Diabetes mellitus is a major contributor to kidney failure,with diabetic nephro-pathy being a common microvascular complication.The increasing prevalence of diabetes and its complications suggests a rise in associated...Diabetes mellitus is a major contributor to kidney failure,with diabetic nephro-pathy being a common microvascular complication.The increasing prevalence of diabetes and its complications suggests a rise in associated morbidity and mortality.Recent studies highlight increased mortality related to diabetic kidney disease,with disparities across demographic and geographic groups.Novel pharmacological treatments,including sodium-glucose cotransporter 2 inhibitors,non-steroidal mineralocorticoid receptor antagonists,and glucagon-like peptide-1 agonists,offer promise in slowing disease progression and reducing renal mortality.However,the growing epidemics of obesity and diabetes necessitate prioritizing public health policies focused on primary and secondary prevention,along with comprehensive multidisciplinary care.展开更多
BACKGROUND Social determinants of health are social and economic factors that influence health intervention outcomes.Type 2 diabetes is a highly prevalent disease,primarily affecting individuals in low-to-middle-incom...BACKGROUND Social determinants of health are social and economic factors that influence health intervention outcomes.Type 2 diabetes is a highly prevalent disease,primarily affecting individuals in low-to-middle-income countries.However,the association between social determinants and cardiovascular complications in type 2 diabetes has not been widely studied.AIM To examine the relationship between social determinants of health and cardiovascular complications in individuals with type 2 diabetes.METHODS We conducted a retrospective cohort study with an analytical component at a national-level referral hospital for military personnel in Bogota,Colombia.Patients treated at the diabetes clinic between September 2021 and December 2022 who met the inclusion criteria were included.A total of 583 patients participated in the study.We performed descriptive,bivariate,and binary logistic regression analyses,adjusting for confounding variables.RESULTS Among the 583 patients included,urban residency[odds ratio(OR)=3.05,95%confidence interval(CI):1.01-9.20]and a middle or high educational level(OR=2.33,95%CI:1.14-4.72)were associated with an increased risk of coronary artery disease.Additionally,receiving diabetes education beyond that provided by the clinic(OR=2.15,95%CI:1.14-4.05)and lack of access to spaces for physical activity(OR=4.05,95%CI:1.31-12.5)were associated with a higher risk of diabetic nephropathy and cerebrovascular disease,respectively.CONCLUSION Programs for diabetes management should account for social determinants of health that contribute to cardiovascular complications and increased healthcare costs.Population-based studies are needed to guide targeted interventions and clarify causal relationships.展开更多
BACKGROUND Acromegaly,a disease of excess growth hormone,is known to alter bone structure and increase the risk of osteoporosis and fractures.This study aimed to assess the prevalence of vertebral,non-vertebral,and hi...BACKGROUND Acromegaly,a disease of excess growth hormone,is known to alter bone structure and increase the risk of osteoporosis and fractures.This study aimed to assess the prevalence of vertebral,non-vertebral,and hip fragility fractures,as well as osteoporosis,in a cohort of patients with acromegaly.AIM To assess the prevalence of vertebral fragility fractures,non-vertebral fragility fractures,hip fragility fractures,and osteoporosis in patients diagnosed with acromegaly.METHODS Data were collected on age,sex,body mass index(BMI),time from diagnosis of acromegaly,insulin-like growth factor(IGF-1)levels,disease control,pharmacological management,risk factors for osteoporosis,vertebral fragility fractures,non-vertebral fragility fractures,hip fragility fractures,and osteoporosis.RESULTS A total of 124 patients with acromegaly were included(67 men and 57 women).The mean age at diagnosis was 44±12 years;the mean time from diagnosis was 12±8 years;and the mean BMI was 27±4 kg/m².Fragility fractures were found in 27 patients(21%).There were no significant differences in the presence of osteoporosis or fragility fractures according to age,sex,BMI,duration of acrom egaly,or IGF-1 levels at diagnosis.A higher percentage of patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis(46%vs 15%;P<0.05).CONCLUSION A high prevalence of osteoporosis and fragility fractures was found in patients with acromegaly,regardless of age,sex,BMI,time from diagnosis,IGF-1 levels,and disease control.More patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis.Taken together,our results suggest that the severity of the disease and the need for second-line therapies,may be associated with the increased risk of osteoporosis.展开更多
