Experimental and Clinical Endocrinology & Diabetes最新文献

{"title":"Severe Acquired Primary Hypothyroidism in Children and its Influence on Growth: A Retrospective Analysis of 43 Cases.","authors":"Marianne Becker,&nbsp;Oliver Blankenstein,&nbsp;Erwin Lankes,&nbsp;Dirk Schnabel,&nbsp;Heiko Krude","doi":"10.1055/a-1538-8241","DOIUrl":"https://doi.org/10.1055/a-1538-8241","url":null,"abstract":"<p><strong>Introduction: </strong>Severe acquired hypothyroidism in childhood is a rare condition, mostly caused by autoimmune thyroiditis. Scarce and inconsistent data based on small patient numbers exist concerning its impact on growth in height.</p><p><strong>Methods: </strong>Patient files at a single centre university hospital over 8 years were retrospectively reviewed. We identified 43 patients (mean age 10.6 years, 3.3-15.25, 59% prepubertal, 88% females) in a cohort of children older than 3 years with an initial TSH>30 mIU/l and reduced T4 or fT4; congenital and drug-induced hypothyroidism were excluded.</p><p><strong>Results: </strong>All patients had signs of autoimmune thyroiditis (93% positive autoantibodies, 95% typical ultrasonography, 63% goiter). Median TSH was 100 mIU/l [0.3-4 mIU/l]), median fT4 3.55 pg/ml [8-19 pg/ml], median T4 2.85 µg/dl [5.3-11 µg/dl]. Presenting symptoms included goiter (26%), tiredness (23%), weight gain (19%), and growth retardation (19%). The diagnosis was made incidentally in 26% patients. In 75% growth was retarded (median height standard deviation score (SDS)-0.55), in 17% height SDS was<-2 at diagnosis. Midparental height SDS at diagnosis correlated significantly with T4 and fT4 (r=0.77, p=0.0012 and r=0.53, p=0.021 respectively). Catch-up growth under T4 substitution was significantly greater in prepubertal than in pubertal children (p 0.049).</p><p><strong>Conclusion: </strong>This so far largest pediatric cohort with severe acquired hypothyroidism confirms a serious impact on growth which, however in most cases, showed a certain catch-up growth after adequate L-thyroxine therapy. The pubertal state seems to be important for catch-up growth. A significant number of patients were not diagnosed clinically, although affected by severe hypothyroidism.</p>","PeriodicalId":12241,"journal":{"name":"Experimental and Clinical Endocrinology & Diabetes","volume":"130 4","pages":"217-222"},"PeriodicalIF":1.8,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39485355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum NT-pro-BNP Levels Predict Cardiovascular Events in Acromegaly Patients.","authors":"Marta Ragonese,&nbsp;Gianluca Di Bella,&nbsp;Federica Spagnolo,&nbsp;Loredana Grasso,&nbsp;Angela Alibrandi,&nbsp;Guiseppe Giuffrida,&nbsp;Mariacarla Moleti,&nbsp;Francesco Ferraù,&nbsp;Salvatore Cannavò","doi":"10.1055/a-1540-5009","DOIUrl":"https://doi.org/10.1055/a-1540-5009","url":null,"abstract":"<p><strong>Background: </strong>Acromegaly is associated with an increased risk of fatal and non-fatal cardiovascular (CV) events. Controlling acromegaly decreases, but does not normalize this risk. Brain natriuretic peptide (BNP) assessment is used in the general population for the diagnosis of heart failure and to predict ischemic recurrences and mortality. This is a retrospective, longitudinal, monocenter study that evaluates the role of serum N-terminal fragment of BNP (NT-pro-BNP) for predicting CV events in acromegaly patients.</p><p><strong>Methods: </strong>Serum NT-pro-BNP levels were measured in 76 patients with acromegaly (23 males, 57.7±1.5 years), and compared with other predictors of CV events. NT-pro-BNP cut-off value discriminating the occurrence of CV events was determined by ROC analysis. CV events were recorded during a follow-up of 78.6±6.4 months.