Endocrinology Outpatient Clinic Research Articles

Prevalence and incidence of heart failure in patients with type 2 diabetes mellitus. Results of the prospective DIABET-IC study

Abstract Introduction Heart failure (HF) is one of the major health problems in our environment today. Type 2 diabetes mellitus (DM2) is an important cardiovascular risk factor and can increase the burden of HF through various mechanisms. The incidence of HF in DM2 has not been well studied. Purpose The aim of our study was to evaluate the prevalence and incidence of HF in patients with DM2 followed in hospital cardiology and endocrinology departments. Methods The DIABET-IC study is a longitudinal cohort, prospective, multicenter follow-up study that included 1,249 consecutive patients with DM2 in 2018-2019 in 30 Spanish centers in cardiology and endocrinology outpatient clinics. HF was diagnosed according to the clinical records and following the criteria of the European Society of Cardiology. The prevalence of HF at the inclusion visit was analyzed, as well as the incidence of HF (new diagnoses) during a 3-year follow-up. Results Mean age was 67.3±+9.9 years, with 31.7% of the patients being women. Cardiology clinics included 61.9% of patients and endocrinology clinics the remaining 38.1%. There was a previous history of coronary artery disease in 38.6%, hypertensive heart disease in 21% and atrial fibrillation in 31.9%. Cardiovascular and antidiabetic drugs prescribed at the baseline and 3-year visits are shown in figure 1. Figure 2 summarizes the results of the study. The prevalence of HF at the baseline visit was 39.2%, 490 cases (with reduced LVEF 17.3%, mildly reduced 8.1% and preserved 13.8%). After a follow-up of 1,935/100 persons-year of cases without baseline HF, 58 incident cases of HF were diagnosed, 7.6% (32 in the first year, 13 in the second and 13 in the third year of follow-up). The incidence rate was 3.01/100 person-years (95%CI: 2.30-3.92). Of these 58 cases, 23.7% were with reduced LVEF, 28.9% with slightly reduced LVEF and 47.4% preserved. The incidence was higher in patients followed by endocrinology (3.90 vs 2.90/100 persons-year; p=0.042). At the end of the 3-year follow-up, including baseline prevalence, 46.8% of all patients had HF. Conclusions The prevalence and incidence of HF in patients with DM2 are very high. The incidence of HF is around 3% per year, which is almost 8 times higher than the rate found in large studies in the general population. Approximately half of the new cases were HF with preserved LVEF, and the other half with LVEF < 50%. The use of new antidiabetic drugs, such as iSGLT2, which have been shown to reduce the incidence of HF, should be encouraged.

The magnitude of chronic constipation and associated factors among type 2 diabetic patients in Harar, Eastern Ethiopia

BackgroundConstipation, which affects 16% of adults worldwide, is a chronic health problem characterized by unsatisfactory frequency of bowel movements, causing pain, bloating or incomplete bowel movements. The study aims to assess the magnitude of chronic constipation and associated factors among T2DM patients attending the endocrinology outpatient clinic at Hiwot Fana Comprehensive Specialized University Hospital from January 1 to May 30, 2023.MethodsHospital-based cross-sectional study design was carried out to assess the magnitude and associated factors of chronic constipation among T2DM patients at Hiwot Fana Comprehensive Specialized University Hospital. Using a single population formula 300 T2DM patients were enrolled in this study. The data was analyzed by using the Epi-Data 4.6 and SPSS version 25. Descriptive, bivariate, multivariate, and logistic regression were used. P < 0.05 was used to declare association.Results300 T2DM patients participated in this survey. Of these 137 (45.7%) were male and 163 (54.3%) were female and the mean age was 58.57 ± 11.09 SD years, the range from 35 to 85 years. The prevalence of constipation was 73 (24.3%) (95% CI: 0.196–0.296). Education status above high school (AOR: 0.151.95% CI: 0.032–0.718), less than 7 h of sleep per day (AOR: 12.39.95% CI: 2.712–56.69), frequent depression (AOR: 6, 84, 95% CI: 2.639–17.743), parents with constipation (AOR: 6.843.95% CI: 2.639–17.743), daily water intake < 1300 ml (AOR: 4.760.95% CI: 1.146–19.773), TAG levels below 150 mg/dl (AOR: 0.050, 95% CI: 0.015–0.166), HbAlc between 6 and 7% (AOR: 0.013.95% CI: 0.001–0.132) ,HbAlc between 7.1 and 8% (AOR: 0.006, 95% CI: 0.001–0.067), and LDL levels were significantly associated with chronic constipation in T2DM patients.ConclusionsThe prevalence of chronic constipation was considerable in T2DM patients. Education level above high school, less than 7 h of sleep per day, frequent depression, parents with constipation, daily water intake < 1300 ml, TAG and HbAlc play a significant role in the development of chronic constipation in T2DM patients. T2DM patients can reduce the extent of constipation by treating the above problem in a timely and timely manner.

