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Taha SI, Salem L, Hassan RM, El-Bassiouny M, Hamdy M, El-Mohamdy MA. Periorbital melanosis and its possible association with insulin resistance and vitamin D deficiency: A pilot case-control study. J Int Med Res 2024; 52:3000605241270648. [PMID: 39161263 PMCID: PMC11334248 DOI: 10.1177/03000605241270648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/24/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVE To investigate the possible association of periorbital melanosis (POM) with insulin resistance (IR) and vitamin D serum levels. METHODS In this pilot, case-control study, we included 100 adult patients with POM and 100 age- and sex-matched healthy control subjects. Vitamin D levels and IR indices (i.e., homeostatic model assessment-insulin resistance [HOMA-IR], triglycerides/high-density lipoprotein cholesterol (TG/HDL-c) ratio, adiponectin/leptin (A/L) ratio) were compared between cases and controls. RESULTS Compared with controls, POM cases had significantly higher values of HOMA-IR and TG/HDL-c ratio, and significantly lower values of A/L and vitamin D. HOMA-IR and TG/HDL-c ratio were statistically significantly positively correlated with POM severity while Vitamin D and A/L ratio were statistically significantly negatively correlated. CONCLUSION POM was associated with indices of IR and vitamin D deficiency. However, the exact causal link among POM, IR, and vitamin D needs to be established. However, the results of this pilot study suggest that POM may have potential as a cutaneous non-invasive marker of these metabolic disorders which would assist in detecting and treating them at an early stage.
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Affiliation(s)
- Sara I. Taha
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Lamyaa Salem
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rasha Mohamad Hassan
- Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahy El-Bassiouny
- Department of Dermatology, Andrology and Venereology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Marwa Hamdy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Marwa Adham El-Mohamdy
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Dutta K, Bhatt SP, Madan S, Ansari IA, Tyagi K, Pandey S, Misra A. Acanthosis nigricans independently predicts hepatic fibrosis in people with type 2 diabetes in North India. Prim Care Diabetes 2024; 18:224-229. [PMID: 38245384 DOI: 10.1016/j.pcd.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Acanthosis nigricans (AN) is a skin condition characterized by hyperpigmentation and thickening, often found in individuals with insulin resistance. Despite this well-established association, the potential link between AN and hepatic fibrosis in people with type 2 diabetes (T2D) has yet to be thoroughly explored. METHODOLOGY We recruited a total of 300 people with T2D, half of whom had AN (n, 150), and the other half without AN (n, 150). We evaluated body composition, biochemistry, and hepatic fat analysis (using the controlled attenuation parameter, CAP), as well as assessments of hepatic stiffness (using the kilopascal, kPa) using Fibroscan. We used multivariable regression analysis to find independent predictors of AN and their relationship to hepatic fibrosis. Furthermore, we developed a prediction equation and AUC for hepatic fibrosis. RESULTS Upon comparison between AN vs. NAN group, following were significatly higher; weight, BMI, hepatic transaminases, liver span, CAP, and kPa. After adjusting for age, weight, body mass index, diabetes duration, and specific anti-hyperglycaemic drugs (gliclazide, DPP-4 inhibitors, pioglitazone, and Glucagon-like peptide-1 receptor agonists), adjusted OR for AN were, liver span, 1.78 (95% CI: 0.91-3.49, p = 0.09), CAP, 7.55 (95% CI: 0.93-61.1, p = 0.05), and kPa, 2.47 (95% CI: 1.50-4.06, p = 0.001). A ROC analysis of predictive score for hepatic fibrosis showed optimal sensitivity and specificity at a score cut-off of 25.2 (sensitivity 62%, specificity 63%), with an AUC of 0.6452 (95% CI: 0.61235-0.76420). CONCLUSION Acanthosis nigricans has the potential to be used as an easy-to-identify clinical marker for risk of hepatic fat and fibrosis in Asian Indians with T2D, allowing for early detection and management strategies.
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Affiliation(s)
- Koel Dutta
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B-16, Chirag Enclave, New Delhi, India
| | - Surya Prakash Bhatt
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B-16, Chirag Enclave, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, India; Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Madan
- National Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, India
| | - Irshad Ahmad Ansari
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B-16, Chirag Enclave, New Delhi, India
| | - Kanika Tyagi
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B-16, Chirag Enclave, New Delhi, India
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Anoop Misra
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B-16, Chirag Enclave, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, India; Diabetes Foundation (India), SDA, New Delhi, India.
