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Coughlan AK, Khan F, Brassill MJ. A Novel Genetic Variant Resulting in Familial Hypocalciuric Hypercalcaemia. Ir Med J 2022; 115:545. [PMID: 35420006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Presentation A 17-year-old male was referred to the endocrinology service with an incidental finding of hypercalcaemia. Over the course of the previous year his calcium ranged from 2.64-2.77mmol/L (reference range: 2.2-2.6mmol/L) in the setting of a normal/low parathyroid hormone (PTH) of 14-35pg/ml (reference range: 15-65pg/ml). Diagnosis Following biochemical confirmation of hypocalciuric hypercalcaemia he was referred for molecular genetic analysis which showed a heterozygous variant in the CASR gene previously undescribed in the literature: c.491A>G; p.GIn164Arg. Treatment The patient and his parents were reassured with regard to the benign nature of the condition and counselled with regard to its inheritance. Discussion Though there is little data on this genetic variant, it is assumed to have caused familial hypocalciuric hypercalcaemia (FHH) in this gentleman. FHH is an important differential in hypercalcaemia as it can be misdiagnosed as primary hyperparathyroidism, potentially leading to unnecessary surgical intervention.
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Affiliation(s)
- A K Coughlan
- Department of Endocrinology, Tipperary University Hospital, Clonmel, Co. Tipperary, Ireland
| | - F Khan
- Department of Endocrinology, Tipperary University Hospital, Clonmel, Co. Tipperary, Ireland
| | - M J Brassill
- Department of Endocrinology, Tipperary University Hospital, Clonmel, Co. Tipperary, Ireland
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McGettigan S, Mohamed AS, Pillay I, Brassill MJ. 58 EVALUATION OF DIABETES MELLITUS IN A COHORT OF FRAIL OLDER ADULTS. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
The aim of this study was to identify the prevalence of diabetes in a cohort of frail older adults who attended a model 3 hospital and explore the relationship between frailty and diabetes in this cohort. Prognosis and treatment of diabetes can vary greatly in the presence of frailty.
Methods
A multidisciplinary team provide liaison geriatric input to frail older adults in this hospital. Comprehensive geriatric assessments (CGAs) are carried out on patients identified using a VIP tool or via inpatient consults. These CGAs were reviewed regarding frailty scores, social/falls history, medications and diabetes complications including hypoglycaemia.
Results
CGAs were reviewed for 213 patients from September to November 2019. Fifty eight patients had a diagnosis of diabetes (27.2%), and all were type 2. The median age was 84. The average Clinical Frailty Scale score was 5.4 indicating mild to moderate frailty. Over two thirds of patients (n = 137) were on more than 5 medications. Seventy-six patients had a history of falls, and 24 (31.5%) of those had diabetes. Twenty-one patients were prescribed either sulphonylureas and/or insulin, and 7 of these were living alone. One patient had a sulphonylurea stopped on admission following CGA. Five patients had a documented history of hypoglycaemia, 2 of these patients were on insulin and 1 was on a sulphonylurea. The median HbA1c was 49 mmol/mol. Fifteen patients had diabetes complications, including 3 with retinopathy and 6 with neuropathy. The median duration of diabetes was 9.5 years. The majority of patients were managed at primary care level (n = 48, 82.75%).
Conclusion
The management of frail older adults with diabetes is complicated by multimorbidity and increased risk of adverse effects of treatment such as hypoglycaemia. Frailty assessment should be a routine component of a diabetes review for all older adults, and then glycaemic targets and medication choices should be adjusted accordingly.
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Affiliation(s)
- S McGettigan
- Tipperary University Hospital , Clonmel, Ireland
| | - A S Mohamed
- Tipperary University Hospital , Clonmel, Ireland
| | - I Pillay
- Tipperary University Hospital , Clonmel, Ireland
| | - M J Brassill
- Tipperary University Hospital , Clonmel, Ireland
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Mannion J, Nagle N, Wassell G, Brassill MJ. Lipid profile analyses of patients with and without type-2 diabetes in a cardiac rehabilitation population. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Type 2 diabetes mellitus (T2DM) can double your risk of coronary artery disease (CAD). SGLT2 inhibitors reduce all-cause mortality for patients with T2DM and CAD, targeting metabolic syndrome components like HbA1c, blood pressure and weight. Lipid profiles are intrinsically linked to obesity however the secondary effects of SGLT2 inhibitors remain unclear, with studies showing a rise in HDLc and LDLc with these medications.