8481 A 32 Year Old Male With Recurrent Acute Pancreatits and Severe Hypertriglyceridemia: Importance of Considering Genetic Variants

Abstract Disclosure: M.F. Salazar Zelaya: None. J.D. Sibaja Jiménez: None. Background : Hypertriglyceridemia is a common medical scenario in daily practice, causing a variety of symptoms including recurrent episodes of acute pancreatits, which can be severe. Multiple genetic variants can lead to different spectrums of the disease. CLINICAL CASE: A 32 year old male police officer presented to our Endocrinology Outpatient Clinic with a history of long standing hypertriglyceridemia and six previous episodes of acute pancreatits, two in the last twelve months. Familiy history was negative for lipid disorders. The patient had adecuate adherence to diet and exercise as well to prescribed medications, which included Fenofibrate 250 mgs/day and Rosuvastatin 40 mgs/day. The patient denied consumption of alcoholic beverages. Recent abdominal ultrasound was reported without abnormalities. His lipid panel reported elevated triglycerides at 5831 mg/dl (n&amp;lt;150 mg/dl), Total Cholesterol normal at 147 (n&amp;lt;200 mg/dl), low HDL levels at 12 mg/dl (range 12-92 mg/dl) and direct LDL Cholesterol at 120 mg/dl. His TSH value was normal at 1.02 uUI/mL (range 0.55-4.78 uUI/mL). Creatinine level was normal at 0.81 mg/dl (range 0.7-1.3 mg/dl). Liver function tests were normal with AST level at 25 IU/L (range 13-39 IU/L) ALT levels at 22 IU/L (range 7-52 IU/L) and alcaline phosphatase at 62 IU/L (range 34-104 IU/L).His fasting glucose level were normal at 82 mg/dl (n&amp;lt;100 mg/dl). Due to a high Familial Chylomicronemia Syndrome clinical score (13 points) we proceeded with genetic analysis of this patient. Next Generation Sequencing for genes related with chylomicronemia (APOA5, APOC2, GPIHBP1,LMFI, LPL) was performed to determine gene sequence plus copy number variation.Two heterocigote variants were reported, both in the LPL gene. The first one: LPL (NM 000237.3) c.644&amp;gt;A;p.Gly215Glu heterozygous is a missense variant already reported in the literature, registered in ClinVar (ID 1522) and the Leiden Open Variation Database. This variant is classified as pathogenic according to criteria PS3, PM1, PP3, PP5 of the American College of Medical Genetics and Genomics. The second one: LPL (nm 000237.3): c.383C&amp;gt;A;p.Thr128Asn;heterozygous is also a missense variant which to the extent of our knowledge has previously been reported only once in the literature: ClinVar (ID 1520537). This variant is classified currently as of unknown clinical significance according to PM2 criteria. There is however and entry reported (PMID: 8778602) of another variant affecting the same codon (p.Thr128AIa) that is associated to chylomicronemia syndrome. Conclusion: In cases of severe hypertriglyceridemia, suspicion and determination of gene variants are of great importance nowadays as they could eventually guide treatment, given the availability in some countries (and currently pending FDA approval) of new pharmacological therapies such as apo C-III inhibitors. Presentation: 6/2/2024

9359 Patients’ Perspectives On Telemedicine In Endocrinology

Abstract Disclosure: P. Rotman Pikielny: None. L. Barzilay Yoseph: None. M. Kasher Meron: None. K. Rodrig: None. S. Shapira: None. Background: Telemedicine has emerged as an important and sometimes crucial tool in patient care, particularly during the COVID-19 pandemic. It offers numerous benefits, including time efficiency and improved access to specialized services. However, its adoption by endocrinology is constrained by the traditional emphasis on the physician-patient relationship and physical examinations. Objectives: This study evaluated patients’ perspectives on telemedicine, regarding specific aspects of satisfaction, including communication, wait times, and financial and time burdens. Methods: Surveys were delivered via text messages sent after telephone vs. frontal visits in an outpatient endocrinology clinic in a tertiary referral center. The surveys, sent from Nov 2022 to Dec 2023, investigated various aspects of satisfaction with the appointment and were based on the Telemedicine Satisfaction Questionnaire, a 5-point Likert scale questionnaire. Variations in preference levels across diverse patient groups were also examined. Answers were received via the REDCap application. Patients were told that responses were optional and answering the survey granted informed consent. Results: A total 135 patients completed the questionnaire, 93 who attended telephone and 42 after frontal visits. The groups were similar clinically: 77% were women, with an average age of 63 years. Visits were held mainly due to diabetes (22%), osteoporosis (31%), or obesity 10%), with no statistical differences between groups. 60% were followed more than a year. More patients who had telephone visits (69.9%) had previous experience with telephone visits vs. patients who had frontal visits (40.5%; p&amp;lt;0.004). Patients who had telephone visits reported higher satisfaction with wait time (p=0.002), physicians' explanations (p=0.03) and lower financial and time burdens (p&amp;lt;0.001). However, they were less able to share personal situations with the physician (p&amp;lt;0.001). More patients who experienced telephone visits thought they were preferrable to frontal visits (p&amp;lt;0.001). Notably, individuals with long-term follow-up and non-diabetic endocrine conditions had more interest in telemedicine. Conclusions: Patients report high satisfaction with telemedicine, but constrained in-person interactions remain a notable limitation. Telemedicine may not suit all patient groups or all time-points of patient care, requiring adaptation for broader use. Further research with higher response rate and specifications of different patient populations are essential to generalize these findings. Presentation: 6/2/2024

