smyth, Mara Z. Vitolins, Estelle V. Lambert, Naomi Levitt, Kathy Goggin

Manuscripts, Articles, Book Chapters and Other Papers

Introduction: Low and middle-income countries like South Africa are experiencing major increases in burden of non-communicable diseases such as diabetes and cardiovascular conditions. However, evidence-based interventions to address behavioural factors related to these diseases are lacking. Our study aims to adapt the CDC's National Diabetes Prevention Program (DPP) within the context of an under-resourced urban community in Cape Town, South Africa.

Methods/analysis: The new intervention (Lifestyle Africa) consists of 17 weekly sessions delivered by trained community health workers (CHWs). In addition to educational and cultural adaptations of DPP content, the programme adds novel components of text messaging and …

Shared Learning Meeting Launch – November 8, 2019

Know Diabetes by Heart and Diabetes INSIDE Shared Learning

No abstract provided.

High Dose Biotin And Its Effects On Thyroid Function Testing, Emily C. Skutnik Do, Rebecca A. Lopes A, Sandhya Venkataraman Do, Angela Magdaleno Do, Leslie A. Colip Md

Department of Medicine

No abstract provided.

Long-Term Safety And Efficacy Of Subcutaneous Pasireotide In Patients With Cushing's Disease: Interim Results From A Long-Term Real-World Evidence Study., Luca Manetti, Timo Deutschbein, Jochen Schopohl, Kevin C J Yuen, Michael Roughton, Ulrike Kriemler-Krahn, Libuse Tauchmanova, Ricardo Maamari, Carla Giordano

Articles, Abstracts, and Reports

PURPOSE: Clinical trials have demonstrated the favorable efficacy/safety profile of pasireotide in patients with Cushing's disease (CD). We report interim long-term results of an ongoing real-world evidence study of subcutaneous pasireotide in patients with CD.

METHODS: Adults with CD receiving pasireotide, initiated before (prior-use) or at study entry (new-use), were monitored for ≤ 3 years during a multicenter observational study ( http://clinicaltrials.gov identifier NCT02310269). Primary objective was to assess long-term safety of pasireotide alone or with other CD therapies.

RESULTS: At the time of this interim analysis, 127 patients had received pasireotide (new-use, n = 31; prior-use, n = 96). …

Metformin Blunts Muscle Hypertrophy In Response To Progressive Resistance Exercise Training In Older Adults: A Randomized, Double‐Blind, Placebo‐Controlled, Multicenter Trial: The Masters Trial, R. Grace Walton, Cory M. Dungan, Douglas E. Long, S. Craig Tuggle, Kate Kosmac, Bailey D. Peck, Heather M. Bush, Alejandro G. Villasante Tezanos, Gerald Mcgwin, Samuel T. Windham, Fernando Ovalle, Marcas M. Bamman, Philip A. Kern, Charlotte A. Peterson

Center for Muscle Biology Faculty Publications

Progressive resistance exercise training (PRT) is the most effective known intervention for combating aging skeletal muscle atrophy. However, the hypertrophic response to PRT is variable, and this may be due to muscle inflammation susceptibility. Metformin reduces inflammation, so we hypothesized that metformin would augment the muscle response to PRT in healthy women and men aged 65 and older. In a randomized, double-blind trial, participants received 1,700 mg/day metformin (N = 46) or placebo (N = 48) throughout the study, and all subjects performed 14 weeks of supervised PRT. Although responses to PRT varied, placebo gained more lean body …

Colostrum And Mature Breast Milk Analysis Of Serum Irisin And Sterol Regulatory Element-Binding Proteins-1c In Gestational Diabetes Mellitus, Syeda Sadia Fatima, Erum Khalid, Asma Akbar Ladak, Syed Adnan Ali

Department of Biological & Biomedical Sciences

Background: We aimed to evaluate irisin and SREBP-1c levels in serum, colostrum and mature breast milk in women with and without gestational diabetes (GDM); and to relate them with maternal glucose, lipid profile and weight status of babies.
Methods: GDM positive women (n = 33) and normal glucose tolerant women (NGT) (n = 33) were recruited. Maternal blood samples were collected at 28th week of gestation and later at 6-week post-partum while breast milk samples of the lactating mothers were collected within 72 hours of birth (colostrum) and at 6 weeks post-partum (mature milk). Irisin and SREBP-1c levels were analyzed …

Morning Cortisol As An Alternative To Short Synecthan Test For The Diagnosis Of Primary Adrenal Insufficiency, Imran Ulhaq, Tauseef Ahmad, Adeel Khoja, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Objective: To determine 7-9 am serum cortisol less than 5mcg/dl is an independent reliable confirmatory test for the diagnosis of primary adrenal insufficiency (PAI).

