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Hare MJL, Maple-Brown LJ, Shaw JE, Boyle JA, Lawton PD, Barr ELM, Guthridge S, Webster V, Hampton D, Singh G, Dyck RF, Barzi F. Risk of kidney disease following a pregnancy complicated by diabetes: a longitudinal, population-based data-linkage study among Aboriginal women in the Northern Territory, Australia. Diabetologia 2023; 66:837-846. [PMID: 36651940 PMCID: PMC10036460 DOI: 10.1007/s00125-023-05868-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/12/2022] [Indexed: 01/19/2023]
Abstract
AIMS/HYPOTHESIS The aim of this work was to investigate the risk of developing chronic kidney disease (CKD) or end-stage kidney disease (ESKD) following a pregnancy complicated by gestational diabetes mellitus (GDM) or pre-existing diabetes among Aboriginal women in the Northern Territory (NT), Australia. METHODS We undertook a longitudinal study of linked healthcare datasets. All Aboriginal women who gave birth between 2000 and 2016 were eligible for inclusion. Diabetes status in the index pregnancy was as recorded in the NT Perinatal Data Collection. Outcomes included any stage of CKD and ESKD as defined by ICD-10 coding in the NT Hospital Inpatient Activity dataset between 2000 and 2018. Risk was compared using Cox proportional hazards regression. RESULTS Among 10,508 Aboriginal women, the mean age was 23.1 (SD 6.1) years; 731 (7.0%) had GDM and 239 (2.3%) had pre-existing diabetes in pregnancy. Median follow-up was 12.1 years. Compared with women with no diabetes during pregnancy, women with GDM had increased risk of CKD (9.2% vs 2.2%, adjusted HR 5.2 [95% CI 3.9, 7.1]) and ESKD (2.4% vs 0.4%, adjusted HR 10.8 [95% CI 5.6, 20.8]). Among women with pre-existing diabetes in pregnancy, 29.1% developed CKD (adjusted HR 10.9 [95% CI 7.7, 15.4]) and 9.9% developed ESKD (adjusted HR 28.0 [95% CI 13.4, 58.6]). CONCLUSIONS/INTERPRETATION Aboriginal women in the NT with GDM or pre-existing diabetes during pregnancy are at high risk of developing CKD and ESKD. Pregnancy presents an important opportunity to identify kidney disease risk. Strategies to prevent kidney disease and address the social determinants of health are needed.
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Affiliation(s)
- Matthew J L Hare
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
- Endocrinology Department, Royal Darwin Hospital, Darwin, NT, Australia.
| | - Louise J Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Endocrinology Department, Royal Darwin Hospital, Darwin, NT, Australia
| | - Jonathan E Shaw
- Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jacqueline A Boyle
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Paul D Lawton
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Department of Renal Medicine, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Elizabeth L M Barr
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Steven Guthridge
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Vanya Webster
- Aboriginal and Torres Strait Islander Advisory Group, Diabetes across the Lifecourse: Northern Australia Partnership, Menzies School of Health Research, Darwin, NT, Australia
| | - Denella Hampton
- Aboriginal and Torres Strait Islander Advisory Group, Diabetes across the Lifecourse: Northern Australia Partnership, Menzies School of Health Research, Darwin, NT, Australia
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
| | - Gurmeet Singh
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Roland F Dyck
- Department of Medicine and Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | - Federica Barzi
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- UQ Poche Centre for Indigenous Health, University of Queensland, Brisbane, QLD, Australia
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Stapleton C, Watkins E, Hare MJL, Timms F, Wood AJ, Titmuss A. The prevalence of diabetes distress and its association with glycaemia in young people living with insulin-requiring-diabetes in a regional centre in Australia. J Paediatr Child Health 2022; 58:2273-2279. [PMID: 36206303 PMCID: PMC10092535 DOI: 10.1111/jpc.16221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 01/09/2023]
Abstract
AIM Emotional responses, such as feeling overwhelmed with diabetes-related treatment, burnt-out and anxiety, are known as 'diabetes distress'. This study aimed to determine diabetes distress among children, adolescents and parents/carers managing insulin-requiring diabetes in a regional Australian setting, and to assess association with glycaemia. METHODS All children, adolescents and their parents/carers attending a regional hospital outpatient diabetes clinic between March 2018 and June 2019 were invited to complete a validated child, adolescent or parent/carer diabetes distress questionnaire. Demographics and time-matched clinical data were obtained from hospital records. A cross-sectional analysis was performed. RESULTS A total of 43 young people and 30 parents/carers completed a diabetes distress questionnaire during the study period. Diabetes distress was common, with 63% of young people and 67% of parents/carers nominating at least one serious concern. After adjustment for potential confounding factors, higher glycaemia (HbA1c %) was associated with higher distress scores among both young people (ß 6.2, 95% confidence interval (CI): 3.2-9.2, P < 0.001) and carers/parents (ß 5.6, 95% CI:1.5-9.8, P < 0.001). Diabetes distress did not differ by child age, duration of diagnosis or mode of insulin administration. For children, adolescents and carers, 'serious concerns' most commonly related to the impact of diabetes upon family and peer relationships. CONCLUSIONS Diabetes distress was common and associated with sub-optimal glycaemia. Routine screening for diabetes distress should be considered in paediatric services. Development of strategies to minimise diabetes distress for youth and families is required.
