bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Unusual Presentation of New Onset Type 1 Diabetes Mellitus With Concurrent Addison’s Disease in an Adolescent Male
Authors: Clemente Ethel G , Mathew Nina , Ergun-Longmire Berrin 
Published: May 2021

Abstract
Introduction: Majority of children and adolescents diagnosed with Type 1 Diabetes Mellitus (T1D) present with the classic symptoms of polyuria, polydipsia and polyphagia, associated with hyperglycemia. Concurrent conditions at the time of T1D diagnosis may alter its presentation and potentially lead to challenges in diagnosis and management.
Clinical Case: We present a 17-year-old male with worsening fatigue and unintentional weight loss for two months, then one week of emesis and abdominal pain. Initial work-up by his primary care provider showed sodium 125 mmol/L (133–145), potassium 5.7 mmol/L (3.5–5.1), HCO3 20 mmol/L (21–31), anion gap 13 mmol/L (9–18), random glucose 141 mg/dL (70–199). Due to hyponatremia and dehydration, he was sent to a local emergency room where he was found to be mildly hypotensive at 87/57 mmHg. He received intravenous fluids for hydration and was sent home. On out-patient follow up, he appeared well despite being hypotensive. His additional labs revealed a random glucose of 330 mg/dl and elevated HbA1C of 8.3% (4.4–5.6). His urine was positive for glucose but negative for ketones. He was admitted for further management of new onset diabetes. On admission, he was well appearing and in no acute distress. Blood pressure was 86/57 mmHg, heart rate was 109 bpm, and other physical exam findings were unremarkable. Although his hyperglycemia improved after initiation of insulin therapy, his electrolyte abnormalities persisted, raising suspicion for adrenal insufficiency. An ACTH stimulation test was performed, with both baseline and 60-minute cortisol levels low at 1 ug/dl and 0.9 ug/dl, respectively, confirming adrenal insufficiency. He responded well to glucocorticoid and mineralocorticoid replacement. His electrolytes and blood pressure normalized. Further testing confirmed elevated levels of Glutamic Acid Decarboxylase antibodies 0.19 nmol/L (less than 0.02), Islet Antigen 2 Antibodies: 3.38 nmol/L (less than 0.02), and 21-Hydroxylase antibodies, consistent with T1D with concomitant Addison’s disease (AD).
Conclusion: About 0.5% of patients with T1D have AD, but the diagnosis of T1D typically precedes AD for several years, thus the coexistence of both autoimmune conditions at diagnosis is rare.
Ketogenic Diet in a Patient With Type 1 Diabetes Mellitus With Hypoglycemia Unawareness
Authors: Sukkari Mohamad Anas , Cotten Lucia , Alam Murtaza , Temponi Emily , John Priya D , Davis Georgia , Vellanki Priyathama 
Published: May 2021

Abstract
Introduction: The high fat, low carbohydrate ketogenic diet has become increasingly popular in recent years for weight loss and glycemic control in patients with type 2 diabetes. Although prior studies have suggested this diet can improve glycemic control and decrease glucose variability, the impact of a ketogenic diet on rates of hypoglycemia in patients with hypoglycemia unawareness is not well described. Case Description: Our patient is a 37 year-old woman with Type 1 diabetes for 13 years complicated by hypoglycemia unawareness with HbA1c of 7.7%. Her insulin treatment regimen included insulin glargine 22 units daily, insulin aspart using a 1:15 carbohydrate ratio for prandial insulin dosing with a correction factor of 90. She had 5 episodes of severe hypoglycemia within the previous 3 months. The patient decided to resume a ketogenic diet given her previous improvement in glycemic control. Ketosis was confirmed using urine ketone strips performed by the patient. After 2 weeks on the ketogenic diet, a professional blinded continuous glucose monitor (CGM) was used for 4 weeks to monitor glycemic control.
CGM data for weeks 1 and 2 showed overall stability of time in target glucose range [TIR, 60% and 69%, respectively], with a slight increase in time spent below range [TBR, 13% and 17%, respectively]. During week 3, the patient experienced a significant decline in TIR to 31%, and associated increase in hypoglycemia (TBR, 13% to 28%). In addition, glycemic variability increased during this time [CV (coefficient of variation), 40.6% during week 1 to 58.1% during week 3]. Patient did not experience symptoms concerning for DKA, and continued to have asymptomatic hypoglycemia despite reductions in her insulin doses during week 3. Following these dose adjustments, CGM data during week 4 were similar to week 1 (TIR 65%, TBR 10%, CV 35%). Patient stopped following the ketogenic diet after 6 weeks due to social factors.