Methods: A total of 164 patients who visited the outpatient or inpatient department of Aga Khan University Hospital from June 2011 to June 2017 were included for the study. All those patients whose levels came out less than 5mcg/dl were recruited for the study and they all underwent SST. Other demographic and laboratory data were also recorded.

Results: The sensitivity of morning cortisol for diagnosis of PAI is 100% if levels are <1mcg/dl and decreases to 71.88% if levels are up to 5mcg/dl.

Conclusion: Morning cortisol is …

A Mixed-Methods, Randomized Clinical Trial To Examine Feasibility Of A Mindfulness-Based Stress Management And Diabetes Risk Reduction Intervention For African Americans With Prediabetes, Cheryl L. Woods-Giscombe, Susan A. Gaylord, Yin Li, Carrie E. Brintz, Shrikant I. Bangdiwala, John B. Buse, John D. Mann, Chanee Lynch, Pamela Phillips, Sunyata Smith, Karyn Leniek, Laura Young, Saada Al-Barwani, Jeena Yoo, Keturah Faurot

Publications and Research

African Americans have disproportionately high rates of stress-related conditions, including diabetes and diabetes-related morbidity. Psychological stress may negatively influence engagement in risk-reducing lifestyle changes (physical activity and healthy eating) and stress-related physiology that increase diabetes risk. ,is study examined the feasibility of conducting a randomized trial comparing a novel mindfulness-based stress management program combined with diabetes risk-reduction education versus a conventional diabetes risk-reduction education program among African American adults with prediabetes and self-reported life stress. Participants were recruited in collaboration with community partners and randomized to the mindfulness- based diabetes risk-reduction education program for prediabetes (MPD; n = 38) or …

Evaluation Of Kidney Injury Molecule-1 As A Disease Progression Biomarker In Diabetic Nephropathy, Fatima Abid Khan, Syeda Sadia Fatima, Ghulam Mustafa Khan, Sana Shahid

Department of Biological & Biomedical Sciences

Background & Objective: Kidney Injury Molecule-1 (KIM-1) is a peptide whose release into circulation is specific to tubular injury. This study aimed to estimate levels of kidney injury molecule-1 in diabetic patients with and without kidney disease. And evaluate the role of KIM-1 as an early screening marker of progressive kidney injury.
Methods: This follow-up study included n=85 subjects from the diabetic clinic of Jinnah Post Graduate Medical Center (JPMC) in collaboration with Aga Khan University from November 2016 till September 2017. They were divided as: i) Group A1 (n=30) participants with diabetes for <5 years without microalbuminuria ii) Group A2 (n= 30) subjects with diabetes for 6-10 years with microalbuminuria; iii) Group B (n=25) subjects as healthy control group. All study participants were followed for 6 months and their blood glucose, urea, creatinine, electrolytes, albuminuria and serum KIM-1 were assayed.
Results: High KIM-1 at baseline was …

Expression Of Integrin And Tgfbi In Human Retinal Pericytes, Andrew T C Tsin, Brenda Su, Laura Valdez, Edgar Serrato

School of Medicine Publications and Presentations

Purpose: The aim for this study is to investigate the expression of integrin α3, β1 and TGF-β induced protein (TGFBI) and the secretion of TGFBI by primary culture of human retinal pericytes (pHRP). Evidence suggests that chronic diabetes associate with HRP apoptosis leading to the development of diabetic retinopathy.

