Diabetic neuropathy is a common and disabling chronic complication of type 2 diabetes mellitus (T2DM). Sudomotor dysfunction, can be objectively assessed using electrochemical skin conductance (ESC). Research design and methods A longitudinal analysis was conducted among participants from the Center of Comprehensive Care for the Patient with Diabetes (CAIPaDi). Participants were adults aged 18–70 years, non-smokers, and with less than five years since their T2DM diagnosis. Sudomotor function was evaluated using Sudoscan. The primary outcome was incident sudomotor deterioration. Kaplan–Meier curves, log-rank tests, and multivariable Cox proportional hazards models were used to evaluate time to deterioration and independent predictors. Results Among 4676 participants, incident sudomotor deterioration occurred during follow-up, with nearly half of events detected at the first annual evaluation. Being a woman (HR 1.50, 95% CI 1.07–2.18; p = 0.01), age ≥ 50 years (HR 0.98, 95% CI 0.97–1.00; p = 0.02), and higher systolic blood pressure (HR 1.24 per 10 mmHg, 95% CI 1.11–1.37; p < 0.001) were independently associated with incident sudomotor deterioration. Conclusions In adults with recently diagnosed T2D, sex (woman), older age, and higher systolic blood pressure were associated with earlier sudomotor deterioration, suggesting that vascular and biological susceptibility contribute to early autonomic nerve dysfunction.
Neuroendocrine tumors (NETs) are known to produce growth hormone (GH) and growth hormone-releasing hormone (GHRH) leading to acromegaly. Ectopic production of these hormones can lead to ectopic acromegaly which is very rare. Ectopic acromegaly secondary to GHRH has been studied more extensively than GH-related ectopic acromegaly. Given the extreme rarity of these neoplasms, comprehensive guidelines for diagnosis and management of these NETs are currently lacking. This chapter summarizes the literature on clinical presentation, challenges in diagnosis and management of these NETs. The diagnosis of ectopic acromegaly is often difficult as clinical features do not differ from eutopic acromegaly, and we discuss herein when the clinical suspicion should be held high. GHRH serum concentrations are a useful diagnostic tool when ectopic production is suspected. Once the ectopic source is identified using imaging including advanced molecular imaging, the choice of treatment is surgical resection of the respective NET. Other therapies include use of somatostatin receptor analogues and chemo- or immuno-therapies as an adjunct or in refractory cases.
Aims The hypothesis was that depressed patients compared to non-depressed patients with newly diagnosed type 2 diabetes mellitus (T2DM) had higher levels of soluble Triggering Receptor Expressed on Myeloid Cells 2 (sTREM2) as a sign of increased microglial activation. The aim was to explore a potential association between depression and sTREM2. Materials and methods Cross-sectional and multicentre study which included adults with serologically verified, newly diagnosed T2DM. Associations with depression and high sTREM2 (>3.38 pg/mL) were assessed using multiple regression analyses. Potential covariations were explored for age, sex, anxiety, soluble neuropilin-1 (sNRP-1), C-peptide, body mass index (BMI), Haemoglobin A1c, physical inactivity, smoking, and prior cardiovascular disease. ELISA techniques were used to analyse sTREM2, sNRP-1, and C-peptide. Results Included were 726 patients (aged 18–94 years, women 38%, depressed 16%, anxious 23%, physically inactive 32%). The prevalence was for high sTREM2 (>3.38 pg/mL) 20%, low sNRP-1 (<225.5 ng/ml) 24%, and high C-peptide (≥1.60 nmol/L) 26%.Associated with depression (n = 630) were anxiety (adjusted odds ratio (AOR) 10.5, p < 0.001), low sNRP-1 (AOR 3.3, p < 0.001), high sTREM2 (AOR 2.0, p = 0.016), high C-peptide (AOR 1.9, p = 0.024), and physical inactivity (AOR 1.8, p = 0.025).Associated with high sTREM2 (n = 656) were BMI (per kg/m2) (AOR 1.08, p < 0.001) and depression (AOR 1.8, p = 0.015). Conclusions Depressed patients compared non-depressed patients with newly diagnosed T2DM had higher levels of sTREM2. High sTREM2, high C-peptide, low sNRP-1, physical inactivity, and anxiety, were independently associated with depression. Depression and BMI were independently associated with high sTREM2. The hypothesis was supported.
Background People with cystic fibrosis-related diabetes (CFRD) are at risk of hypoglycaemia related to insulin therapy; and hypoglycaemia is also prevalent in those without CFRD. Although people with other forms of diabetes mellitus are at risk of hypoglycaemia within 48 h after exercise, this has not been objectively measured in people with CF. This study investigated the prevalence of post-exercise hypoglycaemia in adults with CF (pre- and post-commencement of elexacaftor/tezacaftor/ivacaftor (ETI)), compared to healthy controls. Methods Participants completed a 20-min supervised, moderate-intensity cycling session and wore a continuous flash glucose sensor. The prevalence of hypoglycaemia was defined as the number of participants and percentage of time glucose levels were < 3.9 mmol/L and < 3.0 mmol/L within the 48 h after exercise. Results 15 adults with CF pre-ETI (abnormal glucose tolerance (impaired glucose tolerance, n = 2, or CFRD, n = 5)), 32 adults with CF post-ETI (21 abnormal glucose tolerance (impaired glucose tolerance, n = 10, or CFRD, n = 11)) and 15 healthy controls completed the study. There were no significant differences in the prevalence or duration of hypoglycaemia post-exercise between the CF and control groups; and no change after commencing ETI. There was also no significant increase in the prevalence or duration of hypoglycaemia for people with CF with abnormal glucose tolerance when comparing the 48 h post-exercise period to the 48 h period with the least exercise. Conclusions The absence of any increase in significant hypoglycaemia in the post-exercise period should be reassuring for people with CF who have abnormal glucose tolerance, whether prescribed ETI or not, and their clinicians.
