Journal of Clinical and Translational Endocrinology最新文献

{"title":"Association of ADHD symptoms with type 2 diabetes and cardiovascular comorbidities in adults receiving outpatient diabetes care","authors":"Ali Zare Dehnavi ,&nbsp;Yanli Zhang-James ,&nbsp;Dan Draytsel ,&nbsp;Ben Carguello ,&nbsp;Stephen V. Faraone ,&nbsp;Ruth S. Weinstock","doi":"10.1016/j.jcte.2023.100318","DOIUrl":"10.1016/j.jcte.2023.100318","url":null,"abstract":"<div><h3>Background</h3><p>The relationship between attention-deficit/hyperactivity disorder (ADHD) symptoms and type 2 diabetes mellitus (T2D) and its cardiovascular outcomes have not been sufficiently studied.</p></div><div><h3>Methods</h3><p>2,986 adults with T2D from the Joslin Diabetes Center at Upstate Medical University were assessed for ADHD-like symptoms, executive dysfunction, and emotional control using the Adult Self-Report Scale V1.1 (ASRS) expanded version. Surveys were sent electronically, and clinical data were obtained from the electronic medical record. Pearson chi-square test was used for categorical variables association. When ASRS scores were the dependent variable, negative binomial regression correcting for demographic variables that were associated with the ASRS scores was used.</p></div><div><h3>Results</h3><p>155 (49.2%) of respondents met DSM-5 criteria for ADHD using the ASRS scores; Only ten (3.6%) of respondents had an ICD10 diagnosis of ADHD in their medical record; Forty-three (13.7%) had either a diagnosis of ADHD in the medical history or were taking medications used by people with ADHD. Higher levels of ADHD-like symptoms were found in patients with T2D compared with population norms. There was a modest association of the ASRS executive dysfunction subscale with overall cardiovascular comorbidities (p = 0.03). However, the p-value did not survive the multiple testing correction. Both ADHD-like symptoms and symptoms associated with emotional control, however, were not associated with specific cardiovascular diseases, hypertension, or with HbA1c, LDL-cholesterol, triglycerides, ALT, creatinine, or eGFR.</p></div><div><h3>Conclusion</h3><p>Our results suggest that adults with T2D attending a tertiary care diabetes clinic are at risk for having ADHD-like symptoms, highlighting the importance of screening for ADHD symptoms in this specialty setting and referring undiagnosed adult patients for further assessment and treatment of ADHD. Larger studies are needed to clarify the relationship between ADHD-like symptoms, executive dysfunction, and emotional control with diabetic control and comorbidities.</p></div>","PeriodicalId":46328,"journal":{"name":"Journal of Clinical and Translational Endocrinology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10130340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9386587","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":"Risk stratification using the 2021 IDF-DAR risk calculator and fasting experience of Bangladeshi subjects with type 2 diabetes in Ramadan: The DAR-BAN study","authors":"A.B.M. Kamrul-Hasan ,&nbsp;Muhammad Shah Alam ,&nbsp;Md. Ahamedul Kabir ,&nbsp;Sumon Rahman Chowdhury ,&nbsp;Muhammad Abdul Hannan ,&nbsp;Emran Ur Rashid Chowdhury ,&nbsp;Md. Mainul Ahsan ,&nbsp;Choman Abdullah Mohana ,&nbsp;Mohammad Hasan Iftekhar ,&nbsp;Mohammad Jahid Hasan ,&nbsp;Samir Kumar Talukder","doi":"10.1016/j.jcte.2023.100315","DOIUrl":"10.1016/j.jcte.2023.100315","url":null,"abstract":"<div><h3>Aims</h3><p>To risk-stratify patients with type 2 diabetes mellitus (T2DM) according to the IDF-DAR 2021 guidelines and observe their responsiveness to risk-category-based recommendations and fasting experience.</p></div><div><h3>Methods</h3><p>This prospective study, conducted in the <em>peri</em>-Ramadan period of 2022, evaluated adults with T2DM and categorized them using the IDF-DAR 2021 risk stratification tool. Recommendations for fasting according to the risk categories were made, their intention to fast was recorded, and follow-up data were collected within one month of the end of Ramadan.