Endocrine Abstracts

Glucose uptake is mediated by a family of glucose transport proteins, which are known to be expressed in specific insulin-sensitive tissues. Magnesium (Mg) is essential for autophosrylation of insulin receptor (INSR) and translocation of glucose transporter 4 (GLUT4) to the plasma membrane to facilitate glucose homeostasis. The specific effect of magnesium on INSR and GLUT4 expression in a diabetic state is however lacking. We conducted this s...

Aims and Objective: A transmembrane cell-adhesion protein, the Coxsackie-adenovirus receptor (CAR) serves as an entry receptor for enteroviruses and may be essential for their ability to infect cells. Since beta-cell enteroviral infection could contribute to the development of Type 1 diabetes, it is important that CAR expression is analysed in the human pancreas. CAR exists as at least 5 isoforms and we have studied the expression of these dif...

Aim: One of the hallmarks of type 2 diabetes (T2D) is impaired beta cell function, which develops in part as a result of widespread cellular de-differentiation. The current state-of-the-art defines beta cells as a heterogeneous islet population, with the existence of individual subpopulations including specialised ‘pacemakers’. We sought here to understand how overexpression-induced beta cell maturity affects such heterogeneity, befo...

Background: Metformin is currently the first drug of choice for treatment of type 2 diabetes (T2D). Metformin is known to reduce lipid levels through activation of AMP activated protein kinase-alpha (AMPKα). Metformin induces deficiency of vitamin B12 (B12) in patients with T2D. In humans, studies have shown that low B12 is associated with dyslipidemia (higher triglycerides and low HDL). Therefore, we investigated whether B12 deficiency m...

Introduction: Diabetes mellitus (DM) is a common co-morbidity in patients with heart failure and reduced left ventricular ejection fraction (HF-REF), and is associated with adverse prognosis. Subgroup analyses of randomized controlled trials suggest patients with DM benefit prognostically from beta-adrenoreceptor blockers (BB) and angiotensin converting enzyme inhibitors (ACEi). However, it remains unclear whether escalating doses of these age...

Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) is the hepatic manifestation of metabolic syndrome and is tightly associated with insulin resistance and type 2 diabetes (T2DM), both risk factors for disease progression, liver failure and cardiovascular complications. A multidisciplinary approach involving hepatologists and diabetologists working alongside allied health professionals is thus advocated for the management of NAFLD. Interv...

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Background: During fetal development, the heart switches substrate preference from glucose to fatty acids, such that in the adult heart, 50–70% of ATP is derived from fatty acid oxidation. What triggers this switch is currently unclear. In vivo, the late gestation rise in glucocorticoid levels is essential for structural and functional maturation of the fetal heart. Glucocorticoid treatment of fetal cardiomyocytes induces express...

Background: The exposure to HAART has increased the chances of developing Diabetes among HIV patients. Hyperglycaemia is more common among those on Protease inhibitors (PI)-based regimens compared to other regimens. Glycated hemoglobin (HbA1c ) is now being recommended by the American Diabetes Association (ADA) for the screening of Diabetes because of convenience as it does not require fasting.Objective: We aimed to dete...

Background: Obesity and subsequent insulin resistance is becoming more frequent among type 1 diabetes (T1DM) patients, leading to ‘double diabetes’ and potentially increasing vascular risk. Studies in double diabetes remain limited and this population is not fully characterised.Aims: To investigate the prevalence of overweight and obese T1DM patients and analyse the effects of increasing weight on cardiovascula...

Chemerin, a chemoattractant protein, acts via a G-protein coupled chemokine receptor, i.e. Chemokine like Receptor 1/ChemR23; levels of which are elevated in pro-inflammatory states such as obesity and type 2 diabetes mellitus (T2DM). Obesity and T2DM patients are at high risk of developing cardiovascular disorders such as atherosclerosis. We have reported that chemerin induces human endothelial cell angiogenesis and since dy...

