Search Our Scientific Publications & Authors

Diabetes Ther 2021 Jun 12. Epub 2021 Jun 12.

Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Introduction: Sodium-glucose co-transporter-2 (SGLT2) inhibitors moderately reduce glucose levels in type-2 diabetes mellitus (T2DM). Some cases of diabetic ketoacidosis (DKA) were reported with SGLT2 inhibitors. However, data on the long-term safety of dapagliflozin in Saudi Arabia are lacking. Read More

Can J Diabetes 2021 Apr 28. Epub 2021 Apr 28.

Department of Medicine, Sinai Health System and the University of Toronto, Toronto, Ontario, Canada; Department of Medicine, General Internal Medicine, University of Toronto, Toronto, Ontario, Canada.

Objectives: The magnitude and precision regarding the risk of diabetic ketoacidosis (DKA) with sodium-glucose cotransporter-2 (SGLT2) inhibitors is unclear. Thus, we examined the risk of DKA with SGLT2 inhibitors in both observational studies and large clinical trials.

Methods: Searches were performed in PubMed, Embase, CENTRAL and Google Scholar (from inception to April 15, 2019) without language restrictions, including conference proceedings and reference lists. Read More

Medicine (Baltimore) 2021 Jun;100(23):e26237

Internal Medicine Residency Program, UPMC Pinnacle Harrisburg Hospital.

Introduction: Severe hypertriglyceridemia (HTG) is a rare complication of insulin resistance. Its presentation with diabetic ketoacidosis (DKA) has been reported in a few cases, where most patients have type-1 diabetes mellitus (DM). Our case represents a unique presentation of DKA associated with severe HTG above 10,000 mg/dL in an adult with type-2 DM. Read More

J Intensive Care Med 2021 Jun 11:8850666211023718. Epub 2021 Jun 11.

Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Accurate prediction of severity and mortality in diabetic ketoacidosis (DKA) is important for allocation of resources. The APACHE II and SOFA scores are used to predict mortality in critically ill patients, however neither has been tested exclusively in DKA. We sought to determine if these scoring systems can accurately predict mortality in patients with DKA. Read More

Cardiovasc Endocrinol Metab 2021 Jun 18;10(2):89-98. Epub 2020 Aug 18.

Division of Cardiology.

Objectives: To demonstrate a magnitude of the cardiovascular benefits, concomitantly analyzing the safety outcomes of sodium-glucose cotransporter 2 inhibitor (SGLT2-I) comprehensively, as a class effect in a larger sample size combined from recent randomized control trials.

Methods: We searched electronic databases using specific terms and evaluated 6 efficacy and 10 safety outcomes. Odds ratios (ORs) and 95% confidence interval (CI) were used to compare two interventions. Read More

Can J Diabetes 2021 Mar 16. Epub 2021 Mar 16.

Department of Pediatrics, Queen's University, Kingston, Ontario, Canada.

Objectives: Our aim in this study was to identify pediatric patients presenting in diabetic ketoacidosis (DKA) who received initial treatment inconsistent with current guidelines, and then to track associated complications.

Methods: This retrospective chart review examined 47 pediatric patients admitted to our institution with DKA, including those transferred from community hospitals. Primary outcome measures were exposure to treatment-related risk factors for cerebral edema (CE), including administration of an intravenous (IV) insulin bolus, IV bicarbonate, insulin within 1 hour of IV fluid start and non-NPO (nil per os) status. Read More

Am J Emerg Med 2021 May 21;49:142-147. Epub 2021 May 21.

Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States of America; Division of Health Informatics, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States of America.

Objective: To identify trends in pediatric emergency department (ED) utilization following the COVID-19 pandemic.

Methods: We performed a cross-sectional study from 37 geographically diverse US children's hospitals. We included ED encounters between January 1, 2010 and December 31, 2020, transformed into time-series data. Read More

Medicine (Baltimore) 2021 May;100(19):e25795

Department of Endocrinology and Metabolism.

