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Curr Aging Sci 2018 Dec 5. Epub 2018 Dec 5.

Acute Geriatrics Unit, Monza (MB). Italy.

Introduction: Doege-Potter syndrome (DPS) is a rare but life-threatening paraneoplastic syndrome, characterized by non-islet cell tumor-induced hypoglycemia (NICTH) secondary to a solitary fibrous tumor (SFT), which secretes an incompletely processed form of insulin-like growth factor 2 (IGF-2).

Results: A 96-year-old woman was admitted with head trauma due to an accidental fall. During her hospital stay she experienced frequent hypoglycemic episodes. Read More

Diabetes Obes Metab 2018 Dec 5. Epub 2018 Dec 5.

Department of Endocrinology, Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School.

Aims: To compare the efficacy and safety of saxagliptin and glimepiride in type 2 diabetes (T2D) patients inadequately controlled with metformin monotherapy.

Materials And Methods: In this 48-week, multi-centre, open-label, randomized, parallel trial, a total of 388 T2D patients were 1:1 randomized to saxagliptin or glimepiride group. The primary endpoint was the achievement of HbA1c<7. Read More

Diabetes Obes Metab 2018 Dec 6. Epub 2018 Dec 6.

University of Perugia School of Medicine, Perugia, Italy.

Aims: To identify factors associated with achievement of glycated haemoglobin A1c (HbA1c) target at 24 weeks after commencing basal insulin therapy in people with type 2 diabetes mellitus (T2DM).

Materials And Methods: Post-hoc pooled analysis of 16 randomised, treat-to-target trials involving people with T2DM inadequately controlled on oral anti-hyperglycaemic drugs (n=3415) initiated on once-daily insulin glargine 100 U/mL (Gla-100). Clinical outcomes were assessed by HbA1c response at 24 weeks and people classified as "good responders" by reaching HbA1c <7. Read More

J Endocr Soc 2018 Dec 1;2(12):1357-1362. Epub 2018 Nov 1.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Context: Mutations in genes encoding the lipoprotein lipase enzyme, its cofactor, or transport proteins can cause severe familial hypertriglyceridemia, resulting in serious complications, such as severe pancreatitis, hepatosplenomegaly, lipid encephalopathy, and failure to thrive. Current treatment includes a low-saturated-fat formula enriched with high medium-chain triglyceride (TGs), oral fibrates, omega-3 fatty acids, or plasmapheresis.

Case Description: A 71-day-old infant with very severe hypertriglyceridemia and recurrent pancreatitis associated with a likely pathogenic variant in the gene was treated successfully with insulin infusion and a locally prepared low-fat formula feed after stopping breast milk. Read More

Clin Epidemiol 2018 8;10:1639-1648. Epub 2018 Nov 8.

Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK,

Purpose: To understand the patient characteristics associated with treatment choice at the first treatment intensification for type 2 diabetes.

Patients And Methods: This is a noninterventional study, using UK electronic primary care records from the Clinical Practice Research Datalink. We included adults treated with metformin monotherapy between January 2000 and July 2017. Read More

Acta Diabetol 2018 Dec 3. Epub 2018 Dec 3.

Health and Social Research Centre, Universidad de Castilla-La Mancha, C/ Santa Teresa Jornet, s/n, 16071, Cuenca, Spain.

Aims: To assess the effectiveness of insulin glargine 300 ui/ml (Gla-300) compared with insulin glargine 100 ui/ml (Gla-100) on reducing nocturnal hypoglycemia and improving glycemic control in type 1 and type 2 diabetes patients.

Methods: We systematically searched in Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials until July 4th, 2018. This study was registered with PROSPERO (CRD42017080134). Read More

J Pak Med Assoc 2018 Dec;68(12):1840-1842

Department of Endocrinology, Bharti Hospital, Karnal, India.

Management of diabetes in infants and toddlers requires the administration of multiple subcutaneous insulin injections and frequent monitoring of blood glucose. However, there are significant unique challenges in managing insulin injections in this age group due to unpredictable eating and activity patterns, less subcutaneous fat, increased risk of hypoglycaemia, and the child's inability to communicate symptoms and comprehend the need for insulin. Insulin pumps and pen devices are preferable to insulin syringes. Read More

Mol Metab 2018 Nov 20. Epub 2018 Nov 20.

Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address:

Objective: Life-threatening hypoglycemia is a major limiting factor in the management of diabetes. While it is known that counterregulatory responses to hypoglycemia are impaired in diabetes, molecular mechanisms underlying the reduced responses remain unclear. Given the established roles of the hypothalamic proopiomelanocortin (POMC)/melanocortin 4 receptor (MC4R) circuit in regulating sympathetic nervous system (SNS) activity and the SNS in stimulating counterregulatory responses to hypoglycemia, we hypothesized that hypothalamic POMC as well as MC4R, a receptor for POMC derived melanocyte stimulating hormones, is required for normal hypoglycemia counterregulation. Read More

Vet J 2018 Dec 21;242:33-38. Epub 2018 Sep 21.

Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Viikintie 49, FI-00014 Helsinki, Finland.

The commonly used sedative α-adrenoceptor agonist dexmedetomidine has adverse cardiovascular effects in dogs that can be prevented by concomitant administration of the peripherally acting α-adrenoceptor antagonist MK-467. An ancillary effect of dexmedetomidine is to decrease insulin release from the pancreas, whereas MK-467 stimulates insulin release. This study assessed the effects of co-administered dexmedetomidine and MK-467 in a canine glibenclamide-induced hypoglycaemia model. Read More

Int J Obstet Anesth 2018 Nov 17. Epub 2018 Nov 17.

Department of Anaesthesiology, Nara Medical University, Kashihara, Nara, Japan.

Eur J Intern Med 2018 Nov 28. Epub 2018 Nov 28.

Maccabi Health Services, Tel Aviv, Israel; Ben Gurion University, Beer Sheva, Israel.

Objective: To examine the association between hypoglycemic events and inpatient and outpatient mortality rates, and to characterize the profile of patients with diabetes who develop hypoglycemia during hospitalization in order to identify risk factors and potentially avoid it.

Research Design And Methods: This retrospective cohort study analyzed data of 3410 patients with diabetes hospitalized during 2012. The associations among biochemical measures, severity of hypoglycemia, inpatient length of stay, and mortality during hospitalization, one month and within one year after discharge were evaluated. Read More

Med Clin (Barc) 2018 Nov 29. Epub 2018 Nov 29.

Hospital Central de Asturias, Servicio de Endocrinología y Nutrición, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.

Objective: To analyze the effect of sodium glucose cotransporter 2 (SGLT2) inhibitors in a group of insulin-dependent type 2 diabetes mellitus (T2D) patients.

Patients And Methods: One hundred and five insulin treated T2D patients were enrolled. Primary endpoints were: fasting plasma glucose, HbA1c, weight, total insulin doses (TDI), total basal insulin (TDB) and total rapid insulin (TDR). Read More

J Clin Endocrinol Metab 2018 Dec 3. Epub 2018 Dec 3.

Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.

Context: Multiple autosomal recessive genes have been etiologically linked to Primary Adrenal Insufficiency (PAI). Recently, SGPL1 gene mutations were recognized as causes of steroid-resistant nephrotic syndrome type 14 (NPHS14), a sphingolipidosis with multisystemic manifestations including PAI. Interestingly, this is the only monogenetic form of nephrotic syndrome (NS) and the sole sphingolipidosis causing adrenal disease. Read More

J Pediatr Endocrinol Metab 2018 Dec 5. Epub 2018 Dec 5.

The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.

Background Treatment for type 1 diabetes mellitus (T1DM) has greatly changed by the general use of insulin analogs and continuous subcutaneous insulin infusion (CSII). To investigate whether these advances have been translated into continued improvement in glycemic control in Japanese children and adolescents, we analyzed the registration data of the two consecutive recent cohorts of Japanese childhood-onset T1DM patients. Methods The registration data including hemoglobin A1c (HbA1c), hypoglycemia and insulin regimen were compared between the two cohorts (862 patients in the 2008 cohort and 1090 in the 2013 cohort). Read More

Australas J Dermatol 2018 Dec 4. Epub 2018 Dec 4.

Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China.

Recently, several studies have reported their experience in using oral atenolol in patients with infantile haemangioma (IH), especially as an alternative to propranolol, but the efficacy and safety of oral atenolol has not been evaluated. We searched PubMed (Medline), Central, Embase, Web of Science and EBSCOhost (until May 2018) for the eligible studies reporting more than 10 IH patients who were treated with oral atenolol with detailed original data, including outcomes, regimens and adverse events (AEs). The data was standardised and analysed by using R software with meta-package. Read More

Nutr Res Pract 2018 Dec 13;12(6):469-478. Epub 2018 Sep 13.

