Indian Journal of Endocrinology and Metabolism最新文献

{"title":"Effect of Millets Once a Day on Glycaemic Control among Women with Gestational Diabetes Mellitus in a Tertiary Care Setting - A Randomized Controlled Trial.","authors":"Mahadevan Duraiswamy, Venkatachalam Jayaseelan, Jayalakshmy Ramakrishnan, Sasirekha Rengaraj, Yuvaraj Krishnamoorthy, Mohammed Kais, Murali Subbaiah","doi":"10.4103/ijem.ijem_314_24","DOIUrl":"https://doi.org/10.4103/ijem.ijem_314_24","url":null,"abstract":"<p><strong>Introduction: </strong>Gestational diabetes mellitus (GDM) affects 14% of pregnancies globally, with a prevalence of 9-16% in India. Low-glycaemic index (GI) foods like millets may help control glycaemia in GDM. This study compared glycaemic control between GDM patients consuming millets once a day (MOD) and those receiving enhanced medical nutrition therapy (MNT) for 1 month.</p><p><strong>Methods: </strong>A parallel-arm randomized controlled trial was conducted among 224 GDM mothers at a tertiary centre from April 2022 to December 2023. Participants were randomized into two groups: The Enhanced MNT group received standard care with education materials, while the MOD group received 200 g of millets daily for 1 month and recipes. Follow-ups were at 2 weeks and 1 month. The primary outcome was the difference in glycaemic control between groups, analysed with a 95% confidence interval (CI) and <i>P</i> < 0.05 significance.</p><p><strong>Results: </strong>Of the 219 participants who completed the study (97.8%), adherence was 77.6% in the MOD group and 78.5% in the Enhanced MNT group. In an intention-to-treat analysis, an additional 11.6% (95% CI: -1.5% to 24.7%) in the MOD group achieved glycaemic control compared to the Enhanced MNT group, which was not statistically significant (<i>P</i> = 0.083). However, the MOD group had a significant mean post-prandial blood glucose reduction of -4.55 (95% CI: -8.55 to -0.56; <i>P</i> = 0.025).</p><p><strong>Conclusion: </strong>Both interventions effectively controlled glycaemic levels, with the MOD group showing slightly better post-prandial glucose control. Adherence to the protocol was high.</p><p><strong>Trial registration: </strong>CTRI Registry CTRI/2022/04/042013.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"28 6","pages":"581-588"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of ¹⁷⁷Lu-DOTATATE Peptide Receptor Radionuclide Therapy in Progressive Metastatic Neuroendocrine Tumors from a Tertiary Care Center.","authors":"David Mathew, Saumya S Sunny, Justin Benjamin, Junita R John, Felix K Jebasingh, Josh T Georgy, Ashish Singh, Regi Oommen","doi":"10.4103/ijem.ijem_372_23","DOIUrl":"https://doi.org/10.4103/ijem.ijem_372_23","url":null,"abstract":"<p><strong>Introduction: </strong>Functioning neuroendocrine tumors (NETs) that do not respond to standard therapies are commonly considered for Peptide Receptor Radionuclide Therapy (PRRT). The benefit of ¹⁷⁷Lu-DOTATATE PRRT in patients with progressive metastatic NET was analyzed and survival in multi-organ involvement.</p><p><strong>Methods: </strong>Forty-one patients with refractory, progressive, or advanced symptomatic NETs, with or without previous treatment modalities were studied. They were treated with ¹⁷⁷Lu-DOTATATE IV infusion 150 mCi per dose up to four cycles. Retrospectively, they were assessed for response to PRRT based on clinical, Imaging-Contrast CT/⁶⁸Ga-DOTATATE PET-CT, and biochemical markers. After treatment, classification based on disease status, symptomatic improvement, and response to treatment based on Chromogranin A level was done. The organs involved and their respective survival benefits, as estimated by Kaplan Meier, were plotted for 60 months.</p><p><strong>Results: </strong>The mean serum Chromogranin A level at baseline was 2841 U/ml (Median = 3150). The main site of primary NET was in the pancreas, and the most common site for metastases was the liver. Following PRRT, all patients, except one, reported an improvement in their baseline complaints. Most (82%) reported no new symptoms, and 50% had a reduction in serum Chromogranin A levels. Follow-up imaging showed regression in one patient, static tumor in 18, and progression in rest. Considering radiological and clinical responses, the overall benefit was noticed in 29 (70%) patients. Despite symptomatic improvement, there was no significant survival benefit for those with pancreatic, liver, or nodal metastasis.