bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maturity Onset Diabetes of the Young Masquerading as New Onset Diabetes Mellitus Type 1
Authors: Miller Assia , Bargman Renee 
Published: May 2021

Abstract
Introduction:/background: Maturity-onset diabetes of the young (MODY) is a heterogeneous group of monogenic disorders with autosomal dominant mode of inheritance. Mutation in hepatocyte nuclear factor-1β (HNF-1β) gene results in an error of embryonic development of pancreas and nephron, leading to MODY type 5. MODY 5 accounts for 1% of maturity-onset diabetes of the young. It has peak incidence in adolescence/early adulthood, and is associated with renal pathology. Clinical Case: A 15-year boy with history of hypertension and Hashimoto thyroiditis with normal thyroid function was referred for Hb A1C of 6.7% (&lt; 6.4%). Physical exam was remarkable for normal weight at 64%, normal BMI at 83%, absence of thyromegaly or acanthosis nigricans. Diabetes was confirmed by 2 hour Oral Glucose Tolerance Test study (baseline glucose 154 mg/dL (&lt;126 mg/dL), 2 hour glucose 384 mg/dL (&lt;140 mg/dL)). Small doses of insulin (total daily dose 0.1 units/kg/day) resulted in good glucose control. Further labs were significant for weakly positive TTG and GAD antibodies (tTG Ab IgA 55.5 U/mL (&lt;4.0 U/mL), GAD-65 Ab 0.05 nmol/L (&lt; 0.02 nmol/L)), positive TPO (0.0 - 34.9 IU/mL) and detectable ATA antibodies 45.8 IU/mL (0.0 - 40.0 IU/mL), C-peptide 2.9 ng/mL (0.9–7.1 ng/mL). Islet cell, Insulin and Zinc transporter 8 antibodies were negative. Over the next few months he was weaned off insulin and subsequently he had a high insulin of 29.43 uU/mL (3.0 - 17.0 uU/mL) with glucose level of 169 mg/dL. Renal US was performed as part of the work up for hypertension and revealed a small right calculus with no hydronephrosis and a small 8-mm cortical cyst in the right kidney. Urinalysis showed microalbuminuria. Upper GI endoscopy and colonoscopy with biopsy ruled out celiac disease. Presumptive diagnosis of MODY was entertained despite positive TPO, ATA, TTG and GAD antibodies suggesting autoimmune endocrinopathies. His Hb A1C levels were in the range of 5.7 to 6 % during the 15 months of follow up. Genetic testing for MODY resulted in heterozygous deletion of exons 1–9 of the HNF1B gene consistent with MODY5. Conclusion: This is a case of MODY 5 with weakly positive GAD 65 antibodies that was initially misdiagnosed as type 1 diabetes. The presence of weakly positive antibodies should not preclude a work up for MODY in a patient who does not have the clinical features of classic type 1 DM.
Non-Tropical Diabetic Hand Syndrome in Peru: A Case Report
Authors: Miranda Gonzalo Francisco , Rafael Luciana del Pilar 
Published: May 2021

Abstract
Background: The diabetic foot is the most studied spectrum in relation to musculoskeletal complications in diabetic patients but upper extremities may be affected, producing from superficial hand injuries to multiorganic failure due to sepsis. Tropical diabetic hand syndrome has been used to describe a potentially dangerous infection in the hand, generally diagnosed in areas of the tropics. Nevertheless, cases have been seen in non-tropical areas in marginal urban areas which are part of the spectrum of Non tropical diabetic hand syndrome.