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Affiliation(s)
- Ciara Stapleton
- Paediatric Department, Division of Women, Children and Youth, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Elizabeth Watkins
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Matthew J L Hare
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Francesca Timms
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Anna J Wood
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Angela Titmuss
- Paediatric Department, Division of Women, Children and Youth, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Hare MJL, Zhao Y, Guthridge S, Burgess P, Barr ELM, Ellis E, Butler D, Rosser A, Falhammar H, Maple-Brown LJ. Prevalence and incidence of diabetes among Aboriginal people in remote communities of the Northern Territory, Australia: a retrospective, longitudinal data-linkage study. BMJ Open 2022; 12:e059716. [PMID: 35569825 PMCID: PMC9125760 DOI: 10.1136/bmjopen-2021-059716] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the prevalence and incidence of diabetes among Aboriginal peoples in remote communities of the Northern Territory (NT), Australia. DESIGN Retrospective cohort analysis of linked clinical and administrative data sets from 1 July 2012 to 30 June 2019. SETTING Remote health centres using the NT Government Primary Care Information System (51 out of a total of 84 remote health centres in the NT). PARTICIPANTS All Aboriginal clients residing in remote communities serviced by these health centres (N=21 267). PRIMARY OUTCOME MEASURES Diabetes diagnoses were established using hospital and primary care coding, biochemistry and prescription data. RESULTS Diabetes prevalence across all ages increased from 14.4% (95% CI: 13.9% to 14.9%) to 17.0% (95% CI: 16.5% to 17.5%) over 7 years. Among adults (≥20 years), the 2018/2019 diabetes prevalence was 28.6% (95% CI: 27.8% to 29.4%), being higher in Central Australia (39.5%, 95% CI: 37.8% to 41.1%) compared with the Top End region (24.2%, 95% CI: 23.3% to 25.1%, p<0.001). Between 2016/2017 and 2018/2019, diabetes incidence across all ages was 7.9 per 1000 person-years (95% CI: 7.3 to 8.7 per 1000 person-years). The adult incidence of diabetes was 12.6 per 1000 person-years (95% CI: 11.5 to 13.8 per 1000 person-years). CONCLUSIONS The burden of diabetes in the remote Aboriginal population of the NT is among the highest in the world. Strengthened systems of care and public health prevention strategies, developed in partnership with Aboriginal communities, are needed.
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Affiliation(s)
- Matthew J L Hare
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Yuejen Zhao
- Population and Digital Health, NT Health, Darwin, Northern Territory, Australia
| | - Steven Guthridge
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Paul Burgess
- Population and Digital Health, NT Health, Darwin, Northern Territory, Australia
- Primary Health Care Division, Top End Region, NT Health, Darwin, Northern Territory, Australia
| | - Elizabeth L M Barr
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Elna Ellis
- Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Deborah Butler
- Sector and System Leadership Division, NT Health, Darwin, Northern Territory, Australia
| | - Amy Rosser
- Primary Health Care Division, Central Australia Region, NT Health, Alice Springs, Northern Territory, Australia
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Louise J Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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4
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Wood AJ, Boyle JA, Barr ELM, Barzi F, Hare MJL, Titmuss A, Longmore DK, Death E, Kelaart J, Kirkwood M, Graham S, Connors C, Moore E, O'Dea K, Oats JJN, McIntyre HD, Zimmet PZ, Lu ZX, Brown A, Shaw JE, Maple-Brown LJ. Type 2 diabetes after a pregnancy with gestational diabetes among first nations women in Australia: The PANDORA study. Diabetes Res Clin Pract 2021; 181:109092. [PMID: 34653565 DOI: 10.1016/j.diabres.2021.109092] [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: 05/11/2021] [Revised: 07/22/2021] [Accepted: 09/29/2021] [Indexed: 11/20/2022]
Abstract
AIMS To determine among First Nations and Europid pregnant women the cumulative incidence and predictors of postpartum type 2 diabetes and prediabetes and describe postpartum cardiovascular disease (CVD) risk profiles. METHODS PANDORA is a prospective longitudinal cohort of women recruited in pregnancy. Ethnic-specific rates of postpartum type 2 diabetes and prediabetes were reported for women with diabetes in pregnancy (DIP), gestational diabetes (GDM) or normoglycaemia in pregnancy over a short follow-up of 2.5 years (n = 325). Pregnancy characteristics and CVD risk profiles according to glycaemic status, and factors associated with postpartum diabetes/prediabetes were examined in First Nations women. RESULTS The cumulative incidence of postpartum type 2 diabetes among women with DIP or GDM were higher for First Nations women (48%, 13/27, women with DIP, 13%, 11/82, GDM), compared to Europid women (nil DIP or GDM p < 0.001). Characteristics associated with type 2 diabetes/prediabetes among First Nations women with GDM/DIP included, older age, multiparity, family history of diabetes, higher glucose values, insulin use and body mass index (BMI). CONCLUSIONS First Nations women experience a high incidence of postpartum type 2 diabetes after GDM/DIP, highlighting the need for culturally responsive policies at an individual and systems level, to prevent diabetes and its complications.
