Relation between weight gain during pregnancy and postpartum reclassification in gestational diabetes

PURPOSE

Gestational diabetes mellitus (GDM) is the most common metabolic disease in pregnancy. It is known that GDM is a precursor to type 2 diabetes (T2D). There is evidence that excessive gestational weight variation (GWV) increases the risk of GDM. So, in this study, we aimed to evaluate the association between GWV and the persistence of diabetes in postpartum reclassification.

METHODS

A retrospective observational study including pregnant women based on data from the Portuguese National Registry of Gestational Diabetes. Six-to-eight weeks after delivery, all women included underwent a reclassification test. We performed unadjusted and adjusted logistic regression models to evaluate the associations between GWV and diabetes diagnosis at the reclassification test. A subgroup analysis according to the pre-gestational BMI was also performed.

RESULTS

We included 10,389 pregnant women, of which 19.6% had GDM in a previous pregnancy. The median of GWV was 10.0 [6.4, 14.0] kg and was found to be higher for those with a normal BMI. At the DM reclassification test, 1% of the women were diagnosed with T2D. We found a negative association between GWV and postpartum diabetes mellitus (DM). We also present a subgroup analysis, and these associations were only significant for the group with a normal pre-gestational BMI.

CONCLUSION

Our results showed that women with normal pre-gestational BMI and lower GWV were more likely to have a diagnosis of DM in the postpartum reclassification test. This study helps to fill the gap in the effect of GWG on the persistence of diabetes in postpartum reclassification.

Efficacy, Toxicity, and Prognostic Factors of Re-treatment With [177Lu]Lu-DOTA-TATE in Patients With Progressing Neuroendocrine Tumors: The Experience of a Single Center

PURPOSE

Peptide receptor radionuclide therapy (PRRT) is an effective and safe treatment of unresectable or metastatic, progressive neuroendocrine tumours (NETs). However, if progression occurs after the initial PRRT, treatment options remain limited. Our aim was to evaluate the efficacy and safety of a repeat 177Lutetium-[DOTA°,Tyr3]octreotate ([177Lu]Lu-DOTA-TATE) PRRT course in patients with progressive NET after the first [177Lu]Lu-DOTA-TATE PRRT (peptide receptor radionuclide therapy first treatment (PRRT1)).

METHODS

This is a nine-year retrospective observational study of 20 patients who were re-treated with PRRT (peptide receptor radionuclide therapy retreatment (PRRTR)) after PRRT1.

RESULTS

The median progression-free survival (PFS) following PRRT1 was 32 months (interquartile range (IQR): 16.5-44.5). After PRRT1, all 20 patients progressed. Of the 20 patients included, two were lost during follow-up. The median PFS after PRRTR was 17.5 months (IQR: 7-39). At the time of analysis, 15/18 patients progressed, and 3/18 had stable disease after PRRTR. Among those patients who progressed, the median time to progression was nine months (IQR: 0-17). The median overall survival from the time of the first cycle of PRRT1 was 66 months (IQR: 65-90). No significant renal or liver toxicity was reported, nor was there a drop in haemoglobin. The decrease in platelet count after PRRTR was statistically significant (p=0.03). Two cycles at PRRTR (vs. 1) were associated with a longer PFS (p=0.014) and the presence of metastases pre-PRRTR was associated with a shorter time to progression following PRRTR (p=0.04).  Conclusion: Patients who progressed after PRRT1 can achieve good PFS and minor toxicity. Our study reinforces the efficacy and safety of PRRTR and provides an analysis of factors associated with better outcomes, which can aid clinicians in clinical decision-making.

Glycemic Control and Metabolic Parameters in Children and Adolescents With Type 1 Diabetes

AIM

The association between glycemic control and metabolic status is poorly defined in children and adolescents with T1D, besides being biologically plausible. We aimed to evaluate the association between glycemic control and body mass index (BMI), blood pressure (BP), and lipid profile in children and adolescents with T1D.

