Corticosteroid-induced hyperglycemia is a common medical problem that can lead to frequent emergency room visits, hospital admissions and prolonged hospital stay, in addition to the well known morbidity associated with hyperglycemia. However, the diagnosis and treatment of corticosteroid-induced hyperglycemia is surprisingly undervalued by most professionals, probably because of the lack of quality studies to determine specific strategies of action. In the present review, we discuss the pathophysiology of corticosteroid-induced hyperglycemia, focusing on diverse patterns of hyperglycemia induced by the different formulations, and provide clues for diagnosis based on the duration of treatment and the administration schedule of corticosteroids. We propose a treatment strategy based on both the pathophysiology of the process and the mechanism of action of different corticosteroids, and take into account dosing and administration timing to predict the duration of therapy. Finally, we propose treatment goals that differ slightly between the transient and continuous use of corticosteroids based on evidence from clinical practice guidelines of diabetes care both in ambulatory and hospital settings.
Bariatric surgery in patients with T1DM mainly provides benefits of weight reduction, on insulin requirements, obesity comorbidities, and some benefits in diabetes complications, but might have only minimal effect on the glycemic control in the long term. This trial was registered at www.controlledtrials.com as ISRCTN49980913.
After LSG there is a global tendency to an accelerated gastric emptying, although only significant in the antrum preservation group; however, no differences were observed regarding the %EWL between groups after 1 year follow-up.
Background. It remains uncertain whether the metabolic syndrome (MS) or insulin resistance contribute to the association between vitamin D deficiency and obesity. Methods. We conducted a cross-sectional survey of 343 subjects who were overweight or obese. We analyzed anthropometric data and the presence or absence of MS. Additionally, we determined 25-hydroxyvitamin D (25OHD) and insulin concentrations, and the HOMA index was calculated. Chi-square test,Mann-Whitney U test, Student's t-tests,and logistic regression analysis were used. Results. The mean age of the patients was 42 ± 11 years, and 65.9% were women. The mean BMI was 34.7 ± 8.3 kg/m2 and 25(OH)D levels were 53.7 ± 29.8 nmol/L. Forty-six patients (13.4%) had MS. Vitamin D status was associated with the degree of obesity, especially with a BMI > 40 kg/m2. Patients with MS had lower levels of 25(OH)D than patients without (43.3 ± 29.0 versus 55.3 ± 29.6 mmol/L, resp.), and the odds ratio for hypovitaminosis D was 2.7 (confidence interval (CI), 1.14–6.4) (P = .023) for patients with MS versus patients without MS, irrespective of the degree of obesity. Conclusions. Our data confirm the association between vitamin D and MS and suggest that this association is independent of the degree of obesity.
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