Conclusion: A ketogenic diet was associated with increased frequency of hypoglycemic events. In a patient with Type 1 diabetes and hypoglycemia unawareness, use of ketogenic diet may further increase the risk of severe hypoglycemia.
Alpha and Beta Cell Dysfunction Improves With Effective Insulin Therapy in Treatment Naive Type 2 Diabetes - a Prospective Observational Study
Authors: Ramesh Jayanthy , Makineni Ashok Chakravarthy , Mudimela Madhubabu , Madhira Srivalli 
Published: May 2021

Abstract
Abstract: Type 2 diabetes mellitus is characterized by insulin resistance and progressive beta cell decline. Elevated glucagon levels and impaired incretin axis also contribute to the poor glycemic status. Early intensive glycemic control, reduces long-term vascular complications and may preserve β-cell function. Clinical studies of effect of early insulin therapy on combined alpha and beta cell function are lacking. Objective: To determine the effect of early insulin therapy on combined alpha and beta cell dysfunction (islet cell dysfunction) in newly diagnosed type 2 diabetes. Methods: 56 newly diagnosed type 2 diabetes patients, attending the endocrinology OPD at a tertiary teaching hospital were enrolled in this treatment related follow up study after institutional ethical committee clearance, conducted between May 2017 to December 2018. Patients with HbA1C &gt; 8.5% to &lt;12.5% (n=56) were included in the study. Metabolic (FPG, PPG, HbA1c), and Hormonal parameters (plasma glucagon levels,fasting and 2 hour mixed meal stimulated C peptide and levels) were assessed both at baseline and after 6 months of insulin treatment. Initiating dose of insulin was 0.5 U/kg/day and the dose was titrated according to FPG and 2 hr PPG in order to maintain glycemic goals as per ADA standards. Results: The study included 56 subjects with mean age of 41.24 ± 5.64 years and a mean BMI of 25.5 kg/m2. At the end of 6 months of the study, a significant reduction in the mean FPG, PPG, HbA1C were observed,[FPG (139±14.47 mg/dl), PPG (179.89 ± 19.42mg/dl),HbA1c (7.54± 0.63%)] as compared to baseline mean FPG, (216.30 ± 42.35 mg/dl),2 hour PPG (338.44 ±62.89 mg/dl), HbA1C (10.39 ± 1.56 %) (p &lt;0.001). Baseline glucagon levels were high (197.68± 49.09 pg/ml), and were significantly reduced at 6 months of insulin therapy (107.06±49.09 pg/ml).(p &lt;0.001). In comparison to the baseline a significant increase in both fasting (0.73±0.27 ng/ml) and stimulated c-peptide (1.54±1.02 ng/ml) (p&lt;0.001) levels was observed at end of the study. Conclusion: Combined alpha and beta cell (Islet) dysfunction prevails in newly diagnosed T2DM. And early insulin therapy significantly improves both these defects. The documentation of this novel beneficial effect on islet cell dysfunction in our study strengthens the concept of early insulin therapy in newly diagnosed Type 2 diabetes patients.