6705 Sheehan syndrome: a case report

Abstract Disclosure: F.S. Rodrigues: None. C.C. Silva: None. W. Da Silva: None. T.M. Caldas: None. L. Rocha: None. Introduction: Sheehan's Syndrome, or postpartum hypopituitarism, is characterized by hyperplasia and an increase in the number of prolactin-secreting cells, secondary to a major hemorrhagic event occurring during or after childbirth. In this situation, the anterior pituitary gland can increase in size and suffer ischemia due to vascular hypoflow. Consequently, there is low production of one or more of the hormones produced by the gland, which can generate heterogeneous clinical presentations. As a preventive treatment, polytransfusion is recommended in cases of large hemorrhage. OBJECTIVE: To present a case of Sheehan’s Syndrome, which developed after a birth complicated by a major hemorrhagic event, even after receiving polytransfusion. CASE REPORT: A woman, 45 years old, being monitored at the endocrinology outpatient clinic for 2 years. As a history, there was a severe hemorrhage during her cesarean section, which occurred 30 years ago, in which she received a blood transfusion of a total of 1.2 liters of packed red blood cells. 7 years ago, she was diagnosed with hypothyroidism and 2 years ago with hyperprolactinemia. In 2022, she was also diagnosed with adrenal insufficiency. At that time, she underwent a magnetic resonance imaging (MRI) scan of the sellaturcica region, which was found to be partially empty. The patient's recent exams showed TSH: 3.15 μUI/mL (0.4-4.0); Free T4: 0.88 ng/dL (0.93-1.7); Cortisol 8h: 8 μg/dL (5-25); LH: 15 mIU/mL (1.1-14.7); FSH: 43 mIU/mL (2.8-9); Estradiol: 8 ng/dL (12.4-398); Prolactin: 28 ng/mL (1.9-25), basal GH 0’ 0.054/30’ 2.51/60’ 2.48/90’ 3.74 ng/mL (up to 10), ACTH 17 pg/mL (up to 46). Since then, she has been undergoing endocrinological monitoring for hormone replacement therapy to treat the hormonal changes caused by late-diagnosed Sheehan Syndrome. DISCUSSION: Sheehan's Syndrome is a rare disease, characterized by low blood flow and necrosis of the pituitary gland due to postpartum hemorrhage. The diagnosis results from obtaining a good clinical history associated with hormonal levels. This patient presented significant bleeding after cesarean section requiring transfusions. However, despite transfusions, the patient developed hypothyroidism, hyperprolactinemia, and adrenal insufficiency. The MRI confirmed the suspected diagnosis, showing the partially empty sellaturcica. Conclusion: The diagnosis of Sheehan Syndrome is based on very broad clinical manifestations, with MRI of the sellaturcica contributing to confirming the diagnosis. Although the preventive treatment is blood transfusion, the patient developed the disease, highlighting the need for continued monitoring of pregnant women with a history of significant bleeding during childbirth. Therefore, outpatient monitoring of the patient is necessary with a focus on hormonal levels so that clinical complications are avoided. Presentation: 6/2/2024

Thyroid Nodules and Insulin Resistance in Type 2 Diabetes Patients

Abstract Background Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. DM can result from deterioration in function and//or a loss of mass in pancreatic tissue. The disease burden of DM is expected to increase in the next few years and decades. The Atlas of the International DM Federation estimated that 537 million adults (20–79 years) were living with DM in 2022, and this number could increase to 643 million by 2030 and 781 million by 2045 Aim of the Work To find out the association between Insulin resistance and thyroid nodules in T2DM. Patients and Methods This study was a Case-control study that was conducted to find association between insulin resistance and thyroid nodules in T2DM cases. The present study was carried out on 80 patients attending Ain Shams University internal medicine department and endocrinology outpatient clinic during the period from August 2021 to May 2023. Results Therefore, the aim of the current work is to find out the assosciation between insulin resistance and thyroid nodules in T2DM. Our study showed that fasting insulin and HOMI-IR were significantly higher in diabetic patients with nodules than in diabetic patients without nodules (P = 0.029 &amp; P = 0.001 respectively). Our study also showed that fasting insulin and HOMI-IR were predictive risk factors for thyroid nodules. Moreover, our results revealed that fasting insulin &amp; IR were positively correlated with thyroid nodule volume and size. Our study showed that there was a significant increase in the mean of FT4 levels in diabetic patients with thyroid nodules (when compared to diabetic patients without thyroid nodules (P = 0.043). Yet, no significant correlation was found between Thyroid nodule volume, Thyroid nodule size, and IR with FT4. The binary logistic regression analysis showed that FT4 was a risk factors for thyroid nodule in the T2DM patients. Furthermore, the results showed that there was a significant increase in the mean of TPO levels in diabetic patients with thyroid nodules when compared to diabetic patients without thyroid nodules (P = 0.038). The binary logistic regression analysis showed that TPO was risk factor for thyroid nodule in the T2DM patients. There was a significant increase in the mean value of fasting blood glucose level in diabetic groups with thyroid nodules when compared to those without thyroid nodules (P &amp;lt; 0.001). Pearson's correlation test also showed significant positive correlation between thyroid nodule size and fasting blood glucose (r = 0.400, P = 0.010) as well as fasting blood insulin (r = 0.440, P = 0.005). The binary logistic regression analysis showed that FBG, PPGL were risk factors for thyroid nodule in the T2DM patients. Conclusion Our research demonstrates that IR is strong risk factors for thyroid nodule occurrence but its prevalence in diabetic cases is not evaluated in our study. So, it is of great clinical significance to perform thyroid Ultrasonography on patients with T2DM. The independent correlates of TNs were multifactorial, and there existed differences in different physiological states