Rationale: Sintilimab is a novel programmed cell death receptor-1 (PD-1) inhibitor approved in the treatment of classical Hodgkin's lymphoma and undergoing clinical trials for various malignancies. As a PD-1 inhibitor, sintilimab is known to cause autoimmune adverse events similar to other PD-1 inhibitors. Diabetic ketoacidosis (DKA) is a rare but severe adverse event of this therapy. Read More

AACE Clin Case Rep 2021 Jun 4. Epub 2021 Jun 4.

Duke University Hospital, Department of Pediatric Critical Care 5260Y Duke North DUMC Box 3046 Durham, NC 27710.

Objective: The coronavirus disease-2019 (COVID-19) pandemic has introduced countless challenges to the medical field. While pediatric patients are reported to have lower rates of COVID-19 mortality, the presence of pre-existing conditions can heighten the severity of their clinical presentation.

Case Report: Our patient, a six year old female with known type 1 diabetes, presented with acute onset of abnormal breathing and altered mental status. Read More

Ther Adv Drug Saf 2021 29;12:20420986211012854. Epub 2021 May 29.

Paediatrician, Waverley Paediatrics, Glen Waverley, Victoria, Australia.

Background: Retrospective analyses of large databases of treated patients can provide useful links to the presence of drug misuse or rare and infrequent adverse effects, such as agranulocytosis, diabetic ketoacidosis or neuroleptic malignant syndrome. The aim of this study is to describe the adverse effects to antipsychotics reported in the Australian Database of Adverse Event Notifications (DAEN).

Methods: Data were collected from the DAEN - a spontaneous reporting database. Read More

Med Sci Law 2021 Jun 9:258024211020936. Epub 2021 Jun 9.

Adelaide Medical School, The University of Adelaide, Australia.

Diabetic ketoacidosis (DKA) is a life-threatening condition arising in individuals with insulin-dependent diabetes mellitus, associated with hyperglycaemia and hyperketonaemia. While drugs such as methadone, cocaine and certain prescription medications may precipitate DKA, the potential effect of methamphetamine is unclear. Analysis of autopsy and toxicology case files at Forensic Science SA, Adelaide, South Australia, was therefore undertaken from 1 January to 31 December 2019 of all cases where methamphetamine was detected in post-mortem blood samples. Read More

ESC Heart Fail 2021 Jun 8. Epub 2021 Jun 8.

Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia.

The number of patients receiving sodium-glucose cotransporter 2 inhibitors (SGLT2is), especially those with heart failure, is increasing worldwide. SGLT2is control glycaemia by triggering glycosuria with simultaneous facilitation of a more ketogenic metabolic profile. Patients therefore are more prone to develop euglycaemic diabetic ketoacidosis (euDKA), an entity largely unknown beyond diabetes care professionals. Read More

Diabetes Care 2021 Jun 7. Epub 2021 Jun 7.

Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA.

Objective: Advances in diabetes technology have transformed the treatment paradigm for type 1 diabetes, yet the burden of disease is significant. We report on a pivotal safety study of the first tubeless, on-body automated insulin delivery system with customizable glycemic targets.

Research Design And Methods: This single-arm, multicenter, prospective study enrolled 112 children (age 6-13. Read More

Diabetes Care 2021 Jun 7. Epub 2021 Jun 7.

Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO.

Objective: We previously reported a high (30%) but stable prevalence of diabetic ketoacidosis (DKA) at youth-onset diagnosis of type 1 diabetes (2002 and 2010). Given the changing demographics of youth-onset type 1 diabetes, we sought to evaluate temporal trends in the prevalence of DKA at diagnosis of type 1 diabetes from 2010 to 2016 among youth <20 years of age and evaluate whether any change observed was associated with changes in sociodemographic distribution of those recently diagnosed.

Research Design And Methods: We calculated prevalence of DKA within 1 month of type 1 diabetes diagnosis by year and evaluated trends over time (2010-2016) ( = 7,612 incident diabetes cases; mean [SD] age 10. Read More

AACE Clin Case Rep 2021 Mar-Apr;7(2):158-162. Epub 2020 Dec 28.