Clinical Case: A 52-year-old woman, from marginal urban area of Lima- Peru with type 2 diabetes mellitus (T2DM) of 6 years in poor metabolic control. She was admitted to the emergency room with two weeks of volume increase, erythema, purulent secretion, flogosis in the fifth finger of the left hand and fever. Initial tests confirmed mild diabetic ketoacidosis and sepsis (pH: 7.29; Glucose: 320 mg / dl, Bicarbonate: 15 mEq/L, Ketone bodies - urine (+), leukocytes 14360 cells/mm3, CRP: 180). Intravenous antibiotic was started. A surgical debridement and amputation of the fifth finger of the left hand was decided. Patient with unfavorable evolution, on the eight day, was admitted to new surgical debridement without clinical improvement. Arterial Doppler Ultrasound and CT angiography confirmed distal arterial insufficiency due to monophasic flow in the left ulnar artery with the presence of collateral circulattion. A third surgical debridement and amputation of the fourth finger of the left hand was done with favorable postoperative clinical evolution.
Non tropical diabetic hand syndrome affects predominantly women, between 50 to 60 years, with low socio-cultural level and deficient glycemic control, as in case presented. Other factors include body mass index &lt; 20kg/m2, DM 1 and diabetic neuropathy. Diabetic neuropathy is the most common risk factor in Non tropical diabetic hand syndrome cases, with a prevalence of 88%, while peripheral arterial disease was present in 11% of cases. In this report, neuropathy and peripheral arterial disease were present.
Conclusion: Non tropical diabetic hand syndrome is uncommon and underdiagnosed complication of Diabetes Mellitus that has an important clinical repercussion as an important cause of disability. Detailed physical examination of the hands in a patient with diabetes for detection of these cases is highlighted because an early diagnosis and treatment improves prognosis.
Smartphone Camera to Image the Retina for Primary Care MDs and Diabetologists
Authors: Lau Chap-Kay Kendra , Wu Gloria 
Published: May 2021

Abstract
Background: Imaging is an important tool for diagnosis of hypertension and diabetes for all physicians. In the US, 300 million smartphones were purchased in 2019. Purpose: A smartphone-based ophthalmoscope for fundus imaging was compared to an office based retina camera to evaluate the average time spent on each device. Methods: Inclusion criteria: Patients with 20/20-20/50 vision, informed consent was obtained. D-Eye/iphone digital direct ophthalmoscope (Padova, Italy) was used on the dilated and undilated eyes of patients, video recorded to attain an image of the optic nerve and internally timed in the iPhone. Optos (Marlborough, MA) was then used to take retinal images of both dilated and undilated eyes of patients for comparison. The start time and end time was recorded from the timestamp of the 1st and last image taken on Optos, then the difference between both timestamps was calculated to obtain time spent on Optos. Results: For dilated patients (n=12, 24 eyes), the average time taken to obtain a clear video of both eyes using D-Eye was 28.08 seconds. The average time to take images of both eyes using Optos was 1.83 minutes. For undilated patients (n=10, 20 eyes), the average time of a clear video of both eyes using D-Eye was 29.8 seconds. The average time to take clear images of both eyes using Optos was 1.2 minutes.
Conclusion: The portable D-Eye attachment may be useful at primary care settings, eye MD offices, bedside, ER, and wheelchair patients for evaluation and diagnosis. The D-Eye attachment for the smartphone is useful for imaging both dilated and undilated eyes. We look forward to future studies of the D-Eye for more complex retinal images.