BARRIERS TO INITIATE INSULIN THERAPY AND ITS ASSOCIATION WITH DURATION OF DIABETES MELITIS AND DEMOGRAPHIC FACTORS IN UNCONTROLLED TYPE 2 DIABETIC PATIENTS, A CROSS SECTIONAL STUDY

Objectives: To determine different barriers to initiate insulin therapy and association of duration of diabetes mellitus and demographic factors with barriers in initiation of insulin therapy in Uncontrolled type 2 diabetic patients.Materials and Methods: We conducted a cross sectional study conducted among patients with type 2 diabetic patients presenting to endocrinology outpatient clinics in two Tertiary care hospitals of Peshawar ie. Khyber Teaching hospital and hayatabad medical complex Peshawar. The duration of study was 03 months after approval of synopsis. The sample size was 257.The study population was selected by consecutive non probability sampling technique. The data was collected by pre designed questionnaire. All the included patients were interviewed on pre designed questionnaire. Data was processed in SPSS version 22.Results: In study we found that patients face different barriers to initiate insulin therapy. In our study, side effects of insulin was the barrier for 97(37.7%) of the patient, difficulty in carrying insulin was barrier for 128(49.8%) patients , dose adjustment of insulin was barrier for 90(35%) patients, fear if insulin needle was barrier for 89 (34.6%) patients, self administration of insulin was barrier for 98(38.1%) patients , affordability of insulin was barrier accounting for 114(44%) patients , frightened about insulin therapy by someone was barrier for116 (45.1%) patients. The association between economic status of patient and the barrier that they are frightened by someone was statistically significant. Chi-square test was also run between duration of diabetes with all barriers in which one association was found nearly signifi cant i.e. the association of duration of diabetes with difficulty in carrying insulin with the p value of 0.064.Conclusion: The most common barrier in insulin therapy initiation of patients in the study was difficulty in carrying insulin. We found that there is near to signifi cant association between duration of diabetes and difficulty in carrying insulin. There is significant association between economic status of patient and frightened by someone. The lower the economic status the more frightened about Insulin use.

The Relationship Between Nutritional Status and Self-Esteem in Adult Women with Type 2 Diabetes: A Cross-Sectional Study

Aim: This study was aimed to determine the relationship between nutritional knowledge level and self-esteem in adult women with type 2 diabetes. Material and Method: The sample of this descriptive cross-sectional study consisted of 387 participants. Data were collected in an endocrinology outpatient clinic via face-to-face interviews. The data collection form consisted of a 'Personal Information Form', 'Nutrition Habits Section', 'Nutrition Knowledge Level and Food Preference Scale', 'Rosenberg Self-Esteem Scale'. Number and percentage were used in the SPSS package program. Results that were not normally distributed were evaluated according to non-parametric tests. Results: The mean age of the participants was 42.00±11.35 years and the educational level of 31.2% was primary school. The mean total score of the scales obtained by the participants was average. In the study, no relationship was found between basic nutrition knowledge level and food preference and self-esteem in adult women with type 2 diabetes. Conclusion: Basic nutrition knowledge and food preferences of women with Type 2 Diabetes were moderate and their self-esteem was adequate. It is important for health professionals to plan individual trainings by determining the nutritional knowledge levels and food preferences of women, and to ensure that diabetes control and self-esteem are increased in the effective management of diabetes and in the promotion of women's health.

Demographic and Clinical Characteristics of Patients with Primary Hypothyroidism and Adequacy of Levothyroxine Replacement Therapy in Them: A Nationwide Study in Bangladesh

ABSTRACT Background: Despite the huge burden of primary hypothyroidism in Bangladesh, no nationwide study has been conducted describing the demographic and clinical characteristics of these patients; data on the adequacy of levothyroxine (L-T4) replacement are also lacking. This study aimed to fill the knowledge gap. Materials and Methods: This cross-sectional study was conducted among patients with primary hypothyroidism attending the endocrinology outpatient clinics of several hospitals throughout Bangladesh from July 2023 to December 2023. Adults with primary hypothyroidism who had been on L-T4 replacement for at least 1 year were included. Data on their demographic and disease-related characteristics were collected. Serum thyroid-stimulating hormone (TSH) was measured; TSH 0.4–4.0 μIU/mL was considered the therapeutic target for nonmalignant thyroid cases. Results: Two thousand six hundred and forty-one patients (median age 37 years, 86.4% female, and median disease duration 5 years) were included. Hashimoto’s thyroiditis was the most common (40.9%) cause of hypothyroidism; 1.9% had differentiated thyroid cancer (DTC), and the etiology was not established in many (40.2%). Only 26.8% of patients had high adherence to L-T4. Among the non-DTC cases (n = 2590), over half (53.9%) had TSH within the target range, whether the disease was uncontrolled in the remaining 46.1% (TSH was below the target range in 5.6% and above the target range in 40.5%). Among the DTC cases (n = 51), only a few (9.8%) had a TSH within the target range; TSH was below and above the range in 2% and 88.2% of these patients, respectively. In the nonmalignant hypothyroid cases, vegetarian diet, smokeless tobacco use, disease duration &gt;5 years, iron or calcium supplements consumption within 4 h of L-T4 intake, and low or medium adherence to L-T4 were associated with uncontrolled hypothyroidism. Conclusion: For nearly half of Bangladeshi patients with primary hypothyroidism, L-T4 replacement is not optimal. Physicians should address the barriers to reaching the therapeutic goal for these patients.