METHODS

Observational cross-sectional study including children and adolescents (5-18 years old) followed in our outpatient clinic with the diagnosis of T1D for at least a year. We used linear regression models (unadjusted and adjusted to sex and age) to evaluate the association between glycated hemoglobin (A1c) and time in range (TIR), several prespecified metabolic parameters, and prespecified demographic and clinical characteristics. We considered a p-value of <0.05 to be statistically significant.

RESULTS

A total of 144 patients were included, 51% of whom were female. The population had a mean age of 12.7±3.4 years old. We report a positive association between A1c and BMI, systolic and diastolic BP, total- and LDL-cholesterol and triglycerides. Females and patients diagnosed at a younger age presented with higher A1c values. There is a tendency for a negative association between TIR and the former parameters. Higher A1c levels and lower TIR were associated with higher glycemic variability and were treated with a higher basal insulin per Kg dose.

CONCLUSION

Our results support an important association between worse glycemic control and an unhealthier metabolic profile in children and adolescents with T1D. We can hypothesize that a good glycemic profile is needed to achieve good metabolic control at a young age.

Total thyroidectomy in a patient awaiting heart transplant with amiodarone-induced thyrotoxicosis: A case report

Thyroid function may have a severe impact in cardiac function. Herein, we present the case report of a 53-year-old male patient awaiting heart transplant with amiodarone induced thyrotoxicosis that presented a marked improvement of his cardiac function after total thyroidectomy.

Quality of Life in Children Diagnosed With Non-classic Congenital Adrenal Hyperplasia

Background

Non-classical congenital adrenal hyperplasia (NC-CAH) is a chronic disease characterised by excessive androgen production that may negatively affect the quality of life (QoL) of affected patients. Pediatric Quality of Life Inventory 4.0 (PedsQL™) is a validated tool to assess health-related QoL (HRQoL).

Methods

A cross-sectional study including 19 patients with NC-CAH was carried out in the pediatric endocrinology department. NC-CAH patients who agreed to participate were included. Anthropometric data was collected. PedsQL™ was applied to the patients and their parents. Patients were divided into four groups according to age: 2-4, 5-7, 8-12, and 13-18 years old. The control group consisted of healthy individuals from the instrument's validation studies for the Portuguese population and the standard control population used in the PedsQL™ validation study.

Results

The only difference found concerns the parents' score results for children aged 8-12, which showed physical health and emotional dimension scores significantly higher (86.16±9.86 vs.68.90±23.02 p=0.004, 69.17±14.14 vs. 65.82±19.24 p=0.004), while psychosocial health's score and total scale score were significantly lower than the control group (59.99±9.90 vs. 69.34±14.07 p=0.047, 73.11±4.65 vs.78.86±16.61 p=0.017).

Conclusion

HRQoL scores are not negatively affected by NC-CAH in most group ages, with the exception of the parents' reports on HRQoL for children aged 8-12. Further studies with a greater number of patients are needed to determine the impact of this chronic disease on the HRQoL of children.

MON-584 Albuminuria and Obesity - Which Are the Associated Factors?

Introduction

The association between obesity and renal dysfunction has been widely studied. Albuminuria is a cardiovascular risk factor and the most prevalent marker of kidney injury in people with obesity. Despite the higher prevalence of hypertension and diabetes in those patients, other contributing factors are still unknown.

We aimed to explore the factors related to albuminuria in obesity, analyzing its variation after bariatric surgery.

Methods

We evaluated 2518 patients undergoing bariatric surgery, of those, 1243 with preoperative albuminuria measurement were included in this study. Albuminuria was determined by the albumin-creatinine ratio (RAC) in an occasional urine sample (mg/g) or by the 24-hour urine albumin excretion rate (TEA) (mg/24h). Means and medians were compared using Student’s T-test or Mann-Whitney tests, respectively. Spearman correlation was used.