</p></div><div><h3>Results</h3><p>Among 1328 participants (age 51.1 ± 11.9 years, female 61.1 %), only 29.6 % had pre-Ramadan HbA1c &lt; 7.5 %. According to the IDF-DAR risk category, the frequencies of participants in the low-risk (should be able to fast), moderate-risk (not to fast), and high-risk (should not fast) groups were 44.2 %, 45.7 %, and 10.1 %, respectively. Most (95.5 %) intended to fast, and 71 % fasted the full 30 days of Ramadan. The overall frequencies of hypoglycemia (3.5 %) and hyperglycemia (2.0 %) were low. Hypoglycemia and hyperglycemia risks were 3.74-fold and 3.86-fold higher in the high-risk group than in the low-risk group.</p></div><div><h3>Conclusion</h3><p>The new IDF-DAR risk scoring system seems conservative in the risk categorization of T2DM patients in terms of fasting complications.</p></div>","PeriodicalId":46328,"journal":{"name":"Journal of Clinical and Translational Endocrinology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/22/16/main.PMC9969239.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10824822","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":"People with diabetes and hypovitaminosis C fail to conserve urinary vitamin C","authors":"Helen Lunt ,&nbsp;Anitra C Carr ,&nbsp;Helen F Heenan ,&nbsp;Emma Vlasiuk ,&nbsp;Masuma Zawari ,&nbsp;Tim Prickett ,&nbsp;Chris Frampton","doi":"10.1016/j.jcte.2023.100316","DOIUrl":"10.1016/j.jcte.2023.100316","url":null,"abstract":"<div><h3>Background</h3><p>Hypovitaminosis C has negative health consequences. People with diabetes and hypovitaminosis C may fail to conserve vitamin C in the urine, thereby displaying evidence of inappropriate renal leak of vitamin C. This study describes the relationship between plasma and urinary vitamin C in diabetes, with a focus on the clinical characteristics of participants with renal leak.</p></div><div><h3>Methods</h3><p>Retrospective analysis of paired, non-fasting plasma and urine vitamin C, and also clinical characteristics, from participants with either type 1 or type 2 diabetes, recruited from a secondary care diabetes clinic. Plasma vitamin C thresholds for renal leak have been defined previously as 38.1 µmol/L for men and 43.2 µmol/L for women.</p></div><div><h3>Results</h3><p>Statistically significant differences in clinical characteristics were seen between those with; i) renal leak (N = 77) and; ii) hypovitaminosis C but no renal leak (N = 13) and; iii) normal plasma vitamin C levels (n = 34). Compared to participants with adequate plasma vitamin C levels, participants with renal leak tended to have type 2 (rather than type 1) diabetes, a lower eGFR and a higher HbA1c.</p></div><div><h3>Conclusion</h3><p>In the diabetes population studied, renal leak of vitamin C was common. In some participants, it may have contributed to hypovitaminosis C.</p></div>","PeriodicalId":46328,"journal":{"name":"Journal of Clinical and Translational Endocrinology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ce/b4/main.PMC9982671.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10848181","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":"A picture is worth a thousand words: A culturally-tailored video-based approach to diabetes education in Somali families of children with type 1 diabetes","authors":"Muna Sunni ,&nbsp;Jennifer Kyllo ,&nbsp;Carol Brunzell ,&nbsp;Janyce Majcozak ,&nbsp;Munira Osman ,&nbsp;Abdirahman M. Dhunkal ,&nbsp;Antoinette Moran","doi":"10.1016/j.jcte.2023.100313","DOIUrl":"10.1016/j.jcte.2023.100313","url":null,"abstract":"<div><h3>Objectives</h3><p>Type 1 diabetes (T1D) is highly prevalent in Somali immigrant children and hemoglobin A1c (HbA1c) levels are elevated in this population compared to non-Hispanic Whites. Current self-management diabetes education has not been tailored to this population. We aimed to improve delivery of T1D education to Somali immigrants by developing and testing a culturally-appropriate video-based curriculum.