bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Troublesome Triad: Hypertriglyceridemia-Induced Acute Pancreatitis in Diabetic Ketoacidosis
Authors: Rashid Hytham , Martin Jessie , Truong Alan , Nix Emily , Thoppil Deepu , Sadat Mir Ali 
Published: May 2021

Abstract
Background: Diabeticketoacidosis (DKA) is an acute metabolic derangement that can triggerhypertriglyceridemia-induced acute pancreatitis (HTGAP). While DKA classicallypresents in patients with Type 1 Diabetes Mellitus (DM1), previous literaturedescribes HTGAP in DKA as the initial presentation of Type 2 Diabetes Mellitus(DM2). The following case illustrates the diagnostic complexities of thisenigmatic triangle.
Clinical Case: Apreviously healthy, 28-year-old Hispanic male with a family history of DM2presented to the ED complaining of a sharp epigastric 10/10 pain radiating tothe right flank for one day that evolved into nausea with intractablenonbilious, nonbloody vomiting. He recently immigrated from Mexico City and hasnot seen a physician since childhood. He denied any tobacco, alcohol, norillicit substance use. Oninitial exam, he was afebrile and hemodynamically stable with dry mucosa,epigastric tenderness with voluntary guarding, but no evidence of jaundice,scleral icterus, nor abdominal distention. Pertinent initial labs foundglucosuria and ketonuria with a normal CBC, but his CMP was delayed as hisblood was lipaemic requiring serial dilutions that found hyperglycemia (415mg/dL, n &lt;140), decreased carbon dioxide (17 mmol/L, n:23–29), a high aniongap (18 mmol/L, n&lt;12), elevated ALT (154 u/L, n:4–36). Additional testingfound severely elevated triglycerides (4,427 mg/dL, n&lt;150 mg/dL), elevated lipase(536 u/L, n&lt;160), elevated Beta-hydroxybutyrate (5.30 mg/dL, n&lt;2.81), andan elevated HgA1C (10.1%, n&lt;5.7). These findings confirmed the diagnosis ofDKA with concerns for underlying HTGAP. CT abdomen showed hepatic steatosis andperipancreatic inflammation, confirming the diagnosis. Hewas admitted to the ICU, received aggressive IV fluid resuscitation with 5%dextrose in half normal saline while on an insulin infusion, with morphine andondansetron to control his pain and nausea. His abdominal pain resolved as histriglycerides trended down and anion gap closed. He was transitioned to an oraldiet with subcutaneous insulin prior to discharge on insulin and fenofibrate. At 1 month follow up, he reported medication compliance and denied anyrecurrence.
Conclusion: While DKA rarely triggers HTGAP in &lt;4% of pancreatitis cases, HTGAP willexacerbate DKA as the pancreatic inflammation leads to acute beta celldysfunction causing insulin deficiency, propagating lipolysis. A serumtriglyceride level &gt;1000 mg/dL is required for diagnosis of HTGAP, and thedegree of elevation is associated with the severity of pancreatitis.
Reference: Timilsina, S, et al. (2019). Triad of Diabetic Ketoacidosis,Hypertriglyceridemia, and Acute Pancreatitis: Severity of Acute PancreatitisMay Correlate with the Level of Hypertriglyceridemia. Cureus, 11(6), 4930–4934.
Association Between Metformin and Prevention of Dementia in T2DM Adult Patients
Authors: dos Santos Natalia Moles , Zocaratto Mariana Araujo , Denipote Valeria Coelho , Mendes Julia Dutra , Spagnuolo Fernando Jose 
Published: May 2021