Combination Therapy With Premixed & Basal Insulin Analogues in Asian Indians With Type 2 Diabetes
Authors: Srivastava Brijendra Kumar , Anjana R M , Singla Amit , Jebarani S , Viswanathan Mohan 
Published: May 2021

Abstract
Many individuals with type 2 diabetes (T2DM) eventually need insulin for better glycaemic control. Different insulin regimens like basal, premixed, basal plus, split mixed and basal bolus are used in T2DM management. There is not much literature on a combination of premixed insulin in the morning along with basal insulin at night. Such a regimen is preferred by people with T2DM, who do not want to take an afternoon insulin dose due to inconvenience. To study the effect of a premixed insulin given in the morning and long acting basal insulin analogue given at night in T2DM subjects, we looked into this combination. We performed a retrospective study to look into the effects of premixed and basal insulin analogue combination in patients with T2DM (in addition to oral antidiabetic agents). From the diabetes electronic medical records of a tertiary care hospital for diabetes at Chennai in South India, 648 patients on premixed and basal insulin analogue combination, who came for a follow-up visit were included in the final analysis. Baseline characteristics included body weight, BMI, blood pressure, fasting lipid profile, fasting and post prandial plasma glucose and HbA1c were analysed at baseline, and a change in the parameters was studied at the first follow up visit between 5 to 7 months. Mean age of the study population was 60.7± 13.1 years with mean diabetes duration of 20.5 ± 8.0 years. Out of 648 patients included, three fifths were male. Statistically significant improvement was observed in body weight, BMI, HbA1c, systolic blood pressure, lipid profile, fasting blood sugars (P &lt; 0.001) and post prandial blood sugars (P= 0.005) in comparison to baseline values. Significant reduction in HbA1c (1.7 %, p &lt; 0.0001) was observed in those with in the highest tertile of HbA1c (11.3 ± 1.0 %) in comparison to the baseline values. At follow up, nearly a third of study subjects achieved a HbA1c target of &lt; 8% (30.1 % vs 18.4 0%, p =0.0005) in comparison to the baseline values. 28.7 % patients on combination therapy achieved a fasting blood sugar value of &lt; 130 mg/dl at follow up compared to 18.2 % patients at baseline (p &lt;.0001). Similarly, 22 % of the patients on combination therapy also achieved post prandial blood sugars of &lt;180 mg/dl at follow up, compared to 12.2 % (P&lt;.0001) at baseline. This study shows that in T2DM subjects, a simple regimen of premixed and basal insulin analogue combination helps in improving the glycaemic control.
Effect of Oral Calcium Supplementation on Insulin Sensitivity in Patients With Metabolic Syndrome
Authors: Myint Ye , Sein Mya Thanda , Than Khin Saw , Ko Ko , Latt Tint Swe 
Published: May 2021

Abstract
Background: Evidence from epidemiological research suggests that dietary calcium may protect against metabolic abnormality in populations at high risk. Observational studies show the relationship between dietary calcium intake and metabolic syndrome. However evidence for beneficial effect of elemental calcium supplementation on metabolic syndrome is limited. Aims: Present studydetermined whether oral calcium supplementation reduced insulin resistance in patients with metabolic syndrome or not. Methods; Hundred patients who have metabolic syndrome without diabetes mellitus, parathyroid disease, chronic renal failure, pregnancy and lactationwere randomly allocated to the group receiving 1500 mg/ day of elemental calcium as calcium carbonate for 8 weeks and the control group. The primary outcome was change in insulin resistance as measured by homeostasis model assessment of insulin resistance (HOMA-IR). Other outcomes were changes of serum free ionized calcium (FiCa) level with accompanying serum parathyroid hormone (PTH) level. Fasting serum glucose was measured by glucose oxidase method. Serum insulin and PTH level were measured by enzyme linked immunoassay. Total serum ionized calcium was analyzed by Atomic Absorption Spectrophotometry. Serum FiCa(mg/dl) level was calculated by using following formula = [6Ca-(K/3)]/(K+6). Results: Mean age of participants was 47.38±13.2 years in calcium supplement group (n = 50) and 49.46±12.9 years in control group (n=50). Mean body mass index was not significant different between two groups (30.91 ±4.23 vs 30.37 ± 4.62 kg/m2). More female were involved in both group, 72% vs 62% respectively. Baseline biochemical parameters of the participants between two groups were not significantly different. After 8 week intervention period, mean serum FiCa increased significantly from 2.64±1.19 mg/dl to 5.82± 5.59 mg/dl, p&lt;0.0001, serum PTH decreased significantly from 57.88 ±17.05 pg/ml to 35.7±23.12 pg/ml, p&lt;0.0001, HOMA-IR decreased significantly from 5.14 ± 3.71 to 2.94±1.51, p&lt;0.0001. None of these parameters were significantly affected in control group. By comparing biochemical changes of calcium supplement group to control group, Mean (SEM) of paired difference changes were observed in serum FiCa level [3.18(0.81) vs 0.81(0.25)mg/dl, p&lt;0.05], serum PTH level [22.18(3.24) vs 3.58(1.99)pg/ml, p&lt;0.0001] and HOMA-IR [2.19(0.45) vs 0.43(0.21), p&lt;0.05]. It indicated that elemental calcium supplementation not only reduced insulin resistance but also decompensated the higher level of PTH to normal range by replenishing FiCa significantly. Conclusion: Eight-week oral elemental calcium supplementation of 1500mg/day showed beneficial effect on insulin sensitivity in patients with metabolic syndrome.
