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Pofi R, Caratti G, Ray DW, Tomlinson JW. Treating the Side Effects of Exogenous Glucocorticoids; Can We Separate the Good From the Bad? Endocr Rev 2023; 44:975-1011. [PMID: 37253115 PMCID: PMC10638606 DOI: 10.1210/endrev/bnad016] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/25/2023] [Accepted: 05/26/2023] [Indexed: 06/01/2023]
Abstract
It is estimated that 2% to 3% of the population are currently prescribed systemic or topical glucocorticoid treatment. The potent anti-inflammatory action of glucocorticoids to deliver therapeutic benefit is not in doubt. However, the side effects associated with their use, including central weight gain, hypertension, insulin resistance, type 2 diabetes (T2D), and osteoporosis, often collectively termed iatrogenic Cushing's syndrome, are associated with a significant health and economic burden. The precise cellular mechanisms underpinning the differential action of glucocorticoids to drive the desirable and undesirable effects are still not completely understood. Faced with the unmet clinical need to limit glucocorticoid-induced adverse effects alongside ensuring the preservation of anti-inflammatory actions, several strategies have been pursued. The coprescription of existing licensed drugs to treat incident adverse effects can be effective, but data examining the prevention of adverse effects are limited. Novel selective glucocorticoid receptor agonists and selective glucocorticoid receptor modulators have been designed that aim to specifically and selectively activate anti-inflammatory responses based upon their interaction with the glucocorticoid receptor. Several of these compounds are currently in clinical trials to evaluate their efficacy. More recently, strategies exploiting tissue-specific glucocorticoid metabolism through the isoforms of 11β-hydroxysteroid dehydrogenase has shown early potential, although data from clinical trials are limited. The aim of any treatment is to maximize benefit while minimizing risk, and within this review we define the adverse effect profile associated with glucocorticoid use and evaluate current and developing strategies that aim to limit side effects but preserve desirable therapeutic efficacy.
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Affiliation(s)
- Riccardo Pofi
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Giorgio Caratti
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - David W Ray
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
- Oxford Kavli Centre for Nanoscience Discovery, University of Oxford, Oxford OX37LE, UK
| | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
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2
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Heneberg P. Diabetes in stiff-person syndrome. Trends Endocrinol Metab 2023; 34:640-651. [PMID: 37586963 DOI: 10.1016/j.tem.2023.07.005] [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: 02/28/2023] [Revised: 07/08/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023]
Abstract
Anti-glutamic acid decarboxylase (GAD) autoantibodies are a hallmark of stiff-person syndrome (SPS) and insulin-dependent diabetes mellitus (IDDM). However, patients with concurrent IDDM and SPS often manifest insulin resistance, and SPS-associated IDDM probably has heterogeneous causes. Some patients manifest IDDM associated only with high titers of anti-GAD65 caused by SPS. By contrast, other patients develop IDDM only after being treated with high-dose corticosteroids or they progress to insulin dependency following their treatment with high-dose corticosteroids. The profile of autoantibodies differs markedly between type 1 diabetes mellitus (T1DM), late-onset diabetes mellitus, and SPS-associated IDDM. Therefore, as with new-onset diabetes after transplantation (NODAT), SPS-associated IDDM should be classified as a specific diabetes entity, the pathophysiology of which requires increased attention.
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Affiliation(s)
- Petr Heneberg
- Charles University, Third Faculty of Medicine, Prague, Czech Republic.
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3
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Kutpruek S, Suksri K, Maneethorn P, Semprasert N, Yenchitsomanus PT, Kooptiwut S. Imatinib prevents dexamethasone-induced pancreatic β-cell apoptosis via decreased TRAIL and DR5. J Cell Biochem 2023; 124:1309-1323. [PMID: 37555250 DOI: 10.1002/jcb.30450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 08/10/2023]
Abstract
Prolonged administration of dexamethasone, a potent anti-inflammatory drug, can lead to steroid-induced diabetes. Imatinib, a medication commonly prescribed for chronic myeloid leukemia (CML), has been shown to improve diabetes in CML patients. Our recent study demonstrated that dexamethasone induces pancreatic β-cell apoptosis by upregulating the expression of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and its receptor, death receptor 5 (DR5). We hypothesized that imatinib may protect against dexamethasone-induced pancreatic β-cell apoptosis by reducing the expression of TRAIL and DR5, thereby favorably modulating downstream effectors in apoptotic pathways. We test this hypothesis by assessing the effects of imatinib on dexamethasone-induced apoptosis in rat insulinoma cell line cells. As anticipated, dexamethasone treatment led to increased TRAIL and DR5 expression, as well as an elevation in superoxide production. Conversely, expression of the TRAIL decoy receptor (DcR1) was decreased. Moreover, key effectors in the extrinsic and intrinsic apoptosis pathways, such as B-cell lymphoma 2 (BCL-2) associated X (BAX), nuclear factor kappa B (NF-κb), P73, caspase 8, and caspase 9, were upregulated, while the antiapoptotic protein BCL-2 was downregulated. Interestingly and importantly, imatinib at a concentration of 10 µM reversed the effect of dexamethasone on TRAIL, DR5, DcR1, superoxide production, BAX, BCL-2, NF-κB, P73, caspase 3, caspase 8, and caspase 9. Similar effects of imatinib on dexamethasone-induced TRAIL and DR5 expression were also observed in isolated mouse islets. Taken together, our findings suggest that imatinib protects against dexamethasone-induced pancreatic β-cell apoptosis by reducing TRAIL and DR5 expression and modulating downstream effectors in the extrinsic and intrinsic apoptosis pathways.
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Affiliation(s)
- Suchanoot Kutpruek
- Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanchana Suksri
- Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Petcharee Maneethorn
- Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Namoiy Semprasert
- Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pa-Thai Yenchitsomanus
- Research Department, Division of Molecular Medicine, Mahidol University, Bangkok, Thailand
| | - Suwattanee Kooptiwut
- Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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4
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Muacevic A, Adler JR. Pathophysiology, Diagnostic Criteria, and Approaches to Type 2 Diabetes Remission. Cureus 2023; 15:e33908. [PMID: 36819346 PMCID: PMC9936340 DOI: 10.7759/cureus.33908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 01/20/2023] Open
Abstract
Diabetes mellitus is a prevalent, life-threatening, and costly medical illness. Type 2 diabetes is defined by insulin resistance caused by persistent hyperglycemia, and it is frequently diagnosed by tests such as fasting blood glucose levels of more than 7.0 mmol/L or HbA1c values of more than 6.5%. Pathogenesis and development of type 2 diabetes mellitus are clearly varied, with genetic and environmental factors both leading to it. The attainment of glycated hemoglobin (HbA1c) levels below the diagnostic level and maintaining it for a minimum of six months without pharmacotherapy, is described as diabetes remission. Diagnosis is a two-part procedure. To begin, the diagnosis of diabetes must be confirmed, and then the type of diabetes must be determined. Even in patients who succeeded to maintain remission, follow-up with the physician and regular tests should be done to prevent any expected diabetes complications.