</p></div><div><h3>Methods</h3><p>This cross-sectional study involved Somali youth ≤ 19 years with T1D followed at two pediatric tertiary centers in Minnesota. Ten Somali-language T1D education videos were developed (∼60 min for total program) based on core ADA curriculum and tailored to address cultural concerns and misconceptions. A diabetes knowledge questionnaire was administered to parents of all participants and to children aged ≥12 years. Pre- and post-educational session questionnaire mean scores were compared using a paired <em>t</em>-test to assess knowledge improvement immediately post-video education (primary endpoint) and retention at 3 months (secondary endpoint). HbA1c was measured pre- and 6 months post education (exploratory endpoint).</p></div><div><h3>Results</h3><p>Twenty-two Somali parents of 22 children participated (mean age 12.3 ± 4 years; 36 % female), 12 children ≥12 years. Diabetes knowledge scores significantly improved immediately post-video education compared to baseline (<em>p</em> = 0.012). This improvement persisted 3 months later (<em>p</em> = 0.0008). There was no significant change in mean HbA1c from baseline at 6 months post education (9.0 ± 1.5 % vs 9.3 ± 1.9; <em>p</em> = 0.6).</p></div><div><h3>Conclusion</h3><p>Culturally and linguistically tailoring diabetes education materials to African immigrants and delivering it audio-visually could improve effectiveness of diabetes education and increase knowledge and retention compared to simply translating standard diabetes education materials. The effect on HbA1c needs further study with a larger sample size.</p></div>","PeriodicalId":46328,"journal":{"name":"Journal of Clinical and Translational Endocrinology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a4/b1/main.PMC9937942.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9317489","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":"Bone resorption and incretin hormones following glucose ingestion in healthy emerging adults","authors":"Wang Shin Lei ,&nbsp;Eugene B. Rodrick ,&nbsp;Staci L. Belcher ,&nbsp;Andrea Kelly ,&nbsp;Joseph M. Kindler","doi":"10.1016/j.jcte.2023.100314","DOIUrl":"10.1016/j.jcte.2023.100314","url":null,"abstract":"<div><h3>Background</h3><p>Studies in adults indicate that macronutrient ingestion yields an acute anti-resorptive effect on bone, reflected by decreases in C-terminal telopeptide (CTX), a biomarker of bone resorption, and that gut-derived incretin hormones, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1), facilitate this response. There remain knowledge gaps relating to other biomarkers of bone turnover, and whether gut-bone cross-talk is operative during the years surrounding peak bone strength attainment. This study first, describes changes in bone resorption during oral glucose tolerance testing (OGTT), and second, tests relationships between changes in incretins and bone biomarkers during OGTT and bone micro-structure.</p></div><div><h3>Methods</h3><p>We conducted a cross-sectional study in 10 healthy emerging adults ages 18–25 years. During a multi-sample 2-hour 75 g OGTT, glucose, insulin, GIP, GLP-1, CTX, bone-specific alkaline phosphatase (BSAP), osteocalcin, osteoprotegerin (OPG), receptor activator of nuclear factor kappa-β ligand (RANKL), sclerostin, and parathyroid hormone (PTH) were assayed at mins 0, 30, 60, and 120. Incremental areas under the curve (iAUC) were computed from mins 0–30 and mins 0–120. Tibia bone micro-structure was assessed using second generation high resolution peripheral quantitative computed tomography.</p></div><div><h3>Results</h3><p>During OGTT, glucose, insulin, GIP, and GLP-1 increased significantly. CTX at min 30, 60, and 120 was significantly lower than min 0, with a maximum decrease of about 53 % by min 120. Glucose-iAUC_0-30 inversely correlated with CTX-iAUC_0-120 (rho = -0.91, P &lt; 0.001), and GLP-1-iAUC_0-30 positively correlated with BSAP-iAUC_0-120 (rho = 0.83, P = 0.005), RANKL-iAUC_0-120 (rho = 0.86, P = 0.007), and cortical volumetric bone mineral density (rho = 0.93, P &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>Glucose ingestion yields an anti-resorptive effect on bone metabolism during the years surrounding peak bone strength. Cross-talk between the gut and bone during this pivotal life stage requires further attention.