Effects of Roux-en-Y Gastric Bypass on Type 2 Diabetes Mellitus
Authors: Maraschin Clara K , Blume Carina A , Teló Gabriela H , Trindade Manoel M R , Schaan Beatriz D 
Published: May 2021

Abstract
Abstract: Bariatric surgery is the most effective treatment for classes II and III obesity patients. This surgically induced weight loss is associated with better glycemic control and higher type 2 diabetes mellitus (T2DM) remission rate compared to conventional medical therapy. Roux-en-Y gastric bypass (RYGB) is the most commonly technique performed, and its risks and benefits are well known. We sought to assess the effects of one-year post-RYGB on glycemic control and T2DM remission in a tertiary care teaching public hospital in Porto Alegre, Southern Brazil. This retrospective cohort study included all patients submitted to RYGB between 2010 and 2019 at Hospital de Clínicas de Porto Alegre. Type 2 diabetes mellitus remission was defined as the absence of oral antidiabetic medication and insulin use in association with a glycosylated hemoglobin (HbA1c) &lt;6.5% one-year post-RYGB. This study was approved by the local Ethics Committee (2018-0088). A total of 549 RYGB procedures were performed from 2010 to 2019 among patients aged 42.2 ± 10.7 years, mostly women (84.7%), white (88%), and with a body mass index (BMI) of 49.4 ± 8.5 kg/m². The preoperative prevalence of T2DM was 31.2% (n=171), of which 93.6% used oral antidiabetic medication and 15.6% used insulin. Among T2DM patients, 39% used at least two oral antidiabetic drugs in association, most of them being metformin (91%) and sulfonylureas (19.3%). Preoperative fasting plasma glucose and HbA1c were 143 ± 48.1 mg/dL and 7.3 ± 1.6%, respectively, reducing to 93.6 ± 21.3 mg/dL (p&lt;0.001) and 5.4 ± 0.7% (p=0.002), respectively, one year after RYGB. Excess weight loss one-year post-RYGB was 68.7 ± 17.1%, similar between patients with and without T2DM (p=0.48). At 12 months, 77.4% of T2DM patients discontinued their oral antidiabetic drugs or insulin, and the disease remission rate was 71.3%. Bariatric surgery was effective for T2DM remission among classes II and III obesity patients, which is in accordance with the current literature.
Support: CNPq, FIPE (HCPA)
Efficacy and Safety of a Sodium-Glucose Co-Transporter-2 Inhibitor Versus Placebo as an Add-on Therapy for People With Type 2 Diabetes Inadequately Treated With Metformin: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Lim Jia Leng , Bergero Georgina , Acharya Yogesh , Shaw James , Liew Aaron 
Published: May 2021

Abstract
Metformin monotherapy is often insufficient to achieve or sustain glycemic targets in people with type 2 diabetes. Therefore, we performed a systematic review and meta-analysis to assess the efficacy, safety and tolerability of sodium-glucose co-transporter-2 inhibitors versus placebo as add-on therapy after metformin in type 2 diabetes. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search was performed in the PubMed, www.clinicaltrials.gov and Cochrane Central Register of Controlled Trials databases for relevant randomized controlled trials up until 30th October 2020 that compared sodium-glucose co-transporter-2 inhibitors versus placebo as add-on therapy to metformin. A random-effects model was used. Thirteen randomized controlled trials (4270 participants) met the inclusion criteria. Compared with placebo, sodium-glucose co-transporter-2 inhibitor treatment, as add-on therapy to metformin, was associated with a significant reduction in HbA1c level (mean difference [MD]: -0.6%, 95% CI: -0.7, -0.5; p&lt;0.01), fasting plasma glucose level (MD: -1.4mmol/l; 95% CI; -1.5, -1.3; p&lt;0.01), weight (MD: -2.0kg; 95% CI: -2.2, -1.8; p&lt;0.01), systolic blood pressure (MD: -4.7mmHg; 95% Cl: -5.4, -3.9; p&lt;0.01) and diastolic blood pressure (MD: -2.0mmHg; 95% Cl: -2.5, -1.5; p&lt;0.01). Significantly more participants achieved HbA1c &lt;7% (odds ratio [OR]: 3.1; 95% CI: 2.6, 3.6; p&lt;0.01) in the sodium-glucose co-transporter-2 inhibitor group. Genital mycotic infections (OR: 2.6; 95% CI: 1.4, 4.6; p&lt;0.01) were more common with sodium-glucose co-transporter-2 inhibitors, but there was no significant statistical difference in urinary tract infections (OR: 1.4; 95% CI: 1.0, 2.0; p=0.06), in hypoglycemia (OR: 1.5; 95% CI: 1.0, 2.4; p=0.07), or in discontinuation rates due to adverse events (OR: 0.9; 95% CI: 0.6, 1.5; p=0.68) between the two groups. In summary, in comparison with placebo, add-on therapy with a sodium-glucose co-transporter-2 inhibitor is significantly more efficacious in lowering HbA1c, fasting plasma glucose, weight and blood pressure in people with type 2 diabetes following inadequate glycemic control with metformin. The rate of discontinuation due to adverse events was similar despite higher risk of genital mycotic infections.