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5
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Li JX, Cummins CL. Fresh insights into glucocorticoid-induced diabetes mellitus and new therapeutic directions. Nat Rev Endocrinol 2022; 18:540-557. [PMID: 35585199 PMCID: PMC9116713 DOI: 10.1038/s41574-022-00683-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 02/08/2023]
Abstract
Glucocorticoid hormones were discovered to have use as potent anti-inflammatory and immunosuppressive therapeutics in the 1940s and their continued use and development have successfully revolutionized the management of acute and chronic inflammatory diseases. However, long-term use of glucocorticoids is severely hampered by undesirable metabolic complications, including the development of type 2 diabetes mellitus. These effects occur due to glucocorticoid receptor activation within multiple tissues, which results in inter-organ crosstalk that increases hepatic glucose production and inhibits peripheral glucose uptake. Despite the high prevalence of glucocorticoid-induced hyperglycaemia associated with their routine clinical use, treatment protocols for optimal management of the metabolic adverse effects are lacking or underutilized. The type, dose and potency of the glucocorticoid administered dictates the choice of hypoglycaemic intervention (non-insulin or insulin therapy) that should be provided to patients. The longstanding quest to identify dissociated glucocorticoid receptor agonists to separate the hyperglycaemic complications of glucocorticoids from their therapeutically beneficial anti-inflammatory effects is ongoing, with selective glucocorticoid receptor modulators in clinical testing. Promising areas of preclinical research include new mechanisms to disrupt glucocorticoid signalling in a tissue-selective manner and the identification of novel targets that can selectively dissociate the effects of glucocorticoids. These research arms share the ultimate goal of achieving the anti-inflammatory actions of glucocorticoids without the metabolic consequences.
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Affiliation(s)
- Jia-Xu Li
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Carolyn L Cummins
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
- Banting and Best Diabetes Centre, University of Toronto, Toronto, ON, Canada.
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6
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Pal R, Joshi A, Bhadada SK, Banerjee M, Vaikkakara S, Mukhopadhyay S. Endocrine Follow-up During Post-Acute COVID-19: Practical Recommendations Based on Available Clinical Evidence. Endocr Pract 2022; 28:425-432. [PMID: 35158058 PMCID: PMC8832848 DOI: 10.1016/j.eprac.2022.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE COVID-19 affects multiple endocrine organ systems during the disease course. However, follow-up data post-COVID-19 is scarce; hitherto available limited data suggest that most of the biochemical endocrine dysfunctions observed during acute phase of COVID-19 tend to improve after recovery. Hence, we aim to provide a rational approach toward endocrine follow-up of patients during post-acute COVID-19. METHODS We performed a literature review across PubMed/MEDLINE database looking into the effects of COVID-19 on endocrine system and subsequent long-term endocrine sequelae. Accordingly, we have presented a practical set of recommendations regarding endocrine follow-up post-acute COVID-19. RESULTS COVID-19 can lead to new-onset hyperglycemia/diabetes mellitus or worsening of dysglycemia in patients with preexisting diabetes mellitus. Hence, those with preexisting diabetes mellitus should ensure optimum glycemic control in the post-COVID-19 period. New-onset diabetes mellitus has been described post-acute COVID-19; hence, a selected group of patients (aged <70 years and those requiring intensive care unit admission) may be screened for the same at 3 months. Thyroid dysfunction (euthyroid sick syndrome and atypical thyroiditis) and adrenal insufficiency have been described in COVID-19; however, thyroid/adrenal functions usually normalize on follow-up; hence, widespread screening post-acute COVID-19 should not be recommended. Pituitary apoplexy and male hypogonadism have rarely been documented in COVID-19; therefore, appropriate follow-up may be undertaken as per clinical context. Hypocalcemia during COVID-19 is not uncommon; however, routine estimation of serum calcium post-COVID-19 is not warranted. CONCLUSION The recommendations herein provide a rational approach that would be expected to guide physicians to better delineate and manage the endocrine sequelae during post-acute COVID-19.
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Affiliation(s)
- Rimesh Pal
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ameya Joshi
- Endocrinology Division, Bhaktivedanta Hospital, Thane, India
| | - Sanjay K. Bhadada
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Address correspondence to Sanjay K. Bhadada, DM, Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Nehru Hospital Extension, Room number: 001, Chandigarh, India 160012
| | - Mainak Banerjee
- Department of Endocrinology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Suresh Vaikkakara
- Department of Endocrinology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology, Institute of Postgraduate Medical Education and Research, Kolkata, India
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7
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Riddle MC, Cefalu WT, Evans PH, Gerstein HC, Nauck MA, Oh WK, Rothberg AE, le Roux CW, Rubino F, Schauer P, Taylor R, Twenefour D. Consensus report: Definition and interpretation of remission in type 2 diabetes. Diabet Med 2022; 39:e14669. [PMID: 34460965 DOI: 10.1111/dme.14669] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023]
Abstract
Improvement of glucose levels into the normal range can occur in some people living with diabetes, either spontaneously or after medical interventions, and in some cases can persist after withdrawal of glucose-lowering pharmacotherapy. Such sustained improvement may now be occurring more often due to newer forms of treatment. However, terminology for describing this process and objective measures for defining it are not well established, and the long-term risks versus benefits of its attainment are not well understood. To update prior discussions of this issue, an international expert group was convened by the American Diabetes Association to propose nomenclature and principles for data collection and analysis, with the goal of establishing a base of information to support future clinical guidance. This group proposed "remission" as the most appropriate descriptive term, and HbA1c <6.5% (48 mmol/mol) measured at least 3 months after cessation of glucose-lowering pharmacotherapy as the usual diagnostic criterion. The group also made suggestions for active observation of individuals experiencing a remission and discussed further questions and unmet needs regarding predictors and outcomes of remission.