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Affiliation(s)
- Anna J Wood
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; Department of Endocrinology, Royal Darwin Hospital, 58 Rocklands Drive, Tiwi, NT 0810, Australia.
| | - Jacqueline A Boyle
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, Vic 3168, Australia
| | - Elizabeth L M Barr
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; Baker Heart and Diabetes Institute, 75 Commercial Road, Vic 3004, Australia
| | - Federica Barzi
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; UQ Poche Centre for Indigenous Health, The University of Queensland, 31 Upland Road, St Lucia, QLD 4067, Australia
| | - Matthew J L Hare
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; Department of Endocrinology, Royal Darwin Hospital, 58 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Angela Titmuss
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; Department of Paediatrics, Division of Women, Children and Youth, Royal Darwin Hospital, 58 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Danielle K Longmore
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Elizabeth Death
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Joanna Kelaart
- Baker Heart and Diabetes Institute, 75 Commercial Road, Vic 3004, Australia
| | - Marie Kirkwood
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Sian Graham
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Christine Connors
- Top End Health Service, Northern Territory Department of Health, P.O. Box 41326, Casuarina, NT 0811, Australia
| | - Elizabeth Moore
- Aboriginal Medical Services Alliance Northern Territory, 43 Mitchell Street, Darwin City, NT 0800, Australia
| | - Kerin O'Dea
- University of South Australia, 101 Currie Street, SA 5001, Australia
| | - Jeremy J N Oats
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Vic 3053, Australia
| | - Harold D McIntyre
- Mater Research, The University of Queensland, Raymond Terrace, South Brisbane, QLD 4101, Australia
| | - Paul Z Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Wellington Road, Clayton, Vic 3800, Australia
| | - Zhong X Lu
- Monash Health Pathology, Monash Health, Clayton Road, Clayton, Vic 3168, Australia; Department of Medicine, Monash University, Wellington Road, Clayton, Vic 3800, Australia
| | - Alex Brown
- University of Adelaide, SA 5005, Australia; South Australian Health and Medical Research Institute, North Terrace, SA 5000, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, 75 Commercial Road, Vic 3004, Australia
| | - Louise J Maple-Brown
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; Department of Endocrinology, Royal Darwin Hospital, 58 Rocklands Drive, Tiwi, NT 0810, Australia
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5
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Hare MJL, Deitch JM, Kang MJY, Bach LA. Clinical, psychological and demographic factors in a contemporary adult cohort with diabetic ketoacidosis and type 1 diabetes. Intern Med J 2021; 51:1292-1297. [PMID: 32358796 DOI: 10.1111/imj.14877] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/12/2020] [Accepted: 04/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is a potentially life-threatening but often preventable acute complication of type 1 diabetes (T1D). Understanding clinical and psychosocial characteristics of people with DKA, particularly those with multiple presentations, may aid the development of prevention strategies. AIMS To describe clinical, psychological and demographic factors in adults with DKA and particularly those factors associated with recurrent admissions. METHODS A retrospective analysis was performed of all admissions with DKA in people with T1D over a 4-year period from 1 November 2013 to 31 October 2017 at a metropolitan tertiary hospital in Australia. Potential cases were identified by International Classification of Diseases-10th Revision coding data. Data were then manually extracted by clinicians from the electronic medical record. RESULTS There were 154 clinician-adjudicated admissions for DKA among 128 people with T1D. Of these, 16 (13%) had multiple DKA admissions. Forty-one (32%) had a history of depression. The most common factors contributing to presentation included insulin omission (54%), infection (31%), alcohol excess (26%) and new diabetes diagnosis (16%). Compared to people with single admissions, those with recurrent DKA were more likely to smoke (69% vs 27%, P = 0.003), be unemployed (31% vs 11%, P = 0.04) and use illicit substances (44% vs 17%, P = 0.02). CONCLUSIONS There is a high prevalence of psychiatric illness, illicit substance use and social disadvantage among people admitted with DKA, particularly those with recurrent presentations. Insulin omission, often due to inappropriate sick day management, was the most common reason for DKA occurrence. Innovative multidisciplinary models of care are required to address these challenges.
