Clinical Medicine Insights-Endocrinology and Diabetes最新文献

{"title":"Search for Genetic Predictors of Adult Autoimmune Polyendocrine Syndrome in Monozygotic Twins.","authors":"Marina Yuryevna Yukina,&nbsp;Anna Aleksandrovna Larina,&nbsp;Evgeny Vitalyevich Vasilyev,&nbsp;Ekaterina Anatolyevna Troshina,&nbsp;Diana Arshaluysovna Dimitrova","doi":"10.1177/11795514211009796","DOIUrl":"https://doi.org/10.1177/11795514211009796","url":null,"abstract":"<p><p>Autoimmune polyendocrine syndromes (APS) are a heterogeneous group of diseases characterized by the presence of autoimmune dysfunction of 2 or more endocrine glands and other non-endocrine organs. The components of the syndrome can manifest throughout life: in childhood-APS type 1 (the juvenile type) and in adulthood-APS type 2, 3, and 4 (the adult types). Adult types of APS are more common in clinical practice. It is a polygenic disease associated with abnormalities in genes encoding key regulatory proteins of the major histocompatibility complex (MHC). The search of for candidate genes responsible for mutations in adult APS is continuing. Genetic predisposition is insufficient for the manifestation of the APS of adults, since the penetrance of the disease, even among monozygotic twins, does not approach 100% (30-70%). The article presents the case of isolated Addison's disease and APS type 2 in monozygotic twins with a revealed compound heterozygosity in the candidate gene VTCN1.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2021-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/11795514211009796","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38953949","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":"Diabetic Ketoacidosis Management and Treatment Outcome at Medical Ward of Shashemene Referral Hospital, Ethiopia: A Retrospective Study.","authors":"Getu Melesie Taye,&nbsp;Amente Jorise Bacha,&nbsp;Fetene Abeje Taye,&nbsp;Mohammed Hussen Bule,&nbsp;Gosaye Mekonen Tefera","doi":"10.1177/11795514211004957","DOIUrl":"https://doi.org/10.1177/11795514211004957","url":null,"abstract":"<p><strong>Background: </strong>Diabetic Ketoacidosis (DKA) is the most common and yet potentially life-threatening acute complication of diabetes that progresses rapidly to death and requires immediate medical intervention.</p><p><strong>Objective: </strong>To assess the DKA management and treatment outcome/in-hospital mortality and its predictors among hospitalized patients with DKA at the Medical ward of Shashemene Referral Hospital (SRH).</p><p><strong>Method: </strong>A retrospective study was conducted at the Medical Ward of SRH from 01 February 2015 to 31 January 2017. A systematic random sampling technique was used to select study subjects based on the inclusion criteria. Thus, of 236 reviewed charts, only 225 patients with DKA fulfilled inclusion criteria. Treatment outcome was considered good for patients who have shown improvement at discharge, while poor for patients who left against medical advice or died in the hospital. Logistic regression analysis was done to determine independent predictors for treatment outcome/in-hospital mortality using SPSS version 20 with statistical significant at <i>P</i> ⩽ .05.</p><p><strong>Results: </strong>Of 225 patients with DKA, 124 (55.1%) were male. Regular insulin was prescribed to all patients and antibiotics were administered to 87 (38.7%). Potassium supplementation was given only for 28 (12.4%). Non-adherence to insulin treatment (n = 91; 40.4%) and infection (n = 66; 29.3%) were the principal DKA precipitating factors. Even though 73.8% of hospitalized patients with DKA have shown good treatment outcomes, DKA contributed 12% in-hospital mortality. The result of multivariate logistic regression analysis shown that hypoglycemia is the only independent predictor for in-hospital mortality[<i>P</i> = .03]. Moreover, the independent predictors for poor DKA treatment outcome were found to be smoker [<i>P</i> = .04], Urinary tract infection (UTI) relative to other co-morbid condition [<i>P</i> < .001], severe hypokalemia which increase risk of poor treatment outcome by around 4 times [<i>P</i> = .02], and use of Metronidazole as a concurrent medication relative to other concurrent medication [<i>P</i> = .03].</p><p><strong>Conclusion: </strong>There was a high in-hospital mortality rate due to correctable causes. This mortality is unacceptable as it was majorly related to the poor practice of potassium supplementation and hypoglycemia due to insulin. Thus, clinicians and stakeholders should have to focus on modifiable factors (hypokalemia, UTI, and hypoglycemia) to reduce poor treatment outcome/in-hospital mortality.