Judi Erickson

Carotid intima media thickness decreases after pancreas transplantation

BACKGROUND Pancreas transplantation (PTX) improves diabetic microvascular complications, but it is unknown whether PTX alters macrovascular disease. Carotid intima media thickness (IMT) has been shown to correlate with cardiovascular events, so this study was designed to evaluate changes in carotid IMT after PTX. METHODS Four groups were studied: PTX candidates (n=60); successful PTX recipients (n=89; mean time since PTX=4.0+/-0.3 years); patients with type 1 diabetes but without nephropathy (n=20); and normal controls (n=32). Mean IMT and mean of maximum carotid IMT measurements (mean-max IMT), hemoglobin A1C, serum creatinine, body mass index (BMI), blood pressure, smoking status, use of hypolipidemic medications, and fasting lipids were determined in all groups. RESULTS Age, gender distribution, and BMI were not different among the groups. Duration of diabetes was also equal between pre- and post-PTX groups. Mean and mean-max IMT were greatest pre-PTX and decreased after PTX (P<0.05) to a value that was not different from controls. Hemoglobin A1C and creatinine decreased, and high density lipoprotein (HDL) increased after PTX (P<0.05), but there were no significant differences in other lipids, BMI, use of lipid lowering agents, blood pressure, or smoking status. CONCLUSIONS Carotid IMT is lower after PTX, suggesting a reduction in overall cardiovascular risk independent of changes in use of hypolipidemic agents, smoking, blood pressure, BMI, or lipids, except HDL. Improved carotid IMT after successful PTX predicts a reduction in future vascular disease events and suggests that the macrovascular disease of type 1 diabetes is at least partially reversible with improved glucose control.

The Prevalence of Vitamin D Deficiency Is Similar between Thyroid Nodule and Thyroid Cancer Patients.

Introduction. There are reported associations between vitamin D deficiency and breast, prostate, and colon cancer, but the relationship in thyroid cancer has not been evaluated. Methods. We evaluated serum calcium, creatinine, albumin, and 25-hydroxy vitamin D (25-OH-D) in 42 thyroid nodule, 45 thyroid cancer in remission, and 24 active thyroid cancer patients. Results. 25-OH-D was not different between groups. The percent with 25-OH-D levels <75 nmol/L was not significantly different between groups and was not affected by season of measurement, age, or cancer stage. Multivariate regression showed a BMI of ≥30 kg/m2 to be the only significant predictor of vitamin D deficiency. Conclusions. Rates of vitamin D deficiency are similar in thyroid nodules and thyroid cancer, although higher than the general population. This is different than previous studies for other cancers, which show higher rates of vitamin D deficiency. BMI was the only predictor of vitamin D deficiency.

Comparison of CT and dual-energy DEXA using a modified trunk compartment in the measurement of abdominal fat

The quantification of abdominal fat is a marker of health risk. While dual-energy x-ray absorptiometry (DEXA) is easily applied, it measures overall fat, although abdominal fat may be a better indicator of health risk from obesity. We have evaluated whether a subcomponent of DEXA measurements correlates better with computed tomography (CT) for body fat than those traditionally used. Forty-seven healthy adults (22 M/25 F), aged 54.5±15.8 yr (mean±SD), with BMI of 27.1±4.6 kg/m2 participated in a cross-sectional study. Body fat was measured using abdominal CT and DEXA for total fat, trunk fat, and a modified trunk measurement that excludes the chest, termed “lower trunk,” and compared. The coefficient of variation for DEXA measurements for trunk, lower trunk, and total body were 1.98, 3.12, and 0.85%, respectively. Mean DEXA for percentage fat ranged from 31.7% to 34.1% for trunk, lower trunk, and total body, compared to 54.2% for abdominal CT (p<0.003 for each pairwise comparison). Lower trunk, whole trunk, and total body DEXA measurements were not different. Measurement of subcomponents of fat content by DEXA is not superior to whole body measurements and remains consistently lower than measurements by CT.

Reproductive hormones after pancreas transplantation.