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Affiliation(s)
- Matthew J L Hare
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia.,Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,Endocrinology Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Jessica M Deitch
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
| | - Matthew J Y Kang
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia.,Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia
| | - Leon A Bach
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine (Alfred), Monash University, Melbourne, Victoria, Australia
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New RH, Hare MJL, MacKay D, Kasireddy V, Ellis E, Thomas ME, Chitturi S. Profound Hypocalcemia Following Thyroidectomy for Graves’ Disease. J Endocr Soc 2021. [DOI: 10.1210/jendso/bvab048.437] [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: 11/19/2022] Open
Abstract
Abstract
Introduction: While transient parathyroid insufficiency is not an uncommon complication of thyroidectomy, severe and prolonged hypocalcemia attributed to a combination of post-surgical hypoparathyroidism, hungry bone syndrome (HBS) and hypovitaminosis D is unusual.
Clinical Case: A 17-year-old female from a remote community in Australia with Graves’ disease, complicated by exophthalmos and atrial flutter, underwent total thyroidectomy due to challenges with medication adherence leading to persistent thyrotoxicosis. FT4 was >150 pmol/L (normal 10–20 pmol/L) almost two years after diagnosis. Pre-operatively, she received Lugol’s iodine, carbimazole and beta-blockade. The operation was uncomplicated and three parathyroid glands were preserved. Within six hours of thyroidectomy, she developed symptomatic hypocalcemia with corrected calcium 1.9 mmol/L (7.6 mg/dL) (normal 2.2–2.65 mmol/L). PTH level was 0.8 pmol/L (normal 1.4–9.0 pmol/L). Magnesium and phosphate levels were initially normal but hyperphosphatemia developed the following day. 25-OH vitamin D was low (29 nmol/L, normal 50–150 nmol/L) and was corrected with high dose cholecalciferol.
Despite use of continuous intravenous calcium gluconate in addition to oral calcium carbonate, as well as both intravenous and oral calcitriol and magnesium, urinary calcium excretion remained undetectable. Teriparatide 20 mcg BD was commenced on post-operative day 14 with no demonstrable improvement in serum calcium. Less than 48 hours after cessation of parenteral calcium on day 18 post-operation, corrected calcium and ionised calcium declined to 1.47 mmol/L (5.9 mg/dL) and 0.46 mmol/L (normal 1.15–1.33 mmol/L) respectively, prompting recommencement of calcium infusion.
Her remarkably high requirement for calcium replacement with negligible urinary calcium excretion for at least one month in spite of parenteral calcium infusion for a total of three weeks’ duration is highly suggestive of HBS which became evident due to post-surgical hypoparathyroidism. She had elevated ALP (618 U/L, normal 35–140 U/L) and increased bone resorption marker (N-telopeptide/creatinine 262 nmol BCE/mmol, normal <100 nmol BCE/mmol), with osteopenia at lumbar spine (Z-score -1.7) and femur (Z-score -1.3). Additionally, vitamin D deficiency is likely to have contributed to the severity of hypocalcemia.
60 days after surgery, she was still requiring calcium carbonate 2500 mg QID (4 g/day elemental calcium) and calcitriol 1 mcg TDS. Her phosphate level had normalised and ALP gradually declined to 241 U/L.
Clinical Lesson: This case highlights the importance of attaining euthyroid status as early as possible pre-operatively to allow near-complete reversal of thyrotoxicosis-induced osteodystrophy, as indicated by normalisation of serum ALP, and ensuring vitamin D levels are replete prior to thyroidectomy for Graves’ disease.
