Hortensia Mircescu

Barriers to physical activity among patients with type 1 diabetes

OBJECTIVE—To determine, in an adult population with type 1 diabetes, barriers to regular physical activity using a diabetes-specific barriers measure (the Barriers to Physical Activity in Diabetes [type 1] [BAPAD1] scale) and factors associated with these barriers. RESEARCH DESIGN AND METHODS—One hundred adults with type 1 diabetes answered a questionnaire assessing perceived barriers to physical activity and related factors. A1C was obtained from the medical chart of each individual. RESULTS—Fear of hypoglycemia was identified as being the strongest barrier to physical activity. Greater knowledge about insulin pharmacokinetics and using appropriate approaches to minimize exercise-induced hypoglycemia were factors associated with fewer perceived barriers. Greater barriers were positively correlated with A1C levels (r = 0.203; P = 0.042) and negatively with well-being (r = −0.45; P < 0.001). CONCLUSIONS—Fear of hypoglycemia is the strongest barrier to regular physical activity in adults with type 1 diabetes, who should therefore be informed and supported in hypoglycemia management.

Clinical Evaluation of the Presence of Abnormal Hormone Receptors in Adrenal Cushing's Syndrome

ACTH-independent cortisol production in adrenal Cushings syndrome previously was believed to be autonomous. Recent work by our group and others has shown that, in certain patients with bilateral macronodular adrenal hyperplasia or unilateral adrenocortical tumor, cortisol production may be under the control of abnormal or ectopic hormone receptors. The aberrant regulation of cortisol production by GIP, vasopressin, β-adrenergic agonists, hCG/LH, or serotonin illustrates this concept. The identification of an abnormal adrenal receptor offers the possibility of new pharmacological approaches to control hypercortisolism by suppressing the endogenous ligands or by blocking the abnormal receptor with specific antagonists. This review will describe the in vivo investigation protocols utilized by our group to identify the presence of abnormal hormone receptors in primary adrenal Cushings syndrome.

Physical activity level and body composition among adults with Type 1 diabetes

Aims  Physical activity is part of a healthy lifestyle and contributes to prevent weight gain and cardiometabolic disorders. Adults with Type 1 diabetes are at risk of weight gain attributable to various factors, including a high prevalence of sedentary lifestyle related to fear of exercise‐induced hypoglycaemia. This project aims to observe the association between physical activity level and body composition in adults with Type 1 diabetes.

The diversity of abnormal hormone receptors in adrenal Cushing's syndrome allows novel pharmacological therapies

Recent studies from several groups have indicated that abnormal or ectopic expression and function of adrenal receptors for various hormones may regulate cortisol production in ACTH-independent hypercortisolism. Gastric inhibitory polypeptide (GIP)-dependent Cushings syndrome has been described in patients with either unilateral adenoma or bilateral macronodular adrenal hyperplasia; this syndrome results from the large adrenal overexpression of the GIP receptor without any activating mutation. We have conducted a systematic in vivo evaluation of patients with adrenal Cushings syndrome in order to identify the presence of abnormal hormone receptors. In macronodular adrenal hyperplasia, we have identified, in addition to GIP-dependent Cushings syndrome, other patients in whom cortisol production was regulated abnormally by vasopressin, ss-adrenergic receptor agonists, hCG/LH, or serotonin 5HT-4 receptor agonists. In patients with unilateral adrenal adenoma, the abnormal expression or function of GIP or vasopressin receptor has been found, but the presence of ectopic or abnormal hormone receptors appears to be less prevalent than in macronodular adrenal hyperplasia. The identification of the presence of an abnormal adrenal receptor offers the possibility of a new pharmacological approach to control hypercortisolism by suppressing the endogenous ligands or by using specific antagonists for the abnormal receptors.