Department of Medicine, St. Joseph's University Medical Center, Paterson, New Jersey.

Objective: The main objective was to describe and review a unique case that presented with diabetic ketoacidosis, positive insulin autoantibodies (IAAbs, which are found in Hirata disease and are usually present with hypoglycemia), and laboratory findings characteristic of type B insulin resistance syndrome (TBIRS) and systemic lupus erythematosus. Confirmation of TBIRS was obtained in Germany as immunoassay for insulin receptor antibodies (IRAbs) is not available in the United States.

Methods: A literature review on TBIRS and cases that present with IAAbs and IRAbs simultaneously was conducted. Read More

AACE Clin Case Rep 2021 Mar-Apr;7(2):127-131. Epub 2020 Dec 28.

Scripps Clinic Medical Group, Division of Diabetes and Endocrinology, La Jolla, California.

Objective: To report the first case of diabetic ketoacidosis (DKA) and its management in a patient with diet-controlled prediabetes and metastatic breast cancer treated with alpelisib, a PI3K (phosphatidylinosiotol-3-kinase) inhibitor.

Methods: Literature on the topic is reviewed. The case is that of a 66-year-old female with diet-controlled prediabetes and metastatic breast carcinoma who had initiated alpelisib 2 weeks prior to being admitted for diabetic ketoacidosis. Read More

Anesth Essays Res 2020 Jul-Sep;14(3):539-542. Epub 2021 Mar 22.

Department of Anesthesiology, Brooke Army Medical Center, Fort Sam Houston, TX, USA.

Emergent surgery in the setting of a concomitant medical (nonsurgical) emergency challenges the anesthesiology team with multiple and often conflicting concerns. During these rare situations, general anesthesia is often employed. This case report demonstrates a safe and effective regional anesthetic technique utilized as the primary anesthetic during emergent surgery in the setting of a medical emergency. Read More

J Investig Med High Impact Case Rep 2021 Jan-Dec;9:23247096211021231

Saint Joseph's University Medical Center, Paterson, NJ, USA.

We report 11 cases of combined diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic coma (HHNK) in coronavirus 2019 patients who presented to our institution in New Jersey, USA. The median age was 47 years (range 12-88 years). Out of the 11 patients, 7 were male and 4 were female. Read More

Diabetes Technol Ther 2021 Jun 4. Epub 2021 Jun 4.

University Medical Centre Ljubljana, 14Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, Ljubljana, Slovenia;

Aims: To investigate the short-term effects of the first wave of COVID-19 on clinical parameters in children with type 1 diabetes (T1D) from 82 worldwide centres participating in the SWEET registry.

Methods: Aggregated data per person with T1D ≤ 21 years of age were compared between May/June 2020 (first wave), August/September 2020 (after wave) and the same periods in 2019. Hierarchic linear and logistic regression models were applied. Read More

Int J Pediatr Adolesc Med 2021 Jun 23;8(2):107-111. Epub 2020 Nov 23.

College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), Riyadh, Saudi Arabia.

Background And Objectives: The hereditable nature of type 1 diabetes mellitus (T1DM) makes it a condition that is in some cases shared among siblings. Studies that focus on the epidemiology of T1DM among siblings are scarce. The primary focus of the study is to estimate the prevalence of familial T1DM among siblings and the secondary focus is to identify the presence of any special clinical or biochemical characteristics specific to this entity. Read More

Cureus 2021 May 1;13(5):e14796. Epub 2021 May 1.

Endocrine Oncology, Karmanos Cancer Center, Detroit, USA.

We present the third case of alpelisib-induced diabetic ketoacidosis. Alpelisib is an antineoplastic agent that inhibits phosphatidylinositol 3-kinase (PI3K), which plays a key role in multiple biological processes such as cell differentiation, proliferation, and survival. Thereby, the inhibition of this pathway should cause antitumor activity. Read More

BMJ Open Diabetes Res Care 2021 Jun;9(1)

Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.

Introduction: The aims of this study were to characterize insulin-treated individuals aged ≥75 years with type 2 diabetes using basal insulin analogs (BIA) or regular insulins (human insulin (HI)/neutral protamine Hagedorn (NPH)) and to compare the benefits and risks.