</p><p><strong>Results: </strong>CV events occurred in 9.2% of patients. Mean log(NT-pro-BNP) concentration was higher in patients who experienced CV events than in those who did not (p<0.01) and in patients who died due to CV events than in those who died due to other causes (p<0.01). Based on the ROC curve, a cut-off value of 91.55 pg/mL could predict CV events (OR 19.06). Log(NT-pro-BNP) was lower in surgically treated patients by surgery (p<0.05), and in those cured by neurosurgery (p<0.02).</p><p><strong>Conclusions: </strong>High NT-pro-BNP value is an independent middle-term predictor of fatal or non-fatal CV events in patients with acromegaly. According to this parameter, surgically treated patients show lower CV risk than those managed with medical therapy, especially if the disease is cured.</p>","PeriodicalId":12241,"journal":{"name":"Experimental and Clinical Endocrinology & Diabetes","volume":"130 4","pages":"229-236"},"PeriodicalIF":1.8,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3f/97/10-1055-a-1540-5009.PMC9072124.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39752692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients with Central Hypothyroidism are Less Sufficiently Treated with Levothyroxine than Patients with Primary Hypothyroidism.","authors":"Barbara Samec,&nbsp;Gaja Setnikar,&nbsp;Simona Gaberscek,&nbsp;Tomaz Kocjan","doi":"10.1055/a-1543-8826","DOIUrl":"https://doi.org/10.1055/a-1543-8826","url":null,"abstract":"<p><strong>Background: </strong>Contrary to patients with hypothyroidism after radioiodine (HRI) or after thyroidectomy (HTh), patients with central hypothyroidism (CH) cannot rely on thyrotropin (TSH) level to guide their treatment with L-thyroxine (L-T4). Consequently, they are at constant risk of under- or overtreatment. We aimed to establish the adequacy of L-T4 treatment in patients with CH in our cohort.</p><p><strong>Methods: </strong>Consecutive patients with CH on L-T4 treatment were compared with patients adequately treated for HRI or HTh. Levels of free thyroxine (fT₄) and free triiodothyronine (fT₃) were evaluated and the fT₄/fT₃ ratio was calculated.</p><p><strong>Results: </strong>Forty patients with CH, 136 patients with HRI and 43 patients with HTh were included in this study. Patients with HRI were significantly younger than patients with HTh and CH (p<0.001 for both). Levels of fT₄ were significantly lower in CH than in adequately treated patients with HRI and HTh (median (range), 15.6 (12.7-21.3), 18.4 (12.2-28.8), and 18.7 (13.8-25.5) pmol/L, respectively, p<0.001 for both comparisons). Levels of fT₃ did not differ significantly (p=0.521) between CH, HRI and HTh (median (range), 4.5 (2.7-5.9), 4.3 (3.2-6.2), and 4.4 (2.9-5.5) pmol/L, respectively). Accordingly, the fT₄/fT₃ ratio was significantly lower in the CH group than in HRI and HTh groups (median (range), 3.7 (2.5-5.2), 4.2 (1.2-7.7), and 4.4 (2.5-6.1), respectively, p<0.001 for both comparisons).</p><p><strong>Conclusions: </strong>Patients with CH have lower fT₄ levels and lower fT₄/fT₃ ratios than patients adequately treated for HRI or HTh. The cause for this difference may be the unreliable TSH levels in patients with CH.</p>","PeriodicalId":12241,"journal":{"name":"Experimental and Clinical Endocrinology & Diabetes","volume":"130 4","pages":"223-228"},"PeriodicalIF":1.8,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39263130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ZFAND3 Overexpression in the Mouse Liver Improves Glucose Tolerance and Hepatic Insulin Resistance.","authors":"Kahori Shimizu,&nbsp;Yuya Ogiya,&nbsp;Kaede Yoshinaga,&nbsp;Hajime Kimura,&nbsp;Shotaro Michinaga,&nbsp;Moe Ono,&nbsp;Ayako Taketomi,&nbsp;Tomoyuki Terada,&nbsp;Fuminori Sakurai,&nbsp;Hiroyuki Mizuguchi,&nbsp;Koji Tomita,&nbsp;Toru Nishinaka","doi":"10.1055/a-1400-2656","DOIUrl":"https://doi.org/10.1055/a-1400-2656","url":null,"abstract":"<p><p>Genome-wide association studies have identified more than 300 loci associated with type 2 diabetes mellitus; however, the mechanisms