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Mihuta MS, Paul C, Borlea A, Roi CM, Velea-Barta OA, Mozos I, Stoian D. Unveiling the Silent Danger of Childhood Obesity: Non-Invasive Biomarkers Such as Carotid Intima-Media Thickness, Arterial Stiffness Surrogate Markers, and Blood Pressure Are Useful in Detecting Early Vascular Alterations in Obese Children. Biomedicines 2023; 11:1841. [PMID: 37509481 PMCID: PMC10376407 DOI: 10.3390/biomedicines11071841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
Obese children present a higher cardio-metabolic risk. Measuring vascular biomarkers that assess the evolution of arterial stiffness, subclinical atherosclerosis, and hypertension in such patients could be helpful in the long term. We studied 84 children, aged from 6 to 18 years: 50 obese subjects, versus 34 of normal weight. Clinical examination involved: BMI, waist circumference, waist-to-height ratio, and detection of the presence of acanthosis nigricans and irregular menstrual cycles (the latter in adolescent girls). The carotid intima-media thickness (CIMT) was measured with the Aixplorer MACH 30 echography device. The pulse wave velocity (PWV), augmentation index (AIx), and peripheral and central blood pressures (i.e., SBP, DBP, cSBP, cDBP, and cPP) were acquired through a Mobil-O-Graph device. Obese subjects underwent body composition analysis with a Tanita BC-418. Blood tests were: HOMA-IR, lipid panel, uric acid, and 25-OH vitamin D. All vascular biomarkers presented increased values in obese subjects versus controls. The following cut-off values were significant in detecting obesity: for PWV > 4.6 m/s, cSBP > 106 mmHg for the <12-year-olds, PWV > 4.5 m/s and cSBP > 115 mmHg for the 12-15-year-olds, and PWV > 5 m/s, cSBP > 123 mmHg for the >15-year-olds. AIx is higher in obese children, regardless of their insulin resistance status. Waist circumference and waist-to-height ratio correlate to all vascular parameters. HOMA-IR is an independent predictor for all vascular parameters except CIMT. Cut-off values for PWV of >4.8 m/s, SBP > 125 mmHg, and a cSBP > 117 mmHg predicted the presence of acanthosis nigricans. Obese girls with irregular menses displayed significantly higher PWV, SBP, and DPB. Elevated levels of uric acid, LDL-c, non-LDL-c, triglycerides, and transaminases, and low levels of HDL-c and 25-OH vitamin D correlated with higher arterial stiffness and CIMT values. We conclude that CIMT and the markers of arterial stiffness are useful in the early detection of vascular damage in obese children.
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Affiliation(s)
- Monica Simina Mihuta
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Corina Paul
- Department of Pediatrics, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Andreea Borlea
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Cristina Mihaela Roi
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Oana-Alexandra Velea-Barta
- 3rd Department of Odontotherapy and Endodontics, Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ioana Mozos
- Department of Functional Sciences-Pathophysiology, Center for Translational Research and Systems Medicine, Victor Babes University of Medicine and Pharmacy, 300173 Timisoara, Romania
| | - Dana Stoian
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Choudhary S, Srivastava A, Saoji V, Singh A, Verma I, Dhande S. Association of acanthosis nigricans with metabolic syndrome - An analytic cross-sectional study. An Bras Dermatol 2023:S0365-0596(23)00065-X. [PMID: 36964104 DOI: 10.1016/j.abd.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/25/2022] [Accepted: 07/16/2022] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Globally, few studies have been undertaken to assess the association of acanthosis nigricans (AN) with metabolic syndrome (MS). Most of the available studies have either focused on a particular age group, gender, ethnicity or on a single component of MS. OBJECTIVES To determine the association between AN and MS as a whole and with all individual components of MS in adult patients of either gender. MATERIAL AND METHODS This was a cross-sectional study with a comparative group. Eighty-one subjects were recruited in each group. Fasting plasma glucose (FPG) and lipid profile were done. MS was defined by using the international diabetic federation (IDF) criteria. Association of body mass index (BMI), waist circumference, blood pressure, FPG, high-density lipoprotein (HDL) and triglycerides (TG) with AN was assessed by Pearson's chi-square test followed by univariate and multivariate analysis. RESULTS The prevalence of MS was found to be significantly higher in the group with AN. On univariate analysis, a significant association of AN was found with BMI, waist circumference, high systolic and diastolic blood pressure, HDL, and TG. Multivariate analysis revealed a significant association between waist circumference, high systolic and diastolic blood pressure, and high TG levels with AN. The risk of MS was found to be eight times higher in cases of AN. STUDY LIMITATIONS The small sample size and single-center data are the limitations of the present study. CONCLUSION AN is strongly associated with MS as a whole and with its individual components including increased waist circumference, hypertension, and dyslipidemia.