A 60 year old lady presented to her GP with symptoms, she described as ‘morning sickness’.She also reported nausea (better after eating), mild epigastric discomfort.Examination revealed a soft non tender abdomen, with no organomegaly.She was referred for urgent upper GI endoscopy and abdominal USS.Initial bloods showed impaired liver function,...

Background: Genomic damage plays an important role in the pathogenesis of Type 2 Diabetes Mellitus (T2DM) and its complications. This instability increases with impaired metabolic control, and is aggravated by the presence of advance glycation-end products (AGEs) causing more cell damage. The aim of this study was to analyse the presence of genomic instability in patients with T2DM and its association with the levels of AGEs, namely glycated h...

Introduction: Diabetes mellitus (DM) challenges our health systems because of its prevalence, chronicity, complications, cost and complexity of care. Auditing care processes and outcomes is needed for monitoring implementation of existing guidelines, designing interventions and tracking progress. We assessed the care processes (CP) and intermediate outcomes (IO) among patients with DM who attended the diabetes clinic of a tertiary hospital in ...

Case History: 37 years old female, presented to Emergency department with worsening SOB over last 24 hours. On systemic enquiry, patient complained of epigastric pain after eating and admitted to un-intentional 22 Kg weight loss in last four months. She clinically appeared dehydrated, with mild epigastric tenderness and no other abnormal signs. She denied any alcohol ingestion or illicit drug use. She had treated Vitamin B12 deficiency and idi...

Introduction: According to think glucose traffic light referral, Diabetic patients with persisting hyperglycaemia or recurrent hypoglycaemia should be referred to diabetes specialist team, which include diabetic specialist nurses (DSN). In our trust, the point of care alerts the system when BM is <4 mmol/l and > 20 mmol/l.Aims and Methods: We conducted a retrospective analysis of all patients within a 2 week peri...

Introduction: We undertook an audit evaluating the glycaemic management of patients on steroids. This audit is based on the Joint British Diabetes Societies guideline on Management of Hyperglycaemia and Steroid (Glucocorticoid) Therapy, 2014.Method: The audit was conducted prospectively over a period of 5 days. All patients on steroids greater than 5 mg of Prednisolone, or an equivalent dose of alternative synthetic gluc...

A 71 year old gentleman presented with polydipsia, polyuria and nocturia for two weeks and weight loss of 10.5 Kg over the preceding two years. He had hypertension controlled with valsartan, hydrochlorthiazide, amlodipine and doxazosin. His average alcohol intake was 55 units per week. His brother had diabetes of uncertain aetiology. Examination was unremarkable apart from mild dehydration. His body mass index was 28 kg/m2 and there...

Frequent measurement of blood glucose among hospitalized patients including those in critically ill areas is routinely practiced. Evidence suggests that tight glycaemic control among hospitalized patients reduced complications such as sepsis and has been shown to reduce length of stay. Most commercially available devices have not been assessed in critically ill patients, furthermore point of care (POC) glucose testing among paediatric populati...

Background: The Medical columnist has not always been welcomed by the Medical Community.The Lancet, in its August 30, 1873 editorial had pointed out with regrets that a weekly periodical, the English Mechanic and World of Science had inaugurated a medical column edited by a member of the London medical establishment. The editorial had concluded that “we cannot but regard such conduct as an infraction of the etiquette of the profession, and hardly worthy of a Fell...

We present a challenging case of a 51 years old men, diagnosed with diabetes as he presented to emergency department with osmotic symptoms and hyperglycaemia. He was started on insulin and referred to diabetes clinic.On review, glycaemic control was sub-optimal (HbA1c 94 mmol/mol) and his insulin was changed from biphasic to basal-bolus regimen. His BMI was 21 kg/m2 and no family history of diabetes was report...

Coeliac disease is more common in people who have Type 1 diabetes mellitus (DM) because of their autoimmune co-existence. Between 4 and 9% of people with Type 1 DM will also have coeliac disease. The updated NICE guideline (NG 20 coeliac screening) recommends that adult with Type 1 DM should be tested for coeliac disease at diagnosis and retested if any symptoms of coeliac disease develop.Study method & Result: Newly...