Reference range thyroid-stimulating hormone is associated with physical activity energy expenditure in overweight and obese postmenopausal women: a Montreal-Ottawa New Emerging Team Study

Clinical and, to a lesser extent, subclinical hypothyroidism is associated with a variety of metabolic abnormalities, including increased body mass index, unfavorable lipoprotein profile, and increased biomarkers for atherosclerosis. Energy expenditure could act as a confounding factor in the association reported between thyroid-stimulating hormone (TSH) levels and cardiometabolic risk factors. The objective of the study was to investigate the relationship between reference range plasma TSH and energy expenditure as well as blood pressure, lipid, and inflammation parameters in women. One hundred four postmenopausal, overweight and obese, spontaneously euthyroid women were included in the study. We evaluated total energy expenditure by doubly labeled water, resting energy expenditure by indirect calorimetry, physical activity energy expenditure (PAEE = [total energy expenditure × 0.90] - resting metabolic rate), body weight, and percentage of fat mass by dual-energy x-ray absorptiometry. Blood pressure, plasma lipoproteins profile, and high-sensitivity C-reactive protein levels were also measured. Mean TSH was 2.39 ± 1.09 mIU/L. We observed that high-density lipoprotein cholesterol (r = -0.20, P ≤ .05) was negatively associated with TSH, whereas systolic blood pressure (r = 0.21, P ≤ .05) and apolipoprotein B (r = 0.22, P ≤ .05) were positively correlated with TSH. However, these correlations were no longer significant after controlling for PAEE. A significant negative correlation was found between TSH and PAEE (r = -0.23, P ≤ .05). Our results suggest that, although TSH in the reference range is associated with some cardiometabolic risk factors, this is in large part explained by lower PAEE. In turn, lower PAEE could increase the cardiometabolic risk.

Treatment of Hypoglycemia in Adult Patients with Type 1 Diabetes: An Observational Study

OBJECTIVES 1) To characterize the nutritional treatment of hypoglycemia in adult patients with type 1 diabetes mellitus and 2) to compare the characteristics of participants who follow the recommendations with the characteristics of those who do not. METHODS A total of 121 adults with type 1 diabetes were included in this cross-sectional analysis. Participants completed a food record and a glycemia and insulin doses logbook to collect data on mild to moderate hypoglycemic events (glycemia <4.0 mmol/L or 4.0 to 5.0 mmol/L with symptoms) and their treatments over a 2-day period. Participants were identified as overcorrecting if they consumed, within 15 minutes after the episode, >20g of carbohydrates for correction. Self-administered questionnaires about fear of hypoglycemia were completed, and cardiometabolic profile variables were measured (glycated hemoglobin, blood pressure, lipid profile and body mass indexes). RESULTS Of the 121 participants, 94 (78%) reported at least 1 hypoglycemic event, for a total of 271 events (2.2±2.1 episodes per patient). Of these events, 64% were treated within 15 minutes, and they were treated primarily with fruit juice or sweet beverages (39%) or mixed snacks (29%). Average carbohydrate intake for treatment was 32±24 grams. Of the participants, 73% overtreated their episodes. They were significantly younger and had greater fear of hypoglycemia than those who treated the episodes adequately. No difference was observed for cardiometabolic variables. CONCLUSIONS The majority of patients in our cohort overtreated their hypoglycemic episodes. These results suggest that hypoglycemia-correction education needs to be reinforced.

208 Long-term and seasonal impact of a vitamin D3 (cholecalciferol) supplementation protocol on vitamin D [25(OH)D] serum levels among cystic fibrosis adults in a Montreal clinic

Vitamin D deficiency is a widely reported problem in patients with Cystic Fibrosis (CF). Objectives To analyse the long term and seasonal impact on vitamin D [25(OH)D] serum levels of our vitamin D3 protocol. Methods A retrospective study was performed in our CF adult clinic. Data for 200 patients were obtained from their medical files for 2009, and compared to their own latest data available (2013–2014). Protocol Total starting D3 prescribed dose was 2800 IU/day during the summer months (May to October), 4400 IU/day during the winter months (November to April) or the weekly dose equivalent. Results Population studied: 55% male/45% female, age 34.4±8.3 years, FEV1% 65.1±21.4, BMI 23.2±3.5 kg/m 2 , 85.5% with pancreatic insufficiency. Mean 25(OH)D serum levels were significantly superior after the protocol (64.7±25.6 nmol/L vs 92.3±28.4 nmol/L, p TableLong-term impact of D3 Protocol25(OH)D serum level adequacyProportion of patientsBefore D3 ProtocolAfter D3 ProtocolDeficient, 150 nmo1/L0.5%3% Before the protocol, patients showed significant seasonal variation in 25(OH)D serum levels with lower levels in winter months compared to summer months (58.6±28.6 nmol/L vs 69.6±21.7 nmol/L, p Conclusion This study suggests that a vitamin D3 supplementation protocol with higher doses during winter months was efficient for the long term and seasonal management of vitamin D deficiency in our Montreal adult CF clinic.