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Affiliation(s)
- Sanjiv Choudhary
- Department of Dermatology, All India Institute of Medical Sciences, Nagpur, Maharashtra, India.
| | - Ankita Srivastava
- Department of Dermatology, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Vikrant Saoji
- Department of Dermatology, Jawahar Lal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
| | - Adarshlata Singh
- Department of Dermatology, Jawahar Lal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
| | - Isha Verma
- Department of Dermatology, Jawahar Lal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
| | - Shivani Dhande
- Department of Dermatology, Jawahar Lal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
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Girisha B, Philip N, Shetty S, Pinto A, Noronha T. Estimation of metabolic syndrome in acanthosis nigricans - A hospital based cross-sectional study. Indian J Dermatol 2022; 67:92. [PMID: 35656279 PMCID: PMC9154168 DOI: 10.4103/ijd.ijd_442_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and Objectives Acanthosis nigricans is characterized by hyperpigmentation and velvet-like thickening of the skin. It symmetrically involves the neck, axilla, groins, antecubital and popliteal fossae, umbilical, and perianal areas. Acanthosis nigricans is a marker for insulin resistance and is increasingly found to be associated with metabolic syndrome. We conducted this study to estimate the frequency of metabolic syndrome in acanthosis nigricans. Methods In this hospital-based, cross-sectional study, we evaluated 60 patients with acanthosis nigricans with neck involvement. They were examined for other areas of involvement by acanthosis nigricans. Axillary and neck severity was graded based on the scale described by Burke et al. Insulin resistance was interpreted using homeostatic model assessment (HOMA-IR). Metabolic syndrome was diagnosed according to the SAM-NCEP criteria. Collected data were analyzed using IBM SPSS Statistics, Version 22 (Armonk, NY: IBM Corp). Results Axilla was the most common site involved in 51 patients (85%) followed by knuckles (55%). Metabolic syndrome was found in 78.3% of our patients, and 56.66% had insulin resistance. A statistically significant association of severity grading of axillary acanthosis nigricans with both metabolic syndrome (P = 0.001) and insulin resistance (P = 0.03) was noted. However, no meaningful association was found between the severity grading of neck acanthosis nigricans with both metabolic syndrome (P = 0.4) and insulin resistance (P = 0.08). The association of neck texture grading of acanthosis nigricans with insulin resistance was statistically significant (P = 0.005). Conclusions Metabolic syndrome was seen in 78.3% of acanthosis nigricans. Axillary severity grading was associated with metabolic syndrome.
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Thappa DM, Chandrashekar L, Rajappa M, Usha R, Muthupandi K, Mohanraj PS, Munisamy M, Singh N. Assessment of Patients with Periorbital Melanosis for Hyperinsulinemia and Insulin Resistance. Indian Dermatol Online J 2021; 12:244-249. [PMID: 33959520 PMCID: PMC8088194 DOI: 10.4103/idoj.idoj_491_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/02/2020] [Accepted: 10/21/2020] [Indexed: 11/12/2022] Open
Abstract
Background: Periorbital melanosis (PM) is one of the most common dermatological condition seen in routine practice. Several cutaneous markers such as acanthosis nigricans have been associated with insulin resistance (IR). However, the association of PM with IR needs to be substantiated. Objective: The objective of the study is to evaluate the association of circulating adipokines and IR with PM. Materials and Methods: In this cross-sectional study, we recruited 100 patients with PM and 100 age- and gender-matched healthy controls. The serum levels of leptin, adiponectin, fasting glucose, fasting insulin, insulin-like growth factor-1 (IGF-1), homeostatic model assessment of insulin resistance (HOMA-IR), and leptin: adiponectin ratio (L/A ratio) were assayed. Results: The serum levels of leptin, fasting glucose, fasting insulin, HOMA-IR, L/A ratio were significantly higher in patients with PM as compared to controls. The serum levels of adiponectin were significantly lower in cases as compared to controls. On multivariate regression analysis, leptin, adiponectin, and HOMA-IR were found to be significant, even after adjusting for BMI, blood pressure and LDL and HDL cholesterol. Conclusion: Our findings suggest that patients with PM have hyperinsulinemia, IR, and elevated L/A ratio. PM as a marker of IR in adults may help in identifying patients early and thus aid in the early prevention and management of the disease.