</p></div>","PeriodicalId":46328,"journal":{"name":"Journal of Clinical and Translational Endocrinology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/97/1c/main.PMC9950953.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9427185","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":"Long-term efficacy of sensor-augmented pump therapy (Minimed 640G system) combined with a telemedicine follow-up in patients with type 1 diabetes: A real life study","authors":"Léonie Makuété Notemi ,&nbsp;Lamia Amoura ,&nbsp;Fatéma Fall Mostaine ,&nbsp;Laurent Meyer ,&nbsp;Dominique Paris ,&nbsp;Samy Talha ,&nbsp;Julien Pottecher ,&nbsp;Laurence Kessler","doi":"10.1016/j.jcte.2022.100306","DOIUrl":"10.1016/j.jcte.2022.100306","url":null,"abstract":"<div><h3>Objective</h3><p>Evaluate the efficacy of a new modality of insulin therapy associating both the sensor-augmented pump therapy with predictive low-glucose management (SAP-PLGM) and a telemedicine follow-up in patients with Type 1 diabetes (T1D) in a real-life setting.</p></div><div><h3>Methods</h3><p>T1D adults under Minimed 640G system with a telemedicine follow-up for glucose management were included in a retrospective study. The primary endpoint was HbA1c while continuous glucose monitoring parameters (CGM) and treatment compliance were the secondary endpoints. These parameters were analyzed according to the therapeutic indication, HbA1c ≥ 8 % (Group<!--> <!-->A) or severe hypoglycemic events (Group<!--> <!-->B) and in patients switched to SAP-PLGM therapy.</p></div><div><h3>Results</h3><p>62<!--> <!-->patients were analyzed with a 28 ± 12 months of follow-up. In Group<!--> <!-->A, HbA1c decreased from 8.3 ± 0.4 % to 7.7 ± 0.7 % (<em>p</em> &lt; 0.05) and to 7.9 ± 0.3 % (<em>p</em> &lt; 0.05) after 2 and 3 years, respectively. In patients switched to SAP-PLGM therapy, HbA1c decreased from 7.7 ± 0.7 % to 7.2 ± 0.8 % (<em>p</em> &lt; 0.05) at 2 years. After 6 months, the time-below-range (&lt;70 mg/dL) decreased from 2.1 % [0.6–4] to 1.1 % [0.3–2.6] (<em>p</em> &lt; 0.05). Severe hypoglycemic events decreased from 1.62 to 0.5<!--> <!-->events/patient/year in Group<!--> <!-->B (p &lt; 0.05). At 3 years, treatment compliance was 92 % [70–97] in the total population.</p></div><div><h3>Conclusions</h3><p>Long-term real-life treatment with the SAP-PLGM therapy combined with telemedicine was associated with improved glycemic control in T1D, along with high treatment compliance.</p></div>","PeriodicalId":46328,"journal":{"name":"Journal of Clinical and Translational Endocrinology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/02/d9/main.PMC9550647.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33512270","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":"Bone metabolism and incretin hormones following glucose ingestion in young adults with pancreatic insufficient cystic fibrosis","authors":"Wang Shin Lei ,&nbsp;Marissa J. Kilberg ,&nbsp;Babette S. Zemel ,&nbsp;Ronald C. Rubenstein ,&nbsp;Clea Harris ,&nbsp;Saba Sheikh ,&nbsp;Andrea Kelly ,&nbsp;Joseph M. Kindler","doi":"10.1016/j.jcte.2022.100304","DOIUrl":"10.1016/j.jcte.2022.100304","url":null,"abstract":"<div><h3>Background</h3><p>Gut-derived incretin hormones, including glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide 1 (GLP-1), regulate post-prandial glucose metabolism by promoting insulin production. GIP, GLP-1, and insulin contribute to the acute bone anti-resorptive effect of macronutrient ingestion by modifying bone turnover. Cystic fibrosis (CF) is associated with exocrine pancreatic insufficiency (PI), which perturbs the incretin response. Cross-talk between the gut and bone (“gut-bone axis”) has not yet been studied in PI-CF. The objectives of this study were to assess changes in biomarkers of bone metabolism during oral glucose tolerance testing (OGTT) and to test associations between incretins and biomarkers of bone metabolism in individuals with PI-CF.