The Relationship between Vitamin D, Inflammatory Markers, and Insulin Resistance in Children.

In this study, we investigated 25-hydroxyvitamin D (25(OH)D, vitamin D), inflammatory hematologic ratios such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), monocyte/HDL-C ratio (MHR) and plasma atherogenic index (PAI) and possible relationships with insulin resistance (IR) in children. A total of 210 individuals, including 96 children with IR and 114 children without IR, aged 6-18 years, who were admitted to the Pediatric Endocrinology Outpatient Clinic at Medicine Hospital, Istanbul Atlas University were included in our study. Compared to patients without IR, NLR, PLR, SII, and MHR were significantly higher in patients with IR. Fasting insulin, PAI, homeostasis model assessment of insulin resistance (HOMA-IR), and HOMA-β were significantly higher and quantitative insulin sensitivity check index (QUICKI) was considerably lower in patients with IR compared to those without IR. NLR, SII, and MHR were lower in normal vitamin D groups than the others (p < 0.001). PLR was lower in the group with normal vitamin D levels than the groups with insufficient or deficient levels of vitamin D (D < 21). We found that vitamin D deficiency in childhood is related to increased levels of circulating inflammatory markers (NLR, PLR, MHR, PAI), IR, and decreased insulin sensitivity. According to our results, supplementation of vitamin D may be beneficial in averting IR and enhanced systemic inflammation.

Whole Day Workload: Evaluation of a New Outcome Measure in Occupational Therapy for Adults With Type 1 Diabetes.

Typical whole day workload is a metric with potential relevance to the occupational balance and well-being of individuals with chronic conditions. To examine the reliability and validity of using multiple daily NASA Task Load Index measures (whole day TLX) as an indicator of typical whole day workload experienced by adults with Type 1 diabetes (T1D). Participants with T1D completed cross-sectional measures and 2 wk of ecological momentary assessments (EMA) and daily diaries. Reliability was assessed across subgroups (e.g., workers vs. nonworkers); validity was evaluated with multilevel confirmatory factor analysis and with tests of convergent and divergent validity with patient-reported outcomes and blood glucose measures. Three outpatient endocrinology clinics in the United States. Data from 164 U.S. adults with T1D (42% Latino, 30% White). Measures used included the whole day TLX (assessed via 2 wk of daily diaries), time in target blood glucose range (assessed with a continuous glucose monitor), illness intrusiveness (measured cross-sectionally), and stress (measured cross-sectionally and with EMA). Number of days required for at least 0.70 reliability of the average whole day TLX ranged between 2 and 6 days depending on the subgroup. Results supported convergent and divergent validity of the average of the whole day TLX, including associations with average stress (r = .63, p < .001) and time in target blood glucose range (r = -.25, p = .002). The whole day TLX was a reliable and valid indicator of typical whole day workload. Plain-Language Summary: The health management responsibilities for Type 1 diabetes can be extremely burdensome. When these responsibilities are experienced, in addition to duties such as work and caregiving, the totality of demands experienced (i.e., whole day workload) can create further issues, such as unhealthy physiological changes and interference with self-care. We tested the psychometric properties of a measurement tool that assesses the typical level of workload people experience. This measure, referred to as the NASA Task Load Index (whole day TLX), was found to be a reliable and valid indicator of typical whole day workload. Occupational therapists may use the whole day TLX to track progress in interventions focused on reducing clients' whole day workload exposure to promote their health and well-being. Occupational therapists' expertise in areas such as activity analysis, task adaptation, and energy conservation makes them especially well-suited to intervene on whole day workload.

Health Literacy and Medication Adherence Among Patients with Type 2 Diabetes in Jordan: A Cross-Sectional Study.

