Alejandra Lorena Tamez-Peña

Steroid hyperglycemia: Prevalence, early detection and therapeutic recommendations: A narrative review

Steroids are drugs that have been used extensively in a variety of conditions. Although widely prescribed for their anti-inflammatory and immunosuppressive properties, glucocorticoids have several side effects, being hyperglycemia one of the most common and representative. In the present review, we discuss the main epidemiologic characteristics associated with steroid use, with emphasis on the identification of high risk populations. Additionally we present the pathophysiology of corticosteroid induced hyperglycemia as well as the pharmacokinetics and pharmacodynamics associated with steroid use. We propose a treatment strategy based on previous reports and the understanding of the mechanism of action of both, the different types of glucocorticoids and the treatment options, in both the ambulatory and the hospital setting. Finally, we present some of the recent scientific advances as well as some options for future use of glucocorticoids.

Inpatient hyperglycemia: Clinical management needs in teaching hospital *

The prevalence of hyperglycemia among hospitalized patients is 32%–38% [1]. Observational studies have demonstrated an increase in complications, hospital stay, and use of resources, despite 30% of these subjects not having a diagnosis of diabetes mellitus (DM) [1,2,4]. It is known that insulin plays an important role in the prevention of complications associated with hyperglycemia, and could be helpful in hospitalized patients with hyperglycemia [3]. Generally the identification of hyperglycemia and treatment strategies used in the management of hospital hyperglycemia continue to be deficient because of many barriers [1,4]. Clinical inertia, poor hyperglycemia treatment hierarchy, its association with more “attention demanding” pathologies (miocardic infarctions, among others) and lack of established algorithms in most hospitals are some examples of those barriers [4]. The main aim of this study is to present the prevalence of hospital hyperglycemia in patients on admission as well as the differences in the treatment, other prognostic variables that affect hospital stay and mortality and the frequency of DM diagnosis. We carried out an observational, retrospective study following the STROBE recommendations. We investigated a convenience sample in the University Hospital in Monterrey, NL Mexico from December 2010 to February 2011. Medical records of 269 patients admitted to different departments of the hospital, were reviewed. Patients of both sexes were selected consecutively, regardless of their age. Patients with incomplete records and those admitted to the Intensive Care Unit were excluded; following the consensus panel ACE/ADA for glucose target in NonICU patients setting [5]. Out of 269 patients that met inclusion criteria, 31 were excluded because they had no glucose determinations at admission. All others were analyzed. Demographic variables, family history of DM and the presence of cardiovascular risk factors (DM, antihypertensive andhypolipidemic therapy, smoking, and cardiovascular disease (CVD) and chronic kidney disease (CKD)), in the medical records were collected. Patients with hyperglycemia were defined as an admission or in-hospital fasting blood glucose level of 140 mg/dl (7.8 mmol/l) or greater [5]. Patients with hyperglycemia were subdivided into known diabetes and new onset hyperglycemia. We identified the proportion of patients with an HbA1c determination during

Rosiglitazone as an option for patients with acromegaly: a case series

IntroductionIn the patient with acromegaly, pituitary surgery is the therapeutic standard. Despite undergoing surgery, a significant number of patients with acromegaly continue to have uncontrolled growth hormone secretion. These patients require other treatments such as external irradiation and/or drug therapy.Case presentationWe present the clinical and laboratory responses to six months of treatment with rosiglitazone in four cases. In all four cases, the patients had persistent growth hormone overproduction despite previous surgical treatment and other conventional therapy. Case 1 is a 57-year-old Caucasian woman, case 2 is a 51-year-old Hispanic man, case 3 is a 32-year-old Hispanic woman, and case 4 is a 36-year-old Hispanic man. In three of these patients, basal and nadir growth hormone and insulin-like growth factor 1 levels were significantly decreased (P < 0.05 and P < 0.01, respectively).ConclusionRosiglitazone could be a treatment option in select patients with acromegaly.

The rate of primary hypothyroidism in diabetic patients is greater than in the non-diabetic population. An observational study

BACKGROUND AND OBJECTIVE The aim of our study was to identify the rate of diabetic patients treated for hypothyroidism and compare them with a group without type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS We reviewed the computerized clinical records of 5161 patients. We identified diabetic patients treated with l-thyroxine. We compared the prevalence of PH with those patients under treatment with levothyroxine without T2DM. We excluded patients with a thyroid neoplasia, thyroid surgery, panhypopituitarism, or surgical complications of multinodular goiter or a thyroid nodule. Subclinical hypothyroidism was not considered. RESULTS We included 1848 adult patients with T2DM in the study group, 58% women and 42% men. For the control group, we included 3313 non-diabetic patients, 55% women and 45% men. The mean age in the study group was 52±7 years, and 47±4 years in the control group (p<.001). The rate of hypothyroidism in the study group was 5.7%, and in the control group 1.8% (odds ratio of 3.45; 95% confidence interval 2.51-4.79) (p<.001). CONCLUSION A strong association between T2DM and hypothyroidism was found. We recommend a thyroid profile in all patients with T2DM, similar to the recommendation in type 1 diabetes mellitus.Background and objective The aim of our study was to identify the rate of diabetic patients treated for hypothyroidism and compare them with a group without type 2 diabetes mellitus (T2DM).

Brief reportThe rate of primary hypothyroidism in diabetic patients is greater than in the non-diabetic population. An observational studyLa proporción de hipotiroidismo primario en pacientes diabéticos es mayor que la de pacientes no diabéticos. Estudio observacional

BACKGROUND AND OBJECTIVE The aim of our study was to identify the rate of diabetic patients treated for hypothyroidism and compare them with a group without type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS We reviewed the computerized clinical records of 5161 patients. We identified diabetic patients treated with l-thyroxine. We compared the prevalence of PH with those patients under treatment with levothyroxine without T2DM. We excluded patients with a thyroid neoplasia, thyroid surgery, panhypopituitarism, or surgical complications of multinodular goiter or a thyroid nodule. Subclinical hypothyroidism was not considered. RESULTS We included 1848 adult patients with T2DM in the study group, 58% women and 42% men. For the control group, we included 3313 non-diabetic patients, 55% women and 45% men. The mean age in the study group was 52±7 years, and 47±4 years in the control group (p<.001). The rate of hypothyroidism in the study group was 5.7%, and in the control group 1.8% (odds ratio of 3.45; 95% confidence interval 2.51-4.79) (p<.001). CONCLUSION A strong association between T2DM and hypothyroidism was found. We recommend a thyroid profile in all patients with T2DM, similar to the recommendation in type 1 diabetes mellitus.Background and objective The aim of our study was to identify the rate of diabetic patients treated for hypothyroidism and compare them with a group without type 2 diabetes mellitus (T2DM).