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Affiliation(s)
- Ru H New
- Department of Endocrinology, Royal Darwin Hospital, Northern Territory, Australia
| | - Matthew J L Hare
- Department of Endocrinology, Royal Darwin Hospital, Northern Territory, Australia
| | - Diana MacKay
- Department of Endocrinology, Royal Darwin Hospital, Northern Territory, Australia
| | - Vidya Kasireddy
- Department of Endocrinology, Royal Darwin Hospital, Northern Territory, Australia
| | - Elna Ellis
- Department of Endocrinology, Alice Springs Hospital, Northern Territory, Australia
| | - Mahiban E Thomas
- Department of Maxillofacial Surgery, Royal Darwin Hospital, Northern Territory, Australia
| | - Sridhar Chitturi
- Department of Endocrinology, Royal Darwin Hospital, Northern Territory, Australia
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Hare MJL, Barzi F, Boyle JA, Guthridge S, Dyck RF, Barr ELM, Singh G, Falhammar H, Webster V, Shaw JE, Maple-Brown LJ. Diabetes during pregnancy and birthweight trends among Aboriginal and non-Aboriginal people in the Northern Territory of Australia over 30 years. Lancet Reg Health West Pac 2020; 1:100005. [PMID: 34327339 PMCID: PMC8315488 DOI: 10.1016/j.lanwpc.2020.100005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/15/2020] [Accepted: 06/29/2020] [Indexed: 10/27/2022]
Abstract
Background Early-life risk factors, including maternal hyperglycaemia and birthweight, are thought to contribute to the high burden of cardiometabolic disease experienced by Indigenous populations. We examined rates of pre-existing diabetes in pregnancy, gestational diabetes mellitus (GDM) and extremes of birthweight over three decades in the Northern Territory (NT) of Australia. Methods We performed a retrospective cohort analysis of the NT Perinatal Data Collection from 1987 to 2016, including all births >20 weeks gestation, stratified by maternal Aboriginal identification. Key outcomes were annual rates of pre-existing diabetes, GDM, small-for-gestational-age, large-for-gestational-age, low birthweight (<2500 g), and high birthweight (>4000 g). Logistic regression was used to assess trends and interactions. Findings 109 349 babies were born to 64 877 mothers, 36% of whom identified as Aboriginal ethnicity. Among Aboriginal women, rates of GDM and pre-existing diabetes, respectively, were 3 · 4% and 0 · 6% in 1987 and rose to 13% and 5 · 7% in 2016 (both trends p<0 · 001). Among non-Aboriginal women, rates of GDM increased from 1 · 9% in 1987 to 11% in 2016 (p<0 · 001), while pre-existing diabetes was uncommon (≤0 · 7% throughout). Rates of small-for-gestational-age decreased, while rates of large-for-gestational-age and high birthweight increased in both groups (all trends p<0 · 001). Multivariable modelling suggests that hyperglycaemia was largely responsible for the growing rate of large-for-gestational-age births among Aboriginal women. Interpretation The burden of hyperglycaemia in pregnancy has grown substantially in the NT over three decades and is impacting birthweight trends. The prevalence of pre-gestational diabetes in Aboriginal women is among the highest in the world. Funding Diabetes Australia Research Program.
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Affiliation(s)
- Matthew J L Hare
- Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Federica Barzi
- Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Steven Guthridge
- Centre for Child Development and Education, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Roland F Dyck
- Department of Medicine, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
| | - Elizabeth L M Barr
- Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Gurmeet Singh
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Henrik Falhammar
- Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Vanya Webster
- Indigenous Reference Group, Diabetes across the Lifecourse: Northern Australia Partnership, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Jonathan E Shaw
- Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Louise J Maple-Brown
- Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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8
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Strelitz J, Ahern AL, Long GH, Hare MJL, Irving G, Boothby CE, Wareham NJ, Griffin SJ. Moderate weight change following diabetes diagnosis and 10 year incidence of cardiovascular disease and mortality. Diabetologia 2019; 62:1391-1402. [PMID: 31062041 PMCID: PMC6647260 DOI: 10.1007/s00125-019-4886-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/26/2019] [Indexed: 12/14/2022]
Abstract
AIMS/HYPOTHESIS Adults with type 2 diabetes are at high risk of developing cardiovascular disease (CVD). Evidence of the impact of weight loss on incidence of CVD events among adults with diabetes is sparse and conflicting. We assessed weight change in the year following diabetes diagnosis and estimated associations with 10 year incidence of CVD events and all-cause mortality. METHODS In a cohort analysis among 725 adults with screen-detected diabetes enrolled in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION)-Cambridge trial, we estimated HRs for weight change in the year following diabetes diagnosis and 10 year incidence of CVD (n = 99) and all-cause mortality (n = 95) using Cox proportional hazards regression. We used linear regression to estimate associations between weight loss and CVD risk factors. Models were adjusted for age, sex, baseline BMI, smoking, occupational socioeconomic status, cardio-protective medication use and treatment group. RESULTS Loss of ≥5% body weight in the year following diabetes diagnosis was associated with improvements in HbA1c and blood lipids and a lower hazard of CVD at 10 years compared with maintaining weight (HR 0.52 [95% CI 0.32, 0.86]). The associations between weight gain vs weight maintenance and CVD (HR 0.41 [95% CI 0.15, 1.11]) and mortality (HR 1.63 [95% CI 0.83, 3.19]) were less clear. CONCLUSIONS/INTERPRETATION Among adults with screen-detected diabetes, loss of ≥5% body weight during the year after diagnosis was associated with a lower hazard of CVD events compared with maintaining weight. These results support the hypothesis that moderate weight loss may yield substantial long-term CVD reduction, and may be an achievable target outside of specialist-led behavioural treatment programmes.