BACKGROUND Acromegaly is caused by a pituitary neuroendocrine tumor(PitNET)with excessive production of growth hormone(GH),leading to multisystem complications.Previous studies have identified predictors of disease pe...BACKGROUND Acromegaly is caused by a pituitary neuroendocrine tumor(PitNET)with excessive production of growth hormone(GH),leading to multisystem complications.Previous studies have identified predictors of disease persistence following surgery and poor response to medical treatment,including tumor size,vertical and horizontal extensions of the adenoma,hyperintensity in T2-weighted magnetic resonance imaging,granulation density,and pre-and postoperative GH and insulin-like growth factor 1(IGF-1)levels.AIM To evaluate PitNET volume as a complementary prognostic factor in patients with acromegaly.METHODS This is a retrospective descriptive study with an analytical component evaluating the correlation between the volumetric analysis of GH-producing PitNETs,IGF-1 levels before and after surgery,disease control during follow-up,and the line of therapy required for disease control in a cohort of patients treated at two centers:Endocrinology Department of the Central Military Hospital and Centros Médicos Colsanitas,Bogotá,Colombia.RESULTS A total of 77 patients with acromegaly(42 men,35 women)were included in this study.The mean age at diagnosis was 42 years(SD:12),with a mean disease duration of 9.9 years(SD:7.2).The mean pituitary tumor volume was 4358 mm^(3)(SD:6291,interquartile range[IQR]:13602).Patients with controlled acromegaly had a mean PitNET volume of 3202 mm^(3)(SD:4845,95%CI:621-5784)compared to 5513 mm^(3)(SD:7447,95%CI:1545-9482)in the uncontrolled group(P=0.15).A PitNET volume exceeding 3697 mm^(3)was associated with a higher likelihood of requiring third or fourth-line therapy(50%vs 36%;P=0.03).CONCLUSION PitNET volume was associated with the need for higher-line therapy to manage acromegaly but did not correlate with long-term disease control or with pre-or postsurgical IGF-1 levels.Nevertheless,a trend towards an inverse relationship between tumor volume and future disease control was observed.While macroadenoma classification remains crucial,among patients with macroadenomas,those with a volume exceeding 3697 mm³could have worse prognosis.展开更多
BACKGROUND Maturity-onset diabetes of the young(MODY)is a monogenic form of diabetes often misdiagnosed as type 1 or type 2.The MODY7 subtype,attributed to variants in the Kruppel-like factor 11(KLF11)gene,is exceedin...BACKGROUND Maturity-onset diabetes of the young(MODY)is a monogenic form of diabetes often misdiagnosed as type 1 or type 2.The MODY7 subtype,attributed to variants in the Kruppel-like factor 11(KLF11)gene,is exceedingly rare,and its clinical spectrum is not fully characterized.Precise genetic diagnosis is essential for appropriate management but is challenging due to phenotypic overlap with other diabetes types.This case report describes a patient with a novel KLF11 variant,contributing to the understanding of this rare condition and its clinical implications.CASE SUMMARY A 50-year-old female with a family history of MODY in her son was initially diagnosed with type 2 diabetes.Due to the family history and a non-obese phenotype,a comprehensive genetic panel for monogenic diabetes was performed.The analysis identified a novel heterozygous missense variant,p.Cys105Phe,in the KLF11 gene,establishing a definitive diagnosis of MODY7.Following this diagnosis,the patient’s treatment was adjusted to include lifestyle modifications,resulting in adequate glycemic control.The patient has since maintained target glycated hemoglobin levels.CONCLUSION Monogenic diabetes type MODY7,caused by a mutation in the KLF11 gene,is extremely rare.Although some studies question its existence,compatible cases continue to be diagnosed,given its inclusion in genetic panels for MODY.展开更多
Metformin-induced vitamin B12 deficiency is a prevalent condition among pa-tients with type 2 diabetes mellitus.In recent years,a growing body of evidence has demonstrated the association between vitamin B12 deficienc...Metformin-induced vitamin B12 deficiency is a prevalent condition among pa-tients with type 2 diabetes mellitus.In recent years,a growing body of evidence has demonstrated the association between vitamin B12 deficiency and the onset,progression,and worsening of diabetic neuropathy(DNP)as well as its im-provement with supplementation in cases of deficiency.Major clinical guidelines for diabetes and DNP remain vague in their recommendations for B12 measu-rement and supplementation,and some guidelines do not address it at all.Given that vitamin B12 therapy is an economical,safe,and widely available treatment in most countries and supported by emerging evidence of its potential benefits,greater efforts should be made to promote systematic screening for vitamin B12 deficiency in all patients with DNP before establishing a definitive diagnosis as well as in patients with diabetes with risk factors for deficiency.Vitamin B12 deficiency should be treated in all affected patients,and supplementation should be considered in those with borderline levels when confirmatory diagnostic tests for deficiency are unavailable.Clinical guidelines should place greater emphasis on the recommendations for measuring and supplementing vitamin B12 in these patients.展开更多