Propose
To compare the effect of cardiac rehabilitation and guideline directed statin therapy on lipid panels of those with diabetes to those without, and to conduct a sub-analysis on SGLT2 inhibited patients to assess for increased HDLc and LDLc.
Methods
We retrospectively reviewed our cardiac rehab records. Data was collected on sequential patients over age 18 who completed cardiac rehab, until 90 diabetics and 90 non-diabetics were identified. Statistical analyses performed using SPSS v.26.
Results
Diabetics had significantly lower total cholesterol, HDL and LDL prior to commencing rehab (Table 1). Diabetics also showed less reduction in total cholesterol and LDL than non-diabetics. Groups had similar follow-up time and anti-lipid therapy. N = 12 (13.3%) diabetics were on SGLT2 inhibitors. This group showed the greatest mean increase of HDL and lowest mean decrease of LDL levels, however, did start with the lowest initial lipid levels.
Conclusions
Diabetics had lower LDL and HDL prior to rehab, which may have led to reduced change in their profiles compared to non-diabetics. Interestingly however, patients on SGLT2 inhibitors showed a trend towards least reduction in mean LDL and the greatest increase in mean HDL compared to other diabetics.
Table 1 Category(Lipids in mmol/L) Non-Diabetics, n = 90 (Mean ± SD) Diabetics, n = 90 (Mean ± SD) p-value SGLT2 cohort, n = 12 (Mean ± SD) Age (Years) 66.1 ± 8.73 67.73 ± 8.88 0.21 66.41 ± 7.8 Max. statin (%) 92.2% 90% 0.16 100% Pre-Total Chol. 4.21 ± 1.29 3.57 ± 0.9 <0.01* 3.36 ± 0.62 Pre-Triglyceride 1.6 ± 0.85 1.87 ± 1.02 0.054 1.63 ± 0.6 Pre-HDL 1.33 ± 0.48 1.12±.029 <0.001* 1.03 ± 0.22 Pre-LDL 2.14 ± 1.03 1.68 ± 0.93 0.002* 1.60 ± 0.57 Change- Total Chol. -0.75 ± 1.13 -0.26 ± 0.09 0.9 -0.09 ± 0.45 Change-HDL -0.01 ± 0.42 +0.03 ± 0.19 0.33 +0.19 ± 0.13 Change- LDL -0.61 ± 0.96 -0.28 ± 0.75 0.01* -0.24 ± 0.63 Lipids rechecked (months) 8.4 ± 0.25 7.9 ± 0.26 0.14 8.25 ± 2.26 Pre-intervention lipid profiles, followed by change in levels over time. *Denotes significance.
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Affiliation(s)
- J Mannion
- South Tipperary General Hospital, Cardiology Department, Clonmel, Ireland
| | - N Nagle
- South Tipperary General Hospital, Cardiology Department, Clonmel, Ireland
| | - G Wassell
- South Tipperary General Hospital, Cardiology Department, Clonmel, Ireland
| | - MJ Brassill
- South Tipperary General Hospital, Department of Endocrinology and Diabetes, Clonmel, Ireland
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Newman C, Egan AM, Ahern T, Al-Kiyumi M, Balan G, Brassill MJ, Brosnan E, Carmody L, Clarke H, Coogan Kelly C, Culliney L, Davern R, Durkan M, Fenlon M, Ferry P, Hanlon G, Higgins T, Hoashi S, Khamis A, Kinsley B, Kirwan B, Kyithar P, Liew A, Matthews L, McGurk C, McHugh C, Murphy MS, Murphy P, Nagodra D, Noctor E, Nolan M, O'Connor E, O'Halloran D, O'Mahoney L, O'Sullivan E, Peters M, Roberts G, Rooney H, Smyth A, Tarachand B, Todd M, Tuthill A, Wan Mahmood WA, Yousif O, Dunne FP. Diabetes care and pregnancy outcomes for women with pregestational diabetes in Ireland. Diabetes Res Clin Pract 2021; 173:108685. [PMID: 33548336 DOI: 10.1016/j.diabres.2021.108685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/16/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
AIMS Pre-gestational diabetes mellitus (PGDM) is associated with adverse outcomes. We aimed to examine pregnancies affected by PGDM; report on these pregnancy outcomes and compare outcomes for patients with type 1 versus type 2 diabetes mellitus; compare our findings to published Irish and United Kingdom (UK) data and identify potential areas for improvement. METHODS Between 2016 and 2018 information on 679 pregnancies from 415 women with type 1 Diabetes Mellitus and 244 women with type 2 diabetes was analysed. Data was collected on maternal characteristics; pregnancy preparation; glycaemic control; pregnancy related complications; foetal and maternal outcomes; unscheduled hospitalisations; congenital anomalies and perinatal deaths. RESULTS Only 15.9% of women were adequately prepared for pregnancy. Significant deficits were identified in availability and attendance at pre-pregnancy clinic, use of folic acid, attaining appropriate glycaemic targets and appropriate retinal screening. The majority of pregnancies (n = 567, 83.5%) resulted in a live birth but the large number of infants born large for gestational age (LGA) (n = 280, 49.4%), born prematurely <37 weeks and requiring neonatal intensive care unit (NICU) admission continue to be significant issues. CONCLUSIONS This retrospective cohort study identifies multiple targets for improvements in the provision of care to women with pre-gestational DM which are likely to translate into better pregnancy outcomes.