Improving health literacy has been found to play a significant role in enhancing medication adherence in patients with type 2 diabetes. The present study aims to evaluate health literacy and its association with medication adherence among diabetic patients in Jordan. This cross-sectional study included 400 diabetic patients, predominantly female (68.8%), with a median age of 58 years, attending the endocrinology outpatient clinic at Albasheer Hospital in Amman, Jordan, between August and December 2023. Patients were recruited using convenience sampling, including those aged 18 and older, literate, diagnosed with T2DM for at least one year, and on at least one medication for T2DM. Sample size was calculated based on the Events Per Variable (EPV) criterion to ensure sufficient power for logistic regression analysis. Data were collected using two validated instruments: the Jordanian Diabetic Health Literacy Questionnaire (JDHLQ), assessing health literacy, and the Medication Adherence Report Scale (MARS-5), measuring medication adherence. A binary logistic regression model was constructed to identify variables associated with adherence levels. The study enrolled 400 diabetic patients (females =68.8%). While most of the participants (70.3%) reported high adherence levels, results revealed a window for health literacy improvement as the median for the JDHLQ score was 22 (ranging from 18 to 25) out of a maximum possible score of 32. More than half of the participants replied "never" to "I forget to take my medications", followed by "I stop taking my medications for a while". The binary regression model revealed that a higher JDHLQ score significantly increased the odds of a high adherence level. The significant association between improved health literacy and medication adherence necessitates the implementation of educational campaigns for enhancing literacy and hence medication adherence among patients with type 2 diabetes.

Understanding the physical literacy development of 8- to 12-year-old children living with chronic medical conditions: A comprehensive, mixed methods inquiry.

Physical literacy is a concept used to describe the combined physical, affective and cognitive capacities facilitating an active lifestyle. Physical activity participation is essential for children living with chronic medical conditions, but knowledge of physical literacy among this group is scarce. An explanatory, sequential mixed methods design was used to comprehensively describe the physical literacies of children with chronic medical conditions (CMCs). Participants were recruited from paediatric cardiology, respirology/cystic fibrosis, neurology, haematology and endocrinology outpatient clinics. All participants completed the Canadian Assessment of Physical Literacy (2nd Edition), and those with higher and lower scores were invited to a semi-structured interview. A deductive-inductive thematic analysis was applied using Margaret Whitehead's conceptualization of physical literacy. Using normative strata, 80.0% of the 99 children assessed (mean age = 9.97 ± 1.3years, 48% girls) were considered beginning or progressing in their overall physical literacy (mean score = 56.5 ± 13.8/100). Meanwhile, physical literacy informed participants' approach to new, active experiences and may have contributed to a strong sense of self. There was a significant difference between endocrinology and haematology patients on total physical literacy score (p = 0.03) but not domain scores. Participants scored high on motivation/confidence (mean = 22.9 ± 5.0/30) but obtained low physical competence (mean = 11.8 ± 5.6/30) and daily behaviour scores (n = 72, mean = 15.5 ± 7.1/30). Main themes represent salient experiences of children with CMCs within the domains of physical literacy, including their need to evaluate active contexts, self-regulate activity intensity and manage physical limitations. Children with CMCs can achieve recommended levels of physical literacy without meeting normative standards for physical competence. Participants would benefit from a physical literacy intervention that targets the development of bodily self-regulation skills and risk evaluation in active settings.

Metabolic syndrome among Egyptian children with Familial Mediterranean Fever: a case–control study

BackgroundFamilial Mediterranean fever (FMF) is the most prevalent inherited autoinflammatory disease globally. Metabolic syndrome (MetS) is a cluster of interrelated risk factors; insulin resistance, obesity, dyslipidemia, and hypertension are the main constituents of MetS.AimThis study aimed to investigate components of metabolic syndrome among Egyptian children with FMF during the attack-free period.Patients and methodsThis is a case–control study that was conducted in the Pediatric Rheumatology Outpatient Clinic and Pediatric Endocrinology Clinic, Children’s Hospital, Faculty of Medicine, Cairo University. It was conducted on 40 patients with FMF. The patients included were of both sexes and aged 10 years or older, during the FMF attack-free period; they were compared to 40 apparently healthy age- and sex-matched children as controls. All subjects in this study were subjected to detailed history taking, anthropometric measurements, general and systemic examinations. Laboratory evaluation (at the time of the study) was done at time of study, in the form of CBC with differential, BUN, creatinine, ESR, serum amyloid A, urine analysis, serum insulin, fasting blood glucose, and lipid profile. FMF gene mutations were collected from patients’ files.ResultsThe mean ± SD age of FMF patients was 12.65 ± 1.82 (10–17) years, while the mean ± SD age of the control group was 12.6 ± 1.82 (10–16) years. Among FMF patients, 50% were males, and 50% were females (F:M = 1:1), while in the control group, 47.5% were females, and 52.5% were males. All FMF patients were during the attack-free period. There was a statistically significant difference between both groups regarding insulin resistance, being more frequent among the FMF patients’ group, with a p-value of 0.025.ConclusionNone of our FMF patients met the criteria for the definition of metabolic syndrome, but there was a significant difference between cases and control regarding insulin resistance with higher frequency among FMF patients, probably due to the ongoing subclinical inflammation. This indicates that children with FMF may be at a higher risk of getting metabolic syndrome later on in life.

Case Report: Hyperandrogenism in Menopause.

