New research was presented at ENDO 2021, the virtual annual meeting of the Endocrine Society, from March 20-23. The features below highlight some of the studies that emerged from the conference.
Hyperglycemia Predicts Severe COVID-19 in Patients With & Without Diabetes
To test the hypothesis that hyperglycemia affects outcomes in patients with COVID-19, researchers examined the effect of admission glucose in a largely non-Hispanic Black (83.5%) adult patient population—because of the disproportionate effects of COVID-19 in this population—with and without diabetes who were hospitalized with COVID-19 between March 1 and May 15, 2020. Patients with diabetes had average hospital stays of 13.0 days, compared with 9.5 days for those without diabetes. Patients with diabetes and an admission glucose greater than 140 mg/dL (vs <140 mg/dL) had 2.4-fold increased odds of intubation and ICU admission, while those with an admission glucose greater than 180 mg/dL (vs <180 mg/dL) had 1.8-fold increase odds of mortality. Patients without diabetes and an admission glucose greater than 140 mg/dL (vs <140 mg/dL) had two-fold increased odds of mortality, 3.5-fold increased odds of ICU admission, and 2.3-fold increased odds of intubation and acute kidney injury, while those with an admission glucose greater than 180 mg/dL (vs <180 mg/dL) had four-fold increased odds of mortality, 2.7-fold increased odds of intubation, and 2.9-fold increased odds of ICU admission.
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Rates & Predictors of Readmission for Diabetic Ketoacidosis Identified in T1D
With the importance of investigating factors affecting those with T1D due to differences in epidemiologic and comorbidity profiles between T1D and other diabetes types, investigators assessed 30-day readmission rates, mortality, length of stay (LOS), and hospitalization charges in adults with T1D who were principally admitted for diabetic ketoacidosis (DKA) between January 1 and November 30, 2017. Among the 91,401 patients with T1D who were discharged alive out of a total of 91,625 hospitalizations for DKA during the study period, the 30-day readmission rate was 20.2% (n = 18,553). Readmissions within 30 days were associated with twice the mortality rate when compared with index admissions and were associated with increased mean LOS and total hospital charges. Independent predictors of readmission included female sex (hazard ratio [HR], 1.14), discharge against medical advice (HR, 1.54), hypertension (HR, 1.28), chronic kidney disease (HR, 1.13), and anemia (HR, 1.42), whereas obesity (HR, 0.70) and hyperlipidemia (HR, 0.92) were associated with lower DKA-associated readmission rates.—————————————————————-
Cognitive Function & Glucose Control Decline Together After Lacunar Stroke
Prior research indicates that diabetes and lacunar stroke are both risk factors for dementia and cognitive dysfunction. With the hypothesis that glycemic status may be a modifiable risk factor for cognitive dysfunction in patients with T2D who experience a lacunar stroke, researchers assessed the relationship between A1C and cognitive function among nearly 950 such patients. They found that every 1% increase in baseline A1C was associated with a 0.06 lower standardized Cognitive Assessment Screening Instrument (CASI) z-score (range, 0-100), with higher baseline A1C values also associated with lower CASI z-scores over time. During follow-up, a 1% increase in A1C over time corresponded with a CASI score decrease of 0.021. These findings remained statistically significant even after adjustment for age, sex, education, race, depression, hypertension, hyperlipidemia, BMI, cardiovascular disease, obstructive sleep apnea, diabetic retinopathy, nephropathy, insulin use, and white matter abnormalities. “Intervention studies are needed in order to delineate if better glucose control could slow the rate of cognitive decline in this high-risk population,” write the study authors.
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Total Body Fat Affects Markers of Puberty in Girls
Although epidemiologic studies have shown that overweight and obese (OW/OB) girls undergo thelarche and menarche earlier than their normal weight (NW) peers, longitudinal studies investigating specifically how body weight and fat affect both clinical and biochemical markers of puberty in girls have been lacking. To fill this gap, study investigators conducted dual-energy x-ray absorptiometry to calculate total body fat (TBF), Tanner staging, breast ultrasound for morphological staging (BMORPH; A-E), pelvic ultrasound, hormone tests, and assessment of menarchal status among girls aged 8.2-14.7 at an average of 1.8 study during 4 years. At baseline, NW girls were older than OW/OB girls (11.3 vs 10.2 years) and had more advanced BMORPH. Luteinizing hormone, estradiol, and ovarian and uterine volumes increased with time but were not affected by TBF. However, TBF x time interactions were seen for follicle stimulating hormone, inhibin B, estrone, total and free testosterone, and androstenedione, with levels found to be initially similar between NW and OW/OB girls but after 1 year, increasing in those with higher TBF, plateauing in girls with mid-range TBF, and decreasing in those with lower TBF. When compared with girls with lower TBF, those with higher TBF progressed through BMORPH stage D slower but achieved menarche earlier.
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Atypical Thyroid Inflammation in Patients With COVID-19
In July 2020, researchers found that 15% of patients hospitalized with severe COVID-19 at their institution had thyrotoxicosis due to atypical subacute thyroiditis, compared with 1% of those hospitalized in the same sub-intensive care units in the Spring of 2019. The scenario was thought to be a combination of thyrotoxicosis and nonthyroidal illness syndrome. A follow-up study of patients—with no history of thyroid disease and who had not been taking thyroid medications, amiodarone, or steroids—3 months after hospitalization for moderate-to-severe COVID-19 found that inflammatory markers and thyroid function had both normalized; however, imaging tests showed that one-third still exhibited focal hypoechoic areas suggestive of thyroiditis, among whom two-thirds had reduced uptake on thyroid scintigraphy and few had antithyroid autoantibodies. “The thyroid dysfunction induced by COVID-19 seems not mediated by autoimmunity,” said the presenting study author. “It is important to continue to follow these patients since they might develop thyroid dysfunction during the following months.”