Abstract
Introduction: In 2020 the World Health Organization estimated that the number of people with dementia was 50 million in the world. Furthermore, it is expected about 10 million new cases every year. Alzheimer’s disease (AD) is the most common form of dementia, which represents more than 50% of the cases. Type 2 diabetes mellitus (T2DM) is a major risk factor for AD and dementia. Even in people without clinical dementia, diabetes is associated with decreased cognitive performance and with increased brain atrophy. If comparing general population and people with diabetes, patients with T2DM had a 73% higher risk of developing dementia and a 56% increased risk of developing AD. Typically, the first medication prescribed for T2DM is metformin and it has been associated with the reduction of cognitive decline and the risk of dementia in patients with T2DM when compared with diabetic patients without medication. A randomized, double-blinded, placebo-controlled study demonstrated that during metformin treatment there was an improvement of executive functioning, learning, memory, and attentional abilities. A possible explanations for the protective effect of metformin in patients with T2DM is that it prevents hyperinsulinemia and the formation of amyloid-β plaques in the brain and the onset of AD. Metformin does not only decrease the plasma glucose level in several mechanisms, but it also characterized to beneficially effect serum lipid profiles, reduce inflammatory cell adhesion to endothelium, and exert anti-inflammatory, anti-apoptotic and anti-oxidative properties. Method: A Clinical Scientific Research was made about correlation among dementia and metformin. Were searched and found in PubMed a total of 61 articles between 2015–2020, but only free access and those who correlated metformin and dementia were used. Results: Studies showed that T2DM patients taking metformin had decreased risk of developing dementia or AD if compared to others diabetic patients that were not taking metformin. However, it is being hard to test antidiabetic therapies in AD, because the mechanisms which tie T2DM to Alzheimer clinical syndrome are not totally known. Therefore, to be as effective as possible it is necessary to treat the patients before they develop extensive amyloid and tau tangle burden. Conclusion: Diabetic patients taking metformin have a protector factor to don’t develop dementia or AD, when compared to those who don’t take metformin since they started the treatment before accumulation of amyloid and tau protein in the brain.
Clinical Effectiveness and Safety of Gliclazide MR and Linagliptin Combination in the Management of Patients With T2DM and Chronic Kidney Disease (CKD) Switched From Glimepiride - a Real-World, Retrospective, Observational Study
Authors: Bhattacharyya Supratik , Khalse Maneesha 
Published: May 2021

Abstract
Background: Type 2 diabetes (T2DM) patients are at high risk of developing to CKD and progressing to adverse outcomes vs Nondiabetics. The aim was to evaluate the effectiveness and safety of gliclazide MR switched from glimepiride in combination with linagliptin considering their associated potential benefits in albuminuria reduction and delaying progression of adverse renal outcomes in T2DM patients with kidney disease as shown in previous data. Methodology: The medical study database of the author’s hospital identified T2DM patients with stage 1–3 CKD with mean eGFR of 50.4 ± 8.56 ml/min/1.73 m2 and were inadequately controlled with glimepiride (mean dose 3.24mg) for the last 3 months. These patients were switched to gliclazide MR with appropriate equivalent dose while DPP-4 inhibitors like linagliptin (5 mg OD) (79%), sitagliptin (14%), vildagliptin (7%), were continued as background therapy. About 59.35% of subjects were on glimepiride 2 mg, 21.93% subjects on glimepiride 3 mg and 18.7% on glimepiride 4 mg. The gliclazide dose was up titrated by 30 mg every 15 days to achieve a target post-prandial glucose (PPG) ≤180 mg/dL. The average dose of gliclazide MR during the study was 44 mg; approximately two-thirds of patients 61% were on 60 mg, 22% on 90mg, and 7% on 30 mg. Patients were counselled to recognize the symptoms and record the hypoglycemic episodes. The statistical analysis included the analysis of changes in glycemic control, risk of hypoglycemia & renal function parameters. The patients were followed up for 24 weeks duration. Results: A total 218 eligible patients (110 female & 108 male) with CKD (stages 1–3) were included. The mean age, body weight, baseline HbA1c, FPG, PPG levels, mean eGFR, and UACR (urine albumin creatinine ratio) were 62.94 ± 8.72 years, 67.9 ± 9.33 kg, 8.51 ±0.81%, 148.53 ± 16.72, 202 ± 18.45 mg/dL, 50.49 ± 8.56 ml/min/1.73 m2 and 154.34 mg/g respectively. Gliclazide MR was initiated substituting glimepiride with appropriate dosing determined by the physician. Two subjects discontinued the therapy due to intolerability. At 24 weeks follow up, HbA1c, FPG, PPG level was reduced by -0.63, -10.33, -30.04%, respectively (p&lt; 0.001). There was a significant reduction in events of overall hypoglycemia (22.25%). Improvement in renal function with respect to eGFR level (+1.77 ml/min/1.73 m2) and albuminuria reduction (-45.56 mg/g) were also observed in patients. Conclusion: This study demonstrates the clinical effectiveness and safety of gliclazide MR with the combination of DPP-4is like linagliptin as an alternate option to glimepiride in diabetes patients with chronic kidney disease.
Detecting Frailty in Elderly Type 2 Diabetes Mellitus (T2DM) Patients in the Southeast of Brazil
Authors: Ramos-Dias João Carlos , Peña Stela Souza , Peng Michelle Li Pin , Oliveira Matheus Rauen , Chamma Rayssa Fabiana , Wanderley Patricia Varotto , Gugoni Lilian Halcsik Sollitari , Barcellos Cristiano Roberto 
Published: May 2021