Research Design And Methods: The analysis was based on data from the DPV (Diabetes-Patienten-Verlaufsdokumentation) and DIVE (DIabetes Versorgungs-Evaluation) registries. To balance for confounders, propensity score matching for age, sex, diabetes duration, body mass index and hemoglobin A1c (HbA1c) as covariates was performed. Read More

Medwave 2021 Apr 23;21(3):e8176. Epub 2021 Apr 23.

Departamento de Pediatría, Centro de Ciencias de la Salud de la Universidad de Texas en Houston, Estados Unidos. ORCID: 0000-0001-5349-5260.

Introduction: The association of COVID-19 with diabetes mellitus is bidirectional. In one direction, diabetes mellitus is associated with an increased risk of severe COVID-19. In the opposite direction, in patients with COVID-19 new-onset diabetes mellitus, severe diabetic ketoacidosis and severe metabolic complications have been described. Read More

Am J Case Rep 2021 Jun 3;22:e930568. Epub 2021 Jun 3.

Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.

BACKGROUND Refeeding syndrome is a complex metabolic disorder that develops following rapid nutritional administration after a long period of undernutrition. The onset mechanism involves intracellular transport of phosphorus, potassium, and water, in association with rapid glucose administration. The resulting hypophosphatemia is extremely dangerous and can cause severe heart failure and fatal arrhythmia. Read More

Neurology 2021 Jun 2. Epub 2021 Jun 2.

Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA

Clin Med (Lond) 2021 Mar;21(Suppl 2):1-2

University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK, and Aston University, Birmingham, UK.

Diagnostics (Basel) 2021 May 29;11(6). Epub 2021 May 29.

Department of Forensic Medicine, Institute of Forensic Medicine, 700455 Iasi, Romania.

Diabetic ketoacidosis (DKA) is a lethal acute hyperglycemic complication of diabetes mellitus (DM) and it represents the initial manifestation of DM in about 15-20% of cases in adults and about 30-40% of cases in children. Postmortem diagnosis of DKA can only be made by applying thanatochemistry. Biochemistry applied postmortem is viewed with skepticism by many practitioners in the forensic field, completely lacking in many forensic services around the world, and especially in the national ones. Read More

J Clin Med 2021 May 10;10(9). Epub 2021 May 10.

Service of Cardiology, Cardiovascular Department, Lausanne University Hospital, 1011 Lausanne, Switzerland.

Canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin belong to a class of antidiabetic treatments referred to as sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors, or SGLT2is). SGLT2is are currently indicated in North America and in Europe in type 2 diabetes mellitus, especially in patients with cardiovascular (CV) disease, high CV risk, heart failure, or renal disease. In Europe, dapagliflozin is also approved as an adjunct to insulin in patients with type 1 diabetes mellitus. Read More

Antioxidants (Basel) 2021 May 9;10(5). Epub 2021 May 9.

Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece.

Recent reports have demonstrated the association between type 1 diabetes mellitus (T1DM) and increased morbidity and mortality rates during coronavirus disease (COVID-19) infection, setting a priority of these patients for vaccination. Impaired innate and adaptive immunity observed in T1DM seem to play a major role. Severe, life-threatening COVID-19 disease is characterized by the excessive release of pro-inflammatory cytokines, known as a "cytokine storm". Read More

Dtsch Med Wochenschr 2021 Jun 1;146(11):710-713. Epub 2021 Jun 1.

Klinik für Endokrinologie und Stoffwechselmedizin, Charité-Universitätsmedizin Berlin.

Monitoring:  With the increasing prevalence of continuous glucose monitoring (CGM) systems, time in range (TIR) is gaining importance as a parameter for optimization of glycemic control in patients with type 1 diabetes mellitus. Recent studies showed improved prevention of cardiovascular events and pregnancy complications in patients with optimized TIR. In addition to TIR, it is recommended to consider Time below Range (TBR) as well to include an assessment of hypoglycemia. Read More