The Peruvian Experience: New-Onset Diabetes Presenting With Diabetic Ketoacidosis in Patients With COVID19 Infections
Authors: Ramos-Yataco Anthony , Capcha Kelly Jasmin Meza , Harbuz-Miller Inga 
Published: May 2021

Abstract
Introduction: Data has emerged about patients with T2DM may experience DKA and HHS if infected with SARS-CoV-2. There is limited data about new-onset diabetes in patients with COVID-19. We describe a case series of three Peruvian patients with new onset diabetes presenting with DKA who remained insulin dependent several months after infection resolution. Case 1: A 59-year-old man with no significant past medical history and normal glucose presented with fever and dyspnea for five days. He was hospitalized with hypoxemic respiratory failure and tested positive forCOVID19. Hypoxemia improved with supportive care, but on day three, he became lethargic, tachycardic, and tachypneic with 95% oxygen saturation on room air. Biochemistry revealed an anion gap metabolic acidosis with pH 7.3, bicarbonate 10 mmol/L (22–28), β-hydroxybutyrate 5.4 mmol/L (&lt;0.5), and glucose 679 mg/dL. He was treated with continuous insulin infusion. After DKA resolved, he was transitioned to basal-bolus insulin and remained insulin-dependent during outpatient follow-up. Case 2: A 49-year-old man in good health prior to admission, was transferred to our hospital for acute respiratory failure and positive testing for SARS-CoV-2. Two days later he became confused, tachycardic, and tachypneic with 90% oxygen saturation. DKA was diagnosed based on a pH 7.1, bicarbonate 8 mmol/L, β-hydroxybutyrate 5 mmol/L and glucose 625 mg/dL. He was transferred to the ICU for continuous insulin infusion. After resolution of his DKA, subcutaneous insulin was started. Preadmission hemoglobin A1c was 4.5%. He remained on insulin post hospital discharge. Case 3: A 33-year-old man with normal glucose prior to admission was transferred to our hospital from an outpatient office with a two-day history of dyspnea and altered sensorium. He was tachycardic and tachypneic with 96% oxygen saturation on 3L nasal cannula. He tested positive for SARS-CoV-2. DKA was diagnosed with glucose 690 mg/dL, bicarbonate 4 mmol/L, serum β-hydroxybutyrate 5.8 mmol/L and pH 6.6. He was resuscitated with intravenous fluids and an insulin infusion was started. DKA resolved after 5 days and he was discharged home on subcutaneous insulin. He remained insulin-dependent on follow-up. Conclusion: New-onset diabetes with DKA due to SARS-CoV-2 is increasingly recognized, and beta-cell dysfunction can be permanent, resulting in insulin-dependent diabetes. Accordingly, our patients remained insulin-dependent several months post discharge.
Using Technology to Treat a Diabetic Emergency at Home in the Time of COVID19 Pandemic
Authors: Mundada Rachana , Marco Cheryl , Miller Jeffrey L 
Published: May 2021

Abstract
Introduction: Severe out-break of the novel coronavirus has majorly impacted the health care facilities across all settings. Hospital facilities especially the ambulatory clinics began to adjust the ways to triage, assess and treat patients by using methods that do not rely on traditional face-face encounter. Here, we present one such scenario from the initial phase of pandemic in which team effort was involved in a diabetic emergency to overcome the barriers of emergent ambulatory care. Case Description: We present a 78-year-old female with past medical history of Type 2 diabetes mellitus, hyperthyroidism, multi-nodular goiter, hypertension, mild coronary artery disease, diastolic heart failure and dyslipidemia who called the clinic with an elevated point of care glucose of 436mg/dl. Other symptoms included high fever, polyuria and polydipsia having just been discharged from hospital with a diagnosis of COVID-19 infection. She was on metformin 500 mg twice a day, glimepiride 2 mg daily, methimazole 5 mg daily, carvedilol 12.5 mg twice a day, losartan 100 mg daily, pravastatin 20 mg daily and furosemide 40 mg daily. Her most recent blood work showed an A1C of 8% (7.4 and 7.1 last year), TSH - 0.29 (0.4 -4.5 mIU/ml), FT4 - 1.1 (0.8–1.8 ng/ml), metabolic panel showed plasma glucose of 283 mg/dl along with normal electrolytes and kidney function. The patient was admitted to hospital about a week ago with flu like illness and high fever and was found to be COVID positive and was discharged home with instructions on isolation and follow up. However, while at home she noticed hyperglycemia 400–500 mg/dl despite oral agents, associated with polyuria and polydipsia but no nausea or vomiting. Given the significant symptomatic hyperglycemia along with symptomatic COVID infection it was clear that she acutely needed insulin therapy. As the patient was insulin naïve and COVID positive, there were several barriers in initiating insulin without hospitalization: we could not get her into the Endocrine office and she was declined ED evaluation because of her COVID positivity. She and the family were relatively computer novice so could not access our electronic health record video system. After discussion over the phone, our certified diabetes educator walked them through the process of downloading an app for video communication. Utilizing remote video communication, the patient’s 20-year-old grandson was educated on all the steps of Insulin use for the patient as she was still delirious. Gratifyingly, she responded well to initiation of insulin and subsequent glucoses were in the 100’s along with improvement in her symptoms. Conclusion: This case emphasizes how team effort and the zeal of health care community to serve patients can overcome shortcomings.