underlying their role in type 2 diabetes mellitus susceptibility remain largely unknown. Zinc finger AN1-type domain 3 (ZFAND3), known as testis-expressed sequence 27, is a type 2 diabetes mellitus-susceptibility gene. Limited information is available regarding the physiological role of ZFAND3 <i>in vivo</i>. This study aimed to investigate the association between ZFAND3 and type 2 diabetes mellitus. ZFAND3 was significantly upregulated in the liver of diabetic mice compared to wild-type mice. To overexpress ZFAND3, we generated a ZFAND3-expressing adenovirus (Ad) vector using an improved Ad vector exhibiting significantly lower hepatotoxicity (Ad-ZFAND3). Glucose tolerance was significantly improved in Ad-ZFAND3-treated mice compared to the control Ad-treated mice. ZFAND3 overexpression in the mouse liver also improved insulin resistance. Furthermore, gluconeogenic gene expression was significantly lower in primary mouse hepatocytes transduced with Ad-ZFAND3 than those transduced with the control Ad vector. The present results suggest that ZFAND3 improves glucose tolerance by improving insulin resistance and suppressing gluconeogenesis, serving as a potential novel therapeutic target for type 2 diabetes mellitus.</p>","PeriodicalId":12241,"journal":{"name":"Experimental and Clinical Endocrinology & Diabetes","volume":"130 4","pages":"254-261"},"PeriodicalIF":1.8,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/a-1400-2656","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25529693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Serum WISP1 Levels are Associated with Lower Extremity Atherosclerotic Disease in Patients with Type 2 Diabetes Mellitus.","authors":"Yangyang Cheng,&nbsp;Xiaohui Du,&nbsp;Bilin Zhang,&nbsp;Junxia Zhang","doi":"10.1055/a-1474-8220","DOIUrl":"https://doi.org/10.1055/a-1474-8220","url":null,"abstract":"<p><strong>Background: </strong>Serum wnt1-induced signaling pathway protein 1 (WISP1) levels are increased with obesity, which is a common complication associated with lower extremity atherosclerotic disease (LEAD). However, to date, the relationship between elevated WISP1 levels and the incidence of lower extremity atherosclerotic disease (LEAD) in type 2 diabetes mellitus (T2DM) remains unclear.</p><p><strong>Methods: </strong>174 newly diagnosed type 2 diabetic patients were enrolled in our study. Patients were divided into two groups, LEAD group (n=100) and control group (n=74). Anthropometric parameters, blood pressure and some biochemical parameters were obtained. Body composition was detected by bioelectrical impedance analysis (BIA). Levels of serum insulin were determined by radioimmunoassay. Serum WISP1 and interleukin 6 (IL-6) levels were determined using an enzyme-linked immunosorbent assay.</p><p><strong>Results: </strong>It was shown that serum WISP1 levels in diabetic patients with LEAD were higher than those without LEAD (<i>P</i><0.001). Serum WISP1 levels were positively related with waist circumference (<i>r</i>=0.237, <i>P=</i>0.003), waist-hip ratio (<i>r=</i>0.22, <i>P=</i>0.006), visceral fat area (<i>r=</i>0.354, <i>P</i><0.001), serum creatinine (<i>r=</i>0.192, <i>P=</i>0.012), interleukin 6 (<i>r=</i>0.182, <i>P=</i>0.032), c-reactive protein (<i>r=</i>0.681, P<0.001), triglycerides (<i>r=</i>0.119, <i>P</i><0.001), fasting glucose (<i>r=</i>0.196, <i>P=</i>0.011), glycated hemoglobin (<i>r=</i>0.284, <i>P</i><0.001), and HOMA-IR (<i>r=</i>0.285, <i>P</i><0.026). Compared with the lowest tertile, the odds ratio of the middle tertile for LEAD incidence was 3.27 (95% CI, 1.24-8.64) and 4.46 (95% CI, 1.62-12.29) for the highest tertile after adjusting confounding factors.</p><p><strong>Conclusion: </strong>The results suggest that increased serum WISP1 levels independently contribute to the incidence of LEAD in patients with newly diagnosed T2DM.