</p><p><strong>Conclusion: </strong>A majority of patients who were treated with PRRT demonstrated clinical, radiological as well as biochemical positive responses warranting an earlier consideration for this well-tolerated treatment modality.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"28 6","pages":"601-610"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rising Trend in the Frequency of Secondary and Tertiary Hyperparathyroidism: Observations from the Indian PHPT Registry.","authors":"Sheenam Garg, Rimesh Pal, Sanjay K Bhadada","doi":"10.4103/ijem.ijem_376_24","DOIUrl":"https://doi.org/10.4103/ijem.ijem_376_24","url":null,"abstract":"","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"28 6","pages":"659"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Oral Semaglutide in Management of Type 2 Diabetes: A Real-World Study from India.","authors":"Aditya Dutta, Shama Mahendru, Rutuja Sharma, Ambrish Mithal","doi":"10.4103/ijem.ijem_266_24","DOIUrl":"https://doi.org/10.4103/ijem.ijem_266_24","url":null,"abstract":"<p><strong>Introduction: </strong>Oral Semaglutide (Sema-o) is the first oral glucagon like peptide-1 receptor analogue (GLP-1RA) commercially available for the treatment of type 2 diabetes (T2D). This study aimed to evaluate the efficacy of Sema-o in patients with T2D when added to the existing therapy.</p><p><strong>Methods: </strong>This retrospective real-world study enrolled adult patients with diabetes taking Sema-o, with at least one follow-up (from February 2022 till October 2023). A proforma recorded baseline and follow-up date, medications, body composition, laboratory and clinical parameters. Data is presented as median (interquartile range) and was analysed using SPSS.</p><p><strong>Results: </strong>A total of 351 patients followed up once, while 56 patients had 4 follow-up visits. Baseline parameters were as follows: age 53 years (43-61), duration of diabetes 10 years (5-16), weight 91 kg (79-103), body mass index (BMI) 32.7 kg/m² (29.3-36.6) and HbA1c 7.9% (6.9-9). The addition of Sema-o in the existing therapy for diabetes resulted in a significant reduction in HbA1c {follow-up: 1^st 0.5%, 2^nd 0.9%, 3^rd 1.1% and 4^th 1.1% (all, <i>P</i> < 0.001)} and % weight reduction {follow-up: 1^st 2%, 2^nd 3.3%, 3^rd 4.1% and 4^th 4.3% (all, <i>P</i> < 0.001)} from baseline. Reductions in BMI, glucose (fasting/post-prandial), lipids, liver enzymes and body composition parameters were significant. Gastro-intestinal side-effects (299 events in 52.4% of patients) were frequent. A total of 34/9.7% patients discontinued Sema-o.</p><p><strong>Conclusion: </strong>Intensification of existing therapy with Sema-o in obese patients with moderately uncontrolled diabetes proved to be an effective and relatively safe strategy. Achieving normoglycemia and reductions in weight, lipids and body fat/visceral fat with Sema-o may confer a much needed cardiometabolic benefit in these patients.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"28 6","pages":"653-658"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elucidating the Prognostic Role of <i>BRAF</i> ^V600E and the Activation Status of the Downstream MAPK Pathway in PTC: A Study from a Tertiary Centre in India.","authors":"Nadeem Kocheri, Priti Chatterjee, Shipra Agarwal, Mehar C Sharma, Sanjana Ballal, Chandrasekhar Bal, Sunil Chumber","doi":"10.4103/ijem.ijem_235_23","DOIUrl":"https://doi.org/10.4103/ijem.ijem_235_23","url":null,"abstract":"<p><strong>Introduction: </strong>Papillary thyroid carcinoma (PTC) has an excellent prognosis, but few cases are treatment-resistant. To check the applicability of combined <i>BRAF</i> ^V600E and MEK-targeted therapy, the current study correlated <i>BRAF</i> ^V600E with the MAPK pathway activation status in a cohort of PTCs. The prognostic relevance of <i>BRAF</i> ^V600E and the usability of immunohistochemistry (IHC) for detecting the mutation were also assessed.</p><p><strong>Methods: </strong>Randomly selected 50 PTC and 15 non-PTC cases were re-classified according to the 2022 WHO classification. The <i>BRAF</i> mutation status was compared with the IHC of BRAF^V600E, pERK1/2, pMEK1/2, and clinicopathological variables, including response to radioactive iodine and disease-free survival.