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Affiliation(s)
- C Newman
- Galway University Hospital, Galway, Ireland.
| | - A M Egan
- Division of Endocrinology Mayo Clinic, Rochester, United States
| | - T Ahern
- Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland
| | - M Al-Kiyumi
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - G Balan
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - M J Brassill
- South Tipperary General Hospital, Clonmel, Co Tipperary, Ireland
| | - E Brosnan
- Mayo University Hospital, Castlebar, Co Mayo, Ireland
| | - L Carmody
- Galway University Hospital, Galway, Ireland
| | - H Clarke
- Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | - C Coogan Kelly
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - L Culliney
- Cork University Hospital, Cork, Co Cork, Ireland
| | - R Davern
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - M Durkan
- Bons Secours Hospital, Cork, Co Cork, Ireland
| | - M Fenlon
- Wexford General Hospital, Co Wexford, Ireland
| | - P Ferry
- Letterkenny General Hospital, Letterkenny, Co Donegal, Ireland
| | - G Hanlon
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - T Higgins
- University Hospital Kerry, Tralee, Co Kerry, Ireland
| | - S Hoashi
- Mullingar Regional Hospital, Mullingar, Co Westmeath, Ireland
| | - A Khamis
- Letterkenny General Hospital, Letterkenny, Co Donegal, Ireland
| | - B Kinsley
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - B Kirwan
- Galway University Hospital, Galway, Ireland
| | - P Kyithar
- Portlaoise General Hospital, Portlaoise, Co Laois, Ireland
| | - A Liew
- Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | - L Matthews
- Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland
| | - C McGurk
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - C McHugh
- Sligo University Hospital, Co Sligo, Ireland
| | - M S Murphy
- South Infirmary Victoria Hospital, Cork, Co Cork, Ireland
| | - P Murphy
- Cork University Hospital, Cork, Co Cork, Ireland
| | - D Nagodra
- Portlaoise General Hospital, Portlaoise, Co Laois, Ireland
| | - E Noctor
- Limerick University Hospital, Co Limerick, Ireland
| | - M Nolan
- University Hospital Kerry, Tralee, Co Kerry, Ireland
| | - E O'Connor
- Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | - D O'Halloran
- Cork University Hospital, Cork, Co Cork, Ireland
| | - L O'Mahoney
- Cork University Hospital, Cork, Co Cork, Ireland
| | | | - M Peters
- University Hospital Waterford, Co Waterford, Ireland
| | - G Roberts
- University Hospital Waterford, Co Waterford, Ireland
| | - H Rooney
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - A Smyth
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - B Tarachand
- University Hospital Waterford, Co Waterford, Ireland
| | - M Todd
- Mayo University Hospital, Castlebar, Co Mayo, Ireland
| | - A Tuthill
- Cork University Hospital, Cork, Co Cork, Ireland
| | - W A Wan Mahmood
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - O Yousif
- Wexford General Hospital, Co Wexford, Ireland
| | - F P Dunne
- Galway University Hospital, Galway, Ireland
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Egan AM, Brassill MJ, Brosnan E, Carmody L, Clarke H, Coogan Kelly C, Culliney L, Durkan M, Fenlon M, Ferry P, Hanlon G, Higgins T, Hoashi S, Khamis A, Kinsley B, Kinsley T, Kirwan B, Liew A, McGurk C, McHugh C, Murphy MS, Murphy P, O'Halloran D, O'Mahony L, O'Sullivan E, Nolan M, Peter M, Roberts G, Smyth A, Todd M, Tuthill A, Wan Mahmood WA, Yousif O, P Dunne F. An Irish National Diabetes in Pregnancy Audit: aiming for best outcomes for women with diabetes. Diabet Med 2020; 37:2044-2049. [PMID: 30710451 DOI: 10.1111/dme.13923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2019] [Indexed: 12/16/2022]
Abstract