Background. Reproductive hormone function after pancreas transplantation (PTX) is unknown as it has not been studied. Methods. We prospectively studied PTX recipients to determine changes in reproductive hormones after PTX. Testosterone or estradiol, leutinizing hormone, follicle stimulating hormone, and prolactin were determined before and 1 year after PTX in 23 patients (10 women, 13 men) followed for more than 1 year after PTX. Of these, 11 received simultaneous kidney-PTX; 8 PTX only; and 4, PTX after kidney. Average age was 38.4±1.6 years and average duration of diabetes was 24.5±1.3 years. Nine (four women, five men) patients had been on dialysis pre-PTX. Sixteen of 23 patients were treated with cyclosporine and seven with FK-506 along with prednisone and azathioprine post-PTX. Results. Mean testosterone in men was normal pre-and post-PTX. Two men had secondary hypogonadism pre-PTX with resolution in one and persistence in the other post-PTX. Five of the ten women had evidence of hypogonadism pre-PTX: three had primary hypogonadism and two had secondary hypogonadism. Post-PTX, 7 of 10 women had abnormal reproductive hormones: 4 had primary hypogonadism, 2 had secondary hypogonadism, and 1 developed hyperestrogenemia with elevated estradiol (482 pg/ml) and leutinizing hormone (41 IU/liter). Mean prednisone dose and cyclosporine trough level were higher in the women than the men (P <0.05). No cases of secondary hypogonadism that developed or resolved post-PTX were related to changes in prolactin, renal function, or hyperglycemia. Conclusions. Women are more likely than men to have reproductive hormone abnormalities pre- and post-PTX and the causes may be multiple.

Vitamin D Insufficiency Is Associated With Diabetes Risk in Native American Children

Aims/Hypothesis. Vitamin D insufficiency has not been well studied in Native American (NA) children, who are at risk for obesity and diabetes. The authors examined vitamin D insufficiency and its association with body mass index (BMI) and insulin resistance. Methods. In a cross-section of NA children 5 to 18 years old (N = 198), anthropometrics, biomarkers of insulin resistance, and 25-hydroxy-vitamin D concentration [25(OH) vitamin D] were measured. BMI% and homeostatic model assessment of insulin resistance (HOMA-IR) were calculated. Results. Mean age was 10.8 ± 0.3 years (mean ± SEM). Mean serum 25(OH) vitamin D was 17.8 ± 0.4 ng/mL and 97% had vitamin D insufficiency [25(OH) vitamin D <30 ng/mL]. After adjusting for BMI, 25(OH) vitamin D was inversely associated with HOMA-IR (P < .0001) and several other markers of insulin resistance. Conclusions/Interpretation. Vitamin D insufficiency was nearly universal in this cohort of NA children and was associated with diabetes and vascular risk markers. Whether vitamin D supplementation can improve insulin resistance must be studied further.

Levothyroxine dose following thyroidectomy is affected by more than just body weight

To determine the factors that affect levothyroxine (LT4) requirements following thyroidectomy.

Body Mass Index Percentile More Sensitive Than Acanthosis Nigricans for Screening Native American Children for Diabetes Risk

BACKGROUND Many Native American tribes use acanthosis nigricans to screen for type 2 diabetes risk. We hypothesized that acanthosis nigricans misses many children at risk for type 2 diabetes. METHODS We evaluated 5- to 18-year-old Native American children and youth to assess the sensitivity and specificity of acanthosis nigricans as a marker for insulin resistance. RESULTS In a cohort of 161 youth (72 males/89 females), mean age was 10.7 years + 3.9. Mean body mass index (BMI) percentile was 76.8 +/- 23.3, and 54% had a BMI at or above the 85th percentile. Acanthosis nigricans was present in 21.7% of the participants and was more common in 12-to 18-year-olds than in 5 to 11-year-olds (p = .02). Of those with acanthosis nigricans, 82.4% had insulin resistance (homeostatic model assessment of insulin resistance >4), but only 48.3% of those with insulin resistance had acanthosis nigricans. In contrast, BMI at or above the 85th percentile had a high sensitivity (74%) for insulin resistance, even though its specificity was lower (58%). CONCLUSIONS The presence of acanthosis nigricans alone was a specific, but not a sensitive, screening tool for identifying youth with insulin resistance. BMI at or above the 85th percentile was a more sensitive screening tool than acanthosis nigricans alone, or acanthosis nigricans and BMI together for identifying children and youth with IR who are at increased risk for type 2 diabetes.