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2021-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/11795514211004957","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38838914","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":"Therapeutic Potential of Peptides Derived from Animal Venoms: Current Views and Emerging Drugs for Diabetes.","authors":"Aimee Coulter-Parkhill, Stephen McClean, Victor A Gault, Nigel Irwin","doi":"10.1177/11795514211006071","DOIUrl":"10.1177/11795514211006071","url":null,"abstract":"<p><p>The therapeutic potential of venom-derived drugs is evident today. Currently, several significant drugs are FDA approved for human use that descend directly from animal venom products, with others having undergone, or progressing through, clinical trials. In addition, there is growing awareness of the important cosmeceutical application of venom-derived products. The success of venom-derived compounds is linked to their increased bioactivity, specificity and stability when compared to synthetically engineered compounds. This review highlights advancements in venom-derived compounds for the treatment of diabetes and related disorders. Exendin-4, originating from the saliva of Gila monster lizard, represents proof-of-concept for this drug discovery pathway in diabetes. More recent evidence emphasises the potential of venom-derived compounds from bees, cone snails, sea anemones, scorpions, snakes and spiders to effectively manage glycaemic control. Such compounds could represent exciting exploitable scaffolds for future drug discovery in diabetes, as well as providing tools to allow for a better understanding of cell signalling pathways linked to insulin secretion and metabolism.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2021-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8491154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39495189","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":"Dyslipidemia Increases the Risk of Severe COVID-19: A Systematic Review, Meta-analysis, and Meta-regression.","authors":"Indriwanto Sakidjan Atmosudigdo,&nbsp;Michael Anthonius Lim,&nbsp;Basuni Radi,&nbsp;Joshua Henrina,&nbsp;Emir Yonas,&nbsp;Rachel Vania,&nbsp;Raymond Pranata","doi":"10.1177/1179551421990675","DOIUrl":"https://doi.org/10.1177/1179551421990675","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and meta-analysis aimed to evaluate whether dyslipidemia affects the mortality and severity of COVID-19, we also aimed to evaluate whether other comorbidities influence the association.</p><p><strong>Methods: </strong>A systematic literature search using PubMed, Embase, and EuropePMC was performed on 8 October 2020. This study's main outcome is a poor composite outcome, comprising of mortality and severe COVID-19.</p><p><strong>Results: </strong>There were 9 studies with 3663 patients. The prevalence of dyslipidemia in this pooled analysis was 18% (4%-32%). Dyslipidemia was associated with increased composite poor outcome (RR 1.39 [1.02, 1.88], <i>P</i> = .010; <i>I</i> ²: 56.7%, <i>P</i> = .018). Subgroup analysis showed that dyslipidemia was associated with severe COVID-19 (RR 1.39 [1.03, 1.87], <i>P</i> = .008; <i>I</i> ²: 57.4%, <i>P</i> = .029). Meta-regression showed that the association between dyslipidemia and poor outcome varies by age (coefficient: -0.04, <i>P</i> = .033), male gender (coefficient: -0.03, <i>P</i> = .042), and hypertension (coefficient: -0.02, <i>P</i> = .033), but not diabetes (coefficient: -0.24, <i>P</i> = .135) and cardiovascular diseases (coefficient: -0.01, <i>P</i> = .506). Inverted funnel-plot was relatively symmetrical. Egger's test indicates that the pooled analysis was not statistically significant for small-study effects (<i>P</i> = .206).</p><p><strong>Conclusion: </strong>Dyslipidemia potentially increases mortality and severity of COVID-19. The association was stronger in patients with older age, male, and hypertension.PROSPERO Registration Number: CRD42020213491.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2021-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179551421990675","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39638054","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":"Mifepristone as Bridge or Adjunct Therapy in the Management of Challenging Cushing Disease Cases.","authors":"Alice Y Chang,&nbsp;Sasan Mirfakhraee,&nbsp;Elizabeth E King,&nbsp;Jennifer U Mercado,&nbsp;Diane M Donegan,&nbsp;Kevin Cj Yuen","doi":"10.1177/1179551421994102","DOIUrl":"https://doi.org/10.1177/1179551421994102","url":null,"abstract":"<p><p>Establishing a definitive diagnosis of Cushing disease (CD), given its clinical and biochemical heterogeneity, initiating effective treatment to control the effects of hypercortisolism, and managing recurrence are challenging disease aspects to address. Mifepristone is a competitive glucocorticoid receptor antagonist that is approved in the US by the Food and Drug Administration to control hyperglycemia secondary to endogenous hypercortisolism (Cushing syndrome) in patients who have glucose intolerance or type 2 diabetes mellitus and have failed surgery or are not candidates for surgery. Herein, we describe 6 patients with CD who received mifepristone as adjunct/bridge therapy in the following clinical settings: to assess clinical benefits of treatment for suspected recurrent disease, to control hypercortisolism preoperatively for severe disease, to control hypercortisolism during the COVID-19 pandemic, and to provide adjunctive