Diabetes Prevalence and Risk Factors in Patients With Chronic Mental Illness on Second-Generation Antipsychotics
Authors: Sahay Priya , Shikh Simran , Akinbowale Carol , Azim Salman Meher , Lamberti J Steven , Olivares Telva E , Brazill Kevin P , Miedlich Susanne U 
Published: May 2021

Abstract
The rates of obesity and type 2 diabetes (T2D) are much higher in patients with chronic mental illness compared to the general population1. Second-generation antipsychotic medications (SGA) are clearly contributory to these adverse metabolic phenotypes2. Thus, annual monitoring of fasting plasma glucose (FPG) levels is recommended to screen for T2D in patients on SGA3. Of note, FPG, and also HbA1c, have poor sensitivities in detecting T2D early, with nearly 50% of cases being missed using either of the above tests when compared to oral Glucose Tolerance Testing (oGTT,4). We thus screened patients with schizophrenia, schizoaffective or bipolar disorder on SGA per oGTT. We hypothesized that we would identify more patients with T2D per oGTT compared to FPG or HbA1c testing alone. To identify risk factors for T2D, we also assessed BMI, waist/hip ratio, blood pressure, dietary habits (UKDDQ = UK Diabetes and Diet Questionnaire), physical activity records (3d pedometer records), measures of psychopathology, cognition (PHQ-9 = Patient Health Questionnaire, SLUMS = Saint Louis University Mental Status exam) as well as HOMA IR (Homeostatic Model Assessment of Insulin Resistance), Matsuda index and lipid profile. Data were analyzed using SPSS, comparing normal and prediabetic patients to patients with T2D (per oGTT criteria). Thus far, we screened 22 patients per oGTT and newly identified 5 patients with T2D (23%), only one patient had T2D per HbA1c criterion, 4 were identified per elevated FPG, 3 patients had elevated 2h plasma glucose levels. Patients with T2D had significantly lower Matsuda indices (p&lt;0.0001); trends towards higher HOMA IR and waist/hip ratios were observed in diabetic compared to non-diabetic patients (p=0.08). Patients with T2D tended to be heavier, had worse dietary habits (higher UKDDQ scores), and surprisingly were less depressed (lower PHQ-9 scores) than non-diabetic patients (p&lt;0.25). In conclusion, oGTT is more sensitive in identifying patients with T2D early compared to FPG or HbA1c alone. Matsuda indices, HOMA IR and waist/hip ratios may serve as additional markers to distinguish non-diabetic from diabetic patients. Since metabolic syndrome and diabetes are all risk factors for an increased cardiovascular mortality in patients with chronic mental illness, identifying and treating T2D early and aggressively should be primary goals of care in this high-risk patient population. References:1 Lean ME, Pajonk FG. Diabetes Care. 2003 May;26(5):1597–605.2 Allison DB, Mentore JL, Heo M, et al. Am J Psychiatry 1999 Nov;156(11):1686–1696.3 American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity. Diabetes Care. 2004 Feb;27(2):596–601.4 Cowie CC, Rust KF, Byrd-Holt DD, et al. Diabetes Care 2010 Mar;33(3):562–568.
