Background:Primary aldosteronism (PA) is a common cause of secondary hypertension and hypokalemia, but it rarely presents with neuromuscular symptoms. Although only a few cases of hypokalemia-induced rhabdomyolysis have been reported, dropped head syndrome (DHS) due to cervical axial muscle weakness has not previously been described in the context of PA. Case Presentation:A 65-year-old woman with a history of hypertension presented with progressive posterior neck weakness, followed by proximal limb soreness and weakness. Cervical spine disease was initially suspected, but CT imaging revealed only degenerative changes without cord compression. Laboratory tests showed severe hypokalemia (1.5 mmol/L), metabolic alkalosis, and markedly elevated creatine kinase and myoglobin levels, consistent with rhabdomyolysis. Her symptoms resolved after potassium supplementation. Endocrine workup revealed an elevated aldosterone-to-renin ratio (ARR) and a positive captopril suppression test. CT and NP-59 SPECT/CT identified a left adrenal functioning adenoma. Laparoscopic adrenalectomy confirmed an aldosterone-producing adrenal cortical adenoma. Postoperatively, the patient achieved complete biochemical remission with normalized potassium levels, improved blood pressure, and no recurrence of muscle weakness or neck symptoms. Conclusion:This case highlights a rare presentation of PA as hypokalemia-induced rhabdomyolysis and DHS mimicking cervical spine pathology. In patients with unexplained focal muscle weakness and persistent hypokalemia, particularly in the setting of hypertension, PA should be considered. Clinicians should maintain a high index of suspicion and pursue comprehensive diagnostic evaluations. Early diagnosis and definitive treatment can prevent long-term complications and enable full metabolic recovery.

Transcutaneous electrical nerve stimulator (TENS) has been demonstrated to be beneficial in glycemic control in animal models, but its application in humans has not been well studied. We randomly assigned 160 patients with type 2 diabetes on oral antidiabetic drugs 1:1 to the TENS study device (n = 81) and placebo (n = 79). 147 (92%) randomized participants (mean [SD] age 59 [10] years, 92 men [58%], mean [SD] baseline HbA 1c level 8.1% [0.6%]) completed the trial. At week 20, HbA 1c decreased from 8.1% to 7.9% in the TENS group (− 0.2% [95% CI − 0.4% to − 0.1%]) and from 8.1% to 7.8% in the placebo group (− 0.3% [95% CI − 0.5% to − 0.2%]) ( P = 0.821). Glycemic variability, measured as mean amplitude of glycemic excursion (MAGE) at week 20 were significantly different in the TENS group vs. the placebo group (66 mg/dL [95% CI 58, 73] vs. 79 mg/dL [95% CI 72, 87]) ( P = 0.009). Our study provides the clinical evidence for the first time in humans that TENS does not demonstrate a statistically significant HbA 1c reduction. However, it is a safe complementary therapy to improve MAGE in patients with type 2 diabetes.

Although it was known that obesity is an independent risk factor for metabolic disorders including diabetes, the factors that link these diseases were obscure. The Hedgehog-interacting protein (Hhip) is a negative regulator in tissue remodeling, and inhibits the proliferation of adipocytes, and promotes their differentiation. In addition, Hhip was positively associated with diabetes. However, the relationship between Hhip and obesity in the human body remains unclear. An analysis of the relationship between Hhip and normal weight, overweight, and obesity levels. Participants receiving a physical checkup were recruited. Anthropometric and biochemical data were collected. Serum Hhip levels were determined by enzyme-linked immunosorbent assay (ELISA). Subjects were classified into normal-weight, overweight, and obese groups based on their body mass index (BMI). The association between Hhip and obesity was examined by multivariate linear regression analysis. In total, 294 subjects who were either of a normal weight (n = 166), overweight (n = 90), or obese (n = 38) were enrolled. Hhip concentrations were 6.51 ± 4.86 ng/mL, 5.79 ± 4.33 ng/mL, and 3.97 ± 3.4 ng/mL in normal-weight, overweight, and obese groups, respectively (p for trend = 0.032). Moreover, the regression analysis showed that BMI (β = −0.144, 95% confidence interval (CI) = −0.397−0.046, p = 0.013) was negatively associated with Hhip concentrations after adjusting for sex and age. Being overweight (β = −0.181, 95% CI = −3.311−0.400, p = 0.013) and obese (β = −0.311, 95% CI = −6.393−2.384, p < 0.001) were independently associated with Hhip concentrations after adjusting for sex, age, fasting plasma glucose, the insulin level, and other cardiometabolic risk factors. Our results showed that overweight and obese subjects had lower Hhip concentrations than those of normal weight. Being overweight and obese were negatively associated with Hhip concentrations. Hhip might be a link between obesity and diabetes.