treatment to radiation therapy. The patients were treated at multiple medical practice settings. Mifepristone treatment in each of the described cases was associated with clinical improvements, including improvements in overall glycemia, hypertension, and weight loss. In addition, in one case where biochemical and radiological evidence of disease recurrence was uncertain, clinical improvement with mifepristone pointed toward likely disease recurrence. Adverse events associated with mifepristone reported in the 6 cases were consistent with those previously reported in the pivotal trial and included cortisol withdrawal symptoms, antiprogesterone effects (vaginal bleeding), hypothyroidism (treated with levothyroxine), and hypokalemia (treated with spironolactone). These cases show how mifepristone can potentially be utilized as a therapeutic trial in equivocal cases of CD recurrence; as a presurgical treatment strategy, particularly during the COVID-19 pandemic; and as bridge therapy, while awaiting the effects of radiation.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2021-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179551421994102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25500520","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":"Quality of Life and Glycemic Control in Saudi Children with Type 1 Diabetes at Different Developmental Age Groups.","authors":"Amir Babiker,&nbsp;Bothainah Al Aqeel,&nbsp;Sarah Marie,&nbsp;Hala Omer,&nbsp;Aban Bahabri,&nbsp;Adnan Al Shaikh,&nbsp;Nada Zahrani,&nbsp;Motasim Badri,&nbsp;Mohamed Al Dubayee,&nbsp;Ibrahim Al Alwan","doi":"10.1177/1179551421990678","DOIUrl":"https://doi.org/10.1177/1179551421990678","url":null,"abstract":"<p><strong>Background: </strong>Children with type 1 diabetes (T1D) at different stages of development have age-specific needs, which can influence their perception of quality of life (QoL). In our study, we aimed to emphasize these age-specific needs and assess the perception of QoL in Saudi children with T1D, as well as their parents correlating QoL scores with children's glycemic control.</p><p><strong>Methods: </strong>This is a cross-sectional study in which children with T1D and their parents from 2 tertiary institutes in Saudi Arabia have answered a standard diabetes-specific QoL questionnaire (PedsQL™ 3.0 diabetes module, translated in Arabic). We also reported glycated hemoglobin (HbA1c) results for these children within a month of completing the questionnaire. The QoL total aggregate and domain scores for self (children) and proxy (parents') reports were compared and correlated with children's HbA1c.</p><p><strong>Results: </strong>A sample was 288 self and proxy reports from 144 children with T1D of 3 age groups: 5 to 7 years (7%), 8 to 12 years (49%), and 13 to 18 years (44%), and their parents. QoL differed significantly between self and proxy reports in the total aggregate and domain scores (<i>P</i>-values range from .02 to <.001). The impact on QoL was significantly higher in female patients (<i>P</i> = .043). Insulin pump users had better HbA1c (<i>P</i> = .007), and HbA1c level was worse in those who intended to fast at Ramadan (<i>P</i> = .005).</p><p><strong>Conclusion: </strong>Children with T1D at different developmental age groups perceive QoL differently than their parents. Adjusting management as per age-specific challenges could potentially improve these children's QoL and glycemic control.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2021-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179551421990678","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25402398","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 Relationship Between Thyroid Function and Body Composition, Leptin, Adiponectin, and Insulin Sensitivity in Morbidly Obese Euthyroid Subjects Compared to Non-obese Subjects.","authors":"Ohoud Al Mohareb,&nbsp;Moath Al Saqaaby,&nbsp;Aishah Ekhzaimy,&nbsp;Muaawia Hamza,&nbsp;Mussa H AlMalki,&nbsp;Fahad Bamehriz,&nbsp;Muhammad Abukhater,&nbsp;Imad Brema","doi":"10.1177/1179551420988523","DOIUrl":"https://doi.org/10.1177/1179551420988523","url":null,"abstract":"<p><strong>Background/objectives: </strong>Thyroid function tests (TFTs) changes in obese people have been studied with increasing interest, however, studies have been inconsistent hence it remains poorly understood. We compared the TFTs of morbidly obese euthyroid Saudi subjects with non-obese controls and then we examined the influence of leptin, adiponectin, and insulin resistance on TFTs.</p><p><strong>Subjects/methods: </strong>Fifty-five euthyroid obese subjects attending bariatric surgery clinic and 52 non-obese age-and gender-matched controls were recruited. We measured body weight, BMI, body composition, thyroid-stimulating hormone (TSH), Free T4 (FT4), Free T3(FT3), thyroid antibodies, fasting leptin, adiponectin, and lipid profile. Insulin resistance was quantified by HOMA-IR. Data are presented as mean ± SEM.