Department of Food and Nutrition, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea.

Background/objectives: Mulberry leaf (ML) has been shown to have an inhibitory effect on α-glucosidase, and suppresses postprandial hyperglycemia, which may be related to its deoxynojirimycin (DNJ) content. This study was conducted to investigate the hypoglycemic and dyslipidemic effects of rice coated with ML rich in DNJ in a type 2 diabetes mouse model.

Materials/methods: The mice were divided into four groups (n = 8 each): non-diabetic normal control (NC); diabetic control (DM-C), fed with 10% polished rice powder (DM-R); and fed with 10% polished rice powder coated with DNJ-rich ML (DM-DNJR). Read More

World J Clin Cases 2018 Nov;6(14):786-790

Department of Clinical Biochemistry and Metabolism, Acibadem Labmed Clinical Laboratories, Istanbul 34752, Turkey.

Glutaric acidemia type II (GAII), also known as multiple acyl-CoA dehydrogenase deficiency, is an autosomal recessive inborn error of amino acid and fatty acid metabolism. We report a case of GAII with novel electron transfer flavoprotein (ETF)-A mutations in a 2-year-old female with thalassemia minor. The patient developed an episode of hypoglycemia and hypotonicity on the postnatal first day. Read More

Food Sci Nutr 2018 Nov 10;6(8):2414-2422. Epub 2018 Oct 10.

Department of Human Development and Family Studies National Taiwan Normal University Taipei Taiwan.

L. (RTL) exhibits a wide range of phytochemical activities, for example, on treatment of diabetes mellitus (DM), in Orient. There is, however, few study regarding the effect of RTL on glycemic-related homeostasis in type 2 DM (T2DM). Read More

Rev Esp Anestesiol Reanim 2018 Nov 30. Epub 2018 Nov 30.

Servicio de Anestesiología y Reanimación, Hospital de Jerez de la Frontera, Jerez de la Frontera (Cádiz), España.

McArdle disease or type V glycogenosis is a rare metabolic myopathy consisting of muscle loss and weakness. These patients have risks associated with anaesthesia. They can present with hypoglycaemia, rhabdomyolysis, acute renal failure, and electrolyte changes. Read More

Trials 2018 Dec 4;19(1):665. Epub 2018 Dec 4.

Department of Pediatric Diabetes and Endocrinology, Clinique Pédiatrique, Centre Hospitalier, Luxembourg City, Luxembourg.

Background: In attempting to achieve optimal metabolic control, the day-to-day management is challenging for a child with type 1 diabetes (T1D) and his family and can have a major negative impact on their quality of life. Augmenting an insulin pump with glucose sensor information leads to improved outcomes: decreased haemoglobin A1c levels, increased time in glucose target and less hypoglycaemia. Fear of nocturnal hypoglycaemia remains pervasive amongst parents, leading to chronic sleep interruption and lack of sleep for the parents and their children. Read More

Diabetes Res Clin Pract 2018 Nov 27. Epub 2018 Nov 27.

Diabetes and Endocrine Service, Liverpool Hospital, South Western Sydney Local Health District, NSW Australia.

Aim: During pregnancy, some women have a low glucose level on the 75g oral glucose tolerance test (OGTT). The implications of this are unclear and there is no guideline on how to manage these women.

Method: We recruited pregnant women with a glucose level <3. Read More

Expert Opin Pharmacother 2018 Nov 30:1-9. Epub 2018 Nov 30.

a Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA.

Introduction: Glucagon-like peptide-1 (GLP-1) receptor agonists are highly potent antihyperglycemic drugs that impose low risk of hypoglycemia and also result in body weight reduction. Currently, all approved members of the class require administration by injection. Areas covered: This manuscript reviews oral semaglutide-an experimental GLP-1 receptor agonist in phase-3 clinical development. Read More

Ann Pharmacother 2018 Nov 30:1060028018816728. Epub 2018 Nov 30.

3 Cleveland Clinic, Cleveland, OH, USA.

Objective: People with type 1 diabetes often have suboptimal glycemic control. The gold standard of treatment is basal-bolus insulin or subcutaneous insulin infusion via insulin pump. Although insulin therapy improves glycemic control, weight gain and hypoglycemia often limit achievement of hemoglobin A (A1C) goals. Read More

Diabetes Obes Metab 2018 Nov 30. Epub 2018 Nov 30.