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Affiliation(s)
- Matthew C Riddle
- Division of Endocrinology, Diabetes, & Clinical Nutrition, Department of Medicine, Oregon Health & Science University, Portland, OR
| | - William T Cefalu
- Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Philip H Evans
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Hertzel C Gerstein
- Population Health Research Institute and Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Michael A Nauck
- Diabetes Division, Katholisches Klinikum Bochum gGmbH, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - William K Oh
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy E Rothberg
- Department of Internal Medicine, Michigan Medicine, and Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Francesco Rubino
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
| | | | - Roy Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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8
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Riddle MC, Cefalu WT, Evans PH, Gerstein HC, Nauck MA, Oh WK, Rothberg AE, le Roux CW, Rubino F, Schauer P, Taylor R, Twenefour D. Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes. J Clin Endocrinol Metab 2022; 107:1-9. [PMID: 34459898 PMCID: PMC8825709 DOI: 10.1210/clinem/dgab585] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 11/19/2022]
Abstract
Improvement of glucose levels into the normal range can occur in some people living with diabetes, either spontaneously or after medical interventions, and in some cases can persist after withdrawal of glucose-lowering pharmacotherapy. Such sustained improvement may now be occurring more often due to newer forms of treatment. However, terminology for describing this process and objective measures for defining it are not well established, and the long-term risks versus benefits of its attainment are not well understood. To update prior discussions of this issue, an international expert group was convened by the American Diabetes Association to propose nomenclature and principles for data collection and analysis, with the goal of establishing a base of information to support future clinical guidance. This group proposed "remission" as the most appropriate descriptive term, and HbA1c < 6.5% (48 mmol/mol) measured at least 3 months after cessation of glucose-lowering pharmacotherapy as the usual diagnostic criterion. The group also made suggestions for active observation of individuals experiencing a remission and discussed further questions and unmet needs regarding predictors and outcomes of remission.
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Affiliation(s)
- Matthew C Riddle
- Correspondence: Matthew C. Riddle, Division of Endocrinology, Diabetes, & Clinical Nutrition, Department of Medicine, Oregon Health & Science University, Portland, OR, USA. E-mail:
| | - William T Cefalu
- Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Philip H Evans
- College of Medicine and Health, University of Exeter, Exeter, U.K
| | - Hertzel C Gerstein
- Population Health Research Institute and Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Michael A Nauck
- Diabetes Division, Katholisches Klinikum Bochum gGmbH, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - William K Oh
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amy E Rothberg
- Department of Internal Medicine, Michigan Medicine, and Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Francesco Rubino
- Department of Diabetes, School of Life Course Sciences, King’s College London, London, U.K
| | - Philip Schauer
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Roy Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, U.K
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9
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Riddle MC, Cefalu WT, Evans PH, Gerstein HC, Nauck MA, Oh WK, Rothberg AE, le Roux CW, Rubino F, Schauer P, Taylor R, Twenefour D. Consensus report: definition and interpretation of remission in type 2 diabetes. Diabetologia 2021; 64:2359-2366. [PMID: 34458934 DOI: 10.1007/s00125-021-05542-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 02/05/2023]
Abstract
Improvement of glucose levels into the normal range can occur in some people living with diabetes, either spontaneously or after medical interventions, and in some cases can persist after withdrawal of glucose-lowering pharmacotherapy. Such sustained improvement may now be occurring more often due to newer forms of treatment. However, terminology for describing this process and objective measures for defining it are not well established, and the long-term risks vs benefits of its attainment are not well understood. To update prior discussions of this issue, an international expert group was convened by the American Diabetes Association to propose nomenclature and principles for data collection and analysis, with the goal of establishing a base of information to support future clinical guidance. This group proposed 'remission' as the most appropriate descriptive term, and HbA1c <48 mmol/mol (6.5%) measured at least 3 months after cessation of glucose-lowering pharmacotherapy as the usual diagnostic criterion. The group also made suggestions for active observation of individuals experiencing a remission and discussed further questions and unmet needs regarding predictors and outcomes of remission.
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Affiliation(s)
- Matthew C Riddle
- Division of Endocrinology, Diabetes, & Clinical Nutrition, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - William T Cefalu
- Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Philip H Evans
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Hertzel C Gerstein
- Population Health Research Institute and Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Michael A Nauck
- Diabetes Division, Katholisches Klinikum Bochum gGmbH, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - William K Oh
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amy E Rothberg
- Department of Internal Medicine, Michigan Medicine, and Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Francesco Rubino
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
| | - Philip Schauer
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Roy Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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10
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Riddle MC, Cefalu WT, Evans PH, Gerstein HC, Nauck MA, Oh WK, Rothberg AE, le Roux CW, Rubino F, Schauer P, Taylor R, Twenefour D. Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes. Diabetes Care 2021; 44:dci210034. [PMID: 34462270 PMCID: PMC8929179 DOI: 10.2337/dci21-0034] [Citation(s) in RCA: 175] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 02/03/2023]
Abstract
Improvement of glucose levels into the normal range can occur in some people living with diabetes, either spontaneously or after medical interventions, and in some cases can persist after withdrawal of glucose-lowering pharmacotherapy. Such sustained improvement may now be occurring more often due to newer forms of treatment. However, terminology for describing this process and objective measures for defining it are not well established, and the long-term risks versus benefits of its attainment are not well understood. To update prior discussions of this issue, an international expert group was convened by the American Diabetes Association to propose nomenclature and principles for data collection and analysis, with the goal of establishing a base of information to support future clinical guidance. This group proposed "remission" as the most appropriate descriptive term, and HbA1c <6.5% (48 mmol/mol) measured at least 3 months after cessation of glucose-lowering pharmacotherapy as the usual diagnostic criterion. The group also made suggestions for active observation of individuals experiencing a remission and discussed further questions and unmet needs regarding predictors and outcomes of remission.
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Affiliation(s)
- Matthew C Riddle
- Division of Endocrinology, Diabetes, & Clinical Nutrition, Department of Medicine, Oregon Health & Science University, Portland, OR
| | - William T Cefalu
- Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Philip H Evans
- College of Medicine and Health, University of Exeter, Exeter, U.K
| | - Hertzel C Gerstein
- Population Health Research Institute and Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Michael A Nauck
- Diabetes Division, Katholisches Klinikum Bochum gGmbH, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - William K Oh
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy E Rothberg
- Department of Internal Medicine, Michigan Medicine, and Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Francesco Rubino
- Department of Diabetes, School of Life Course Sciences, King's College London, London, U.K
| | | | - Roy Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, U.K
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11
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Utilization of Indian diabetes risk score (IDRS) in steroid-induced diabetes. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-00976-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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12
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Nowak KM, Rdzanek-Pikus M, Romanowska-Próchnicka K, Nowakowska-Płaza A, Papierska L. High prevalence of steroid-induced glucose intolerance with normal fasting glycaemia during low-dose glucocorticoid therapy: an oral glucose tolerance test screening study. Rheumatology (Oxford) 2021; 60:2842-2851. [PMID: 33254223 DOI: 10.1093/rheumatology/keaa724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/24/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To evaluate the prevalence and risk factors of new-onset glucose metabolism impairment using an oral glucose tolerance test (OGTT) in patients with normal fasting glycaemia on long-term glucocorticoid (GC) treatment. METHODS An OGTT was performed in 150 patients without a previous history of pre-diabetes or diabetes who were diagnosed with inflammatory rheumatic diseases and treated with GCs >3 months. All participants underwent clinical and biochemical evaluation for risk factors of diabetes: age, sex, current and cumulative dose of steroids, treatment duration, waist circumference, BMI, Homeostatic Model Assessment for Insulin Resistance, fasting insulin concentration, family history of diabetes, CRP, 28-joint DAS with CRP, type of connective tissue disease and trunk fat percentage measured by DXA. Logistic regression analysis was conducted to evaluate the association between the presence of impaired glucose tolerance (IGT) in the OGTT and analysed risk factors. RESULTS A total of 102 patients (68%) had fully normal glucose tolerance. Diabetes, isolated impaired fasting glucose, isolated IGT and combined impaired fasting glucose + IGT was diagnosed in 3.3, 4.67, 19.33 and 4.67% of patients, respectively; 20% of participants had IGT or diabetes despite normal fasting glucose concentration. The median cumulative dose and current dose (5 mg) of GCs and treatment duration were similar compared with the normal glucose tolerance group. In a multivariate logistic regression model, only older age (particularly ≥50 years of age) and trunk fat percentage remained significant factors predicting IGT or diabetes in the OGTT. CONCLUSION New-onset GC-induced glucose intolerance, even in patients on long-term low-dose treatment, is prevalent despite normal fasting glucose concentration and patients should be screened with an OGTT despite the absence of classic risk factors of diabetes.