Methods: pHRP (Cell Systems) were cultured in complete media (15mM glucose) in a humidified, 5% CO2, 37°C condition. Cells were seeded at passage 6 to 8 into a 24 well-plate with coverslips or P10 dishes. Cells (85% confluence) media were then replaced by DMEM media with euglycemic glucose (5.5mM) or hyperglycemic …

Autoimmune Polyglandular Syndrome Type 1: A Case Report And Brief Review., Ifeanyi Nwosu, Oreoluwa Oladiran, Chinyere Ogbonna-Nwosu, Anulika Anyata

Reading Hospital Internal Medicine Residency

Autoimmune polyglandular syndrome (APS) type 1 is a rare autoimmune disorder inherited in an autosomal recessive pattern due to loss of function of the AIRE gene and defective removal of self-reactive T-lymphocytes during the process of thymic T cell maturation. Its manifestation starts early in life with the cardinal clinical disorders being one of muco-cutaneous candidiasis, Addison's disease, and hypoparathyroidism. Recognizing the syndromic nature of one autoimmune disease will facilitate an active search for other conditions which would allow early detection, management, follow-up, and most importantly patient education and counselling to avoid potential complications. We present the case of a …

Individual Free Fatty Acids Have Unique Associations With Inflammatory Biomarkers, Insulin Resistance And Insulin Secretion In Healthy And Gestational Diabetic Pregnant Women., Xinhua Chen, T Peter Stein, Robert A Steer, Theresa O Scholl

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

Objective: We investigated the relationships of maternal circulating individual free fatty acids (FFA) with insulin resistance, insulin secretion and inflammatory biomarkers during mid-pregnancy.

Research design and methods: The data were drawn from a prospective cohort of generally healthy pregnant women (n=1368, African-American 36%, Hispanic 48%, Caucasian 16%) in Camden, NJ. We quantitatively determined 11 FFAs, seven cytokine/adipokine, homeostatic model assessment of insulin resistance (HOMA-IR) and C-peptide levels from the fasting blood samples that were collected at 16 weeks of gestation. Multivariate analyses were performed along with separate analyses for each individual FFA.

Results: High HOMA-IR (p

Conclusion: Our results suggest …

Rising Rural Body-Mass Index Is The Main Driver Of The Global Obesity Epidemic In Adults, Con Burns, Tara Coppinger, Janette Walton, Et Al

Publications

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3,4,5,6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to …

Extracellular Vesicle Encapsulated Micrornas In Patients With Type 2 Diabetes Are Affected By Metformin Treatment., Vikas Ghai, Taek-Kyun Kim, Alton Etheridge, Trine Nielsen, Torben Hansen, Oluf Pedersen, David Galas, Kai Wang

Articles, Abstracts, and Reports

Recently, microRNAs (miRNAs) in circulating extracellular vesicles (EVs), have emerged as a source of potential biomarkers for various pathophysiological conditions, including metabolic disorders such as diabetes. Type 2 diabetes mellitus (T2DM), is the most prevalent form of diabetes in the USA, with 30 million diagnosed patients. Identifying miRNA biomarkers that can be used to assess response to glucose lowering treatments would be useful. Using patient plasma samples from a subset of the Danish Metagenomics of the Human Intestinal Tract (MetaHIT) cohort, we characterized miRNAs from whole plasma, plasma-derived EVs, and EV-depleted plasma by small RNA-sequencing to identify T2DM associated miRNAs. …

Gnrh Agonist Improves Hyperandrogenism In An Adolescent Girl With An Insulin Receptor Gene Mutation., Emily Paprocki, Romina Barral, Heidi Vanden Brink, Marla Lujan, Tania S. Burgert

Manuscripts, Articles, Book Chapters and Other Papers

Type A insulin resistance (IR) is caused by heterozygous mutations in the insulin receptor gene. It presents with mild acanthosis nigricans, severe IR, and hyperandrogenism in the absence of obesity or lipodystrophy. Treatment aims to improve insulin sensitivity and decrease androgens. An adolescent girl was evaluated for secondary amenorrhea and prominent hirsutism. She had a normal body mass index, and laboratory testing revealed an elevated LH to FSH ratio (LH 11.6 mIU/mL, FSH 4.2 mIU/mL), testosterone 96 ng/dL (reference range/dL), free testosterone 2.21 ng/dL (reference rangeA(pGly1032Asp)]. After standard treatment of hirsutism and hyperinsulinism failed, a trial of GnRH agonist therapy …

Erratum. Sodium-Glucose Cotransporter 2 Inhibition And Diabetic Kidney Disease. Diabetes 2019;68:248-257., Radica Alicic, Joshua J Neumiller, Emily J Cox, Brad P Dieter, Katherine Tuttle

Articles, Abstracts, and Reports

No abstract provided.