Postmenopausal androgen excess often occurs due to the imbalance between the rapid decline in ovarian estrogen and a relatively gradual decline in androgen secretion. The rapid onset of hirsutism, alopecia, and acne, on the other hand, is a rare occurrence and requires further investigation in order to rule out an underlying neoplasm. A 54-year-old woman arrived at the endocrinology outpatient clinic for the appearance of hirsutism and defluvium capitis in the past 9 months. She had hypertrichosis of the face, trunk, and mammary areolae and reduced timbre of voice. Circulating androgens were higher than normal levels (testosterone: 7.7 ng/mL, DHEAS: 5437 mcg/L, 17-OH-progesterone: 3.1 nmol/L), gonadotropin and prolactin levels were normal, and Nugent test was negative. Abdominal CT scan was negative for adrenal lesions, while transvaginal ovarian ultrasonography revealed a left adnexal formation (19x18x24 mm) compatible with stromal neoplasm. A bilateral hysteroannessiectomy was performed. Histological examination was diagnostic for multiple ovarian Leydig cell tumors. The most frequent cause of postmenopausal hyperandrogenism is polycystic ovary syndrome. It is necessary to exclude the presence of neoplastic causes (ovarian or adrenal androgen- secreting tumors). In case of marked virilization and severe hyperandrogenism, it is useful to perform transvaginal ultrasonography to search for the presence of ovarian hypertrichosis or androgen-secreting ovarian tumors and a CT/RM scan to study the adrenal glands. The best treatment for hyperandrogenism of neoplastic origin is surgery. Patients who are not candidates for this approach are candidates for therapy with GnRH agonists.

The Effect of the Fear of COVID-19 on Treatment Adherence and Health-Seeking Behavior in Individuals with Type 2 Diabetes

Objective: This descriptive and cross-sectional study aimed to determine the impact of COVID-19 induced fear on the treatment adherence and health-seeking behavior of individuals with type 2 diabetes. Methods: The sample for this research consisted of 150 type 2 diabetes patients who attended the Mersin City Training and Research Hospital endocrinology outpatient clinics for treatment and follow-up. Data collection involved the use of a Personal Information Form, the COVID-19 Fear Scale, the Type 2 Diabetes Mellitus Patient Treatment Adherence Scale, and the Health-Seeking Behavior Scale. Data was analyzed using Student’s t-test, One Way ANOVA and Multiple Linear Regression analysis. Findings: Among the individuals participating in the study, it was determined that while 54.7% were female, 48.7% had an HbA1c level of 8.1 and above, 64% used insulin, 80.7% developed complications related to diabetes and the average age of the participants were 62.9±11.9. Furthermore, the majority were not diagnosed with COVID-19, and they did not require hospitalization due to COVID-19. The adherence to diabetes treatment among the patients was found to be moderate, with the lowest adherence was observed in terms of lifestyle changes and the highest adherence was observed in terms of the emotional and behavioral adherence dimensions. Multiple regression analysis revealed that the fear of COVID-19 did not affect diabetes treatment adherence levels of the patients (p&gt;0.05). It was found that only those patients who were using insulin and those who were not adhering to medical nutritional treatment had lower adherence to diabetes treatment (p

Prevalence and incidence of heart failure in type 2 diabetes patients: results from a nationwide prospective cohort—the DIABET-IC study

BackgroundType 2 diabetes (T2D) patients have an increased risk of heart failure (HF). There are limited data on the association between HF and T2D in specific healthcare settings. This study sought to analyse the prevalence and incidence of HF in a contemporary cohort of T2D patients attending cardiology and endocrinology outpatient clinics.MethodsWe conducted an observational multicentre prospective study (DIABET-IC) that enrolled patients with a T2D diagnosis attending cardiology and endocrinology outpatient clinics in 30 centres in Spain between 2018 and 2019. The prevalence at the start of the study and the incidence of HF after a 3 year follow-up were calculated. HF was defined as the presence of typical symptoms and either: a) LVEF < 40%; or b) LVEF ≥ 40% with elevated natriuretic peptides and echocardiographic abnormalities.ResultsA total of 1249 T2D patients were included in the present analysis (67.6 ± 10.1 years, 31.7% female). HF was present in 490 participants at baseline (prevalence 39.2%), 150 (30.6%) of whom had a preserved ejection fraction. The presence of adverse social determinants and chronic conditions such as chronic kidney disease and atherosclerotic cardiovascular disease were more frequent in HF patients. During the study period, there were 58 new diagnoses of HF (incidence 7.6%) among those without baseline HF. The incidence rate was 3.0 per 100 person-years. Independent predictors of incident HF were smoking, left ventricular ejection fraction, NT-ProBNP, history of tachyarrhythmia and treatment with pioglitazone, oral anticoagulants, or diuretics. Despite an average suboptimal glycaemic control, the use of antidiabetic drugs with cardiovascular benefits was low (30.4% for sodium-glucose cotransporter-2 inhibitors and 12.5% for glucagon-like peptide-1 receptor agonists).ConclusionsIn this contemporary cohort of T2D patients attending cardiology and endocrinology outpatient clinics, the prevalence and incidence of HF were high, comorbidities were frequent, and the use of antidiabetic agents with cardiovascular benefit was low. Outpatient care seems to be a unique opportunity for a comprehensive T2D approach that encompasses HF prevention, diagnosis, and treatment.Graphical

Surgical Offloading versus Medical Conservative Methods in Management of Diabetic Foot Plantar Ulcers (Interventional study)