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Affiliation(s)
- Karolina M Nowak
- Department of Endocrinology, Centre of Postgraduate Medical Education, Bielanski Hospital, Warsaw, Poland
| | - Monika Rdzanek-Pikus
- Department of Endocrinology, Centre of Postgraduate Medical Education, Bielanski Hospital, Warsaw, Poland
| | - Katarzyna Romanowska-Próchnicka
- Department of General and Experimental Pathology, 2nd Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.,Department of Systemic Connective Tissue Diseases , Warsaw, Poland
| | - Anna Nowakowska-Płaza
- Department of Rheumatology, Eleonora Reicher National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Lucyna Papierska
- Department of Endocrinology, Centre of Postgraduate Medical Education, Bielanski Hospital, Warsaw, Poland
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Flynn BP, Birnie MT, Kershaw YM, Pauza AG, Kim S, Baek S, Rogers MF, Paterson AR, Stavreva DA, Murphy D, Hager GL, Lightman SL, Conway-Campbell BL. Corticosterone pattern-dependent glucocorticoid receptor binding and transcriptional regulation within the liver. PLoS Genet 2021; 17:e1009737. [PMID: 34375333 PMCID: PMC8378686 DOI: 10.1371/journal.pgen.1009737] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/20/2021] [Accepted: 07/23/2021] [Indexed: 12/21/2022] Open
Abstract
Ultradian glucocorticoid rhythms are highly conserved across mammalian species, however, their functional significance is not yet fully understood. Here we demonstrate that pulsatile corticosterone replacement in adrenalectomised rats induces a dynamic pattern of glucocorticoid receptor (GR) binding at ~3,000 genomic sites in liver at the pulse peak, subsequently not found during the pulse nadir. In contrast, constant corticosterone replacement induced prolonged binding at the majority of these sites. Additionally, each pattern further induced markedly different transcriptional responses. During pulsatile treatment, intragenic occupancy by active RNA polymerase II exhibited pulsatile dynamics with transient changes in enrichment, either decreased or increased depending on the gene, which mostly returned to baseline during the inter-pulse interval. In contrast, constant corticosterone exposure induced prolonged effects on RNA polymerase II occupancy at the majority of gene targets, thus acting as a sustained regulatory signal for both transactivation and repression of glucocorticoid target genes. The nett effect of these differences were consequently seen in the liver transcriptome as RNA-seq analysis indicated that despite the same overall amount of corticosterone infused, twice the number of transcripts were regulated by constant corticosterone infusion, when compared to pulsatile. Target genes that were found to be differentially regulated in a pattern-dependent manner were enriched in functional pathways including carbohydrate, cholesterol, glucose and fat metabolism as well as inflammation, suggesting a functional role for dysregulated glucocorticoid rhythms in the development of metabolic dysfunction. Adrenal glucocorticoid hormones are released in a characteristic ultradian rhythm that becomes dysregulated during chronic stress, disease, or synthetic corticosteroid treatment. Metabolic dysfunction is a comorbidity associated with all these conditions, but the role that altered glucocorticoid dynamics play is unknown. As the liver is a major site of glucocorticoid action on metabolic homeostasis regulated by the glucocorticoid receptor, we have assessed how different patterns of hormone replacement in adrenalectomised rats differentially regulate gene pathways involved in type II diabetes, cirrhosis, and fatty liver development, via altering the pattern of glucocorticoid receptor binding to regulatory sites. We believe our findings have important implications for therapies that can reproduce the endogenous glucocorticoid rhythm and thus minimize adverse metabolic side-effects in patients.
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Affiliation(s)
- Benjamin P. Flynn
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Matthew T. Birnie
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, United Kingdom
| | - Yvonne M. Kershaw
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, United Kingdom
| | - Audrys G. Pauza
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, United Kingdom
| | - Sohyoung Kim
- Laboratory of Receptor Biology and Gene Expression, National Cancer Institute, National Institute of Health, Bethesda, Maryland, United States of America
| | - Songjoon Baek
- Laboratory of Receptor Biology and Gene Expression, National Cancer Institute, National Institute of Health, Bethesda, Maryland, United States of America
| | - Mark F. Rogers
- Intelligent Systems Laboratory, University of Bristol, Bristol, United Kingdom
| | - Alex R. Paterson
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, United Kingdom
| | - Diana A. Stavreva
- Laboratory of Receptor Biology and Gene Expression, National Cancer Institute, National Institute of Health, Bethesda, Maryland, United States of America
| | - David Murphy
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, United Kingdom
| | - Gordon L. Hager
- Laboratory of Receptor Biology and Gene Expression, National Cancer Institute, National Institute of Health, Bethesda, Maryland, United States of America
| | - Stafford L. Lightman
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, United Kingdom
| | - Becky L. Conway-Campbell
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, United Kingdom
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A Practical Guide for the Management of Steroid Induced Hyperglycaemia in the Hospital. J Clin Med 2021; 10:jcm10102154. [PMID: 34065762 PMCID: PMC8157052 DOI: 10.3390/jcm10102154] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 01/08/2023] Open
Abstract
Glucocorticoids represent frequently recommended and often indispensable immunosuppressant and anti-inflammatory agents prescribed in various medical conditions. Despite their proven efficacy, glucocorticoids bear a wide variety of side effects among which steroid induced hyperglycaemia (SIHG) is among the most important ones. SIHG, potentially causes new-onset hyperglycaemia or exacerbation of glucose control in patients with previously known diabetes. Retrospective data showed that similar to general hyperglycaemia in diabetes, SIHG in the hospital and in outpatient settings detrimentally impacts patient outcomes, including mortality. However, recommendations for treatment targets and guidelines for in-hospital as well as outpatient therapeutic management are lacking, partially due to missing evidence from clinical studies. Still, SIHG caused by various types of glucocorticoids is a common challenge in daily routine and clinical guidance is needed. In this review, we aimed to summarize clinical evidence of SIHG in inpatient care impacting clinical outcome, establishment of diagnosis, diagnostic procedures and therapeutic recommendations.