</p><p><strong>Results: </strong>Mean BMI was 45.6 ± 1.5 and 23.2 ± 0.5 kg/m², for the obese and non-obese controls, respectively, <i>P</i> value < 0.001. Mean TSH was 2.7 ± 0.18 mIU/L in obese subjects and 1.7 ± 0.13 mIU/L (0.27-4.2) in the non-obese controls, respectively, <i>P</i> value .014. Mean FT3 was 3.9 ± 0.1 pmol/L (3.1-6.8) in obese subjects compared to 5.0 ± 0.1 pmol/L in non-obese controls, respectively, <i>P</i> value 0.001, however, FT4 was similar in the 2 groups. In the whole group (<i>N</i> = 107), BMI correlated positively with TSH and negatively with FT3. Leptin correlated negatively with both FT4 and FT3 in the non-obese group only while none of the TFTs correlated with HOMA-IR or adiponectin in either group. Binary logistic regression showed that each 1 unit increase in TSH increased the odds of becoming obese by 12.7, <i>P</i> value 0.009, 95 C.I. (1.9-85.0). Conversely, each - unit increase in FT3 decreased the odds of becoming obese by 0.2, <i>P</i> value 0.023, 95% C.I. (0.05-0.80).</p><p><strong>Conclusions: </strong>We report a small increase in TSH and a small decrease in FT3 within the normal range in obese subjects compared to non-obese controls. We also report a positive correlation between TSH and BMI with increased odds ratio of becoming obese with the increase in TSH and decrease in FT3. These changes may be either causally related or adaptive to the obesity state. FT4 and FT3 seem to correlate with leptin (but not with adiponectin or HOMA-IR) in the non-obese controls only. Larger mechanistic studies are needed to further elucidate the interesting association between obesity and TFTs.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2021-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179551420988523","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25390330","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":"Thanks to Reviewers","authors":"","doi":"10.1177/1179551421994023","DOIUrl":"https://doi.org/10.1177/1179551421994023","url":null,"abstract":"","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90847725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral GLP1 Analog: Where Does the Tide Go?","authors":"Hannah Gardner,&nbsp;Osama Hamdy","doi":"10.1177/1179551420984130","DOIUrl":"https://doi.org/10.1177/1179551420984130","url":null,"abstract":"<p><p>T2D is a potentially preventable disease that has been ranked the seventh leading cause of mortality in the United States. There is strong evidence demonstrating that preventing type 2 diabetes is, in many cases, attainable through lifestyle intervention. Unfortunately, prediabetes is mostly overlooked and awareness with diabetes prevention tools is lacking among primary care physicians. Nationally, efforts were not successful in reversing this epidemic even with an array of diabetes medications. Among the most effective medications for T2D are glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which have been shown to reduce both A1C and body weight. Dulaglutide, liraglutide and injectable semaglutide also reduced cardiovascular events and cardiovascular mortality in patients with established cardiovascular disease or multiple cardiovascular risk factors. In this review, we will examine the first FDA approved oral GLP-1 RA; semaglutide. Moreover, this review will discuss the potential impact oral semaglutide may have on glycemic control, weight loss and cardiovascular comorbidities. It also examines the factors that may impact patient compliance, including cost, side effects and clinical issues. Finally, it deliberates the optimism surrounding the development of oral semaglutide in the treatment of diabetes as well as related conditions, such as obesity and non-alcoholic fatty liver disease (NAFLD).</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2020-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179551420984130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38824119","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":"Diabetic Ketoacidosis on Hospitalization with COVID-19 in a Previously Nondiabetic Patient: A Review of Pathophysiology.","authors":"Rawan M Eskandarani,&nbsp;Shaima Sawan","doi":"10.1177/1179551420984125","DOIUrl":"https://doi.org/10.1177/1179551420984125","url":null,"abstract":"<p><p>Hyperglycaemia during inpatient admission is indicative of higher morbidity and mortality risks in critically ill patients. The severe acute respiratory distress coronavirus 2 (SARS-CoV-2) has been reported to induce ketoacidosis and diabetic ketoacidosis (DKA) even in nondiabetic patients. The pathophysiology of the SARS-CoV-2 infection that can contribute to hyperglycaemia, and the exacerbated inflammatory cytokine storm can overlap with the metabolic chronic inflammatory state attributable to the metabolic syndrome, which underlies diabetes mellitus. In this report, we explore the possible pathophysiology and metabolic mechanisms that lead to metabolic acidosis in nondiabetic patients.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2020-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179551420984125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38853543","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}