Results Age (ρ = 0.073; p = 0.010), body mass index (BMI) (ρ = 0.139; p <0.001), waist circumference (WC) (ρ = 0.220; p <0.001), glycated hemoglobin (HbA1C) (ρ = 0.221; p <0.001), systolic blood pressure (SBP) (ρ = 0.203; p <0.001), diastolic blood pressure (DBP) (ρ = 0.134; p <0.001), uricemia (ρ = 0.141; p <0.001) and C-reactive protein (CRP) levels (ρ = 0.090; p = 0.017) were positively correlated with albuminuria.Patients with albuminuria (TEA / RAC≥30) had higher BMI (45.0 ± 6.0 vs.43.2 ± 5.6kg / m2; p <0.001), WC (129.3 ± 13.1 vs. 122.0 ± 12.9cm; p <0.001), SBP (142.7 ± 18.0 vs.134.1 ± 16.5mmHg; p <0.001), DBP (88.0 ± 12.6 vs.83, 2 ± 10.3mmHg; p <0.001), uricemia (6.1 ± 1.5 vs.5.4 ± 1.4mg / dL; p <0.001) and CRP (11.3 (16.4) vs.8, 3 (9.6) mg / L; p <0.001).Excluding patients with diabetes and hypertension, BMI and WC remained statistically positively correlated with urinary albumin excretion. After surgery, the decrease of albuminuria was correlated with the reduction of HbA1C (ρ = 0.144; p <0.001) and CRP (ρ = 0.113; p = 0.037).

Conclusion Anthropometric, inflammatory and metabolic factors, namely WC, CRP and uricemia, may be involved in the etiopathogenesis of albuminuria in obese patients. Bariatric surgery is the most effective method to reverse obesity and it has been shown to be a promising therapy on the treatment of associated renal dysfunction.

MON-587 Thyroid Hormones within the Normal Range and Cardiac Function in the General Population: The Epiporto Study

Introduction: Thyroid hormones have a central role in cardiovascular homeostasis. Both hypothyroidism and hyperthyroidism are associated with specific cardiovascular changes. However, the association of thyroid hormone levels within the normal range with cardiac function in general population remains largely unknown. Methods: 835 subjects with ≥45 years from EPIPorto population-based cohort study were analyzed. We excluded participants with TSH, FT4 or FT3 outside the reference range and participants with history of myocardial infarction, coronary revascularization, cardiac surgery, valvular heart disease, history of thyroid disease or treatment with drugs that interfere with thyroid function. All participants were submitted to detailed echocardiographic evaluation. The association of TSH, FT4 and FT3 with heart rate, blood pressure (BP), cardiac structure and cardiac function was evaluated with linear regression models unadjusted and adjusted for sex and age (model 1), and for sex, age, BMI, diabetes and hypertension (model 2). We assessed nonlinear associations using restricted cubic splines (3 knots). Results: The mean age of the population was 61.5±10.5 years, with 61.1% female participants. Eleven percent had diabetes, 47.8% dyslipidemia and 54.8% hypertension. Heart rate was positively associated with FT3 levels (model 2: β=1.78 [0.04 to 3.51], p=0.045). Diastolic BP was positively associated with TSH levels (model 2: β=1.50 [0.10 to 2.89], p=0.035). Regarding left ventricle (LV) structure, there was a nonlinear association of FT4 with posterior wall thickness, with lower thickness in the middle of the reference range. Both LV end-diastolic and end-systolic diameters were inversely associated with TSH (β=-3.62 (-5.89 to -1.35), p=0.002; and β=-2.03 (-3.31 to -0.77), p=0.002 in model 2). FT3 was nonlinearly associated with ejection fraction, with higher ejection fractions near the extremes of the normal range of FT3. Concerning diastolic function, FT3 was positively associated with E', and FT4 was negatively associated with E', although these associations were no longer significant in the adjusted models. Conclusions: Variations of thyroid function within the reference range are associated with heart rate, blood pressure, cardiac structure and cardiac function in the general population. Our results suggest that increasing thyroid function (lower TSH, higher FT4 or higher FT3) is associated with higher heart rate, lower diastolic BP and larger LV cavity volumes. On the other hand, both LV wall thickness and LV ejection fraction are non-linearly associated with thyroid hormones, with greater wall thickness and higher ejection fraction near the extremes of normal range of thyroid hormones concentration.