</p>","PeriodicalId":12241,"journal":{"name":"Experimental and Clinical Endocrinology & Diabetes","volume":"130 4","pages":"248-253"},"PeriodicalIF":1.8,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/a-1474-8220","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38935955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing Reference Ranges for Aldosterone, Renin and Aldosterone-to-Renin Ratio for Women in the Third-Trimester of Pregnancy.","authors":"Krzysztof C Lewandowski,&nbsp;Monika Tadros-Zins,&nbsp;Wojciech Horzelski,&nbsp;Mariusz Grzesiak,&nbsp;Andrzej Lewinski","doi":"10.1055/a-1467-2161","DOIUrl":"https://doi.org/10.1055/a-1467-2161","url":null,"abstract":"<p><strong>Objective: </strong>Diagnosis of primary hyperaldosteronism in pregnancy is complicated due to lack of reference ranges for aldosterone, renin and aldosterone-to-renin ratio. We have endeavoured to establish third-trimester reference ranges for the above-mentioned parameters.</p><p><strong>Design & patients: </strong>We performed postural tests for aldosterone and renin (chemiluminescence immunoassay Liason® DiaSorin Inc., Italy) in 70 healthy pregnant women (age 30.53±4.51 years), at 32.38±4.25 weeks of gestation and in 22 non-pregnant healthy women (age 33.08±8.72 years).</p><p><strong>Results: </strong>Aldosterone reference ranges were 6.51-73.97 ng/dl and 12.33-86.38 ng/dl, for supine and upright positions, respectively and that for renin were 6.25-59.36 µIU/ml and 11.12-82.55 µIU/ml, respectively. Aldosterone and renin concentrations were higher in an upright position (p=0.000459 and p=0.00011, respectively). In contrast, aldosterone-to-renin ratio was not affected by posture (i. e. 0.497-3.084 ng/dl/µIU/ml versus 0.457-3.06 ng/dl/µIU/ml, p=0.12), but was higher (p=0.00081) than in non-pregnant controls. In comparison to manufacturer-provided non-pregnant reference range, supine aldosterone concentrations increased by 556% (lower cut-off) and 313% (upper cut-off), while upright aldosterone concentrations increased by 558% (lower cut-off) and 244% (upper cut-off). The reference range for supine renin concentrations increased by 223% (lower cut-off) and 48.7% (upper cut-off), while upright renin concentrations increased by 253% (lower cut-off) and 79% (upper cut-off).</p><p><strong>Conclusions: </strong>There is an upward shift in aldosterone and renin reference ranges in the third-trimester of pregnancy accompanied by an increase in an aldosterone-to-renin ratio, that is not influenced by posture. It remains to be established whether the aldosterone-to-renin ratio may be used as a screening tool for primary hyperaldosteronism in pregnancy.</p>","PeriodicalId":12241,"journal":{"name":"Experimental and Clinical Endocrinology & Diabetes","volume":"130 4","pages":"210-216"},"PeriodicalIF":1.8,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39761938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reductions in Intestinal Taurine-Conjugated Bile Acids and Short-Chain Fatty Acid-Producing Bacteria Might be Novel Mechanisms of Type 2 Diabetes Mellitus in Otsuka Long-Evans Tokushima Fatty Rats.","authors":"Xiaoyun Yang,&nbsp;Wenhui Jiang,&nbsp;Jingli Cheng,&nbsp;Jintong Hao,&nbsp;Fei Han,&nbsp;Yi Zhang,&nbsp;Jie Xu,&nbsp;Chunyan Shan,&nbsp;Jingyu Wang,&nbsp;Yanhui Yang,&nbsp;Juhong Yang,&nbsp;Baocheng Chang","doi":"10.1055/a-1643-1689","DOIUrl":"https://doi.org/10.1055/a-1643-1689","url":null,"abstract":"<p><strong>Background: </strong>The pathogenesis of spontaneously diabetic Otsuka Long-Evans Tokushima Fatty (OLETF) rats, among the best models for human type 2 diabetes mellitus (T2DM), remains poorly defined. Therefore, we investigated the dynamic changes in taurine-conjugated bile acids (T-BAs) and intestinal microbiota during T2DM development in OLETF rats.