</p></div><div><h3>Methods</h3><p>We performed a secondary analysis of previously acquired blood specimens from multi-sample OGTT from individuals with PI-CF ages 14–30 years (n = 23). Changes in insulin, incretins, and biomarkers of bone resorption (C-terminal telopeptide of type 1 collagen [CTX]) and formation (procollagen type I <em>N</em>-terminal propeptide [P1NP]) during OGTT were computed.</p></div><div><h3>Results</h3><p>CTX decreased by 32% by min 120 of OGTT (P &lt; 0.001), but P1NP was unchanged. Increases in GIP from 0 to 30 mins (rho = -0.48, P = 0.03) and decreases in GIP from 30 to 120 mins (rho = 0.62, P = 0.002) correlated with decreases in CTX from mins 0–120. Changes in GLP-1 and insulin were not correlated with changes in CTX, and changes in incretins and insulin were not correlated with changes in P1NP.</p></div><div><h3>Conclusions</h3><p>Intact GIP response was correlated with the bone anti-resorptive effect of glucose ingestion, represented by a decrease in CTX. Since incretin hormones might contribute to development of diabetes and bone disease in CF, the “gut-bone axis” warrants further attention in CF during the years surrounding peak bone mass attainment.</p></div>","PeriodicalId":46328,"journal":{"name":"Journal of Clinical and Translational Endocrinology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6e/4c/main.PMC9467887.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9426211","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":"CGM patterns in adults with cystic fibrosis-related diabetes before and after elexacaftor-tezacaftor-ivacaftor therapy","authors":"Hanna Crow ,&nbsp;Charles Bengtson ,&nbsp;Xiaosong Shi ,&nbsp;Leland Graves III ,&nbsp;Abeer Anabtawi","doi":"10.1016/j.jcte.2022.100307","DOIUrl":"10.1016/j.jcte.2022.100307","url":null,"abstract":"<div><p>Cystic fibrosis-related diabetes (CFRD) is a common complication of cystic fibrosis that is associated with worse outcomes and higher mortality rates. CF transmembrane conductance regulator gene (CFTR) modulators have shown favorable effects on lung function, pulmonary exacerbations, and nutrition status. However, data regarding effects of CFTR modulators on glycemic control among those with CFRD is lacking. In this retrospective study, CGM data was analyzed to determine effect of elexacaftortezacaftor- ivacaftor therapy (ETI), a CFTR modulator, on glucose control among patients with CFRD. No difference was seen in glucose patterns after 3- and 6- months of starting ETI.</p></div>","PeriodicalId":46328,"journal":{"name":"Journal of Clinical and Translational Endocrinology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9547287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33499514","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":"Glycemia and β-cell function before and after elexacaftor/tezacaftor/ivacaftor in youth and adults with cystic fibrosis","authors":"Christine L. Chan ,&nbsp;Andrea Granados ,&nbsp;Amir Moheet ,&nbsp;Sachinkumar Singh ,&nbsp;Timothy Vigers ,&nbsp;Ana Maria Arbeláez ,&nbsp;Yaling Yi ,&nbsp;Shanming Hu ,&nbsp;Andrew W. Norris ,&nbsp;Katie Larson Ode","doi":"10.1016/j.jcte.2022.100311","DOIUrl":"10.1016/j.jcte.2022.100311","url":null,"abstract":"<div><h3>Background</h3><p>Diabetes is prevalent among people with CF (PwCF) and associated with worse clinical outcomes. CFTR modulators are highly effective in improving the disease course of CF. However, the effects of elexacaftor/tezacaftor/ivacaftor (ETI) on glucose metabolism in PwCF are unclear.