Analysis Of Anti-Diabetic Exosomes Secreted From Beige Adipocytes, Rachelle Mendola, Chad Doucette, Daniel Nguyen, Su Su, Aaron Brown

Maine Medical Center

Accumulation of excess fat in white adipose tissue is associated with an increase in risk for type 2 diabetes. Within white fat tissue resides a population of “beige” adipocytes that are activated by cold exposure and expend energy contained in fats, which is released as heat. Increasing energy expenditure through beige adipocyte activation has been shown to reduce diabetic symptoms in rodent models of obesity. However, activation of beige adipocytes through exposure of humans to cold temperatures is uncomfortable and likely not a realistic strategy to control body weight. In addition to its fat burning potential, secreted factors derived from …

Type 2 Diabetes Mellitus (T2dm) “Remission” In Non-Bariatric Patients 65 Years And Older, Srikanth Tangelloju, Bert B. Little, Robert J. Esterhay, Guy Brock, A. Scott Lajoie

Faculty Scholarship

Objective: To analyze the factors associated with type 2 diabetes mellitus (T2DM) “remission” in non-bariatric Medicare patients 65 years and older.

Research Design and Methods: A retrospective cohort analysis of a Medicare Advantage health plan was conducted using administrative data. An individual was identified as T2DM if the individual had: ≥ 2 medical claims for T2DM coded 250.xx excluding type 1 diabetes; or ≥ 2 pharmacy claims related to T2DM; or ≥ 2 combined medical claims, pharmacy claims for T2DM in 12 months. A T2DM individual was in “remission” if they had no T2DM related claims for more than 12 …

A New Paediatric Diabetes Knowledge Test - M-Wikad Development And Factor Analysis., Sarah Tsai, Susana Patton, Stephen Delurgio, David D. Williams, Kavitha Dileepan, Alexander Karmazin, Melinda Storm, Mark A. Clements

Manuscripts, Articles, Book Chapters and Other Papers

Purpose: The purpose of this study was to develop a measure of type 1 diabetes mellitus (T1DM) knowledge that is aimed at youth and is based on contemporary management standards. Methods: An 88-item test was derived from the American Association of Diabetes Educators 7 Self-Care Behaviors. Results: A multidisciplinary team selected the best 49 items which were piloted in a sample of 119 youths (59 males, aged 12-18, having a mean ± standard deviation glycated haemoglobin (A1C) of 9.9%±1.80 (84.7±19.7 mmol/mol). A minimum absolute point-biserial correlation coefficient of 0.250 was used to choose 49 items from the original 88 questions. …

Metabolism During Pregnancy And Postpartum: How Does It Change And What Factors Influence It?, Kristin Yoho

Masters Theses & Specialist Projects

PURPOSE: Pregnancy is a physically impactful process in a woman’s life. During this time, a woman will gain weight and research has shown that many women will retain some extra weight after delivery. Because of this, recovery in the postpartum period is pivotal to avoiding the implications of weight retention. The postpartum period is vastly understudied in both the research and medical communities and this gap between pregnancy and postpartum research needs to be bridged. Therefore, the purpose of this study was to investigate metabolic changes from pregnancy to postpartum and to study how factors such as sleep and breastfeeding …

Kinase Suppressor Of Ras 1 And Exo70 Promote Fatty Acid-Stimulated Neurotensin Secretion Through Erk1/2 Signaling, Stephanie Rock, Xian Li, Jun Song, Courtney M. Townsend, Heidi L. Weiss, Piotr G. Rychahou, Tianyan Gao, Jing Li, B. Mark Evers

Markey Cancer Center Faculty Publications

Neurotensin is a peptide hormone released from enteroendocrine cells in the small intestine in response to fat ingestion. Although the mechanisms regulating neurotensin secretion are still incompletely understood, our recent findings implicate a role for extracellular signal–regulated kinase 1 and 2 as positive regulators of free fatty acid-stimulated neurotensin secretion. Previous studies have shown that kinase suppressor of Ras 1 acts as a molecular scaffold of the Raf/MEK/extracellular signal–regulated kinase 1 and 2 kinase cascade and regulates intensity and duration of extracellular signal–regulated kinase 1 and 2 signaling. Here, we demonstrate that inhibition of kinase suppressor of Ras 1 attenuates …