</p><p><strong>Methods: </strong>OLETF rats and corresponding diabetes-resistant Long Evans Tokushima Otsuka (LETO) rats were fed a normal baseline diet. The progress of T2DM was divided into four phases, including normal glycemia-normal insulinemia (baseline), normal glycemia-hyperinsulinemia, impaired glucose tolerance, and DM. Body weight, liver function, blood lipids, fasting plasma glucose, fasting plasma insulin, fasting plasma glucagon-like peptide (GLP)-1 and GLP-2, serum and fecal T-BAs, and gut microbiota were analyzed during the entire course of T2DM development.</p><p><strong>Results: </strong>There were reductions in fecal T-BAs and short-chain fatty acids (SCFAs)-producing bacteria including <i>Phascolarctobacterium</i> and <i>Lactobacillus</i> in OLETF rats compared with those in LETO rats at baseline, and low levels of fecal T-BAs and SCFAs-producing bacteria were maintained throughout the whole course of the development of T2DM among OLETF rats compared with those in corresponding age-matched LETO rats. Fecal taurine-conjugated chenodeoxycholic acid correlated positively with <i>Phascolarctobacterium</i>. Fecal taurine-conjugated deoxycholic acid correlated positively with <i>Lactobacillus</i> and fasting plasma GLP-1 and inversely with fasting plasma glucose.</p><p><strong>Conclusion: </strong>The fecal BAs profiles and microbiota structure among OLETF rats were different from those of LETO rats during the entire course of T2DM development, indicating that reductions in intestinal T-BAs and specific SCFA-producing bacteria may be potential mechanisms of T2DM in OLETF rats.</p>","PeriodicalId":12241,"journal":{"name":"Experimental and Clinical Endocrinology & Diabetes","volume":"130 4","pages":"237-247"},"PeriodicalIF":1.8,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39744007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 and Cardiovascular Comorbidities.","authors":"Dirk Müller-Wieland,&nbsp;Nikolaus Marx,&nbsp;Michael Dreher,&nbsp;Katharina Fritzen,&nbsp;Oliver Schnell","doi":"10.1055/a-1269-1405","DOIUrl":"https://doi.org/10.1055/a-1269-1405","url":null,"abstract":"<p><p>The emergence of a new coronavirus - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - has resulted in a global pandemic. The associated coronavirus disease 2019 (COVID-19) has resulted in a high number of death worldwide. Observational studies and case reports have provided insights that older age and the presence of chronic diseases is frequently associated with a higher COVID-19 severity. These individuals also seem to have a higher risk of mortality due to COVID-19. In this review we provide insights into the impact chronic diseases associated with the cardiovascular system, such as obesity, diabetes mellitus, hypertension and cardiovascular disease might have on SARS-CoV-2 infection and COVID-19. Additionally we review recommendations and guidance's of international scientific associations and discuss which key learnings might be of importance for the future.</p>","PeriodicalId":12241,"journal":{"name":"Experimental and Clinical Endocrinology & Diabetes","volume":"130 3","pages":"178-189"},"PeriodicalIF":1.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/a-1269-1405","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38577534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conversations and Reactions Around Severe Hypoglycaemia (CRASH): Results from the German Cohort of a Global Survey of People with Type 1 Diabetes or Insulin-Treated Type 2 Diabetes and Caregivers.","authors":"Elisabeth Mönnig,&nbsp;Erik Spaepen,&nbsp;Beatrice Osumili,&nbsp;Beth D Mitchell,&nbsp;Frank Snoek,&nbsp;Mark Peyrot,&nbsp;Werner Kern,&nbsp;Andreas Holstein","doi":"10.1055/a-1310-7963","DOIUrl":"https://doi.org/10.1055/a-1310-7963","url":null,"abstract":"<p><strong>Background: </strong>A global cross-sectional survey (CRASH) was designed to provide information about the experiences of people with diabetes (PWD) and their caregivers in relation to severe hypoglycaemic events.