bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Late Dumping Syndrome Induced Hypoglycemia With GLP-1R Agonist
Authors: Shaghouli Amna Ali , Ballani Razan , Mesbah Naglaa 
Published: May 2021

Abstract
Background: Late dumping syndrome is a prominent post-bariatric surgery side effect. Glucose-dependenthyperinsulinemia, induced by elevated gastric inhibitory polypeptide (GIP) and glucagon-likepeptide-1 (GLP-1) levels, leading to 2–3 hours post-prandial hypoglycemia. In literature, several managements are available: dietary changes, glucosidase inhibitor, andsomatostatin analogues. In case of failure of those strategies, partial or total pancreatectomy isindicated. Recently, management using GLP-1R agonists showed promising effect inmanagement of late dumping syndrome induced post-prandial hypoglycemia. (1)AimThe aim of this study was to investigate the effect of using GLP-1R agonists w/o low glycemicindex diet for treating dumping syndromes induced post-prandial hypoglycemia in post bariatricsurgery patients. Methods: A sample of 27 cases (25 females, 2 males) mean age 44.64, SD 10.2 of post-bariatric surgerywere managed using GLP-1R w/o low-glycemic index diet after being diagnosed with the latedumping syndrome induced post-prandial hypoglycemia for duration 1–3 years post-surgery. The27 were sent a survey of 13 questions related to their experience pre-and post-management plan. Results: Out of the 27 patients, 15 responded to the survey. The results showed 100% of the participantsdeveloped episodes of severe symptomatic late dumping syndrome with hypoglycemiasymptoms diagnosed after one and half years of their symptoms. 87% of them experiencedhypoglycemia post meals 2–3 hours.70 % of the participants got hypoglycemia more than 5episodes per week (less than 4.0 mmol/l) which was confirmed by blood glucose monitoring. After starting treatment with GLP-1R agonists with or without low-glycemic index diet, 87% ofthe participants reported that the hypoglycemia episodes were reduced. Out of those 87%participants 46% did not get any hypoglycemia episode and 54% of them experienced 1–2 timeshypoglycemia episodes. Conclusion: The results of the survey showed the successful reduction or prevention of late dumpinghypoglycemia episodes frequency post-bariatric surgery by GLP 1R agonist with or without lowglycemicindex diet. References: Non, A.N.H.W.H. and Black, H., 2012. Scope of the Problem. Am J Prev Med, 42, pp.563–70.Chiappetta, S. and Stier, C., 2017. A case report: Liraglutide as a novel treatment option in late dumping syndrome. Medicine, 96(12).
Presentation and Management of Liraglutide-Related Pancreatitis: Systematic Review of Case Reports
Authors: Singh Som P , Qureshi Fahad 
Published: May 2021

Abstract
Background: Liraglutide is a glucagon-like peptide-1 (GLP-1 agonist) aimed towards promoting glucose-dependent insulin secretions. This medication is an emerging treatment option for the management of obesity through promoting satiety. However, there are a growing number of cases noting adverse effects of liraglutide. Of note, liraglutide has been seen to elevate serum amylase and lipase levels among users, and therefore promoting acute pancreatitis. Moreover, the overall presentation of liraglutide-related acute pancreatitis can be variable. The aim of this study is to determine qualitative patterns of presentation and meta-analysis of lab changes among acute pancreatitis patients on liraglutide. Methodology: Systematic review of the literature was performed on MEDLINE, Google Scholar, and the Cochrane Database of Systematic Reviews for liraglutide-related acute pancreatitis case studies, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. Meta-Analysis performed using Stata. Results: Twenty-one patient cases were identified then contingently evaluated for acute pancreatitis based on presentation, labs, and treatment outcomes. Within the pancreatitis cases, the average age of onset was 59 ± 16.5 (male = 58 ± 24.5; female = 56 ± 24.6). Upon qualitative review, 14.3% of patients were asymptomatic but showed elevated serum amylase and lipase levels following liraglutide administration (p &lt; 0.05). Among the symptomatic group, there was variation in the duration of liraglutide administration and reported compliance. There was no significant difference among treatment regimes between symptomatic and asymptomatic groups. Conclusion: Longer duration of liraglutide treatment without dose adjustment was notable to show elevated rises in both serum amylase and lipase. However, the variation of patient symptoms cannot be determined through the duration of treatment. Patient demographics do not seem to play a role in acute pancreatitis episodes. Future studies ought to focus on larger patient samples to further develop an understanding of treatment duration, presentation, and management of acute pancreatitis management after liraglutide administration.