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15
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Avinash H, Sudha V, Laxminarayan B, Nandakrishna B, Shastry BA, Asha K, Hande M, Shalini A. The role of osteocalcin in mechanism of Steroid induced diabetes mellitus. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-019-00791-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Alakkas Z, Alzaedi OA, Somannavar SS, Alfaifi A. Steroid-Induced Diabetes Ketoacidosis in an Immune Thrombocytopenia Patient: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923372. [PMID: 32418984 PMCID: PMC7262485 DOI: 10.12659/ajcr.923372] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Patient: Female, 53-year-old Final Diagnosis: Diabetic KetoAcidosis (DKA) Symptoms: Gum bleeding Medication: Steroids Clinical Procedure: — Specialty: Metabolic Disorders and Diabetics
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Affiliation(s)
- Ziyad Alakkas
- Department of Internal Medicine, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia
| | - Ohud A Alzaedi
- Department of Endocrinology, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia
| | | | - Abdulaziz Alfaifi
- Department of Internal Medicine, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia
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17
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DeZubay J, Drew R, Smith J, Mills E, Bell T, Holland M. Type 2 Diabetes Mellitus in Patients with a Prior History of Corticosteroid-induced Hyperglycemia. JOURNAL OF CONTEMPORARY PHARMACY PRACTICE 2019. [DOI: 10.37901/jcphp17-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Richard Drew
- Campbell University College of Pharmacy & Health Sciences
| | | | | | - Tara Bell
- Campbell University College of Pharmacy & Health Sciences
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18
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Usanov SA, Kliuchenovich AV, Strushkevich NV. Drug design strategies for Cushing's syndrome. Expert Opin Drug Discov 2018; 14:143-151. [PMID: 30572739 DOI: 10.1080/17460441.2019.1559146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Cushing's syndrome (CS) is a metabolic disorder caused by chronic hypercortisolism. CS is associated with cardiovascular, metabolic, skeletal and psychological dysfunctions and can be fatal if left untreated. The first-line treatment for all forms of CS is a surgery. However, medical therapy has to be chosen if surgical resection is not an option or is deemed ineffective. Currently available therapeutics are either not selective and have side effects or are only available as an injection (pasireotide). Areas covered: The authors discuss the recent drug developments for the medical treatment of CS through two validated molecular targets. Specifically, the authors look at selective inhibitors of CYP11B1 that reduce cortisol production by inhibiting steroid 11beta-hydroxylase and glucocorticoid receptor (GR) antagonists that interrupt cortisol-mediating transcriptional regulation of related genes. Expert opinion: Patients with CS have limited treatment options; indeed, there is an unmet need for new compounds that target CYP11B1 selectively versus several steroidogenic enzymes and/or GR-signaling pathways. The complexity of steroid biosynthesis and signaling requires the application of structure-based drug discovery techniques that use molecular targets and highly similar off-targets. Significant differences in steroidogenesis between humans and other species necessitates caution over the choice of in vivo model for the preclinical evaluation of future potential compounds.
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Affiliation(s)
- S A Usanov
- a Institute of Bioorganic Chemistry of the National Academy of Science of Belarus , Minsk , Republic of Belarus
| | - A V Kliuchenovich
- b Target Medicals LLC , Skolkovo Innovation Center (Technopark) , Moscow , Russian Federation
| | - N V Strushkevich
- a Institute of Bioorganic Chemistry of the National Academy of Science of Belarus , Minsk , Republic of Belarus
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Schultz H, Pedersen-Bjergaard U, Jensen AK, Engelholm SA, Kristensen PL. The influence on survival of glucocorticoid induced diabetes in cancer patients with metastatic spinal cord compression. Clin Transl Radiat Oncol 2018; 11:19-25. [PMID: 30014043 PMCID: PMC6019865 DOI: 10.1016/j.ctro.2018.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE The influence of glucocorticoid induced hyperglycemia on survival in patients with metastatic spinal cord compression (MSCC) is unknown. MATERIALS AND METHODS In a prospective, observational cohort study 131 patients with MSCC referred to radiotherapy, 30 Gray (Gy) in 10 fractions, and treated with ≥100 mg prednisolone a day were followed with daily blood glucose measurements during radiotherapy. RESULTS During follow-up a total of 56 patients 43% (95% CI = 35-52%) presented plasma glucose values diagnostic of diabetes. Sixteen patients who developed diabetes were treated with insulin, 12% (95% CI = [6%; 18%]) of the total population. The patients developing diabetes with need for insulin therapy during glucocorticoid therapy had a significantly increased mortality compared to those with normal glucose metabolism and with diabetes without need for therapy, hazard ratio = 2.1 (95% CI = 1.08-4.09, p = 0.0285). DISCUSSION To our knowledge this is the first prospective study to describe the influence of glucocorticoid induced diabetes on survival in patients with MSCC from different primary tumors. CONCLUSIONS The results indicate that development of diabetes during high-dose glucocorticoid therapy needing insulin treatment in patients with MSCC from different primary tumors is associated with reduced survival.
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Affiliation(s)
- Helga Schultz
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Institute of Public Health, University of Copenhagen, Denmark
| | - Svend Aage Engelholm
- Department of Oncology, Rigshospitalet, University of Copenhagen, Belgdamsvej 9, 2100 Copenhagen N, Denmark
| | - Peter Lommer Kristensen
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark
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20
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Singh R, Kumar P, Singh R, Dhama K, Kumari S, Yadav JP, Kashyap G, Singh KP, Singh V, Sahoo M. Pathology and polymerase chain reaction detection of ovine progressive pneumonia (maedi) cases in slaughtered sheep in India. Vet World 2017; 10:1401-1406. [PMID: 29263606 PMCID: PMC5732350 DOI: 10.14202/vetworld.2017.1401-1406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/25/2017] [Indexed: 11/16/2022] Open
Abstract
Aim The small ruminant lentiviruses are known to cause maedi-visna (MV) and caprine arthritis - encephalitis in sheep and goats, typically affecting joints, udder, lungs, and the central nervous system. The diagnosis usually involves serology, clinical signs, immunohistochemistry, and polymerase chain reaction (PCR). In the present study, the histopathologically positive pneumonia cases of MV were confirmed by PCR in lung tissue probably for the first time in India. Materials and Methods A total of 888 lungs of adult sheep, aged between 2 and 5 years, were screened during slaughter, of which 121 were found to have pneumonic lesions. The tissues from each pneumonic lung including associated lymph nodes were collected in 10% neutral buffered formalin for histopathology. The frozen tissues of the same were also collected and stored at -20°C for PCR confirmation. Results Three of 121 cases of pneumonic lungs of sheep revealed gross and histopathological lesions suggestive of maedi or ovine progressive pneumonia infection. These 3 cases were further confirmed by PCR technique that amplified 291-base pair DNA in the long terminal repeat sequence of MV provirus. Conclusion This study suggests the low occurrence of MV virus (MVV) infection in India in naturally affected sheep based on pathomorphological lesions and using the molecular tool of PCR detection of the virus in tissues. Further, a combination of pathomorphology or/and PCR testing might be optimal for detecting the animals infected with MVV.