AIMS The purpose of this study was to identify the number of pregnancies affected by pre-gestational diabetes in the Republic of Ireland; to report on pregnancy outcomes and to identify areas for improvement in care delivery and clinical outcomes. METHODS Healthcare professionals caring for women with pre-gestational diabetes during pregnancy were invited to participate in this retrospective study. Data pertaining to 185 pregnancies in women attending 15 antenatal centres nationally were collected and analysed. Included pregnancies had an estimated date of delivery between 1 January and 31 December 2015. RESULTS The cohort consisted of 122 (65.9%) women with Type 1 diabetes and 56 (30.3%) women with Type 2 diabetes. The remaining 7 (3.8%) pregnancies were to women with maturity-onset diabetes of the young (MODY) (n = 6) and post-transplant diabetes (n = 1). Overall women were poorly prepared for pregnancy and lapses in specific areas of service delivery including pre-pregnancy care and retinal screening were identified. The majority of pregnancies 156 (84.3%) resulted in a live birth. A total of 103 (65.5%) women had a caesarean delivery and 58 (36.9%) infants were large for gestational age. CONCLUSIONS This audit identifies clear areas for improvement in delivery of care for women with diabetes in the Republic of Ireland before and during pregnancy.
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Affiliation(s)
- A M Egan
- University Hospital Galway, Galway, Republic of Ireland
| | - M J Brassill
- South Tipperary General Hospital, Clonmel, Republic of Ireland
| | - E Brosnan
- Mayo University Hospital, Castlebar, Republic of Ireland
| | - L Carmody
- University Hospital Galway, Galway, Republic of Ireland
| | - H Clarke
- Portiuncla University Hospital, Ballinasloe, Republic of Ireland
| | - C Coogan Kelly
- St Luke's General Hospital, Kilkenny, Republic of Ireland
| | - L Culliney
- Cork University Hospital, Cork, Republic of Ireland
| | - M Durkan
- Bon Secours Hospital, Cork, Republic of Ireland
| | - M Fenlon
- Wexford General Hospital, Wexford, Republic of Ireland
| | - P Ferry
- Letterkenny University Hospital, Letterkenny, Republic of Ireland
| | - G Hanlon
- St Luke's General Hospital, Kilkenny, Republic of Ireland
| | - T Higgins
- University Hospital Kerry, Tralee, Republic of Ireland
| | - S Hoashi
- Midland Regional Hospital, Mullingar, Republic of Ireland
| | - A Khamis
- Letterkenny University Hospital, Letterkenny, Republic of Ireland
| | - B Kinsley
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - T Kinsley
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - B Kirwan
- University Hospital Galway, Galway, Republic of Ireland
| | - A Liew
- Portiuncla University Hospital, Ballinasloe, Republic of Ireland
| | - C McGurk
- St Luke's General Hospital, Kilkenny, Republic of Ireland
| | - C McHugh
- Sligo University Hospital, Sligo, Republic of Ireland
| | - M S Murphy
- South Infirmary Victoria University Hospital, Cork, Republic of Ireland
| | - P Murphy
- Cork University Hospital, Cork, Republic of Ireland
| | - D O'Halloran
- Cork University Hospital, Cork, Republic of Ireland
| | - L O'Mahony
- Cork University Hospital, Cork, Republic of Ireland
| | | | - M Nolan
- University Hospital Kerry, Tralee, Republic of Ireland
| | - M Peter
- University Hospital Waterford, Waterford, Republic of Ireland
| | - G Roberts
- University Hospital Waterford, Waterford, Republic of Ireland
| | - A Smyth
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - M Todd
- Mayo University Hospital, Castlebar, Republic of Ireland
| | - A Tuthill
- Cork University Hospital, Cork, Republic of Ireland
| | - W A Wan Mahmood
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - O Yousif
- Wexford General Hospital, Wexford, Republic of Ireland
| | - F P Dunne
- University Hospital Galway, Galway, Republic of Ireland
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