Kumamoto University, Kumamoto, Japan.

Aims: To assess the pharmacokinetics/pharmacodynamics (PK/PD) of dapagliflozin, a sodium-glucose co-transporter 2 inhibitor that increases urinary glucose excretion (UGE), and its major metabolite, dapagliflozin-3-O-glucuronide (D3OG), in Japanese patients with type 1 diabetes (T1D) and inadequate glycemic control (HbA1c 7-10%).

Materials And Methods: Japanese patients (18-65 years) with inadequately controlled T1D were randomized 1:1:1 to dapagliflozin 5 mg, 10 mg, or placebo (n=14 each) once daily for seven days with adjustable insulin. The PK/PD characteristics of dapagliflozin and D3OG were assessed on Day 7. Read More

BMJ Open 2018 Nov 28;8(11):e022234. Epub 2018 Nov 28.

Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.

Introduction: Integrating diabetes self-management into daily life involves a range of complex challenges for affected individuals. Environmental, social, behavioural and emotional psychological factors influence the lives of those with diabetes. The aim of this study is to evaluate the impact of a stress management group intervention based on acceptance and commitment therapy (ACT) among adults living with poorly controlled type 1 diabetes. Read More

Diabetes Metab 2018 Nov 26. Epub 2018 Nov 26.

University of Perugia, Perugia, Italy.

Aim: Second-generation basal insulin analogues (e.g. insulin degludec, insulin glargine 300 U/mL), were designed to further extend the duration of insulin action and reduce within-day and day-to-day variability, and consequently hypoglycaemia risk, versus earlier long-acting basal insulins. Read More

BMJ Open Diabetes Res Care 2018 16;6(1):e000563. Epub 2018 Nov 16.

Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.

Background: The association between diabetes mellitus (DM) treatment and dementia is not well understood.

Objective: To investigate the association between treatment of diabetes, hypoglycemia, and dementia risk.

Research Design And Methods: We performed a systematic review and meta-analysis of pharmacological treatment of diabetes and incident or progressive cognitive impairment. Read More

BMJ Open Diabetes Res Care 2018 9;6(1):e000560. Epub 2018 Nov 9.

Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.

Objective: Hypoglycemia is a frequent and potentially dangerous event among patients with diabetes mellitus type 1. Subcutaneous glucagon is an emergency treatment to counteract severe hypoglycemia. The effect of intraperitoneal glucagon delivery is sparsely studied. Read More

Cardiovasc Diabetol 2018 Nov 28;17(1):150. Epub 2018 Nov 28.

University of Leicester, University Rd, Leicester, LE1 7RH, UK.

Background: The global prevalence of type 2 diabetes-related complications is not well described. We assessed prevalence of vascular complications at baseline in DISCOVER (NCT02322762; NCT02226822), a global, prospective, observational study program of 15,992 patients with type 2 diabetes initiating second-line therapy, conducted across 38 countries.

Methods: Patients were recruited from primary and specialist healthcare settings. Read More

Diabetes Obes Metab 2018 Nov 28. Epub 2018 Nov 28.

Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

To compare the performance of a professional (proCGM) and a personal continuous glucose monitoring (persCGM) system worn in parallel under standardised conditions in individuals with type 1 diabetes (T1D). Two CGM systems (iPro2 - proCGM; Minimed 640G - persCGM) worn in parallel using the same sensor (Enlite 2) were compared. Ten people with T1D were included in this single-centre, open-label study in which CGM performance was evaluated. Read More

Neurocrit Care 2018 Nov 27. Epub 2018 Nov 27.

Epilepsy Center, Hauenstein Neurosciences Mercy Health Saint Mary's, Grand Rapids, MI, USA.

Background: Status, refractory status and super refractory status epilepticus are common neurologic emergencies. The objective of this study is to investigate the feasibility, safety and effectiveness of a ketogenic diet (KD) for refractory status epilepticus (RSE) in adults in the intensive care unit (ICU).

Methods: We performed a retrospective, single-center study of patients between ages 18 and 80 years with RSE treated with a KD treatment algorithm from November 2016 through April 2018. Read More

JGH Open 2018 Oct 1;2(5):242-245. Epub 2018 Oct 1.

Department of Pathology University Malaya Kuala Lumpur Malaysia.