Prevalence and Predictors of Hepatic Steatosis Among Adult Population With Prediabetes: Data From NHANES 2017–2018
Authors: Shaheen Magda , Pan Deyu , Friedman Theodore C 
Published: May 2021

Abstract
Previous studies have examined the prevalence of hepatic steatosis in patients with diabetes but few studies examined the relationship between hepatic steatosis and prediabetes. The purpose of this study was to examine the relationship between hepatic steatosis and prediabetes in a representative sample of the U.S. adult 20 years and older. Data from 5,492 participants in the National Health and Nutrition Examination Survey (NHANES) 2017–2018 were analyzed. Participants were considered normal if they have hemoglobin A1c (HbA1c) &lt;5.7%, have prediabetes if their HbA1c was 5.7% to 6.4% and had diabetes if their HbA1c was &gt; 6.5. Hepatic steatosis was diagnosed using fibroscan. We analyzed the data using descriptive, bivariate Chi square, and multiple logistic regression to determine the association between diabetes status, prediabetes status and hepatic steatosis, adjusting for confounding variables and considering the design and sample weights. Of the 5,492 participants, 8.5% had diabetes and 22.6% had prediabetes. The prevalence of hepatic steatosis was 70% among population with diabetes, 46% among the prediabetes group, and 21% in the normal group (p&lt;0.05). In the adjusted logistic regression model, relative to the normal group, patients with diabetes were four times more likely to have hepatic steatosis relative to normal group (adjusted odds ratio [AOR]=4.0, 95% confidence level [CI]=2.4–6.8, p&lt;0.05). Population with prediabetes were two times more likely to have hepatic steatosis relative to the normal group (AOR=2.1, 95% CI=1.6–2.6, p&lt;0.05). Among the population with prediabetes, the predictors of hepatic steatosis were age 50–65 years old relative to 20–34 years old (AOR=1.9, 95% CI=1.1–3.2, p&lt;0.05), overweight (AOR=5.4, 95% CI=2.5–11.8, p&lt;0.05), obese (AOR=16.6, 95% CI=7.2–38.0, p&lt;0.05) relative to normal body mass index, and high triglyceride level (&gt;=200 mg/dL) (AOR=4.2, 95% CI=2.6–6.6, p&lt;0.05) versus normal (&lt;=150 mg/dL). Blacks with prediabetes were 40% less likely to have hepatic steatosis relative to Whites (AOR=0.6, 95% CI=0.4–0.9, p&lt;0.05). Our study indicates that the prevalence of hepatic steatosis is higher in diabetic and prediabetes groups compared to normal group. In addition, those with prediabetes had more than two times higher chance of having hepatic steatosis relative to the normal group. Further longitudinal studies are needed to explore the causal relation between prediabetes and hepatic steatosis among the adult population. Grant numbers: R01MD012579, R24DA017298, U54MD007598, S21MD000103, UL1TR001881
To Evaluate the Relationship of Risk Factor Between Diabetes Mellitus and Thyroid Dysfunction (Thyrobetes)
Authors: Varma Madhumati 
Published: May 2021

Abstract
Introduction: Type 2 diabetes and thyroid dysfunction are common endocrine disorder and shown mutually influence each other. As per the GOQii is a smart-tech enabled, integrated preventive healthcare platform headquartered in California, diabetes has increased from 7.1 to 12% this year. “The incidence of diabetes is highest among older adults at 23.81 per cent and seniors at 36.82 per cent.” As per the report, 13.5% of Indians have cholesterol issues. This past year, thyroid issues have increased from 6.8% to 10.7%. The thyrobetes illustrates relationship the between thyroid diseases and diabetes mellitus.