Normalization of HbA1c Following an Ad-Libitum, Non-Ketogenic Low Carbohydrate Diet Along With Antidiabetic Agents
Authors: Torbay Naji , Nawar Rita 
Published: May 2021

Abstract
Background and Aims: Recent scientific research has found that remission of T2DM can be achieved with substantial weight loss following hypocaloric diet or bariatric surgery. The DiRECT study has shown that after 12 months of dietary management, almost half of participants achieved remission to a non-diabetic state and off antidiabetic drugs. The aim of our study was to investigate the impact of an ad-libitum, low carbohydrate non-ketogenic diet (LCNK) on T2DM control and weight loss of patients reporting to our clinic. Materials and Methods: We reviewed the medical charts of 131 T2DM patients (60% male) who were not receiving insulin; the average number of years with T2DM was 8.4years, mean age was 52.8±1.0 years, mean HbA1c was 8.4±0.1 %, and mean BMI was 32.7±0.6 kg/m2. We instructed patients on an ad-libitum LCNK diet providing 130 - 150g of carbohydrate/day coupled with combination therapy of Metformin and any of the currently available antidiabetic drugs (except those known to induce weight gain). Those on sulfonylurea or glitazones had their doses tapered down and eventually discontinued. Results: All patients came for a first follow up visit within 3 months of being instructed on the diet. Significant weight loss was observed in these patients (91.5±1.7 vs. 85.6±1.5 Kg, p&lt;0.001); equivalent to a 6% decrease in weight. An A1C level below 6.5 % was observed in 60% of our patients who came for a first follow-up visit and it correlated with weight loss. Given that 10% of our population gained weight due to poor adherence to the diet; A1C below 6.5 % was achieved in 50% of our 42 patients who lost between 0-5kg, and in 60% of those who lost between 5-10kg (48 patients), and in 63% of those who lost 10-15kg (19 patients), and in 100% of those who lost more than 15kg (4 patients). We observed in them significant decreases in FBS, cholesterol, LDL, TG, and SGPT. Of the 131 patients, 59 came for a second follow-up visit within 7.5 months and an even more significant weight loss was observed (92.0±2.6 vs. 83.8±2.0 Kg, p&lt;0.001); equivalent to a 9 % decrease. An A1C level below 6.5 % was observed in 63% of patients who came for a second follow-up visit. Given that 14% of the 59 gained weight; A1C below 6.5 % was achieved in 42% of our 12 patients who lost between 0-5kg, and in 61% of those who lost between 5-10kg (19 patients), and in 57% of those who lost 10-15kg (8 patients), and in 90% of those who lost more than 15kg (11 patients). Antidiabetic agents were in general progressively decreased and adjusted to individual needs. At the end 27% were only on metformin. Conclusion: A LCNK diet is easy to prescribe and easily followed by T2D patients (no calorie restriction or counting). We recommend its use especially in the primary care setting because it brings diabetes under immediate control by lowering A1C levels below 6.5% in more than 60% of patients as shown by our results, as well as inducing significant weight loss.