A 33-year-old man was referred with hyperosmotic symptoms of 4 weeks. Clinical examination showed palpable hepatomegaly and no stigmata of liver disease. Findings were random glucose 16. Read More

BMC Health Serv Res 2018 Nov 27;18(1):898. Epub 2018 Nov 27.

School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ, Scotland.

Background: People with type 1 diabetes who attend structured education training in self-management using flexible intensive therapy achieve improved blood glucose control and experience fewer episodes of severe hypoglycaemia. However, many struggle to sustain these improvements over time. To inform the design of more effective follow-up support we undertook a review of qualitative studies which have identified factors that influence and inform participants' self-management behaviours after attending structured education and their need for support to sustain improvements in glycaemic control. Read More

Diabetes Res Clin Pract 2018 Nov 24;147:55-61. Epub 2018 Nov 24.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; Department of Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan. Electronic address:

Aim: Diabetes mellitus (DM) is a known risk factor for dementia. It is unclear whether diabetic ketoacidosis (DKA) further increases the risk of dementia in patients with type 2 DM.

Methods: This retrospective nationwide population-based cohort study was conducted using Taiwan's National Health Insurance database. Read More

Diabetes Res Clin Pract 2018 Nov 24;147:87-92. Epub 2018 Nov 24.

Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo 183-8561, Japan. Electronic address:

Aims: There are as yet no cohort studies of hypoglycemia in type 1 diabetes before starting insulin therapy. Our aim was to determine the frequency and clinical features of hypoglycemia in patients with type 1A diabetes prior to commencing insulin therapy.

Methods: Eighty-seven patients with type 1A diabetes were enrolled, and a retrospective chart review of the patients was conducted. Read More

Brain Res Bull 2018 Nov 24;144:171-179. Epub 2018 Nov 24.

School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA, 71201, United States. Electronic address:

Pharmacologic activation of the hindbrain dorsal vagal complex energy sensor 5'-adenosine monophosphate-activated protein kinase (AMPK) causes site-specific adjustments in hypothalamic AMPK activity. DVC A2 noradrenergic neurons are a likely source of metabolo-sensory cues to downstream network components as they express substrate fuel-sensitive AMPK. This study investigated the hypothesis that DVC AMPK controls hypothalamic sensor, metabolic effector transmitter, and counter-regulatory hormone responses to insulin-induced hypoglycemia. Read More

Diabetol Metab Syndr 2018 21;10:83. Epub 2018 Nov 21.

8Departamento de Medicina da Universidade Federal de São Paulo-UNIFESP, São Paulo, SP Brazil.

Background: Hypoglycemia affects patient safety and glycemic control during insulin treatment of both type 1 (T1DM) and type 2 diabetes mellitus (T2DM). The Hypoglycemia Assessment Tool study in Brazil aimed to determine the proportion of patients experiencing hypoglycemic events and to characterize patient awareness and fear about hypoglycemia, among insulin-treated T1DM or T2DM patients.

Methods: This was a non-interventional, multicenter study, with a 6-month retrospective and a 4-week prospective evaluation of hypoglycemic events. Read More

Prim Care Diabetes 2018 Nov 23. Epub 2018 Nov 23.

Eli Lilly and Company, Basingstoke, UK.

Aim: Real-world effectiveness of insulin therapy is affected by poor treatment persistence, often occurring soon after initiation. An international cross-sectional survey of people with type 2 diabetes mellitus (T2DM) has been conducted to describe reasons for non-persistence with insulin therapy.

Methods: Responders to an online survey in 7 countries were classified as continuers (no gap of ≥7days), interrupters (interrupted therapy for ≥7days within first 6 months, then restarted), and discontinuers (terminated therapy for ≥7days within first 6 months, no restart before survey). Read More

Zhongguo Dang Dai Er Ke Za Zhi 2018 Nov;20(11):944-949

Department of Endocrinology and Metabolism, Tongji Medical College, Wuhan Children's Hospital, Huazhong University of Science and Technology, Wuhan 430015, China.

A boy aged 6 years and 3 months developed upper respiratory tract infection and pyrexia 2 months ago and was given oral administration of nimesulide by his parents according to directions. Half an hour later, the boy experienced convulsions and cardiopulmonary arrest, and emergency examination found hypoketotic hypoglycemia, metabolic acidosis, significant increases in serum aminotransferases and creatine kinase, and renal damage. Recovery of consciousness and vital signs was achieved after cardiopulmonary resuscitation, but severe mental and movement regression was observed. Read More

Zhongguo Dang Dai Er Ke Za Zhi 2018 Nov;20(11):930-933

Department of Rehabilitation Medicine, West China Second University Hospital of Sichuan University, Chengdu 610041, China.