Objective of the Study: This study’s objectives are as follows:To define the interrelation of factors responsible for the link between diabetes and thyroid disease development;To estimate thyroid hormone TSH, free T3, free T4, lipid profile, blood glucose fasting and PP, HbA1c, S. Insulin, ant-TPO antibodies, and USG neck for some thyroid patients;To describe each factor correlation between developing diabetes and thyroid diseases; andTo explain preventive measures for diabetes and thyroid diseases. Research problem of the studyThere are an increasing number of patients who experience diabetes mellitus, hypothyroidism and other types of thyroid dysfunction, but it is difficult to say which disease occurs first. This study seeks to identify the overlapping risk factor for diabetes and thyroid dysfunction. Review of literatureType 2 diabetes mellitus and thyroid dysfunction (TD) are two major public health endocrine problems. The status of iodine and thyroid with diabetic patients less studied. Materials and Methods: The study included 300 patients of diabetes and thyroid dysfunction. The questionnaires were used to record the findings on thyroid hormone TSH, free T3, free T4, lipid profile, blood glucose fasting and PP, and USG neck for some thyroid patients. Inclusion criteria:Sample size -300 patientsNo limit to the age groupNew or follow up cases of diabetic mellitus and thyroid diseaseExclusion criteria:Patients who had an acute illness that affects thyroid gland activityPatients who consumed drugs that could influence the thyroid hormone statusPatients who had feverData collection and tools for statistical analysisInstruments used for analyzing the samples that are availability at JNU hospital.
Statistical Analysis: Statistical analysis will be performed by using SPSS software, student ‘t’ tests, and Pearson’s correlation; if the P* value &lt; 0.005, then it will considered to be statistically significant. Conclusion: Thyroid disease and diabetes are two intertwined conditions. If you have a thyroid condition, you’re at an increased risk for developing diabetes, and if you have diabetes, you’re at an increased risk for thyroid disease.
Virtual Patient Simulation in DKD: Successful Strategy for Improving Recognition and Management
Authors: Larkin Amy , LaCouture Michael 
Published: May 2021

Abstract
Intro: we sought to determine if virtual patient simulation (VPS)-based continuing medical education (CME) intervention could improve performance of diabetologists/endocrinologists related to recognition and management of diabetes kidney disease (DKD). Methods: The intervention comprised a patient presenting at two different time points in a VPS platform that allows learners to order lab tests, make diagnoses, and prescribe treatments in a manner matching the scope and depth of actual practice. Tailored clinical guidance (CG), based on current evidence and expert recommendation, was provided following each decision, followed by the opportunity for the learner to modify to their decisions. Decisions were collected post-CG and compared with each user’s baseline (pre-CG) decisions using a McNemar’s test to determine P values. The activity posted August 30, 2019; initial data was collected through November 7, 2019. Results: 270 diabetologists/endocrinologists completed the activity (all decisions within at least 1 case) and were included. Significant improvements were observed after CG: 1st Patient: • Diagnose CKD stage 3b: 29% absolute improvement (5% pre-CG vs 34% post-CG; P&lt;.01) • Initiate SGLT2 inhibitor: 50% improvement (24% pre-CG vs 74% post-CG; P&lt;.01) • Order patient education: 19% improvement (52% pre-CG vs 71% post-CG; P&lt;.01) • Order follow-up appointment: 18% improvement (53% pre-CG vs 71% post-CG; P&lt;.01) 2nd Patient: • Diagnose CKD stage 3a: 49% absolute improvement (10% pre-CG vs 59% post-CG; P&lt;.01) • Initiate SGLT2 inhibitor: 36% improvement (51% pre-CG vs 87% post-CG; P&lt;.01) • Initiate ACE inhibitor: 11% improvement (85% pre-CG vs 96% post-CG; P&lt;.01) • Order patient education: 12% improvement (66% pre-CG vs 78% post-CG; P&lt;.01). Conclusion: VPS that immerses and engages specialists in an authentic and practical learning experience can improve evidence-based clinical decisions related to patient identification and management of DKD.