</p><p><strong>Results: </strong><i>BRAF</i> ^V600E mutation was present in 38%. Most (87.8%) cases were immunopositive for pMEK1/2 and 40% for pMEK1/2. Although <i>BRAF</i> ^V600E mutation did not correlate with the MAPK activation status, it had an adverse impact on tumour sensitivity to radioiodine (<i>P</i> < 0.05). Five of the seven radioiodine-resistant tumours were <i>BRAF</i> ^V600E-mutated. An Allred cut-off score of 7 had a sensitivity of 100% and a specificity of 84% for detecting the mutation by IHC. All the non-PTC cases were <i>BRAF</i>-wild type, but 20% showed weak immunopositivity for mutated protein and were scored 6.</p><p><strong>Conclusions: </strong><i>BRAF</i> ^V600E-mutated PTCs are more likely to be RAI-resistant. MAPK pathway activation status did not vary significantly with <i>BRAF</i> mutation. Immunopositivity for pMEK1/2 in most suggests a scope for MEK1-targeted therapy in recalcitrant PTC cases even in the absence of the <i>BRAF</i> mutation. In addition, IHC is a reliable technique for detecting <i>BRAF</i> ^V600E mutation but needs validation by correlation with molecular studies.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"28 6","pages":"617-621"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucagon, rather than Glucagon-Like Peptide 1, Mediates Higher Post-Lunch Glucose Excursions during Breakfast Skipping in Asian Indian Patients with Uncontrolled Type 2 Diabetes Mellitus.","authors":"Yash V Chauhan, Mahesh D Hakke, Prudwiraj Sanamandra, Jugal V Gada, Sukirti Misra, Sachin S Rahate, Namrata Varekar, Anagha V Palekar, Premlata K Varthakavi, Nikhil M Bhagwat","doi":"10.4103/ijem.ijem_295_24","DOIUrl":"https://doi.org/10.4103/ijem.ijem_295_24","url":null,"abstract":"<p><strong>Introduction: </strong>The effect and mechanism of skipping breakfast on glycemic control in type 2 diabetes mellitus (T2DM) in Asian-Indians is unknown.</p><p><strong>Methods: </strong>Cross-over, within-group study recruiting 5 habitual breakfast eaters (BE) and 5 habitual breakfast skippers (BS) with uncontrolled T2DM (HbA1c 7-9%). Patients underwent testing after three days of following their usual breakfast habits and after seven days of crossing over to the other arm. Fasting values and incremental area under the curve (iAUC_0-180) of post-lunch levels of glucose, insulin, C-peptide, glucagon-like peptide 1 (GLP-1), and glucagon were measured. Continuous glucose monitoring (CGM) parameters assessed were area under the curve (AUC_0-180) of post-meal glucose values, 24-hour average blood glucose (ABG), time in range (TIR), and glycemic variability.</p><p><strong>Results: </strong>BS led to significantly higher fasting (133.5 ± 34.5 mg/dl vs 110 ± 31.50 mg/dl, <i>P</i> = 0.009) and peak post-lunch (214.6 ± 35.07 mg/dl vs 175.4 ± 39.26 mg/dl, <i>P</i> < 0.001) plasma glucose, and HOMA-IR (3.05 ± 3.89 vs 2.03 ± 1.76, <i>P</i> = 0.007) as compared to BE. Post-lunch iAUC_0-180 during BS was significantly higher for plasma glucose (7623 ± 2947.9 mg/dl × min vs 1922.4 ± 1902.1 mg/dl × min, <i>P</i> < 0.001), insulin (2460 ± 1597.50 mIU/ml × mins vs 865.71 ± 1735.73 mIU/ml × mins, <i>P</i> = 0.028), C-peptide (418.4 ± 173.4 ng/ml × mins vs 127.8 ± 117.1 ng/ml × mins, <i>P</i> < 0.001) and glucagon (7272.7 ± 4077 pg/ml × mins vs 4568.8 ± 2074.9 pg/ml × mins, <i>P</i> = 0.044) as compared to BE, while GLP-1 (1812.7 ± 883 pmol/l × mins during BS vs 1643 ± 910 pmol/l × mins during BE, <i>P</i> = 0.255) did not significantly differ between the two visits. CGM revealed a higher post-lunch AUC_0-180 during BS. There was no difference in post-dinner AUC_0-180, ABG, TIR, or glycemic variability.</p><p><strong>Conclusion: </strong>Skipping breakfast led to higher post-lunch glucose excursions, possibly due to higher glucagon excursion and increased insulin resistance.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"28 6","pages":"645-652"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulinoma in Patients with Diabetes- A Systematic Review of Previously Reported Cases.","authors":"Subhankar Chatterjee, Rana Bhattacharjee, Ritwik Ghosh, Partha P Chakraborty, Anirban Sinha, Animesh Maiti","doi":"10.4103/ijem.ijem_154_24","DOIUrl":"https://doi.org/10.4103/ijem.ijem_154_24","url":null,"abstract":"<p><strong>Introduction: </strong>Paradoxical co-existence of insulinoma and diabetes is extremely rare. Although a few case reports addressed this association, a comprehensive study elucidating this relationship has been lacking. We performed a systematic review of published cases of insulinoma in diabetes.