Initial Combination Empagliflozin and Linagliptin Improves Kidney Fibrotic Marker in Patients With Type 2 Diabetes: A Randomized Controlled Trial
Authors: Sathavarodom Nattapol , Putthanuparp Thanaporn , Pinphanichakarn Verapon 
Published: May 2021

Abstract
Background: Transforming growth factor-beta 1 (TGF- ß1) is a novel cytokine marker and also one of the therapeutic targets in the treatment of diabetic kidney disease. Both sodium glucose co-transporter 2 inhibitor and dipeptidyl-peptides 4 inhibitor reduce TGF- ß 1 level in animal studies, but whether it is effective in human is unknown. Objective: To evaluate the effects of combinations of empagliflozin/linagliptin, comparing with empagliflozin alone, in patients with type 2 diabetes. Material and Methods: Subjects are randomized to a combination of empagliflozin 10 mg and linagliptin 5 mg (n = 23), or empagliflozin 10 mg (n = 22) as add-on to standard treatment for 12 weeks. The primary end point is changed from baseline in serum TGF- ß1 at 12 weeks. Results: Among the 45 subjects who completed the study, mean change in TGF-ß1 was -928.2 + 1,204.2 pg/mL, and +206.6 + 592.5 pg/mL in the empagliflozin/linagliptin group and empagliflozin group, respectively (p &lt;0.001). Mean change in estimated glomerular filtration rate (eGFR) increased in the empagliflozin /linagliptin group 4.4 + 7.59 mL/min/1.73m2, whereas mean eGFR decreased in empagliflozin group -0.06 + 11.16 mL/min/1.73m2 (p =0.133). Mean change in HbA1c was -1.3 + 0.6% and -0.4 + 0.6% in empagliflozin/linagliptin and empagliflozin group, respectively (p&lt;0.001). Baseline level of eGFR significantly correlated with baseline TGF- ß1 but did not predict response to therapy. Conclusion: Initial combination empagliflozin and linagliptin may delay progression of kidney fibrosis as early as 12 weeks of treatment. Our study supports that this combination had synergistic action not only glycemic control but also beneficial in kidney protection. Keyword: transforming growth factor - ß1, diabetic kidney disease, combination empagliflozin and linagliptin
Treatment of Diabetic Wounds With Photodynamic Therapy - Preliminary Results
Authors: Berbert Mariana , Arruda Sicilia , Bichuetti Camila , Campos Alice , Ceron Patricia , Magalhães Fernanda , Moraes Fernanda , Pelegrinelli Ana Claudia , Silva Pamella , Simone Vitoria , Thedei Jr. Geraldo 
Published: May 2021

Abstract
Diabetic patients have greater susceptibility to developing diabetic foot ulcers (DFU), which associated with peripheral arterial disease and/or infection, causes greater difficulty in the healing process. Photodynamic therapy (PDT) presents itself as a promising alternative for ulcer healing. This study aims to analyze the effectiveness and benefits of PDT in the treatment of diabetic wounds, associating the presence of arteriopathy, the size of the lesion, the presence and type of infection and the need for amputation. After the approval of the ethics committee in research and signing of the TCLE, six patients with eight diabetic wounds were evaluated. The study was carried out in an outpatient clinic of a medium complexity hospital in the interior of Minas Gerais, Brazil, with frequency of two weekly meetings, for a period of 5 months. Cultures were collected at the beginning and end of treatment, arterial doppler of the affected lower limb was performed. The photosensitizer used was methylene blue, with subsequent emission of LED light at a power of 100 mW/cm2, for 10 minutes. The data were analyzed by the Qui2 test, using the Software SPSS 25.0, with a significance level of 5% and are described with mean ± EPM. Age was 65.50 ± 7.58 years, 50% male. All had type 2 diabetes mellitus and the disease time was 9.50 ± 8.22 years. Five reported the presence of comorbidities such as SAH and dyslipidemia, and two presented concomitantly nephropathy and retinopathy. One patient was a smoker and two reported previous smoking. All lesions presented grade I classification by Texas classification (superficial cleft not involving tendon, capsule or bone). Five stage B ulcers (infection only), two stage C ulcers (ischemia only) and A stage D ulcer (infection and ischemia). At US arterial doppler, three patients had total viability of the affected limb and three presented arteriopathy, but only two with collateral. There was no association between arteriopathy and injury reduction (p=0.109). The mean area of injury was 11.15 ± 14.93 cm2. There was a reduction of 46.51 ± 31.10%. There was no association between injury area and percentage of reduction (p = 0.213), but there is a tendency for greater reductions in smaller lesions. Infection was present in 75% of the lesions. There was no association between the presence of infection and reduction of lesions (p=0.446). So far, we can conclude that the presence of arteriopathy without collateral, makes the procedure impossible. There was no association with the presence of infection and reduction of the lesion, and can also be used as a stimulator of the healing process. There was no association with wound size and percentage of reduction. It’s a promising therapy that should be better analyzed.