Abstract
Introduction: Brazil is the fifth country with the highest number of diabetes cases in the world, which has been increasing significantly over the last 35 years. In Brazil, the prevalence of diabetes in 2019 was 16.8 million people, 21.8% of whom are elderly. Diabetes potentialize geriatric syndromes, such as frailty, a state of increased vulnerability to stressors and cumulative decline in multiple physiological systems over lifespan. Objective: To identify frailty in elderly patients with T2DM treated in a tertiary care outpatient clinic in the southeast of Brazil and to estimate their cognition. Methods: This is a cross-sectional analytical study. The patients were classified according to the five Fried frailty phenotype criteria: (1) unintentional weight loss ≥ 4.5 kg or 5% of body weight in the previous year; (2) exhaustion assessed by self-reported fatigue, indicated by two questions on the Center for Epidemiological Studies Depression Scale; (3) weakness measured with a dynamometer in the dominant hand and adjusted according to gender and body mass index (BMI); (4) low level of physical activity measured by weekly energy expenditure in kcal (based on self-reported activities and physical exercises); (5) slowness, according to the time spent walking 4.6 meters adjusted by gender and height. In addition, we also evaluated fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), BMI, calf and waist circumference. To estimate the cognition, we used the 10-point cognitive screener (10-CS) to indicate temporal orientation, category fluency and words recall. Results: 50 elderly patients (39 women and 11 men) with mean age of 69.8 years were evaluated. The mean FPG levels was 168 ± 72 mg/dl and HbA1c &gt; 7% was present in 82% of them. BMI ≥ 25 kg/m2 was observed in 40 patients (80%). All male patients have a normal calf circumference (&gt; 34 cm) and 30/39 female patients (76.9%) have a normal calf circumference (&gt; 33 cm). Waist circumferences ≥ 80 cm in women and ≥ 94 cm in men were present in 100% of women and 90.9% of men. Frailty was observed in 34% (n=17) and cognitive impairment in 40% (n=20) of the patients, according to the five Fried frailty phenotype criteria and CS-10, respectively. Conclusion: Early detection of frailty is very important for considering interventions aimed at elderly people. These interventions could reduce the functional decline and the risk of disability in these individuals over time and, besides that, are able to promote a better quality of life.
Diabetes Does Not Worsen Outcomes of Patients Admitted for Hyperthyroidism: Analysis of the National Inpatient Sample
Authors: Shaka Hafeez , Akuna Emmanuel , Williams Dimeji Olukunmi , Asemota Iriagbonse , Edigin Ehizogie , Asotibe Jennifer Chiagoziem , Velazquez Genaro 
Published: May 2021

Abstract
Introduction: Both diabetes mellitus (DM) and hyperthyroidism are common diseases. However, it is unclear if co-existing DM worsens outcomes in patients with hyperthyroidism. This study aims to compare the outcomes of patients primarily admitted for hyperthyroidism with and without a secondary diagnosis of DM.
Methods: Data were extracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalizations for adult patients with hyperthyroidism as principal diagnosis with and without DM as secondary diagnosis using ICD 10 codes. The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges and NSTEMI were secondary outcomes of interest. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders.
Results: There were over 71 million hospitalizations in the combined NIS 2016 and 2017 database. Out of 17,705 hospitalizations for hyperthyroidism, 2,160 (15.9%) had DM. Hospitalizations for hyperthyroidism with DM had similar inpatient mortality [0.35% vs 0.50%, AOR 0.25, 95% CI (0.05–1.30), P= 0.101], total hospital charge [$47,001 vs $36,978 P=0.220], LOS [4.50 vs 3.48 days, P=0.050] and NSTEMI compared to those without DM.
Conclusion: Hospitalizations for hyperthyroidism with DM had similar inpatient mortality, total hospital charges, LOS and odds of undergoing ablation compared to those without obesity.
Effect of Glycemic Control on Outcome of Acute Exacerbation of Chronic Obstructive Pulmonary Disease(AECOPD)
Authors: Guha Abhraneel Parames 
Published: May 2021

Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is defined as a common preventable and treatable disease that is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. In this article we compared hospital stay between diabetic, non diabetic and prediabetic patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) who were treated with corticosteroids. We checked in hospital mortality and 30 day mortality in patients with AECOPD patients with diabetes, Its the first article on this topic from eastern India. Materials and Methods: The study was done in tertiary care centre from November 2017 to April 2019. We included 161 patients with age more than 40 years or more. Patients admitted in hospital with COPD with cough, sputum, dyspnea were included. They were divided into diabetic,prediabetic and non diabetic. We included readmission of patients who were diagnosed previously as AECOPD. Statistical Analysis was performed with help of Epi Info (TM) 7.2.2.2 EPI INFO is a trademark of the Centers for Disease Control and Prevention (CDC). It was a prospective observational study. Results: We found significant association between length of hospital stay and those with AECOPD with diabetes.29.6% of patients with diabetes had a stay of more than two weeks. Hospital stay was found to be 10.8+/-2.30 days in those who had mean random blood sugar (RBS) between 140 -170 mg/dl, 12.98 +/- 2.24 days in those who had RBS between 170–200 mg/dl and 12.62 +/- 3.10 days in those who had RBS more than 200 mg/dl. 89.4% of patient had a BMI (Body mass index) of &lt; 25 kg/square meter. 8.1 % died in hospital and 9.5% died within 30 days of discharge. Among those who were treated with steroids, diabetic patients had a stay of 14.55+/- 0.74 days, compared to prediabetic who had a stay of 14.07+/-1.26 days and non diabetics who had 12.5+/-1.33 days. No association was found between hospital mortality and status of diabetes mellitus. No association was found between 30 day mortality and diabetes mellitus in our study. Conclusion: Diabetes Mellitus and AECOPD are major public health challenges. Whether there is an association between them needs to be addressed, specially in this part of the world. Those patients who were diabetic and treated with steroids had a longer stay than non diabetics and prediabetics. We found no association between hospital mortality and 30 day mortality with diabetes mellitus.
Efficacy and Safety of SGLT2 Inhibitors in Diabetic Kidney Transplant Patients: Review of the Current Literature
Authors: Shuster Shirley , Al-Hadhrami Zeyana , Awad Sara , Moore Sarah , Shamseddin Khaled 
Published: May 2021

Abstract
Introduction: SGLT2 inhibitors are oral hypoglycemic medications used in type 2 diabetes mellitus (T2DM). They act by blocking glucose and sodium reabsorption in the proximal renal tubules. In patients with T2DM and cardiovascular disease, SGLT2 inhibitors have been shown to improve glycemic control, promote weight loss, and reduce major adverse cardiovascular events (MACE). They have also been shown to have favorable renal outcomes in patients with chronic kidney disease (CKD) reducing albuminuria and progression to end-stage renal disease; however, all studies have excluded kidney transplant patients. The objective of this review was to determine the efficacy and safety of SGLT2 inhibitors in the kidney transplant population.
Methods: We conducted a literature review to identify studies which assessed the use of SGLT2 inhibitors in kidney transplant patients with either T2DM or new onset diabetes after transplant (NODAT). The outcomes assessed included blood pressure, glycemic control, body weight, kidney function, proteinuria and complications.
Results: Nine studies, which included 144 patients, were extracted for review. These included x4 case series, x3 cohort studies, x1 randomized control trial (RCT), and x1 case report. The largest study was a prospective RCT from Norway, which assessed empagliflozin versus placebo in 44 patients. Majority of patients had NODAT (n=92) or T2DM (n=50). All patients had estimated glomerular filtration rate (eGFR) &gt;30mL/min/1.73m2 and HbA1C &gt;6.5%. The most commonly used SGLT2 inhibitors were empagliflozin (n=82), canagliflozin (n=34), and dapagliflozin (n=28). SGLT2 inhibitor use in kidney transplant patients was found to demonstrate a small or non-significant reduction in blood pressure, modest improvement in glycemic control and decrease in insulin resistance, and moderate-to-significant weight reduction. It also resulted in stable graft function and one study demonstrated a reduction in proteinuria. The most common adverse effect was urinary tract infection (n=13). There were no cases of diabetic ketoacidosis or development of new ischemic lower limb ulcerations or amputations.
Conclusion: Our literature review suggests beneficial outcomes of SGLT2 inhibitor use in diabetic kidney transplant patients, with no significant adverse effects or complications. Given the limited evidence in this population, we are launching a prospective study in kidney transplant patients with either T2DM or NODAT, and with eGFR ≥30mL/min/1.73m2, to assess the efficacy and safety of SGLT2 inhibitor use in this population. To our knowledge, this will be the first prospective study in Canada assessing SGLT2 inhibitor use in diabetic kidney transplant patients.
Enhanced Insulin Signaling Through Its Receptor Is Needed for the Development of Hyperuricemia in Humans
Authors: Haykal Rasha , Kinzer Alexandra , Abel Brent , Startzell Megan S , Cochran Elaine , Brown Rebecca J 
Published: May 2021