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Affiliation(s)
- Jean Strelitz
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Box 285, Cambridge, CB2 0QQ, UK.
| | - Amy L Ahern
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Box 285, Cambridge, CB2 0QQ, UK
| | | | - Matthew J L Hare
- Departments of Endocrinology, Diabetes and Vascular Medicine, Monash Health, Melbourne, VIC, Australia
| | - Greg Irving
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Clare E Boothby
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Box 285, Cambridge, CB2 0QQ, UK
| | - Nicholas J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Box 285, Cambridge, CB2 0QQ, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Box 285, Cambridge, CB2 0QQ, UK
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Hamblin PS, Wong R, Ekinci EI, Fourlanos S, Shah S, Jones AR, Hare MJL, Calder GL, Epa DS, George EM, Giri R, Kotowicz MA, Kyi M, Lafontaine N, MacIsaac RJ, Nolan BJ, O'Neal DN, Renouf D, Varadarajan S, Wong J, Xu S, Bach LA. SGLT2 Inhibitors Increase the Risk of Diabetic Ketoacidosis Developing in the Community and During Hospital Admission. J Clin Endocrinol Metab 2019; 104:3077-3087. [PMID: 30835263 DOI: 10.1210/jc.2019-00139] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [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] [Received: 01/18/2019] [Accepted: 02/27/2019] [Indexed: 12/16/2022]
Abstract
CONTEXT Diabetic ketoacidosis (DKA) has been associated with the use of sodium glucose cotransporter 2 inhibitors (SGLT2is). OBJECTIVE To determine the incidence, characteristics, and outcomes of DKA in SGLT2i users vs nonusers with type 2 diabetes. DESIGN Retrospective, multicenter, controlled cohort study. SETTING All public hospitals in Melbourne and Geelong (combined population of 5 million), Australia, from 1 September 2015 to 31 October 2017. PATIENTS Consecutive cases of DKA that developed in the community, or during the course of hospital admission, in patients with type 2 diabetes. MAIN OUTCOME MEASURES In SGLT2i users vs nonusers: (i) OR of DKA developing during hospital admission, and (ii) incidence of DKA. RESULTS There were 162 cases of DKA (37 SGLT2i users and 125 non-SGLT2i users) with a physician-adjudicated diagnosis of type 2 diabetes. Of these, DKA developed during the course of inpatient admission in 14 (38%) SGLT2i users vs 2 (2%) non-SGLT2i users (OR, 37.4; 95% CI, 8.0 to 175.9; P < 0.0001). The incidence of DKA was 1.02 per 1000 (95% CI, 0.74 to 1.41 per 1000) in SGLT2i users vs 0.69 per 1000 (95% CI, 0.58 to 0.82 per 1000) in non-SGLT2i users (OR, 1.48; 95% CI, 1.02 to 2.15; P = 0.037). Fifteen SGLT2i users (41%) had peak blood glucose <250 mg/dL (14 mmol/L) compared with one (0.8%) non-SGLT2i user (P < 0.001). CONCLUSIONS SGLT2i users were more likely to develop DKA as an inpatient compared with non-SGLT2i users. SGLT2i use was associated with a small but significant increased risk of DKA.