Trends in Diabetes Subgroups and Their Risk for All-Cause, Cardiovascular Disease and Diabetes-Specific Mortality in the US: A Data-Driven Reproducible Machine Learning Approach
Authors: Antonio-Villa Neftali Eduardo , Fernández-Chirino Luisa , Vargas-Vazquez Arsenio , Bahena-López Jessica Paola , Bello-Chavolla Omar Yaxmehen 
Published: May 2021

Abstract
Background: Diabetes has been described as a heterogeneous entity which can be studied through data-driven subgroups (obesity related [MOD], severe-insulin deficient [SIID], severe-insulin resistant [SIRD] and age-related diabetes [MARD]). However, trends in prevalence and mortality risk are still unclear. Aims: To analyze diabetes subgroup trends and to evaluate mortality risk in the US. Methods: Data and follow-up causes of mortality (all-cause, cardiovascular disease, and diabetes specific) was collected from NHANES cycles 1999–2018. Subgroup diabetes classification was performed using the self-normalizing neural networks algorithm using clinical parameters (HbA1c, time since diabetes diagnosis, HOMA2-IR, HOMA2-B, and BMI) proposed by Bello-Chavolla et al (https://bit.ly/3jSm1xv). Prevalence was estimated using sample weights. 2-year cycles were used as a continuous variable to evaluate the biannual change (BC) of the overall prevalence of diabetes and subgroups. Trends were stratified according to race. Cox-proportional and Fine-Gray semiparametric hazard regression models were used to evaluate mortality risk. Results: Data from 59,204 adult subjects was extracted for trend analysis. Follow-up information was obtained for 3,980 subjects. Diabetes prevalence in the US increased from 8.2% (95%CI 7.8–8.6) in 1999–2000 to 13.9% (95% CI 13.4–14.4) in 2017–2018 (BC 1.38%, 95% CI 1.20–1.56, p&lt;0.001). Non-Hispanic Blacks had the largest increase in diabetes prevalence (BC: 1.40%, 95%CI 0.71–2.08, p=0.027), followed by Non-Hispanic Whites (BC: 1.36%, 95%CI 1.13–1.58, p&lt;0.001), and Mexican Americans (BC: 1.33%, 95%CI 1.20–1.54, p&lt;0.001). Regarding diabetes subgroups, MARD had the highest prevalence, with a moderate increase over time; however, MOD had the greatest increase over time (1.5%, [95%CI 1.2–1.8] to 4.5% [95%CI 4.0–5.0]; BC: 0.73% [95%CI 0.60–0.86], p&lt;0.01). Both SIRD and SIID had non-significant increases in prevalence during the studied period. Non-Hispanic Blacks had an increase in the prevalence in MOD and SIID, Mexican Americans in MOD and SIRD, and non-Hispanic Whites in MOD and MARD. Compared with MOD, the risk for all-cause mortality was higher for MARD (HR 2.9 95% CI: 2.1–3.9), SIRD (HR 2.0 95% CI: 1.5–2.8), and SIID (HR 1.6 95% CI: 1.1–2.3). For CVD mortality, only MARD (HR 2.8 95% CI: 1.4–5.7) and SIRD (HR 2.5 95% CI: 1.2–5.3) displayed higher risk. For diabetes-specific mortality, only MARD (HR 2.2 95% CI: 1.3–3.7) was associated. Conclusion: There is an overall increase in diabetes prevalence and its subgroups from 1999 to 2018; MORD had the highest increase. The risk for all-cause, CVD and diabetes-specific mortality was different among subgroups. Our results supports the use of diabetes subgroups for a better understanding of diabetes and its complications.