Abstract
Background: There is an association between insulin resistance (IR) and hyperuricemia but the direction of causalityand mechanisms are unclear. In obesity and lipodystrophy, IR is “selective”, with lack of insulin signalingcausing hyperglycemia, but enhanced insulin signaling causing dyslipidemia and possibly hyperuricemia. Rare human conditions exist in which there is extreme, non-selective, IR impairing all insulin signalingpathways (e.g. mutations of the insulin receptor, INSR). We hypothesized that hyperinsulinemia withenhanced signaling through the insulin receptor causes hyperuricemia in selective IR, whereas lack ofinsulin signaling through its receptor despite hyperinsulinemia results in normal uricemia in non-selective IR. Method: Cross-sectional retrospective analysis comparing fasting insulin and serum uric acid in patients withsevere IR that was either selective (due to lipodystrophy) or non-selective (due to INSR mutation orautoantibody to the insulin receptor). Visits were chosen based on availability of serum uric acid andinsulin. If multiple visits were available, the visit with the highest insulin value was chosen. Results: We analyzed data of 68 patients with selective IR and 14 patients with non-selective IR. Fasting seruminsulin median [interquartile range] was 23.4 [14, 53] mcU/mL in selective IR vs 215 [73.7, 604] in non-selective IR, p &lt;0.0001. Serum uric acid was 4.8 [2, 6] mg/dL in selective IR vs 3.5 [2, 4] in non-selectiveIR, p=0.0003. Conclusion: Patients with selective IR due to lipodystrophy had elevated serum uric acid, consistent with thehyperuricemia seen in selective IR caused by obesity. By contrast, patients with non-selective IR hadlower serum uric acid despite more severe IR as evidenced by almost 10-fold higher fasting insulin. These observations are consistent with a model in which enhanced insulin signaling through its receptorleads to hyperuricemia in post-receptor IR. Further studies are needed to understand the mechanism bywhich insulin leads to hyperuricemia.
Serum Albumin Modifies the Effect of Peripheral Blood Monocytes on Severity of Diabetic Nephropathy
Authors: Cristancho Cagney 
Published: May 2021

Abstract
Aims: To characterize clinical associations with peripheral blood immune populations, serum inflammatory markers, and diabetic nephropathy in persons with type 2 diabetes mellitus. Methods: We identified a cohort of clinically well-defined patients from a primary care clinic at a medium-sized academic medical center. We queried hospital records between 2018 and 2019 for complete blood counts with differentials, serum inflammatory markers, and urine microalbumin/creatine ratios. 198 patients met these criteria. We assessed univariable and multivariable associations between demographic, clinical, and peripheral blood predictors of kidney end-organ damage as determined by microalbumin/creatinine ratios or estimated glomerular filtration rate. All analyses used linear or logistic regression models. Results: Adjusted analyses demonstrated significant (p&lt;0.01) associations between higher urine albumin-creatinine ratio and peripheral circulating monocytes independent of other established significant risk factors including blood pressure, hemoglobin A1c, age, and gender. We also identify serum albumin as an unexpected but potentially important modifying factor of kidney disease which interacts with monocytes. Conclusion: Circulating monocytes and serum albumin are significantly associated with diabetic nephropathy. These results support the potential role of the innate immune system in diabetic microvascular end-organ damage, and may be readily translatable clinical markers to incorporate into risk-assessment models for prognostication in diabetes.