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Affiliation(s)
- Peter S Hamblin
- Department of Endocrinology and Diabetes, Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Western Precinct, University of Melbourne, St Albans, Victoria, Australia
| | - Rosemary Wong
- Department of Endocrinology and Diabetes, Eastern Health, Box Hill, Victoria, Australia
| | - Elif I Ekinci
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Australia
| | - Spiros Fourlanos
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Sonali Shah
- Department of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia
| | - Alicia R Jones
- Department of Endocrinology and Diabetes, Western Health, St. Albans, Victoria, Australia
| | - Matthew J L Hare
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
| | - Genevieve L Calder
- Department of Diabetes and Endocrinology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Dilan Seneviratne Epa
- Department of Diabetes and Endocrinology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Elizabeth M George
- Department of Endocrinology and Diabetes, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Rinky Giri
- Werribee Mercy Hospital, Werribee, Victoria, Australia
- Diabetes Technology Research Group, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Mark A Kotowicz
- Department of Endocrinology and Diabetes, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
- School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Mervyn Kyi
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Nicole Lafontaine
- Department of Endocrinology and Diabetes, Eastern Health, Box Hill, Victoria, Australia
| | - Richard J MacIsaac
- Department of Diabetes and Endocrinology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Fitzroy, Victoria, Australia
| | - Brendan J Nolan
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
- Department of Endocrinology and Diabetes, Northern Health, Epping, Victoria, Australia
| | - David N O'Neal
- Werribee Mercy Hospital, Werribee, Victoria, Australia
- Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Fitzroy, Victoria, Australia
| | - Debra Renouf
- Department of Endocrinology and Diabetes, Peninsula Health, Frankston, Victoria, Australia
- Peninsula Clinical School, Monash University, Frankston, Victoria, Australia
| | - Suresh Varadarajan
- Department of Endocrinology and Diabetes, Northern Health, Epping, Victoria, Australia
| | - Jennifer Wong
- Department of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia
| | - Sylvia Xu
- Department of Endocrinology and Diabetes, Peninsula Health, Frankston, Victoria, Australia
| | - Leon A Bach
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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10
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Lee PC, Hare MJL, Bach LA. Making sense of newer treatment options for type 2 diabetes. Intern Med J 2018; 48:762-769. [DOI: 10.1111/imj.13947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/23/2017] [Accepted: 12/18/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Phong Ching Lee
- Department of Endocrinology and Diabetes; Alfred Hospital; Melbourne Victoria Australia
- Obesity and Metabolism Unit, Department of Endocrinology; Singapore General Hospital; Singapore
| | - Matthew J. L. Hare
- Department of Endocrinology and Diabetes; Alfred Hospital; Melbourne Victoria Australia
| | - Leon A. Bach
- Department of Endocrinology and Diabetes; Alfred Hospital; Melbourne Victoria Australia
- Department of Medicine (Alfred); Monash University; Melbourne Victoria Australia
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11
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Qian SY, Hare MJL, Pham A, Topliss DJ. Insulinoma presenting with post-prandial hypoglycaemia following fundoplication. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM-17-0131. [PMID: 29367876 PMCID: PMC5777165 DOI: 10.1530/edm-17-0131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 12/18/2017] [Indexed: 11/08/2022] Open
Abstract
Insulinomas are rare neuroendocrine tumours that classically present with fasting hypoglycaemia. This case report discusses an uncommon and challenging case of insulinoma soon after upper gastrointestinal surgery. A 63-year-old man presented with 6 months of post-prandial hypoglycaemia beginning after a laparoscopic revision of Toupet fundoplication. Hyperinsulinaemic hypoglycaemia was confirmed during a spontaneous episode and in a mixed-meal test. Localisation studies including magnetic resonance imaging (MRI), endoscopic ultrasound (EUS) and gallium dotatate positron emission tomography (68Ga Dotatate PET) were consistent with a small insulinoma in the mid-body of the pancreas. The lesion was excised and histopathology was confirmed a localised well-differentiated neuroendocrine pancreatic neoplasm. There have been no significant episodes of hypoglycaemia since. This case highlights several key points. Insulinoma should be sought in proven post-prandial hyperinsulinaemic hypoglycaemia - even in the absence of fasting hypoglycaemia. The use of nuclear imaging targeting somatostatin and GLP1 receptors has improved accuracy of localisation. Despite these advances, accurate surgical resection can remain challenging. Learning points Hypoglycaemia is defined by Whipple's triad and can be provoked by fasting or mixed-meal tests.Although uncommon, insulinomas can present with post-prandial hypoglycaemia.In hypoglycaemia following gastrointestinal surgery (i.e. bariatric surgery or less commonly Nissen fundoplication) dumping syndrome or non-insulinoma pancreatogenous hypoglycaemia syndrome (NIPHS) should be considered.Improved imaging techniques including MRI, endoscopic ultrasound and functional nuclear medicine scans aid localisation of insulinomas.Despite advances in imaging and surgical techniques, accurate resection of insulinomas remains challenging.