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Affiliation(s)
- Rahul Singh
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, Izatnagar - 243 122, Uttar Pradesh, India
| | - Pawan Kumar
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, Izatnagar - 243 122, Uttar Pradesh, India
| | - Rajendra Singh
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, Izatnagar - 243 122, Uttar Pradesh, India
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, Izatnagar - 243 122, Uttar Pradesh, India
| | - Swati Kumari
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, Izatnagar - 243 122, Uttar Pradesh, India
| | - Jay Prakash Yadav
- Division of Veterinary Public Health, ICAR-Indian Veterinary Research Institute, Bareilly, Izatnagar - 243 122, Uttar Pradesh, India
| | - Gayatri Kashyap
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, Izatnagar - 243 122, Uttar Pradesh, India
| | - Karam Pal Singh
- Division of Pathology, Centre for Animal Disease Research and Diagnosis, ICAR-Indian Veterinary Research Institute, Bareilly, Izatnagar - 243 122, Uttar Pradesh, India
| | - Vidya Singh
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, Izatnagar - 243 122, Uttar Pradesh, India
| | - Monalisa Sahoo
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, Izatnagar - 243 122, Uttar Pradesh, India
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21
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Schultz H, Rasmussen BK, Kristensen PL, Jensen AK, Pedersen-Bjergaard U. Early incidence of glucocorticoid-induced diabetes in patients with brain tumors: a retrospective study of the first 7 days of treatment. Neurooncol Pract 2017; 5:170-175. [PMID: 31385948 DOI: 10.1093/nop/npx027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Hyperglycemia or diabetes is a well-known side effect of treatment with glucocorticoids. In patients with brain tumors, glucocorticoids are widely used to treat symptoms of peritumoral edema. We conducted a retrospective study of patients with suspected brain tumor to determine the incidence of and risk factors for glucocorticoid-induced diabetes. Methods This was a retrospective study of patients referred with suspected brain tumor to a neurological department, using data from a clinical database, electronic medical records, the laboratory system, and the pathology information bank. . Nondiabetic patients with a neuroimaging-verified brain tumor treated with high-dose glucocorticoid and monitored with glucose measurements were included in the study. Results Among 809 patients referred with suspected brain tumor, 171 were eligible for the study. Thirty-eight (22%) patients developed glucocorticoid-induced diabetes, defined as 2 glucose measurements ≥200 mg/dl (11.1 mmol/l) within the first week of treatment, and 4 of the patients were treated with insulin. The majority of patients with glucocorticoid-induced diabetes were identified on days 2, 3, and 4, and glucose levels were highest in the afternoon and evening. We were not able to identify any risk factors for glucocorticoid-induced diabetes and glucocorticoid-induced diabetes had no influence on survival in our cohort. Conclusions Glucocorticoid-induced diabetes is frequent in the first 7 days of treatment in patients with brain tumors. The results emphasize the need for screening for glucocorticoid-induced diabetes in this group of patients to avoid comorbidity expected to arise from hyperglycemia.
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Affiliation(s)
- Helga Schultz
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital Hilleroed, Hilleroed, Denmark
| | - Birthe Krogh Rasmussen
- Department of Neurology, Nordsjaellands Hospital Hilleroed, Dyrehavevej, Hilleroed, Denmark
| | - Peter Lommer Kristensen
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital Hilleroed, Hilleroed, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Institute of Public Health, University of Copenhagen, Denmark
| | - Ulrik Pedersen-Bjergaard
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital Hilleroed, Hilleroed, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej, Copenhagen N, Denmark
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22
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Kishimoto M, Noda M. Verification of glycemic profiles using continuous glucose monitoring: cases with steroid use, liver cirrhosis, enteral nutrition, or late dumping syndrome. THE JOURNAL OF MEDICAL INVESTIGATION 2016; 62:1-10. [PMID: 25817276 DOI: 10.2152/jmi.62.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Glycemic control is often difficult to achieve in patients with diabetes, especially in the presence of comorbid diseases or conditions such as steroid-use or liver cirrhosis, or in patients receiving enteral nutrition. Moreover, reactive hypoglycemia due to late dumping syndrome in people having undergone gastrectomy is also a matter of concern. Empirically and theoretically, the typical glycemic profiles associated with these conditions have been determined; however, what actually happens during a 24-h span is still somewhat obscure. In order to verify and provide information about the 24-h glycemic profiles associated with these conditions, 8 patients with the 4 above-mentioned conditions were monitored using a continuous glucose monitoring system (CGMS). For all 8 patients, CGMS provided detailed information regarding the 24-h glycemic profiles. The CGM results showed typical glycemic patterns for each condition, and we were moreover able to observe the effects of various practical treatments. Based on these cases, we conclude that the CGMS is highly useful for determining the glycemic patterns of patients with the aforementioned conditions in a practical setting; and this system may be used to monitor the treatment success of such cases.
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Affiliation(s)
- Miyako Kishimoto
- Department of Diabetes, Endocrinology, and Metabolism Center Hospital; 2.Diabetes and Metabolism Information Center, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine
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23
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Kang BJ, Park HW, Nah YW. Posttransplant Diabetes Mellitus after Liver Transplantation: Risk Factors for Persistence. KOREAN JOURNAL OF TRANSPLANTATION 2016. [DOI: 10.4285/jkstn.2016.30.3.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Byeong Ju Kang
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hyung Woo Park
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yang Won Nah
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Brady V, Thosani S, Zhou S, Bassett R, Busaidy NL, Lavis V. Safe and effective dosing of basal-bolus insulin in patients receiving high-dose steroids for hyper-cyclophosphamide, doxorubicin, vincristine, and dexamethasone chemotherapy. Diabetes Technol Ther 2014; 16:874-9. [PMID: 25321387 PMCID: PMC4241952 DOI: 10.1089/dia.2014.0115] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hyperglycemia occurs in cancer patients receiving high-dose steroids with cyclophosphamide, doxorubicin, vincristine, and dexamethasone (hyper-CVAD) protocol. The purpose of our study was to determine insulin requirements in patients with hyperglycemia on hyper-CVAD therapy using a systematic algorithm. SUBJECTS AND METHODS We did a retrospective chart review of 23 leukemia inpatients with hyperglycemia (two glucose values >250 mg/dL) on hyper-CVAD chemotherapy managed by the Endocrine Diabetes Inpatient Team algorithm. We reviewed demographic and glycemic data, insulin dosages, and use of oral hypoglycemic agents. Using our algorithm, the dose of insulin for each patient was titrated daily and with each subsequent cycle of hyper-CVAD. RESULTS Ninety-one percent of patients had known diabetes. The median body mass index was 32.5 (range, 21.6-40.9) kg/m², and median age was 61 (range, 40-80) years. The overall trend in glucose values across cycles showed a statistically significant decrease with each subsequent cycle of hyper-CVAD. Hyperglycemia accounted for 81% of glucose measurements in the first cycle and 60% of glucose values in the last cycle. Patients received 1-1.3 units/kg of insulin per cycle, and insulin requirements were similar across cycles. The distribution of basal versus bolus insulin for each cycle was 63-77% prandial and 23-37% basal. Nine of the 23 patients had at least one glucose value <70 mg/dL, which accounted for 1.3% of all recorded glucose values. None of the patients had severe hypoglycemia. CONCLUSIONS Multiple-dose insulin therapy initiated at 1-1.2 units/kg/day, distributed as 25% basal and 75% prandial, reduced hyperglycemia in patients who were receiving high-dose dexamethasone as part of hyper-CVAD.