文摘Diabetes mellitus is a major contributor to kidney failure,with diabetic nephro-pathy being a common microvascular complication.The increasing prevalence of diabetes and its complications suggests a rise in associated morbidity and mortality.Recent studies highlight increased mortality related to diabetic kidney disease,with disparities across demographic and geographic groups.Novel pharmacological treatments,including sodium-glucose cotransporter 2 inhibitors,non-steroidal mineralocorticoid receptor antagonists,and glucagon-like peptide-1 agonists,offer promise in slowing disease progression and reducing renal mortality.However,the growing epidemics of obesity and diabetes necessitate prioritizing public health policies focused on primary and secondary prevention,along with comprehensive multidisciplinary care.
文摘BACKGROUND Social determinants of health are social and economic factors that influence health intervention outcomes.Type 2 diabetes is a highly prevalent disease,primarily affecting individuals in low-to-middle-income countries.However,the association between social determinants and cardiovascular complications in type 2 diabetes has not been widely studied.AIM To examine the relationship between social determinants of health and cardiovascular complications in individuals with type 2 diabetes.METHODS We conducted a retrospective cohort study with an analytical component at a national-level referral hospital for military personnel in Bogota,Colombia.Patients treated at the diabetes clinic between September 2021 and December 2022 who met the inclusion criteria were included.A total of 583 patients participated in the study.We performed descriptive,bivariate,and binary logistic regression analyses,adjusting for confounding variables.RESULTS Among the 583 patients included,urban residency[odds ratio(OR)=3.05,95%confidence interval(CI):1.01-9.20]and a middle or high educational level(OR=2.33,95%CI:1.14-4.72)were associated with an increased risk of coronary artery disease.Additionally,receiving diabetes education beyond that provided by the clinic(OR=2.15,95%CI:1.14-4.05)and lack of access to spaces for physical activity(OR=4.05,95%CI:1.31-12.5)were associated with a higher risk of diabetic nephropathy and cerebrovascular disease,respectively.CONCLUSION Programs for diabetes management should account for social determinants of health that contribute to cardiovascular complications and increased healthcare costs.Population-based studies are needed to guide targeted interventions and clarify causal relationships.
文摘BACKGROUND Acromegaly,a disease of excess growth hormone,is known to alter bone structure and increase the risk of osteoporosis and fractures.This study aimed to assess the prevalence of vertebral,non-vertebral,and hip fragility fractures,as well as osteoporosis,in a cohort of patients with acromegaly.AIM To assess the prevalence of vertebral fragility fractures,non-vertebral fragility fractures,hip fragility fractures,and osteoporosis in patients diagnosed with acromegaly.METHODS Data were collected on age,sex,body mass index(BMI),time from diagnosis of acromegaly,insulin-like growth factor(IGF-1)levels,disease control,pharmacological management,risk factors for osteoporosis,vertebral fragility fractures,non-vertebral fragility fractures,hip fragility fractures,and osteoporosis.RESULTS A total of 124 patients with acromegaly were included(67 men and 57 women).The mean age at diagnosis was 44±12 years;the mean time from diagnosis was 12±8 years;and the mean BMI was 27±4 kg/m².Fragility fractures were found in 27 patients(21%).There were no significant differences in the presence of osteoporosis or fragility fractures according to age,sex,BMI,duration of acrom egaly,or IGF-1 levels at diagnosis.A higher percentage of patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis(46%vs 15%;P<0.05).CONCLUSION A high prevalence of osteoporosis and fragility fractures was found in patients with acromegaly,regardless of age,sex,BMI,time from diagnosis,IGF-1 levels,and disease control.More patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis.Taken together,our results suggest that the severity of the disease and the need for second-line therapies,may be associated with the increased risk of osteoporosis.