</p><p><strong>Methods: </strong>We conducted a literature search using PubMed and Google Scholar, employing various combinations of the following terms: 'insulinoma', 'diabetes', 'nesidioblastosis', 'endogenous hyperinsulinism', 'hypoglycaemia', and 'hyperglycaemia' (from January 1900 to January 30, 2024). Exclusion criteria included non-English publications, duplicate articles, reports lacking sufficient data, cases of endogenous hyperinsulinemic hypoglycaemia other than insulinoma, and inaccessible articles. Statistical analysis was performed using appropriate methods.</p><p><strong>Results: </strong>Sixty patients were considered for the final analysis. Mean age was 61 ± 15 years (range: 17-96 years) with a slight female preponderance; 88.3% had type-2 diabetes with a median duration of 8 years. The median delay in diagnosis of insulinoma was 6 months. Median blood glucose varied from 30.5 mg/dL to 235 mg/dL, with a mean HbA1c of 5.6 ± 1.3% (range: 2.9%-8.2%). Critical sampling data were available in 75% of cases. The median size of the insulinoma was 2 cm. Furthermore, 5.2% of insulinomas were extra-pancreatic. Among pancreatic insulinomas, 14.5% were multi-focal. One-third of cases were malignant. Surgical resection was done in 70.9% of cases, while 40% received drug therapy and 12.7% received both, with 20.7% overall mortality. Malignant insulinoma (<i>P</i> = 0.007), micro-angiopathic (<i>P</i> = 0.018) and macro-angiopathic complications (<i>P</i> = 0.039), and other co-morbidities (<i>P</i> = 0.009) were associated with unfavourable prognosis, while being overweight and obese (<i>P</i> = 0.020) at presentation was associated with favourable prognosis.</p><p><strong>Conclusion: </strong>This first systematic review provides insights into the uniqueness of insulinoma in diabetes.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"28 6","pages":"554-561"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Neck Ultrasonography and Nuclear Imaging in the Diagnosis of Congenital Hypothyroidism.","authors":"Soundararajan Sumathy, Sengottaiyan Palanivel, Kethipalli Nagaraju, Chidambaram N B Harisankar, Jeyaraj Ashokraja, Jayachandran Senthilkumar, Palaniyappan Sreenivasan, Subbiah Sridhar","doi":"10.4103/ijem.ijem_7_24","DOIUrl":"https://doi.org/10.4103/ijem.ijem_7_24","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital hypothyroidism (CH) is the most common preventable cause of mental retardation, and the two important causes of CH are thyroid dysgenesis and dyshormonogenesis. Thyroid imaging is an integral part of identifying the specific aetiology of CH. We aimed to study the aetiological profile of CH and compare the imaging findings of ultrasonography (USG) and nuclear scintigraphy.</p><p><strong>Methods: </strong>It is a prospective, cross-sectional study conducted over 3 years. The clinical, USG, and technetium-99 <i>m</i> (99 mTc) scintigraphy reports of CH children were analysed.</p><p><strong>Results: </strong>Sixty-two CH children were included in the study with an equal male-to-female ratio (1.1:1). There was a significant association between parental consanguinity and CH observed in 35.5% of cases (<i>P</i> = 0.006). In USG neck, 44 (71%) had normal and/or enlarged thyroid glands at the eutopic location, 16 (27.4%) cases had an absent gland, and ectopic as well as hypoplastic unilateral gland was observed in one (1.6%) each. Among 35 children, who underwent scintigraphy, 12 (34.3%) had absent uptake, 4 (11.4%) had ectopic uptake, and 1 (2.8%) child had unilateral normal uptake. The remaining 18 (51.5%) children, whose scintigraphy showed normal or avid uptakes, were diagnosed with dyshormonogenesis. Three cases were diagnosed as apparent athyreosis.</p><p><strong>Conclusion: </strong>Dyshormonogeneis is the more commonly observed etiology of CH as compared to thyroid agenesis in the present study. A combined imaging approach with scintigraphy and USG is needed to delineate the specific etiology of CH. We need long-term Indian data to know the paradigm shift in the etiological pattern of CH as compared to Western studies.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"28 6","pages":"611-616"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Our Experiences and Learnings in Diagnosing MODY from Non-Institutional-Based Diabetes Care Clinics.","authors":"Arunkumar R Pande, Santosh Chaubey, Dinesh Kumar, Kumar P Chandra, Thenral Geetha, Akshita Sharma","doi":"10.4103/ijem.ijem_361_23","DOIUrl":"10.4103/ijem.ijem_361_23","url":null,"abstract":"<p><strong>Introduction: </strong>Maturity-onset diabetes of the young (MODY) is a rare group of disorders characterised by impaired functions or development of pancreatic islets and monogenic diabetes at a young age. Diagnosing MODY can be rewarding for both clinicians and patients as it can change the management from generic to targeted therapy.