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Affiliation(s)
- Sarah Y Qian
- Department of Endocrinology and DiabetesThe Alfred Hospital, Melbourne, Australia
| | - Matthew J L Hare
- Department of Endocrinology and DiabetesThe Alfred Hospital, Melbourne, Australia
| | - Alan Pham
- Department of Anatomical PathologyThe Alfred Hospital, Melbourne, Australia
| | - Duncan J Topliss
- Department of Endocrinology and DiabetesThe Alfred Hospital, Melbourne, Australia.,Department of MedicineMonash University, Melbourne, Australia
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12
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Polmear JL, Hare MJL, Catford SR, Topliss DJ, Dooley MJ. Use of anticoagulation in thyroid disease. Aust Fam Physician 2016; 45:109-111. [PMID: 27052045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Hyperthyroidism and atrial fibrillation (AF) are both common in the Australian community, and often encountered in general practice. OBJECTIVE This article discusses the risk of AF and thromboembolism in hyperthyroidism, the role of antithrombotic therapy in this setting, and appropriateness and safety of various antithrombotic agents in thyroid disease. DISCUSSION Prevention of thromboembolism is an important consideration in the care of patients with AF and hyperthyroidism. However, the evaluation of thromboembolic risk and management in this setting is challenging. Thyroid disease results in a pro-coagulant state via disruption of coagulation pathways and alters the pharmacodynamics of anticoagulants. Currently, guidelines regarding anticoagulation in AF do not incorporate hyperthyroidism as an additional risk factor. Until further evidence becomes available, we recommend warfarin as the oral anticoagulant of choice in thyroid disease because of ease of monitoring and reversibility.
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Abstract
Morbidity and mortality from diabetes and its complications are increasing in populations globally. Different ethnic groups have varying degrees of risk. The concept of ethnicity encompasses numerous factors relevant to health including genetics, socioeconomics and health behaviours. Ethnicity-related discordance in the glycaemic markers used to diagnose diabetes and to identify those at risk of diabetes has been reported. Furthermore, many ethnicity- and country-specific diabetes risk prediction models have been developed. This review provides a thorough discussion of the impact of ethnicity on how diabetes is detected and the evidence for and against ethnicity-specific approaches to diagnosis.
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Affiliation(s)
- Matthew J L Hare
- Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia, 3004.
| | - Jonathan E Shaw
- Baker IDI Heart and Diabetes Institute, 99 Commercial Road, Melbourne, Victoria, Australia, 3004.
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14
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Hare MJL, Magliano DJ, Zimmet PZ, Söderberg S, Joonas N, Pauvaday V, Larhubarbe J, Tuomilehto J, Kowlessur S, Alberti KGMM, Shaw JE. Glucose-independent ethnic differences in HbA1c in people without known diabetes. Diabetes Care 2013; 36:1534-40. [PMID: 23275368 PMCID: PMC3661823 DOI: 10.2337/dc12-1210] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether glucose-independent differences in HbA1c exist between people of African, South Asian, and Chinese ethnicities. RESEARCH DESIGN AND METHODS Data from 6,701 people aged 19-78 years, without known diabetes, from Mauritius, and participating in the population-based Non-Communicable Disease Surveys of the main island and the island of Rodrigues were included. Participants were African (n = 1,219 from main island, n = 1,505 from Rodrigues), South Asian (n = 3,820), and Chinese (n = 157). Survey data included HbA1c, plasma glucose during oral glucose tolerance testing (OGTT), anthropometry, demographics, and medical and lifestyle history. RESULTS Mean HbA1c, after adjustment for fasting and 2-h plasma glucose and other factors known to influence HbA1c, was higher in Africans from Rodrigues (6.1%) than in South Asians (5.7%, P < 0.001), Chinese (5.7%, P < 0.001), or Africans from the main island of Mauritius (5.7%, P < 0.001). The age-standardized prevalence of diabetes among Africans from Rodrigues differed substantially depending on the diagnostic criteria used [OGTT 7.9% (95% CI 5.8-10.0); HbA1c 17.3% (15.3-19.2)]. Changing diagnostic criteria resulted in no significant change in the prevalence of diabetes within the other ethnic groups. CONCLUSIONS People of African ethnicity from Rodrigues have higher HbA1c than those of South Asian or African ethnicity from the main island of Mauritius for reasons not explained by plasma glucose during an OGTT or traditional factors known to affect glycemia. Further research should be directed at determining the mechanism behind this disparity and its relevance to clinical outcomes.
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15
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Abstract
Haemoglobin A(1c) (HbA(1c)) has recently been adopted by the World Health Organization into its recommended criteria for diabetes diagnosis. Much debate continues regarding the relative benefits and potential disadvantages surrounding the use of HbA(1c) for this purpose. There is a lack of consensus as to whether this alteration to the definition of diabetes is a step forward or whether it could add further confusion and ambiguity to the debate on the method and criteria for the diagnosis of this globally important disease. This review provides a comprehensive overview of the current issues surrounding how HbA(1c) is measured and reported; and of the evidence for and against its use in diagnosis.
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Affiliation(s)
- M J L Hare
- Baker IDI Heart and Diabetes Institute, Melbourne, Vic., Australia.
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