文摘BACKGROUND Acromegaly is caused by a pituitary neuroendocrine tumor(PitNET)with excessive production of growth hormone(GH),leading to multisystem complications.Previous studies have identified predictors of disease persistence following surgery and poor response to medical treatment,including tumor size,vertical and horizontal extensions of the adenoma,hyperintensity in T2-weighted magnetic resonance imaging,granulation density,and pre-and postoperative GH and insulin-like growth factor 1(IGF-1)levels.AIM To evaluate PitNET volume as a complementary prognostic factor in patients with acromegaly.METHODS This is a retrospective descriptive study with an analytical component evaluating the correlation between the volumetric analysis of GH-producing PitNETs,IGF-1 levels before and after surgery,disease control during follow-up,and the line of therapy required for disease control in a cohort of patients treated at two centers:Endocrinology Department of the Central Military Hospital and Centros Médicos Colsanitas,Bogotá,Colombia.RESULTS A total of 77 patients with acromegaly(42 men,35 women)were included in this study.The mean age at diagnosis was 42 years(SD:12),with a mean disease duration of 9.9 years(SD:7.2).The mean pituitary tumor volume was 4358 mm^(3)(SD:6291,interquartile range[IQR]:13602).Patients with controlled acromegaly had a mean PitNET volume of 3202 mm^(3)(SD:4845,95%CI:621-5784)compared to 5513 mm^(3)(SD:7447,95%CI:1545-9482)in the uncontrolled group(P=0.15).A PitNET volume exceeding 3697 mm^(3)was associated with a higher likelihood of requiring third or fourth-line therapy(50%vs 36%;P=0.03).CONCLUSION PitNET volume was associated with the need for higher-line therapy to manage acromegaly but did not correlate with long-term disease control or with pre-or postsurgical IGF-1 levels.Nevertheless,a trend towards an inverse relationship between tumor volume and future disease control was observed.While macroadenoma classification remains crucial,among patients with macroadenomas,those with a volume exceeding 3697 mm³could have worse prognosis.
文摘BACKGROUND Maturity-onset diabetes of the young(MODY)is a monogenic form of diabetes often misdiagnosed as type 1 or type 2.The MODY7 subtype,attributed to variants in the Kruppel-like factor 11(KLF11)gene,is exceedingly rare,and its clinical spectrum is not fully characterized.Precise genetic diagnosis is essential for appropriate management but is challenging due to phenotypic overlap with other diabetes types.This case report describes a patient with a novel KLF11 variant,contributing to the understanding of this rare condition and its clinical implications.CASE SUMMARY A 50-year-old female with a family history of MODY in her son was initially diagnosed with type 2 diabetes.Due to the family history and a non-obese phenotype,a comprehensive genetic panel for monogenic diabetes was performed.The analysis identified a novel heterozygous missense variant,p.Cys105Phe,in the KLF11 gene,establishing a definitive diagnosis of MODY7.Following this diagnosis,the patient’s treatment was adjusted to include lifestyle modifications,resulting in adequate glycemic control.The patient has since maintained target glycated hemoglobin levels.CONCLUSION Monogenic diabetes type MODY7,caused by a mutation in the KLF11 gene,is extremely rare.Although some studies question its existence,compatible cases continue to be diagnosed,given its inclusion in genetic panels for MODY.
文摘Metformin-induced vitamin B12 deficiency is a prevalent condition among pa-tients with type 2 diabetes mellitus.In recent years,a growing body of evidence has demonstrated the association between vitamin B12 deficiency and the onset,progression,and worsening of diabetic neuropathy(DNP)as well as its im-provement with supplementation in cases of deficiency.Major clinical guidelines for diabetes and DNP remain vague in their recommendations for B12 measu-rement and supplementation,and some guidelines do not address it at all.Given that vitamin B12 therapy is an economical,safe,and widely available treatment in most countries and supported by emerging evidence of its potential benefits,greater efforts should be made to promote systematic screening for vitamin B12 deficiency in all patients with DNP before establishing a definitive diagnosis as well as in patients with diabetes with risk factors for deficiency.Vitamin B12 deficiency should be treated in all affected patients,and supplementation should be considered in those with borderline levels when confirmatory diagnostic tests for deficiency are unavailable.Clinical guidelines should place greater emphasis on the recommendations for measuring and supplementing vitamin B12 in these patients.