Background Many technology-assisted innovations have been used to manage disease. However, most of these innovations are not broadly used by older adults due to their cost. Additionally, disease management through technology-assisted innovations has not been compared with other interventions. Objective In this study, we tested the employment of a free and widely used social and communication app to help older adults with diabetes manage their distress and glycemic control. We also compared the effectiveness of the app with 2 other methods, namely telephone and conventional health education, and determined which subgroup experiences the most effects within each intervention. Methods Adults aged ≥50 years with type 2 diabetes were recruited from Southern Taiwan (N=231) and were allocated to different 3-month interventions. Informed consent was obtained at the Ministry of Science and Technology and approved by the National Cheng Kung University Hospital Institutional Review Board (No. A-ER-102-425). Results Participants in the mobile-based group had significant reductions in hemoglobin A1c compared with the telephone-based and usual care groups (mean changes of –0.4%, 0.1%, and 0.03%, respectively; P=.02). Diabetes-specific distress decreased to a greater extent in the mobile-based group compared to the other 2 groups (mean changes of –5.16, –3.49, and –2.44, respectively, P=.02). Subgroup analyses further revealed that the effects on reducing blood glucose levels in the social and communication app groups were especially evident in patients with lower distress scores, and diabetes-related distress was especially evident in participants who were younger than 60 years or had higher educational levels. Conclusions The findings of this study inform more flexible use of social and communication apps with in-person diabetes education and counselling.

Background Obesity is an independent risk factor for metabolic disorders including diabetes. The Hedgehog-interacting protein (Hhip) is a negative regulator in tissue remodeling, and inhibits the proliferation of adipocytes and promotes their differentiation. In addition, Hhip was positively associated with diabetes. However, relationship between Hhip and obesity in the human body remain unclear. Methods Participants receiving a physical checkup were recruited. Anthropometric and biochemical data were collected. Serum Hhip levels were determined by ELISA. Subjects were classified into normal-weight, overweight, and obese groups based on their body mass index (BMI). The association between Hhip and obesity was examined by a multivariate linear regression analysis. Results In total, 294 subjects who were either of a normal weight ( n =166), overweight ( n =90), or obese ( n =38) were enrolled. Hhip concentrations were 6.51±4.86, 5.79±4.33, and 3.97±3.4 ng/ml in normal-weight, overweight, and obese groups, respectively ( p for trend=0.032). Moreover, the regression analysis showed that BMI (β=-0.144, 95% confidence interval (CI)=-0.397~-0.046, p= 0.013) was negatively associated with Hhip concentrations after adjusting for sex and age. Being overweight (β=-0.181, 95% CI=-3.311~-0.400, p= 0.013) and obese (β=-0.311, 95% CI=-6.393~-2.384, p <0.001) were independently associated with Hhip concentrations after adjusting for sex, age, fasting plasma glucose, the insulin level, and other cardiometabolic risk factors. Conclusions Our results showed that overweight and obese subjects had lower Hhip concentrations than those of a normal weight. Being overweight and obese were negatively associated with Hhip concentrations. Hhip might be a link between obesity and diabetes.

Background: Autosomal dominant polycystic kidney disease is associated with higher risk of new onset diabetes after transplantation. The risk of type 2 diabetes in non-transplanted patients with autosomal dominant polycystic kidney disease is rarely investigated. Methods: We conduct a nationwide study which included adult residents, using National Health Insurance Research Database to identify patients with major illness certificate for autosomal dominant polycystic kidney disease from 2000 to 2012 and to analyze general population using Longitudinal Health Insurance Database 2000. Time trend analysis of prevalence and incidence of type 2 diabetes in patients with autosomal dominant polycystic kidney disease was estimated from the multivariate Poisson regression with generalized estimating equations model, which simultaneously included the calendar year, age, sex, insurance premium, and urbanization. Results: The age and sex standardized annual prevalence (trend test: ����= 0.0641 p＜0.0001) and incidence (trend test: ����=0.0912 p＜0.0001) of type 2 diabetes in patients with autosomal dominant polycystic kidney disease is increasing from 2000 to 2012, but not higher than general population. In these patients, prevalence and incidence of type 2 diabetes is increasing with age, and is more observed in men, in patients with lower insurance premium and in residents in urban area. Conclusion: This study demonstrated the increase in annual prevalence and incidence of type 2 diabetes among adult patients with confirmed autosomal dominant polycystic kidney disease in Taiwan from 2000 to 2012. Risk of type 2 diabetes is not increased in patients with autosomal dominant polycystic kidney disease.