Background: Nonalcoholic fatty liver disease (NAFLD) is commonly associated with type 2 diabetes mellitus (DM) though its prevalence is not well studied. This was a prospective study of prevalence and risk factors of NAFLD in patients with type 2 diabetes. The aim of this study was to determine the frequency of NAFLD in patients with T2DM.Subjects and Methods: A total of 200 patients with T2DM fulfilling the criteria wer...

Aim: After almost 2 centuries, SGLT2-i have made their comeback in human pharmacology through successful re-introduction in diabetes type 2 (T2D). Via restriction of renal glucose reabsorption, SGLT2-i have shown promising results. The aim of this audit was to ensure that current practice at UHCW NHS Trust is in line with the agreed national standards, whilst collecting clinical data from the use of SGLT2-i.Methods: This...

Introduction: Peripheral neuropathy is one of the common complications of diabetes and it may progress to the insensate foot at risk for ulceration. It may be evaluated for using several methods which include biothesiometry and the Michigan Neuropathy Screening Instrument. Assessment of Vibration Perception Thresholds is a validated method of screening for neuropathy while the MNSI is a two part validated screening tool for assessing periphera...

Background: Diabetes Mellitus (DM) is increasing in prevalence worldwide. Sex differences in glycaemia attainment may be relevant in the management of type 2 DM.This study determined gender differences in glycaemic targets in patients with type 2 diabetes attending the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile- Ife.Method: This cross-sectional descriptive study involved fou...

Aims and hypothesis: The aim of this study is to determine the baseline knowledge of diabetes and its management within two Psychiatric Crisis Resolution Teams based at NELFT NHS Foundation Trust. We hypothesise that attendance to diabetes seminars will lead to better knowledge of the condition’s management.Background: A 2014 NHS survey found that 6% of people with mental health conditions also suffered from diabete...

Introduction: Hypoglycaemia is a common and serious complication of diabetes treatment especially in patients who do not have knowledge of the condition and personal glucose metres. Patients with very good drug compliance are at greater risk of developing hypoglycaemia. Sometimes hypoglycaemia among patients on insulin therapy could be symptomatic or asymptomatic. The present study is aimed at measuring the determinants and predictors of hypog...

Introduction: Currently there is no published data nationally in the rate of lost appointments for Gestational Diabetes Mellitus (GDM) care during the antenatal period.Objective: To determine the rate of did not attend appointments (DNAs) for patients with GDM during their antenatal period and the differences in attendance between GDM and obstetric follow-up visits and their associated factors.Methods: A retrospective examination o...

Background: Obesity is increasingly becoming prevalent among the general population and in patients with type 2 diabetes mellitus in particular. This unhealthy association contributes to increased morbidity and mortality from cardiovascular complications in diabetic patients.Objectives: The aim of this study is to determine the prevalence of obesity among type 2 diabetes mellitus patients.Materials...

Introduction: According to guidelines, to predict early signs of micro-vascular complications in patients with diabetes, regular foot examination and perform regular investigations which include HbA1c, urea and electrolytes (U+Es), albumin-creatinine ratio (ACR) and lipid profile.Methods: During February 2017, consecutive patient medical notes were collected from a weekly general diabetic clinic. Using the patient notes ...

South Asians are six times more likely to get diabetes than Europeans. One of the main factors linked with this increased risk is lifestyle factors. Around the late 1950s, those who lived in South Asia had a diet rich in carbohydrates and sugar. However, this was balanced through their exercising habits, as many were hard working labourers who had to physically strain themselves through manual work, therefore burning off those calories appropr...

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Medical plants believed to be safe and cost effective than synthetic hypoglycaemic agents play important roles in the management of diabetes mellitus in developing countries where resources are meagre. We have isolated triterpenes from Syzygium aromaticum as the bioactive compounds that possesses hypoglycaemic effects in experimental diabetes. However, the poor water solubility of triterpenes observed in oral administration has necess...