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(searched for: Microalbuminuria in Type 2 Diabetes Mellitus and Glycemic Control)
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Sciprofile linkMichel P. Hermans, Sylvie A. Ahn, Shaukat Sadikot, Michel F. Rousseau
Diabetes & Metabolic Syndrome: Clinical Research & Reviews, Volume 14, pp 1503-1509; doi:10.1016/j.dsx.2020.07.027

The publisher has not yet granted permission to display this abstract.
M.D.; Mohamed Halawa Salah Shelbaya, M.D. Merhan Nasr
The Medical Journal of Cairo University, Volume 88, pp 1413-1421; doi:10.21608/mjcu.2020.110954

The publisher has not yet granted permission to display this abstract.
Nikoletta Proudan, Murray B Gordon
Journal of the Endocrine Society, Volume 4; doi:10.1210/jendso/bvaa046.1550

Abstract:
Myotonic dystrophy (MD) is a multisystemic, autosomal dominant disorder associated with progressive muscle weakness, premature cataracts, frontal baldness, and cardiac disturbances. MD has been associated with several endocrinopathies including primary testicular failure, autoimmune endocrinopathies (hypothyroidism, hyperthyroidism, multinodular goiter, and Addison’s disease), thyroid carcinoma (primarily papillary), insulin resistance, and type 2 DM. Development of diabetes is thought to be related to formation of an insulin-resistant receptor because of aberrant regulation of mRNA. We describe the first reported case of a patient with MD associated with type I diabetes mellitus, Hashimoto’s thyroiditis with hypothyroidism, and follicular variant of papillary thyroid cancer. A 49-year-old female presented with acute congestive heart failure. The patient had history of type I DM diagnosed at the age of 26, complicated by mild background retinopathy, peripheral neuropathy, and nephropathy with microalbuminuria. The patient first noticed proximal muscle weakness 1 year ago that gradually progressed resulting in multiple falls. She had history of bilateral cataracts status post cataract extraction at age 26. She also had progressive dysphagia requiring PEG placement, and cognitive dysfunction with mood disorder and depression. Family history was significant for myotonic dystrophy in both maternal aunt and uncle as well as 2 cousins. EMG confirmed myotonia however genetic testing was not obtained due to cost. Due to her cognitive dysfunction and depression, she had difficult to control diabetes with HbA1c of 9.9%, and multiple previous admissions for DKA. She was status post total thyroidectomy in 2008 for follicular variant of papillary carcinoma and Hashimoto’s thyroiditis followed by I-131 therapy in 2009 and maintained on levothyroxine suppression therapy. Most recent Tg and Tg Ab were undetectable. On physical exam, the patient had a narrow, sallow face with temporal muscle atrophy, percussion myoclonus involving the thenar eminence of the hands, but no frontal balding. Work up showed LVEF of 20-24% with regional hypokinesis that led to catherization and PCI to LAD. The patient had recurrent NSTEMI which eventually resulted in CABG 1 year after presentation. The association of autoimmune endocrinopathies, thyroid carcinoma and MD suggests a possible cause and effect relationship between these disorders. In patients with diabetes and MD, previously described insulin resistance as well as cognitive dysfunction can hinder good glycemic control increasing risk for complications. Although patients with MD are typically treated by neurologists, evaluation and therapy of endocrine dysfunctions are also necessary.
X Y Zheng, S H Luo, X Y Wei, P Ling, H Y Ai, Z Y Liu, Q Y Lin, J Lü, B Yao, J H Yan, et al.
Published: 18 February 2020
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Wen-Chan Chiu, Yun-Ru Lai, Ben-Chung Cheng, Chih-Cheng Huang, Jung-Fu Chen, Sciprofile linkCheng-Hsien Lu
Published: 25 January 2020
BioMed Research International, Volume 2020, pp 7462158-8; doi:10.1155/2020/7462158