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Affiliation(s)
- Veronica Brady
- Department of Endocrine Neoplasia & Hormonal Disorders, Division of Internal Medicine, University of Texas–MD Anderson Cancer Center, Houston, Texas
| | - Sonali Thosani
- Department of Endocrine Neoplasia & Hormonal Disorders, Division of Internal Medicine, University of Texas–MD Anderson Cancer Center, Houston, Texas
| | - Shouhou Zhou
- Department of Biostatistics, University of Texas–MD Anderson Cancer Center, Houston, Texas
| | - Roland Bassett
- Department of Biostatistics, University of Texas–MD Anderson Cancer Center, Houston, Texas
| | - Naifa Lamki Busaidy
- Department of Endocrine Neoplasia & Hormonal Disorders, Division of Internal Medicine, University of Texas–MD Anderson Cancer Center, Houston, Texas
| | - Victor Lavis
- Department of Endocrine Neoplasia & Hormonal Disorders, Division of Internal Medicine, University of Texas–MD Anderson Cancer Center, Houston, Texas
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25
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Shaharir SS, Gafor AHA, Said MSM, Kong NCT. Steroid-induced diabetes mellitus in systemic lupus erythematosus patients: analysis from a Malaysian multi-ethnic lupus cohort. Int J Rheum Dis 2014; 18:541-7. [DOI: 10.1111/1756-185x.12474] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | | | | | - Norella C. T. Kong
- Nephrology; Universiti Kebangsaan Malaysia Medical Centre; Kuala Lumpur Malaysia
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Beaudry JL, Dunford EC, Teich T, Zaharieva D, Hunt H, Belanoff JK, Riddell MC. Effects of selective and non-selective glucocorticoid receptor II antagonists on rapid-onset diabetes in young rats. PLoS One 2014; 9:e91248. [PMID: 24642683 PMCID: PMC3958344 DOI: 10.1371/journal.pone.0091248] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 02/10/2014] [Indexed: 12/11/2022] Open
Abstract
The blockade of glucocorticoid (GC) action through antagonism of the glucocorticoid receptor II (GRII) has been used to minimize the undesirable effects of chronically elevated GC levels. Mifepristone (RU486) is known to competitively block GRII action, but not exclusively, as it antagonizes the progesterone receptor. A number of new selective GRII antagonists have been developed, but limited testing has been completed in animal models of overt type 2 diabetes mellitus. Therefore, two selective GRII antagonists (C113176 and C108297) were tested to determine their effects in our model of GC-induced rapid-onset diabetes (ROD). Male Sprague-Dawley rats (∼ six weeks of age) were placed on a high-fat diet (60%), surgically implanted with pellets containing corticosterone (CORT) or wax (control) and divided into five treatment groups. Each group was treated with either a GRII antagonist or vehicle for 14 days after surgery: CORT pellets (400 mg/rat) + antagonists (80 mg/kg/day); CORT pellets + drug vehicle; and wax pellets (control) + drug vehicle. After 10 days of CORT treatment, body mass gain was increased with RU486 (by ∼20% from baseline) and maintained with C113176 administration, whereas rats given C108297 had similar body mass loss (∼15%) to ROD animals. Fasting glycemia was elevated in the ROD animals (>20 mM), normalized completely in animals treated with RU486 (6.2±0.1 mM, p<0.05) and improved in animals treated with C108297 and C113176 (14.0±1.6 and 8.8±1.6 mM, p<0.05 respectively). Glucose intolerance was normalized with RU486 treatment, whereas acute insulin response was improved with RU486 and C113176 treatment. Also, peripheral insulin resistance was attenuated with C113176 treatment along with improved levels of β-cell function while C108297 antagonism only provided modest improvements. In summary, C113176 is an effective agent that minimized some GC-induced detrimental metabolic effects and may provide an alternative to the effective, but non-selective, GRII antagonist RU486.
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Affiliation(s)
- Jacqueline L. Beaudry
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Center and Physical Activity and Chronic Disease Unit, York University, Toronto, Ontario, Canada
| | - Emily C. Dunford
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Center and Physical Activity and Chronic Disease Unit, York University, Toronto, Ontario, Canada
| | - Trevor Teich
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Center and Physical Activity and Chronic Disease Unit, York University, Toronto, Ontario, Canada
| | - Dessi Zaharieva
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Center and Physical Activity and Chronic Disease Unit, York University, Toronto, Ontario, Canada
| | - Hazel Hunt
- Corcept Therapeutics, Menlo Park, California, United States of America
| | | | - Michael C. Riddell
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Center and Physical Activity and Chronic Disease Unit, York University, Toronto, Ontario, Canada
- * E-mail:
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27
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Hwang JL, Weiss RE. Steroid-induced diabetes: a clinical and molecular approach to understanding and treatment. Diabetes Metab Res Rev 2014; 30:96-102. [PMID: 24123849 PMCID: PMC4112077 DOI: 10.1002/dmrr.2486] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 07/07/2013] [Accepted: 07/07/2013] [Indexed: 12/14/2022]
Abstract
Since the advent of glucocorticoid therapy for autoimmune disease in the 1940s, their widespread application has led to the concurrent therapy-limiting discovery of many adverse metabolic side effects. Unanticipated hyperglycemia associated with the initiation of glucocorticoids often leads to preventable hospital admissions, prolonged hospital stays, increased risks for infection and reduced graft function in solid organ transplant recipients. Challenges in managing steroid-induced diabetes stem from wide fluctuations in post-prandial hyperglycemia and the lack of clearly defined treatment protocols. The mainstay of treatment is insulin therapy coincident with meals. This article aims to review the pathogenesis, risk factors, diagnosis and treatment principles unique to steroid-induced diabetes.