Effect of Chronic Kidney Disease on Outcomes of Adult Patients Admitted With Hyperosmolar Hyperglycemic State: Analysis of National Inpatient Sample
Authors: Shaka Hafeez , Velazquez Genaro , Velagapudi Sujitha , Edigin Ehizogie , Murthi Mukunthan , Marcos-Abdala Hernan Gerardo , Asemota Iriagbonse , Akuna Emmanuel 
Published: May 2021

Abstract
Background: Treatment guidelines have been well established in patients with HHS and a normal renal function. The mainstay of treatment for patients with HHS includes intravenous volume replacement, potassium replacement, and blood glucose correction by administering insulin. However, this treatment protocol cannot be directly applied to a patient with decreased GFR as it increases the risk of hypoglycemic episodes due to decreased insulin clearance along with increasing the risk of hyperkalemia and volume overload. Hence titrating insulin, maintaining euvolemia and normokalemia becomes further challenging in a patient with HHS in the setting of CKD. Although the above-mentioned complications are well described in multiple studies, there is not enough evidence demonstrating the association between the inpatient mortality and secondary outcomes in patients with HHS with and without CKD.
Objective: To compare the inpatient mortality and secondary outcomes in patients admitted with HHS with CKD vs without CKD.
Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 and 2017. About 42 740 hospitalizations who had HHS as primary diagnosis were enrolled and further stratified based on the presence or absence of CKD as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes included length of hospital stay, total Hospital charges, Sepsis, Septic Shock, Acute Kidney Injury (AKI), and Acute Respiratory Failure (ARF). Multivariate regression analysis was done to adjust for confounders.
Results: Out of the 42 740 hospitalizations with HHS, about 9 545 had CKD. The in-hospital mortality for patients with HHS was 305 overall, out of which 105 patients had Atrial Fibrillation as a secondary diagnosis. Compared with patients without CKD, patients with CKD had similar in-hospital mortality (aOR 0.93, 95% CI 0.48–1.8, p=0.83) when adjusted for patient and hospital characteristics. Patients with HHS and CKD had similar length of hospital stay, total hospital charges, rate of Sepsis, Septic Shock, and ARF in comparison to patients without CKD; however, patients with CKD had higher odds of developing AKI thorough out hospitalization.
Conclusion: This study found that patients admitted with HHS and CKD have similar in-hospital mortality when compared to patients without CKD. However, the study group with CKD has higher odds of developing AKI when compared to the group without CKD. Although AKI is common and correctable in HHS, the above-mentioned association is possible due to the judicious IV fluid replacement in an HHS patient with CKD as a concern for volume overload. Further studies are needed to identify contributing risk factors and establishing fluid replacement guidelines in a patient with HHS and CKD.
Impact of Atrial Fibrillation on In-Hospital Outcomes in Patients With Hyperosmolar Hyperglycemic State: Analysis of National Inpatient Sample
Authors: Velazquez Genaro , Shaka Hafeez , Murthi Mukunthan , Marcos-Abdala Hernan , Velagapudi Sujitha , Akuna Emmanuel , Asemota Iriagbonse , Edigin Ehizogie , Williams Dimeji 
Published: May 2021

Abstract
Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia and its negative prognostic impact on the morbidity and mortality of hospitalized patients has been well described. In patients with Hyperosmolar hyperglycemic state (HHS), mortality rates can reach up to 20% and poor outcomes have been reported in people with older age, presence of comorbid conditions and concurrent infections. However, the impact of atrial fibrillation on the hospital outcomes of patients admitted with HHS has not been well documented.
Objective: We wanted to compare the outcomes for HHS hospitalizations for patients with and without Atrial fibrillation.
Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 and 2017. About 42 740 hospitalizations who had HHS as primary diagnosis were enrolled and further stratified based on the presence or absence of Atrial Fibrillation as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes included length of hospital stay, total Hospital charges, Sepsis, Septic Shock, Acute Kidney Injury (AKI), and Acute Respiratory Failure (ARF). Multivariate regression analysis was done to adjust for confounders.