</p><p><strong>Methods: </strong>This study reports the retrospective analysis of data collected from four clinics between March 2016 and February 2023 from Lucknow, a city in northern India. Fifty-three individuals are suspected to be affected by MODY based on ISPAD guidelines. Following a detailed clinical evaluation, they were referred for genetic diagnostic testing.</p><p><strong>Results: </strong>The cohort consists of 19 females and 34 males with a mean age of diagnosis of 25.3 years and a body mass index of 22.3 Kg/m². Genetic testing detected variants in 13/53 (~24.5%) individuals. Five cases had significant pathogenic/likely pathogenic variants, <i>HNF1A</i> gene in two [(p.Phe268LeufsTer74) (p.Arg200Gln)], one each in <i>HNF4A</i> (Arg311His), <i>PDX1</i>(p.Ala228GlyfsTer33), and a case with suggestive digenic variants in <i>HNF1A</i> gene (p.Arg200Gln) and <i>HNF1B</i> [(p.Leu13Met)]. Variants of uncertain significance (VUSs) with inconclusive evidence of pathogenicity were reported in eight patients, and five were considered to be clinically significant as they are lean young onset, sulfonylurea-responsive, and presented with diabetes without acanthosis nigricans and with high pretest probability. These individuals harboured variants in <i>HNF1A</i> (p.Thr425_Thr429delinsPro), <i>HNF1B</i> (p.Ser19Phe), <i>CEL</i> (p.Val681ArgfsTer6), <i>ABCC8</i> (p.Ile872Met), and <i>KCNJ11</i> (p.Arg221Cys) genes.</p><p><strong>Conclusion: </strong>We found a diagnostic yield of around 10% of pathogenic or likely pathogenic variants in individuals who were suspected to have MODY. As it is a field that is still evolving, we might consider starting with oral agents under close supervision in those individuals who have VUS; there are some proportions of individuals who might not have classical sulfonylurea-responsive genetic variants, but they might respond to it.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"28 5","pages":"480-487"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11642506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approved and Emerging Hormone-Based Anti-Obesity Medications: A Review Article.","authors":"Wael R Sidrak, Sanjay Kalra, Atul Kalhan","doi":"10.4103/ijem.ijem_442_23","DOIUrl":"10.4103/ijem.ijem_442_23","url":null,"abstract":"<p><p>Obesity is a heterogeneous, complex, and chronic disease that has a detrimental impact on disability-adjusted life years across the globe. Recent advancements in our understanding of gut-brain communication at the molecular level have driven the development of next-generation anti-obesity medications (AOMs). Glucagon-like peptide-1 receptor agonists (GLP1RAs) remain the front-runners in this rapidly evolving landscape of hormone-based AOMs. Two GLP1RAs, namely Liraglutide and Semaglutide, have been approved by the Food and Drug Administration (FDA) and European Medicine Agency (EMA) for use in clinical practice for weight loss. Three oral GLP1RAs, namely Semaglutide, Danuglipron, and Orforglipron, are undergoing advanced clinical trials in individuals with obesity. Amylin receptor agonist (AMYRA) Cagrilintide, when used alone or in combination with Semaglutide, has demonstrated substantial weight reduction in clinical trials. Tirzepatide, a dual agonist for the glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptors, has been observed to be associated with a significant placebo-subtracted weight reduction of 17.8% in a 72-week randomized controlled trial. Novel approaches targeting glucagon signalling have also yielded promising preliminary results. Three long-acting GLP1R/glucagon receptor (GCGR) dual agonists, namely Survodutide, Mazdutide, and Pemvidutide, exhibited significant weight loss in clinical trials. Retatrutide, a GLP1R/GCGR/GIPR tri-agonist, has been associated with a placebo-subtracted weight reduction of -22.1% in a 48-week phase-II trial. As a note of caution, long-term data on such medications' safety and cardiovascular benefits is yet to be ascertained. Our review provides a comprehensive overview of the approved and emerging hormone-based AOMs, highlighting the diversity of options that might become available in the near future.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"28 5","pages":"445-460"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11642516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}