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Affiliation(s)
- Devinder M Thappa
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Laxmisha Chandrashekar
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Medha Rajappa
- Department of Biochemistry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - R Usha
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - K Muthupandi
- Department of Biochemistry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Palani S Mohanraj
- Department of Biochemistry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Malathi Munisamy
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Nidhi Singh
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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Nithun TM, Ranugha PSS, Betkerur JB, Shastry V. Association of Acanthosis Nigricans and Insulin Resistance in Indian Children and Youth - A HOMA2-IR Based Cross-Sectional Study. Indian Dermatol Online J 2019; 10:272-278. [PMID: 31149570 PMCID: PMC6536082 DOI: 10.4103/idoj.idoj_303_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction: The American Diabetes Association includes acanthosis nigricans (AN) as an indicator of diabetes mellitus risk in overweight youth entering puberty. Some argue that AN is not an independent predictor of insulin resistance (IR), when body mass index (BMI) is controlled for. There is a paucity of studies on the association of AN and IR among children and young adults from India. Homeostatic model assessment-IR (HOMA2-IR), a computerized updated model, which is supposed to be superior to HOMA1-IR, has rarely been used for quantification of IR. Methods: Sixty cases (irrespective of BMI), aged 2–24 years with AN, and 30 age- and sex-matched normal weight controls were included. A thorough clinical examination and grading of AN was done. BMI, fasting glucose levels, and fasting insulin levels were measured for all. HOMA-IR calculator V.2.2.3 was used to calculate IR. Those with HOMA 2-IR >1.8 were considered insulin-resistant. Lifestyle modifications were advised for patients with IR. Results: The mean HOMA2-IR value in cases and controls was 2.422 and 1.322, respectively, which was statistically significant. Overweight and obese cases had 2.5 and 11.25 times higher risk of having IR, respectively, by logistic regression. The association of AN with IR was found to be statistically significant in normal weight cases when compared with controls (P = 0.045). Grade 4 of neck severity (P = 0.007), Grade 3 of neck texture (P = 0.001), and Grade 4 of axillary severity (P = 0.001) of AN were found to be significantly associated with IR. Limitations: The relatively small sample size may not reflect the accuracy of AN as a marker of IR. Conclusion: Acanthosis nigricans is associated with IR in both normal and obese. We propose that all children, adolescents, and youth with AN be screened for IR irrespective of BMI. Early identification and prompt lifestyle interventions may prevent or delay the onset of diabetes later.
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Affiliation(s)
- T M Nithun
- Department of Dermatology, MIMER Medical College, Pune, Maharashtra, India
| | - P S S Ranugha
- Department of Dermatology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Jayadev B Betkerur
- Department of Dermatology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Veeranna Shastry
- Department of Dermatology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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Koh YK, Lee JH, Kim EY, Moon KR. Acanthosis Nigricans as a Clinical Predictor of Insulin Resistance in Obese Children. Pediatr Gastroenterol Hepatol Nutr 2016; 19:251-258. [PMID: 28090470 PMCID: PMC5234421 DOI: 10.5223/pghn.2016.19.4.251] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 09/21/2016] [Accepted: 10/24/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE This study aimed to evaluate the utility of acanthosis nigricans (AN) severity as an index for predicting insulin resistance in obese children. METHODS The subjects comprised 74 obese pediatric patients who attended the Department of Pediatrics at Chosun University Hospital between January 2013 and March 2016. Waist circumference; body mass index; blood pressure; fasting glucose and fasting insulin levels; lipid profile; aspartate transaminase, alanine transaminase, glycated hemoglobin, C-peptide, and uric acid levels; and homeostatic model assessment insulin resistance (HOMA-IR) and quantitative insulin check sensitivity index (QUICKI) scores were compared between subjects with AN and those without AN. Receiver operating characteristic curves were used to investigate the utility of the AN score in predicting insulin resistance. HOMA-IR and QUICKI were compared according to AN severity. RESULTS The With AN group had higher fasting insulin levels (24.1±21.0 mU/L vs. 9.8±3.6 mU/L, p<0.001) and HOMA-IR score (5.74±4.71 vs. 2.14±0.86, p<0.001) than the Without AN group. The AN score used to predict insulin resistance was 3 points or more (sensitivity 56.8%, specificity 83.9%). HOMA-IR scores increased with AN severity, from the Without AN group (mean, 2.15; 95% confidence interval [CI], 1.72-2.57) to the Mild AN (mean, 4.15; 95% CI, 3.04-5.25) and Severe AN groups (mean, 7.22; 95% CI, 5.08-9.35; p<0.001). CONCLUSION Insulin resistance worsens with increasing AN severity, and patients with Severe AN (AN score ≥3) are at increased risk of insulin resistance.