Results: Out of the 42 740 hospitalizations with HHS, about 3 295 had Atrial Fibrillation. The in-hospital mortality for patients with HHS was 305 overall, out of which 60 patients had Atrial Fibrillation as secondary diagnosis. Compared with patients without Atrial Fibrillation, patients with Atrial Fibrillation had a similar in- hospital mortality (aOR 0.77, 95% CI 0.39–1.52, p=0.45) when adjusted for patient and hospital characteristics. Patients with HHS and Atrial Fibrillation had similar length of hospital stay, total Hospital charges, rate of Sepsis, Septic Shock, AKI, and ARF in comparison to patients without Atrial Fibrillation.
Conclusion: Our study suggests that the presence of atrial fibrillation in hospitalized HHS patients is not associated with increased mortality or longer duration of hospital stay. This data is essential since it helps identify HHS patients with increased risk of complications. As previous reports have suggested that AF, especially of new onset in critically ill patients is a marker of increased disease severity, the lack of such impact in patients with HHS requires further studies.
Inpatient Hypoglycemia in Patients With Chronic Kidney Disease
Authors: Do Justin , Mojazi-Amiri Hoda , Heineke Hyunju S , Ayutyanont Napatkamon , McQueen Chelsea , Moghadam Bahman , Kubomoto Scott 
Published: May 2021

Abstract
Background: Inpatient hypoglycemia has been shown to be associated with increased mortality, more complications, and greater length of stay [1]. Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) are at greater risks for hypoglycemia due to their decreased degradation of insulin, reduced glycogen stores, and decreased renal gluconeogenesis. With the association between inpatient hypoglycemia and increased morbidity and mortality, it is valuable to determine other risks factors that may contribute to hypoglycemia in the hospital setting.
Objective: Determine the rates of hypoglycemia (glucose &lt;70 mg/dl) and severe hypoglycemia (glucose &lt;54 mg/dl) along with risk factors, such as type of insulin used and initial hyperglycemia at admission, for patients with diabetes mellitus (DM) and CKD/ESRD.
Methods: A retrospective cohort analysis was conducted on 74,266 hospitalized patients who had DM and CKD/ESRD or DM alone, within 155 HCA Healthcare hospitals from January 2019 through June 2019.
Results: Among hospitalized patients with DM, hypoglycemia was more common in patients with ESRD (n=5234) compared to patients with CKD without ESRD (n=18659) and patients without CKD/ESRD (n=52373) (34.37% vs. 23.66% vs. 12.91%, respectively, p&lt;0.01). Similarly, severe hypoglycemia was more common in patients with ESRD compared to patients with CKD without ESRD, and patients without CKD/ESRD (18.09% vs. 11.19% vs. 5.28%, respectively, p&lt;0.01).
When evaluating patients with ESRD, a higher point of care (POC) glucose at time of admission was associated with an increased risk of subsequent hypoglycemia. Within the first 24 hours of hospital admission, hypoglycemia was more common if the patient’s initial POC glucose was greater than 300 with an incidence of 13.67% compared to 11.21% (n=955, p=0.033). Among patients with ESRD and an admission glucose &gt; 300, having an order for dialysis within the first 24 hours of admission was associated with increased risk of hypoglycemia (OR= 1.2181, p=0.0014). Diabetics with subsequent hypoglycemia had higher initial glucose levels on admission when compared to diabetics who did not experience hypoglycemia during their hospital stay. Mean = 221.61±82.32 vs 205.54±74.51 (p=0.000002).
Conclusion: In hospitalized patients with DM, CKD and ESRD are associated with increased risk of hypoglycemia. Amongst diabetics, patients with ESRD and CKD account for over 50% of cases of severe hypoglycemia. Severe hypoglycemia occurred in 18% of patients who had both diabetes and ESRD. An elevated glucose at admission is associated with a subsequent hypoglycemia in patients with ESRD. It is important to manage DM in patients with CKD and ESRD carefully as they may be more likely to experience hypoglycemia due to overcorrection and decreased clearance of insulin.
1.Hulkower et al., Diabetes Manag 2014 Mar;4(2):165–176.