Abstract Aims/Introduction The present study investigated the longitudinal associations between depressive symptoms and glycemic control in nationally representative adults with type 2 diabetes, and tested the effects of sex and perceived family support in moderating this association. Materials and Methods In this longitudinal study of middle‐aged and older adults who participated in the 2002 and 2006 Health and Retirement Study, and the 2003 and 2006 Diabetes Study (n = 398), we applied a cross‐lagged structural equation model to examine the reciprocal relationship between depressive symptoms and glycemic control over a 3‐year period. Results Men and women were not different in terms of the depressive symptoms and glycemic control relationship, with a stronger association noted for higher depressive symptom scores predicting worse glycemic control (β = 0.22, critical ratio 3.03), as opposed to worse glycemic control predicting higher depressive symptom scores. Family and friend support for diabetes self‐management serves as an important buffer. In patients with low family and friend support, more depressive symptoms at baseline were associated with subsequent worse glycemic levels (β = 0.36, critical ratio 4.03). In contrast, in individuals who had strong support, depressive symptoms did not predict subsequent glycemic control. Conclusions The present study provided evidence for the relationship between glycemic control and depression, finding that depressive symptoms predicted poorly controlled glycemic status, especially when the participants perceived inadequate support from their family or friends. A quick survey in clinics to assess the level of family or friend support for diabetes management and depressive symptoms might be an important part of individualized diabetic care.

Continuous glucose monitoring (CGM) uses subcutaneous sensors and records the average interstitial sensor current every 5 min in the recorder; data are subsequently exported to a computer 4 to 7 days later when calibration with self-measured blood glucose is made retrospectively. How middle-aged and older patients perceive the added technology intervention is not clear.The study aimed to understand the factors associated with the adoption of new technology in diabetes care, to understand the feelings and behaviors while using it, and to determine the changes in attitudes and behavior after completing the use of the new technology at the 3-month follow-up.Middle-aged and older type 2 diabetes patients who had received professional continuous glucose monitoring (iPro 2 [Medtronic]) were invited for semistructured in-depth interviews on the day of the CGM sensor removal and at 3 months after CGM-based counseling. A phenomenography approach was used to analyze the interview data.A total of 20 type 2 diabetes patients (aged 53 to 72 years, 13 males and 7 females, 4 to 40 years duration of diabetes, mean glycated hemoglobin 8.54% [SD 0.71%]) completed 2 sections of semistructured in-depth interviews. Physician guidance and participant motivation toward problem solving were found to be factors associated with adoption of the device. Participants indicated that technology can be a reminder, a supervisor, and a visualizer of blood glucose, all of which are helpful for disease management. However, CGM is somewhat inconvenient, and some participants also reported that the provision of this new technology might be a hint of disease progression. There was a higher percentage of women compared with men who reported that CGM can be a reminder or a supervisor to help them with diet control.Physician guidance and participants' degree of motivation are keys to adopting new technology in the case of middle-aged and older adults. Although the CGM sensor may cause inconvenience to patients on their limited body movement when wearing the device, it is helpful for diet control and is an effective behavioral modification tool that offers support, especially in the case of women.

Obesity is a public health problem that has raised concerns worldwide and is often associated with hepatic steatosis. Hepassocin is a novel hepatokine that causes hepatic steatosis and induces insulin resistance (IR). However, the role of hepassocin in obesity remains obscure. Thus, the aim of this study was to investigate the relationship between hepassocin levels and obesity. In total, 371 subjects who had a normal weight (NW), were overweight, or were obese were enrolled. We found that hepassocin levels in subjects who were overweight (6,705 ± 1,707 pg/ml) or obese (7,335 ± 2,077 pg/ml) were significantly higher than those of subjects with a NW (5,767 ± 1,500 pg/ml) (p < .001, test for trend). A multiple linear regression analysis showed that the body-mass index, waist circumference, nonalcoholic fatty liver disease, and homeostatic model assessment of IR were independently associated with hepassocin after adjusting for age, sex, high-sensitivity C-reactive protein, systolic blood pressure, high-density lipoprotein-cholesterol, log triglycerides, alanine transaminase, and the estimated glomerular filtration rate. This study provides evidence that subjects who were overweight or obese had significantly higher hepassocin levels than those with a NW. Hepassocin may be a useful biomarker in managing obesity and its related metabolic dysregulation.