</p></div><div><h3>Methods</h3><p>Twenty youth and adults with CF underwent frequently sampled oral glucose tolerance tests (fsOGTT) before and after ETI initiation. Glucose, insulin, and C-peptide were collected at 0, 10, 30, 60, 90, and 120 min after 1.75 g/kg (max 75 g) of dextrose. HbA1c and continuous glucose monitoring (CGM) were collected in a subset. Estimates of insulin secretion (C-peptide index), insulin resistance (HOMA2 IR and IS(OGTT Cpep)), and β-cell function (C-peptide oral disposition index, oDI_coeo), were compared before and after ETI.</p></div><div><h3>Results</h3><p>Participants were a median (IQR) of 20.4 (14.1, 28.6) years old, 75 % male. Follow-up occurred 10.5 (10.0, 12.3) months after ETI initiation. BMI z-score increased from 0.3 (-0.3, 0.8) to 0.8 (0.4, 1.5), p = 0.013 between visits. No significant differences were observed in glucose tolerance, glucose area under the curve, nor fsOGTT glucose concentrations before and after ETI. Median (IQR) C-peptide index increased from 5.7 (4.1, 8.3) to 8.8 (5.5, 10.8) p = 0.013 and HOMA2 IR increased (p &lt; 0.001), while oDI_coeo was unchanged (p = 0.67). HbA1c decreased from 5.5 % (5.5, 5.8) to 5.4 % (5.2, 5.6) (p = 0.003) while CGM variables did not change.</p></div><div><h3>Conclusions</h3><p>BMI z-score and measures of both insulin resistance and insulin secretion increased within the first year of ETI initiation. β-cell function adjusted for insulin sensitivity (oDI_coeo) did not change.</p></div>","PeriodicalId":46328,"journal":{"name":"Journal of Clinical and Translational Endocrinology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/97/5c/main.PMC9816065.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9705476","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":"“It’s embarrassing. I get angry. I get frustrated.”: Understanding severe hypoglycemia and glucagon usage from the perspectives of people with type 1 diabetes","authors":"Allyson S. Hughes ,&nbsp;Katherine Chapman ,&nbsp;Jeoffrey Bispham ,&nbsp;Jeannett Dimsits ,&nbsp;Stuart Weinzimer ,&nbsp;Wendy Wolf ,&nbsp;Nazanin Heydarian","doi":"10.1016/j.jcte.2022.100310","DOIUrl":"https://doi.org/10.1016/j.jcte.2022.100310","url":null,"abstract":"<div><h3>Introduction</h3><p>This study characterized the emotional impact of severe hypoglycemia, views of glucagon, and barriers to glucagon use from the perspective of adults with type 1 diabetes (T1D).</p></div><div><h3>Methods</h3><p>Participants included individuals recruited from the T1D Exchange online community. The current study conducted 7 focus groups consisting of adults with T1D (N = 38, average age 49.4, SD = 16.11 years). Average duration of diabetes was 34.4 years (SD = 17.3) and average self-reported A1c was 6.8 % (SD = 0.7). Focus group interviews were recorded, transcribed, and thematically analyzed.</p></div><div><h3>Results</h3><p>A range of emotions was expressed about severe hypoglycemia including fear, anxiety, stress, frustration, shame, and embarrassment. Participants frequently identified prescription cost and insurance deductibles as barriers to glucagon use. Participants were also concerned about ease of administration—how difficult it is to prepare the glucagon in an emergency. Many participants expressed a preference for auto-injectables over nasal administration. Timing of glucagon action and time to recovery were high priorities. Some participants, while they had not self-administered glucagon, were interested in a mini-dose glucagon they could self-administer. They also identified desirable characteristics of glucagon treatment including reduced cost, long shelf-life, and quick activation.</p></div><div><h3>Conclusions</h3><p>These results highlight the attitudes about severe hypoglycemia and emergency treatment with glucagon. Healthcare professionals should assess glucagon training needs and knowledge when they meet with their patients with diabetes.</p></div>","PeriodicalId":46328,"journal":{"name":"Journal of Clinical and Translational Endocrinology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214623722000187/pdfft?md5=c9e85b73e828513d9ccaef9c4e921608&pid=1-s2.0-S2214623722000187-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72230393","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}