</p><p><strong>Methods: </strong>Adults with type 1 diabetes or insulin-treated type 2 diabetes who had experienced one or more severe hypoglycaemic events within the past 3 years, and adult caregivers for such people, were recruited from medical research panels using purposive sampling. We present here results from Germany.</p><p><strong>Results: </strong>Approximately 100 individuals in each of the four participant groups completed a 30-minute online survey. Survey results indicated that the most recent severe hypoglycaemic event made many participants feel scared (80.4%), unprepared (70.4%), and/or helpless (66.5%). Severe hypoglycaemia was discussed by healthcare professionals at every visit with only 20.2% of participants who had ever had this conversation, and 53.5% of participants indicated that their insulin regimen had not changed following their most recent event. 37.1% of PWD/people with diabetes cared for by caregivers owned a glucagon kit at the time of survey completion.</p><p><strong>Conclusions: </strong>The survey identified areas for improvement in the prevention and management of severe hypoglycaemic events. For healthcare professionals, these include enquiring more frequently about severe hypoglycaemia and adjusting blood glucose-lowering medication after a severe hypoglycaemic event. For individuals with diabetes and their caregivers, potential improvements include ensuring availability of glucagon at all times. Changes in these areas could lead not only to improved patient wellbeing but also to reduced use of emergency services/hospitalisation and, consequently, lower healthcare costs.</p>","PeriodicalId":12241,"journal":{"name":"Experimental and Clinical Endocrinology & Diabetes","volume":"130 3","pages":"145-155"},"PeriodicalIF":1.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/a-1310-7963","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38755569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Considering Insulin Secretory Capacity as Measured by a Fasting C-Peptide/Glucose Ratio in Selecting Glucose-Lowering Medications.","authors":"Andreas Fritsche,&nbsp;Martin Heni,&nbsp;Andreas Peter,&nbsp;Baptist Gallwitz,&nbsp;Monika Kellerer,&nbsp;Andreas L Birkenfeld,&nbsp;Hans-Ulrich Häring,&nbsp;Robert Wagner","doi":"10.1055/a-1242-9809","DOIUrl":"https://doi.org/10.1055/a-1242-9809","url":null,"abstract":"<p><p>Type 2 diabetes mellitus is a heterogeneous disease. Recently introduced new subclassifications promise more efficacious, tailored treatments which could complement current guidelines. In the differentiation of the new diabetes subphenotypes, assessment of insulin secretion is one of the essential components. Based on a large number of insulin secretion measurements, we propose fasting C-peptide/glucose ratio (CGR) as an adequate and practicable estimate of insulin secretion. CGR discriminates insulin deficiency from insulin hypersecretion. We suggest using insulin secretion, determined from CGR, as an essential input for therapeutic decisions at the beginning or modification of diabetes treatment. Furthermore, we propose 3 practical steps to guide decisions in the subtype-specific therapy of diabetes mellitus. The first step consists of detecting insulin deficiency indicated by a low CGR with the need for immediate insulin therapy. The second step is related to high CGR and aims at lowering cardiovascular risk associated with diabetes. The third step is the consideration of a de-escalation of glucose-lowering therapy in individuals with mild diabetes subphenotypes.</p>","PeriodicalId":12241,"journal":{"name":"Experimental and Clinical Endocrinology & Diabetes","volume":"130 3","pages":"200-204"},"PeriodicalIF":1.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/a-1242-9809","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38395179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}