Mitochondrial 3-hydroxy-3-methylglutaryl CoA synthase deficiency (HMCSD) is caused by HMGCS2 gene mutation. This paper reports the clinical and genetic features of an infant with this disease. The 8-month-old female infant was admitted to the hospital with diarrhea for 1 week and fever and convulsion for 1 day. Read More

J Clin Endocrinol Metab 2018 Nov 21. Epub 2018 Nov 21.

Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Context: Patients with type 1 diabetes mellitus (T1DM) have an increased risk of Addison's disease (AD) development but prediction of those at risk is not possible.

Objective: To determine whether there are early clinical indicators that may denote the development of AD in adults with T1DM.

Design: Observational, matched-cohort study. Read More

J Alzheimers Dis 2018 Nov 23. Epub 2018 Nov 23.

Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.

This article describes the protocol for the Systematic Multi-domain Alzheimer's Risk Reduction Trial (SMARRT), a single-blind randomized pilot trial to test a personalized, pragmatic, multi-domain Alzheimer's disease (AD) risk reduction intervention in a US integrated healthcare delivery system. Study participants will be 200 higher-risk older adults (age 70-89 years with subjective cognitive complaints, low normal performance on cognitive screen, and ≥ two modifiable risk factors targeted by our intervention) who will be recruited from selected primary care clinics of Kaiser Permanente Washington, oversampling people with non-white race or Hispanic ethnicity. Study participants will be randomly assigned to a two-year Alzheimer's risk reduction intervention (SMARRT) or a Health Education (HE) control. Read More

Diabetes Ther 2018 Nov 24. Epub 2018 Nov 24.

Diabetes Research Unit Cymru, Swansea University, ABM University Health Board, Swansea, UK.

Introduction: The majority of elderly patients (≥ 65 years of age) with type 2 diabetes mellitus (T2DM) will eventually require insulin therapy, but they are particularly vulnerable to hypoglycemia and challenging to treat. Insulin degludec/insulin aspart (IDegAsp) is a novel co-formulation of 70% insulin degludec and 30% insulin aspart administered in a single injection, either once or twice daily with main meals.

Methods: A combined analysis of the phase 3 BOOST INTENSIFY PREMIX I (NCT01009580) and BOOST INTENSIFY ALL (NCT01059812) trials has previously reported lower rates of hypoglycemia during the maintenance period in patients with T2DM treated with IDegAsp twice daily (BID) versus biphasic insulin aspart 30 (BIAsp 30) BID. Read More

Int J Endocrinol 2018 24;2018:1528437. Epub 2018 Oct 24.

Michigan State University Extension-Flint, USA.

Objective: Many patients with diabetes opt to fast for lab tests, especially for lipid profiles, thus missing breakfast. In parallel, recent studies and international guidelines have indicated that routine fasting for lipid panels may not be necessary. Missing breakfast while fasting for lab tests may invoke hypoglycemia, if patients are not properly instructed about adjusting diabetes medications on the night before or on the day of the lab test. Read More

Pediatr Neurol 2018 Oct 24. Epub 2018 Oct 24.

Research Institute of the McGill University Health Center, Montreal, Quebec, Canada; Department of Pediatrics, Division of Child Neurology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address:

J Obstet Gynaecol Can 2018 Nov;40(11):1445-1452

Department of Obstetrics & Gynecology, College of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.

Introduction: Fetal hyperinsulinemia in gestational diabetes mellitus (GDM) not only is important during intrauterine life, a time when it can result in macrosomia, but also at delivery, since it can result in neonatal hypoglycemia and hyperbilirubinemia. The question is, how long before delivery does maternal glycemic control contribute to newborn insulinemia in GDM?

Methods: In 72 women with GDM, we calculated Spearman's rank (r) correlations between umbilical cord blood C-peptide at birth (a biomarker of insulin secretion), and both maternal glycosylated hemoglobin (HbA1c) and mean blood glucose (MBG) recorded in the last two visits prior to delivery. Iterative correlations were done between umbilical cord blood C-peptide at birth, and maternal glucose control, at 0, 1, 2, 3, 4, and 5 weeks before delivery. Read More