WS13.4 Vitamin D levels among CF adults compared to general adult population in Canada

Introduction: The FDA recently issued a broad safety communication regarding the possible increased risk of osteoporosis-related bone fracture with the use of PPI’s. PPI’s are regularly used in CF for treatment of GORD and to help with the efficiency of PERT. And as osteoporosis is a co-morbidity of CF we aimed to assess if there was any relationship between PPI and bone density in children with CF. Methods: A retrospective review of PPI usage and dxa scans was conducted. Sixtyfour children with mean age of 11 (1.8 SD) were included in study. PPI usage and duration was recorded. Dxa scans were carried out on the Lunar DPXL-PED. Bone mineral density (BMD) was recorded and bone mineral apparent density (BMAD) was calculated. FEV1 was also recorded. Minitab Statistical Package was used to analyse the data. Results: Twenty-two (35%) of children were on PPI’s. Duration of use ranged from 1 to 4 years. PPI usage had a marginally significant negative effect on BMD [Z score mean of −0.31 (no PPI) and −0.94 (on PPI), p = 0.05]. PPI had no effect on BMAD [z score of 0.17 (no PPI) and −0.37 (on PPI), p = 0.08]. The duration of PPI had no influence on BMD or BMAD (p = 0.71 and p = 0.51). There was no difference in FEV1 between the two groups (means of 75% and 76%, p = 0.84). Conclusion: PPI’s may be prescribed more frequently in sicker patients and thus could explain the marginal difference found between groups. However this is not the case here as FEV1 did not differ. Therefore further larger studies are needed in this area. In the meantime, clinicians should be aware of their potential risk when considering PPI therapy and should use the lowest effective dose and duration necessary.

PP2 Les adultes atteints de diabète de type 1 suivent-ils les recommandations nutritionnelles ? Quel impact sur le contrôle glycémique ?

Introduction Nous avons demontre que la precision du calcul des glucides est fondamentale pour optimiser le controle glycemique des patients diabetiques de type 1. Neanmoins afin de reduire le risque cardiovasculaire la therapie nutritionnelle comporte aussi des recommandations pour les apports en macronutriments. L’objectif de ce travail est de determiner si les apports en macronutriments concordent avec les recommandations emises par l’Association Canadienne du Diabete et si l’adhesion est associee a l’A1c et aux fluctuations glycemiques. Patients et Methodes Trente-quatre adultes diabetiques de type 1 depuis en moyenne 23 ans (50 % femmes ; 41,0 ± 10,2 ans ; A1c 7,6 ± 1,4 %) ont complete un journal alimentaire de 3 jours et ont porte un lecteur de glucose en continu. Resultats : Recommandations Apport moyen % patients observant les recommandations % energie ou valeur absolue Proteines 15–20 % 16,0 ± 2,9 % 61,8 Glucides 45–60 % 48,7 ± 8,7 % 70,6 Lipides 33,3 ± 7,0 % 70,6 Gras sature 10,7 ± 2,9 % 14,7 Fibres > 25 g 21, ± 11,7 g 20,6 Dans l’ensemble, 47 % des adultes suivent les recommandations de base (glucides, lipides et proteines). L’observance de ces recommandations (oui/non) n’est pas associee a l’A1c (t = 0,464 ; p = 0,6) ou aux fluctuations glycemiques evaluees par MAGE (t = 0,567 ; p = 0,6). Conclusion Moins de la moitie des patients adherent aux recommandations nutritionnelles de base et cette proportion chute rapidement lorsqu’on considere les cibles en acides gras satures et en fibres. L’adhesion a ces recommandations n’influence pas le controle glycemique mais pourrait avoir un impact significatif sur le risque de maladies cardiovasculaires.

Cushing’s Syndrome due to Aberrant Adrenal Hormone Receptors

Primary adrenal etiologies account for 15‱20% of endogenous Cushing’s syndrome (CS) in adults, and are most commonly secondary to unilateral adenomas or carcinomas (1-3). Bilateral adrenal lesions can be found in up to 10% of adrenal CS cases. Primary pigmented nodular adrenocortical disease (PPNAD or micronodular adrenal dysplasia) can be familial, associated with Carney’s complex, and result from mutations of PKA type 1-α or of unknown genes on chromosome 2 (4).