AIM We compared the effects of two types of basal insulin: long-acting insulin analogues vs. intermediate/long-acting human insulin, on diabetes-related complications in type 1 diabetes. METHODS A total of 1188 patients with type 1 diabetes who had recently started on long-acting insulin analogues or intermediate/long-acting human insulin were identified in 2004-2008 and followed until death or the end of 2013. Clinical outcomes included acute (i.e. hyperglycaemia, hypoglycaemia) and chronic (i.e. nephropathy, retinopathy, neuropathy, cardiovascular diseases) complications. Diabetes-related complications were measured as a composite outcome which included acute and chronic complications. Cox proportional hazards models were used to assess the time to event hazard ratio. Three propensity score (PS) methods were applied to adjust for baseline imbalances between basal insulin groups, including the PS-matching approach (as the main analysis), standardized mortality ratio weighting (SMRW) and inverse probability of treatment weighting (IPTW). RESULTS Long-acting insulin analogues vs. intermediate/long-acting human insulin had a lower risk for a composite of diabetes-related complications {adjusted hazards ratios [aHRs] [95% confidence interval (CI)] 0.782 [0.639, 0.956], 0.743 [0.598, 0.924] and 0.699 [0.577, 0.846] according to the PS-matching approach, SMRW and IPTW, respectively}. Compared with intermediate/long-acting human insulin, using long-acting insulin analogues had a lower hypoglycaemia risk: aHRs (95% CI) 0.681 (0.498, 0.930), 0.662 (0.466, 0.943) and 0.639 (0.471, 0.867) from the PS-matching approach, SMRW and IPTW, respectively. No statistical differences were found between two types of insulin on individual chronic complications. CONCLUSION A trend of lower diabetes-related complications associated with long-acting insulin analogues vs. intermediate/long-acting human insulin was observed. A reduced hypoglycaemia risk with long-acting insulin analogues was confirmed in this 'real-world' study.

Fenretinide is a novel anticancer agent reported to exhibit anti-invasive and antimetastatic activities. It has also been shown to improve obesity and diabetes, although the effects of fenretinide on hypertension are still unknown, and the detailed mechanisms remain unclear. In this study, we have shown that treatment with lipopolysaccharide (LPS) decreased the expression of peroxisome proliferator-activated receptor γ (PPARγ) in RAW264.7 macrophages, and pretreatment with fenretinide reversed the effect of LPS on PPARγ expression. In addition, LPS-induced pro-inflammatory cytokine production, including tumor necrosis factor-α, interleukin 6, and monocyte chemoattractant protein 1 were dose-dependently reversed by fenretinide, and the effects of fenretinide on LPS-induced pro-inflammatory cytokine production were blocked by treatment with PPARγ antagonist. Moreover, fenretinide decreased LPS-induced inducible nitric oxide synthase expression and nitrogen oxide production. These effects were blocked by the pretreatment with PPARγ antagonist in a dose-dependent manner, indicating fenretinide activated PPARγ to exert anti-inflammation activity. In view of the role of inflammation in hypertension and the anti-inflammatory action of fenretinide, we found that administration of fenretinide in spontaneously hypertensive rats significantly decreased blood pressure. Taken together, these results indicate that fenretinide might be a potent antihypertensive agent that works by suppressing inflammation via activating PPARγ.

Although prior studies have examined BMI trajectories in Western populations, little is known regarding how BMI trajectories in Asian populations vary between adults with and without diabetes.

The prevalence of type 2 diabetes mellitus (T2DM) is increasing in the elderly.Because of the unique characteristics of elderly people with T2DM, therapeutic strategy and focus should be tailored to suit this population.This article reviews the guidelines and studies related to older people with T2DM worldwide.A few important themes are generalized: 1) the functional and cognitive status is critical for older people with T2DM considering their life expectancy compared to younger counterparts; 2) both severe hypoglycemia and persistent hyperglycemia are deleterious to older adults with T2DM, and both conditions should be avoided when determining therapeutic goals; 3) recently developed guidelines emphasize the avoidance of hypoglycemic episodes in older people, even in the absence of symptoms.In addition, we raise the concern of glycemic variability, and discuss the rationale for the selection of current options in managing this patient population.