Abstract:
Glycemic variability is associated with higher risk of microvascular complications in patients with type 2 diabetes. To test the hypothesis that glycemic variability can contribute to progression to macroalbuminuria in normal or microalbuminuria in patients with type 2 diabetes. This prospective study enrolled 193 patients with type 2 diabetes at a tertiary medical center. For each patient, the intrapersonal glycemic variability (mean, SD, and coefficient of variation of HbA1c) was calculated using all measurements obtained three years before the study. Patients were divided into four groups stratified by both urine albumin/creatinine ratio and HbA1c-SD. The presence of macroalbuminuria was assessed with Kaplan-Meier plots and compared by log-rank test. Of the 193 patients, 83 patients were in the macroalbuminuria state. Patients in the initial macroalbuminuria group after enrollment had the highest diabetes duration, mean, CV-HbA1c and HbA1c-SD, and uric acid level, and the lowest estimate glomerular filtration rate, followed by subsequent macroalbuminuria and without macroalbuminuria groups. Patients with microalbuminuria and high HbA1c-SD showed the highest progression rate to macroalbuminuria, after a six-year follow-up study by Kaplan-Meier Plots and compared by log-rank test. Higher HbA1C variability is more likely to progress to macroalbuminuria in those patients who are already in a microalbuminuria state. We recommend that clinicians should aggressively control blood glucose to an acceptable range and avoid blood glucose fluctuations by individualized treatment to prevent renal status progression.
Asad Ullah, Rozi Khan, Jaffar Khan, Muhammad Saleem Panezai, Asad Khan Kakar, Muhammad Samsoor Zarak
Archives of Nephrology and Urology, Volume 3, pp 5-16; doi:10.26502/anu.2644-2833015

Abstract:
Objective: To determine the frequency of microalbuminuria in Type 2 Diabetes Mellitus with good glycemic control. Introduction: Diabetes Mellitus is a chronic illness, frequently not diagnosed until complications appear. Microalbuminuria is a renal marker of generalized vascular endothelial damage and early atherosclerosis. Patients with microalbuminuria are at increased risk of microvascular and macrovascular complications of Diabetes Mellitus like myocardial infarction, stroke, and nephropathy. Poor glycemic control increases the risk of microalbuminuria. Methodology: A cross-sectional study is conducted at the Department of Medicine, Bolan Medical College/ Sandeman Provincial Hospital Quetta, Pakistan. The duration of the study is six months from September 2016 to March 2017. A total of 140 Type 2 DM patients with good glycemic control is included in this study. 63 (45%) were female, and 77 (55%) were male with a mean age of 44.47 ± 4.99 years. The mean duration of DM is found to be 4.21 ± 0.94 years. The mean HbA1c level was found to be 6.74 ± 0.17. 21 patients (15%) were found to have microalbuminuria. Conclusion: There is an association of microalbuminuria in diabetic patients with good glycemic control; however, the prevalence is low, but it is still positive. Uncontrolled DM is strongly associated with the prevalence of microalbuminuria. Screening for microalbuminuria and HbA1c test should be done both in new and already diagnosed type 2 diabetic patients as an early marker of renal dysfunction and glycemic control.
Paunipagar P V, Biochemistry, Patil A R
International Journal of Clinical Biochemistry and Research, Volume 6, pp 479-484; doi:10.18231/j.ijcbr.2019.100