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Affiliation(s)
- Jessica L. Hwang
- Department of Medicine, The University of Chicago, Chicago, IL 60637, USA
| | - Roy E. Weiss
- Department of Medicine, The University of Chicago, Chicago, IL 60637, USA
- Department of Pediatrics, The University of Chicago, Chicago, IL 60637, USA
- Correspondence to: Roy E. Weiss, Section of Endocrinology, Diabetes and Metabolism, The University of Chicago, MC 3090, 5841 S. Maryland Ave. Chicago, IL 60637, USA.
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Shaharir SS, Ghafor AHA, Said MSM, Kong NCT. A descriptive study of the factors associated with damage in Malaysian patients with lupus nephritis. Lupus 2014; 23:436-42. [DOI: 10.1177/0961203313518624] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Renal involvement is the most common serious complication in patients with systemic lupus erythematosus (SLE). Objective The objective of this article is to investigate and determine the associated factors of disease damage among lupus nephritis (LN) patients. Methods Medical records of LN patients who attended regular follow-up for at least one year in the Nephrology/SLE Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), were reviewed. Their Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index scores were noted. Univariate analysis and multivariable regression analysis were performed to determine the independent factors of disease damage in LN. Results A total of 150 patients were included and their follow-up duration ranged from one to 20 years. Sixty (40%) LN patients had disease damage (SDI ≥1). In the univariate analysis, it was associated with age, longer disease duration, antiphospholipid syndrome (APS), higher maximum daily oral prednisolone dose (mg/day), lower mean C3 and C4, higher chronicity index and global sclerosis on renal biopsies ( p < 0.05). Patients who received early (≤3 months after the SLE diagnosis) hydroxychloroquine (HCQ), optimum HCQ dose at 6.5 mg/kg/day and achieved early complete remission (CR) were less likely to have disease damage ( p < 0.05). After adjustment for age, gender, disease duration and severity, multivariable regression analysis revealed that a higher maximum daily dose of oral prednisolone was independently associated with disease damage while early HCQ and CR were associated with lower disease damage. Conclusion Higher maximum daily prednisolone dose predicted disease damage whereas treatment with early HCQ and early CR had a protective role against disease damage.
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Affiliation(s)
- SS Shaharir
- Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - AH Abdul Ghafor
- Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - MS Mohamed Said
- Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - NCT Kong
- Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Nunes EA, Gonçalves-Neto LM, Ferreira FB, dos Santos C, Fernandes LC, Boschero AC, Calder PC, Rafacho A. Glucose intolerance induced by glucocorticoid excess is further impaired by co-administration with β-hydroxy-β-methylbutyrate in rats. Appl Physiol Nutr Metab 2013; 38:1137-46. [DOI: 10.1139/apnm-2012-0456] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Glucocorticoid (GC) excess alters glucose homeostasis and promotes modifications in murinometric and anthropometric parameters in rodents and humans, respectively. β-hydroxy-β-methylbutyrate (HMB), a leucine metabolite, has been proposed as a nutritional strategy for preventing muscle wasting, but few data regarding its effects on glucose homeostasis are available. Here, we analyzed whether the effects of GC excess on glucose homeostasis may be attenuated or exacerbated by the concomitant ingestion of HMB. Adult Wistar rats (90-days-old) were assigned to four groups: (1) vehicle treated (Ctl), (2) dexamethasone (DEX) treated (Dex), (3) HMB treated (Hmb), and (4) DEX plus HMB treated (DexHmb). Dex groups received DEX (1 mg·kg body weight (BW)−1, intraperitoneal) for 5 consecutive days. HMB groups ingested HMB (320 mg·kg BW−1, oral gavage) for the same 5 days. HMB ingestion did not attenuate the effects of DEX on food intake and body weight loss, changes in masses of several organs, insulin resistance, and glucose intolerance (p > 0.05). In fact, in DexHmb rats, there was increased fasting glycemia and exacerbated glucose intolerance with the main effect attributed to DEX treatment (p < 0.05). HMB exerted no attenuating effect on plasma triacylglycerol levels from DexHmb rats, but it seems to attenuate the lipolysis induced by β-adrenergic stimulation (20 μmol·L−1isoproterenol) in fragments of retroperitoneal adipose tissue from DexHmb rats. Therefore, HMB does not attenuate the diabetogenic characteristics of GC excess. In fact, the data suggest that HMB may exacerbate GC-induced glucose intolerance.
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Affiliation(s)
- Everson A. Nunes
- Department of Physiological Sciences, Centre of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, Brazil
| | - Luiz M. Gonçalves-Neto
- Department of Physiological Sciences, Centre of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, Brazil
| | - Francielle B.D. Ferreira
- Department of Physiological Sciences, Centre of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, Brazil
| | - Cristiane dos Santos
- Department of Physiological Sciences, Centre of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, Brazil
| | - Luiz C. Fernandes
- Department of Physiological Sciences, Centre of Biological Sciences, Federal University of Paraná, Curitiba, Brazil
| | - Antonio C. Boschero
- Department of Functional and Structural Biology, Institute of Biology, State University of Campinas, Campinas, Brazil
| | - Philip C. Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Alex Rafacho
- Department of Physiological Sciences, Centre of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, Brazil
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Oti SO, van de Vijver SJM, Agyemang C, Kyobutungi C. The magnitude of diabetes and its association with obesity in the slums of Nairobi, Kenya: results from a cross-sectional survey. Trop Med Int Health 2013; 18:1520-30. [PMID: 24118454 DOI: 10.1111/tmi.12200] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the prevalence, awareness, treatment and control of diabetes and to examine the relationship of obesity with raised blood glucose in the slums of Nairobi, Kenya. METHODS We used data from a cross-sectional population-based survey, conducted in 2008-2009, involving a random sample of 5190 (2794 men and 2396 women) adults aged ≥18 years living in two slums - Korogocho and Viwandani - in Nairobi. RESULTS The prevalence (weighted by sampling and response rates) of diabetes was 4.8% (95%CI 4.0-5.7) in women and 4.0% (95%CI 3.3-4.7) in men. Less than a quarter of those found to have diabetes were aware of their condition among which just over half of men and three-quarters of women reported being on any treatment in the 12 months preceding the survey. Overall, fewer than 5% of all people with diabetes had their blood sugar under control. Obesity and overweight were significantly associated with increased odds (1.7, 95%CI 1.1-2.6) of raised blood glucose only among women while adjusting for important covariates. CONCLUSION The prevalence of diabetes in this impoverished population is moderately high, while the levels of awareness, treatment and control are quite low. In this population, obesity is an important risk factor for raised blood glucose particularly among women. Prevention and control strategies that target modifiable risk factors for diabetes and increase access to treatment and control in such disadvantaged settings are urgently needed.
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Affiliation(s)
- Samuel O Oti
- African Population and Health Research Center, Nairobi, Kenya; Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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