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Affiliation(s)
- Young Kwon Koh
- Department of Pediatrics, Chosun University School of Medicine, Gwangju, Korea
| | - Jae Hee Lee
- Department of Pediatrics, Chosun University School of Medicine, Gwangju, Korea
| | - Eun Young Kim
- Department of Pediatrics, Chosun University School of Medicine, Gwangju, Korea
| | - Kyung Rye Moon
- Department of Pediatrics, Chosun University School of Medicine, Gwangju, Korea
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Hari Kumar KVS, Gupta AK, Kumar A. Clinical profile of patients using normal, high and very high insulin doses in type 2 diabetes. Diabetes Metab Syndr 2014; 8:72-74. [PMID: 24907169 DOI: 10.1016/j.dsx.2014.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIMS Insulin requirement varies between patients with diabetes due to insulin resistance. The clinical profile of patients based on their insulin requirement has not been studied earlier. We stratified the patients based on total daily insulin requirement (TDIR) and studied their clinical profile and carbohydrate consumption. MATERIALS & METHODS Sixty patients with type 2 diabetes (aged 30-75 years, using stable insulin dose for last 6 months, HbA1c between 6-7.5%, negative screening tests for Acromegaly and Cushing's disease) participated in this clinical observational study. All patients with major illness, surgery or diabetic ketoacidosis were excluded. The patients were divided into 3 groups: Group 1 (TDIR<1 U/kg, n=30), Group 2 (TDIR 1-2 U/kg, n=20) and Group 3 (TDIR>2U/kg, n=10). Data are presented as mean±S.D and comparison between three groups was done using one way ANOVA test. RESULTS The patients (27M: 33F) had mean age 54.3 ± 12.3 years, diabetes duration 10.1±4.7 years and an A1c of 7±0.38%. Patients in group 3 had lower body weight, BMI and highest carbohydrate consumption when compared with the other two groups (P<0.05). Hypoglycemic episodes and complications did not differ between the groups. CONCLUSION Our data showed that the low body weight and high carbohydrate intake are associated with increased insulin requirement. The clinical implications of our study are to check the carbohydrate intake in patients with high insulin requirement.
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Affiliation(s)
- K V S Hari Kumar
- Department of Endocrinology, Command Hospital, Lucknow 226002, U.P., India.
| | - A K Gupta
- Department of Endocrinology, Command Hospital, Lucknow 226002, U.P., India
| | - Amit Kumar
- Department of Endocrinology, Command Hospital, Lucknow 226002, U.P., India
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Relationship between skin diseases and extracutaneous complications of diabetes mellitus: clinical analysis of 750 patients. Am J Clin Dermatol 2014; 15:65-70. [PMID: 24135944 DOI: 10.1007/s40257-013-0048-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The relationship between skin diseases and extracutaneous complications in diabetes mellitus (DM) is unclear. OBJECTIVE We aimed to investigate the relationship between skin disorders and diabetic neuropathy, nephropathy, and retinopathy in patients with DM. METHODS A total of 750 patients with DM were prospectively enrolled. Demographic and clinical features, skin disorders, glycosylated hemoglobin (HbA1c) levels, and presence of nephropathy, neuropathy, and retinopathy were noted. RESULTS Of the patients, 38.0% had neuropathy, 23.3% had nephropathy, and 22.9% had retinopathy. Any skin disorder was present in 79.2% (n = 594) of patients. The most common skin manifestations were cutaneous infections (47.5%), xerosis (26.4%), and inflammatory skin diseases (20.7%). The frequency of cutaneous infections, fungal infections, diabetic foot, rubeosis faciei, and pigmented purpuric dermatitis was higher in patients with nephropathy than in those without nephropathy. Cutaneous infections, diabetic foot, rubeosis faciei, and diabetic dermopathy were more common in patients with neuropathy. Fungal infections, diabetic foot, rubeosis faciei, diabetic dermopathy, and pigmented purpuric dermatitis were more frequent in patients with retinopathy. Patients with HbA1c ≥8 mmol/mL had more skin disorders than those with HbA1c <8 mmol/mL (P < 0.05 for all). CONCLUSION Skin disorders may be clues to the presence of associated microvascular complications of DM.
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