Heel ultrasonography is not a good screening tool for bone loss after kidney and pancreas transplantation

Abstract:  Background:  Solid organ transplant recipients, particularly simultaneous pancreas kidney recipients, are at high fracture risk. We tested whether quantitative ultrasonography (QUS) of the heel predicts bone mineral density (BMD) by dual energy X‐ray absorptiometry (DXA) in solid organ transplant recipients.

Diabetes, pre-diabetes and insulin resistance screening in Native American children and youth.

Objectives:Early identification of pre-diabetes and insulin resistance (IR) provides an important window of opportunity for diabetes prevention. Little is known about the prevalence of pre-diabetes and IR in Native American (NA) youth. We designed a cross-sectional, community-based study of NA children to estimate the prevalence of diabetes, pre-diabetes and IR and their association with other diabetes risk factors.Study Design:NA children (5–18 years) were screened with body mass index (BMI), blood pressure, oral glucose tolerance test (OGTT), lipids, insulin and highly sensitive C-reactive protein (hsCRP), and calculated homeostatic model assessment of IR (HOMA-IR).Results:Mean age of the cohort (n=201) was 10.8±3.8 years (±s.d.; 94/107 M/F). BMI percentile for age and sex (BMI%) was elevated (⩾85th percentile) in 58.6% of 5–11 years and 51.1% of 12–18 years, and positively correlated with HOMA-IR, blood pressure, triglycerides and hsCRP (P<0.05). The prevalence rate for pre-diabetes and diabetes were 6.5% (3.5–10.8%) and 1.0% (0.1–3.6%), respectively. Mean HOMA-IR was greater in the older than younger age group while prevalence of pre-diabetes was the same. Those with pre-diabetes and diabetes had a greater HOMA-IR, abdominal circumference and BMI% than normal youth.Conclusion:In the first prospective, community-based screening for pre-diabetes, IR and diabetes in United States NA youth using OGTT, while the number of diabetes cases was low, pre-diabetes was found in a significant number of youth, particularly in those with BMI ⩾95th%. As proportions of pre-diabetes were similar in 5–11 and 12–18 year olds, diabetes risk begins early in NA youth.

Dyslipidemia Can Be Controlled in Diabetic as well as Nondiabetic Recipients after Kidney Transplant

Background. Patients with diabetes have been reported to have greater dyslipidemia after kidney transplant (KTX). Because postKTX management of diabetes has changed markedly since those reports, we hypothesized that lipids can be controlled as well in diabetic as in nondiabetic recipients. Methods. We compared lipid levels up to 2 years after KTX (n=192) between diabetic and nondiabetic recipients. The cohort was subdivided into nondiabetic (nonDM-K; n=123), type 2 (DM2-K; n=33), or type 1 diabetes after KTX (DM1-K; n=14), or type 1 after kidney-pancreas transplant (DM1-KP; n=22). Results. Mean age and body mass index of DM2-K were greater than the others (P<0.01), and diabetes groups had a higher pretransplant A1C than nonDM-K (P<0.001). After KTX, lipid levels were not higher in diabetic than in nondiabetic recipients, and did not increase in any group. Total and low-density lipoprotein cholesterol levels decreased in DM1-K (P<0.001), high-density lipoprotein levels decreased in DM1-KP (P=0.02), and triglyceride levels were unchanged after KTX for all groups. A1C improved in DM1-K and DM1-KP (P<0.0001). There was less improvement in lipid levels with tacrolimus-sirolimus immunosuppression than with other steroid-containing regimens (P<0.05). Conclusions. Multiple mechanisms may contribute to better lipid levels in both groups as well as the lack of difference between diabetic and nondiabetic recipients compared with what has been reported previously: greater use of and more effective lipid-lowering agents, no significant weight gain, no difference in renal function between groups, and better control of glucose in the diabetic group. Thus, overall, lipids can be controlled as well in diabetic as in nondiabetic KTX recipients.