Abstract Background As a result, peripheral neuropathy is frequently caused by diabetes (DM). Diabetic plantar foot pressure ulcers develop from the lack of protective pain sensibility as a result of recurrent shear and tear pressures. Relieving pressure on the foot's sole is necessary for the ulcers to heal. The purpose of the study is to compare the effectiveness of surgical and nonsurgical unloading procedures in the healing of plantar ulcers. Subjects and Methods 50 diabetic foot ulcer patients who visited Ain Shams University, the national institute of DM, and the endocrinology outpatient clinic participated in this interventional trial (NIDE). We employed mechanical and surgical unloading methods in this trial, and patients were monitored for 6 months to see how long it took for their injuries to recover. Results At the conclusion of the follow-up period, 88% of the surgical group's pressure ulcers were fully healed, compared to 86.7% of the non-surgical patients (6 months). Infection, recurrence, and non-healing were complications we encountered throughout the follow-up period. Regarding the treatment of plantar diabetic foot ulcers, offloading is crucial (DFUs). Compared to using only non-surgical methods, surgical offloading may hasten the recovery time. A well- trained team is necessary to prevent the issues with improperly fitting footwear and to teach the patient how to use them on a regular basis with the non-surgical offloading technique.

Values and preferences of medication use in patients for primary and secondary prevention of cardiovascular diseases: a mixed-methods exploratory study

BackgroundMedication therapy is a cornerstone for the primary and secondary prevention of cardiovascular diseases (CVD), yet values and preferences regarding medication use remain unclear. ObjectiveThis study aims to explore the values and preferences of medication use in patients for the primary and secondary prevention of CVD. MethodsThis study employed an explanatory sequential mixed methods design. From November 2021 to January 2022, patients meeting the criteria for primary and secondary prevention of CVD were screened at West China Hospital of Sichuan University and Yulin Community Health Service Center in Wuhou District, Chengdu, using stratified purposive sampling for interviews. Qualitative data were collected through focus group interviews to understand the behavior, values, and preferences related to medication use among the participants. The interview content was coded and categorized using MAXQDA 2020, then further sorted, analyzed, and themes were extracted using Colaizzi's seven-step analysis method. Following the qualitative research, a quantitative questionnaire was developed based on the themes identified from the interviews. From November 2022 to February 2023, patients meeting the criteria for primary and secondary prevention of CVD were conveniently sampled from the cardiology, endocrinology, nephrology, and neurology outpatient clinics at West China Hospital of Sichuan University and Yulin Community Health Service Center in Wuhou District, Chengdu. After signing informed consent, the participants' values and preferences regarding medication use were quantitatively analyzed. ResultsThe qualitative study included 21 participants for focus group interviews, yielding four themes: (1) cognition and behavior towards medication; (2) barriers to medication use; (3) facilitators of medication use; and (4) needs for medical services. In the quantitative study, 186 valid questionnaires were returned, yielding a 93.5% response rate. The results indicated common missed doses, and further confirmed the social stigmatization and the burden of medication use identified in the qualitative study. Despite the heterogeneity in medication preferences, participants generally preferred fewer types of drugs and lower frequencies of medication, and were averse to injectable formulations. ConclusionIn clinical practice for the primary and secondary prevention of CVD, the use of compound preparation could be increased, and medication regimens could be integrated with patients' daily lives and work to reduce the medication burden. Additionally, it is important to actively address patients' misconceptions and inappropriate behaviors regarding diseases and medications to improve medication compliance.

A novel heterozygous likely pathogenic SLC5A2 variant in a diabetic patient with glucosuria and aminoaciduria.

Familial renal glucosuria (FRG) is a rare renal tubular disorder characterized by increased urinary glucose excretion despite normoglycemia. It is most commonly caused by pathogenic variants in the solute carrier family V member 2 (SLC5A2) gene. This gene encodes the sodium-glucose cotransporter 2, crucial for glucose reabsorption. We report the case of a 44-year-old male referred to the endocrinology outpatient clinic for unexplained glucosuria despite well-controlled diabetes mellitus with metformin and gliclazide therapy. His main complaints were nocturia and an unintentional 5 kg weight loss in 1 year. A 24-h urinary collection revealed overt glucosuria (23.3 g/1.73 m2/24 h), generalized aminoaciduria, and increased uric acid excretion (fractional excretion: 6.4%). Whole-exome sequencing revealed a novel heterozygous c.469-1G>A likely pathogenic variant in the SLC5A2 gene. Specific analysis of the maturity-onset diabetes of the young type (MODY) gene panel showed no pathogenic variants in the hepatocyte nuclear factor-1A (HNF-1A; MODY3) nor in other MODY-associated genes. We assume that the association of glucosuria, aminoaciduria, and increased uric acid excretion can be explained by the combination of diabetes and the likely pathogenic SLC5A2 variant in this patient. In conclusion, we describe a well-controlled diabetic patient with FRG, associated with a novel heterozygous c.469-1G>A likely pathogenic variant in the SLC5A2 gene. The diagnosis of a renal tubular disorder should be considered in patients with unexplained glucosuria and diabetes mellitus, especially if the latter is well controlled. FRG usually presents with glucosuria but may be associated with generalized aminoaciduria and hyperuricosuria. Genetic analysis should be considered in patients with young-onset diabetes and glucosuria, particularly with a positive family history.