Abstract:
Diabetic nephropathy is the main cause of morbidity and mortality in patients with diabetes mellitus. The results of many clinical studies shows variation in the correlation of HbA1c and microalbuminuria in type 2 diabetes mellitus. In the present study we tried to correlate the HbA1c levels and microalbuminuria with respect to duration in type 2 diabetes mellitus cases and also studied microalbuminuria as a marker of nephropathy in type 2 diabetes mellitus. Materials and Methods: The study was conducted in the Department of Biochemistry at Raichur Institute of Medical Sciences. 100 subjects were recruited based on the inclusion and exclusion criteria, 50 were healthy controls and 50 were type 2 DM patients. FBS, PPBS, blood urea, serum creatinine, HbA1c, serum sodium, serum potassium and urinary micro albumin were analyzed. Statistical analysis was done by using student ‘t’ test and Chi square test. Results: A statistically significant difference was observed in values of FBS, PPBS, blood urea, serum creatinine, HbA1c, serum sodium, serum potassium and urinary microalbumin levels in cases compared to controls. In our study the mean HbA1c values were 5.1321.11% in controls and 7.5121.19% in cases & mean HbA1c value in patients without microalbuminuria is 7.130.84 and in patients with microalbuminuria is 8.121.44 which is statistically significant (p=0.005). Conclusion: The present study concluded that estimating glycosylated hemoglobin as an indicator of glycemic control and microalbuminuria in random urine sample for renal involvement in diabetic subjects provide a convenient method for early diagnosis and intervention. Thus the study suggests microalbuminuria as a nephropathic marker in type 2 diabetes mellitus. The possibility, delay or reverse the progression of diabetic nephropathy can be achieved only by perfect long term metabolic control. Keywords: Diabetic Nephropathy, HbA1c, Microalbuminuria, Type 2 Diabetes Mellitus.
Yanli Li, Min Yi, Xiaoyi Deng, Singla Sethiel Mosha, Wangen Li, Xiaodan Zhang
Published: 22 November 2019
Abstract:
Background : Diabetes mellitus (DM) and thyroid dysfunction (TD) are two closely associated disorders. The coexistence of TD could adversely influence metabolic control and even increase the long-term mortality in patients with DM. The objective of the present study was to investigate the prevalence and risk factors of TD in patients with type 2 DM (T2DM). Methods : This is an observational cross-sectional study. A total of 340 patients with newly diagnosed T2DM who were admitted to ward of endocrinology department were included for analysis. Thyroid function was examined and its relationship with demographic, metabolic and diabetes-related parameters were evaluated Results : The prevalence of TD was 21.2% in the total population. The low T3 syndrome was the most frequent TD, in 14.7% of patients. Low FT3 level was associated with diabetic complications including presence of diabetic ketosis (DK) or diabetic ketoacidosis (DKA) (r = -0.388, P ≤ 0.001) and microalbuminuria (r = -0.302, P ≤ 0.001). Metabolic and demographic factors, including age, glycemic control and insulin resistance also correlated with levels of thyroid hormones. DK or DKA (OR = 6.161, P ≤ 0.001) and microalbuminuria (OR = 3.950, P = 0.002) were risk factors of low T3 syndrome. Conclusion : TD is not rarely seen in patients with newly diagnosed T2DM. Diabetic complications and diabetes-related metabolic and demographic factors are related to the presence of TD.
Yanli Li, Min Yi, Xiaoyi Deng, Singla Sethiel Mosha, Wangen Li, Xiaodan Zhang
Published: 4 November 2019
Abstract:
Background : Diabetes mellitus (DM) and thyroid dysfunction (TD) are two closely associated disorders. The coexistence of TD could adversely influence metabolic control and even increase the long-term mortality in patients with DM. The objective of the present study was to investigate the prevalence and risk factors of TD in patients with type 2 DM (T2DM). Methods : This is an observational cross-sectional study. A total of 340 patients with newly diagnosed T2DM who were admitted to ward of endocrinology department were included for analysis. Thyroid function was examined and its relationship with demographic, metabolic and diabetes-related parameters were evaluated Results : The prevalence of TD was 21.2% in the total population. The low T3 syndrome was the most frequent TD, in 14.7% of patients. Low FT3 level was associated with diabetic complications including presence of diabetic ketosis (DK) or diabetic ketoacidosis (DKA) (r = -0.388, P ≤ 0.001) and microalbuminuria (r = -0.302, P ≤ 0.001). Metabolic and demographic factors, including age, glycemic control and insulin resistance also correlated with levels of thyroid hormones. DK or DKA (OR = 6.161, P ≤ 0.001) and microalbuminuria (OR = 3.950, P = 0.002) were risk factors of low T3 syndrome. Conclusion : TD is not rarely seen in patients with newly diagnosed T2DM. Diabetic complications and diabetes-related metabolic and demographic factors are related to the presence of TD.
Cardiovascular Therapy and Prevention, Volume 18; doi:10.15829/1728-8800-2019-3-48-56

Abstract:
Aim. To study the relationship of chronic kidney disease parameters with glycemic control, subclinical and clinical signs of cardiovascular diseases and laboratory parameters.Material and methods. The study included 528 patients with type 2 diabetes mellitus (T2DM) aged 30-69 years. All respondents answered questions from the ARIC questionnaire about T2DM and cardiovascular diseases. We determined the ankle-brachial index, sonographic left ventricular hypertrophy, intima-media thickness and defined hypertensive, diabetic angiopathy and polyneuropathy. The levels of glycemia, lipid spectrum, creatinine, uric acid, glycohemoglobin were evaluted. Glomerular filtration rate (GFR) was calculated using the Cockroft-Gault method, and microalbuminuria (MAU) was determined using Micral tests.Results. Glycohemoglobin did not depend on MAU (p=0,564), a decrease in GFR was accompanied by an improvement in glycemic control (p=0,393). There was a direct association between MAU and the duration of diabetes (p=0,001), in patients with a longer course of the disease GFR was reduced (p=0,001). With increasing of systolic blood pressure, MAU progressed (p=0,016), while GFR decreased (pConclusion. Reduction of GFR and MAU are the major risk factors for cardiovascular diseases in the Azerbaijani population with T2DM. We suppose that periodic monitoring of these parameters for primary and secondary prevention of diabetic nephropathy plays an important role.
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