乌鸦传媒

BOSTON -- From new trials to case studies, the research presented at this year's annual meeting of the American Association of Clinical Endocrinologists (AACE) provided an in-depth look at new developments in the field of endocrinology. Here are some other highlighted abstracts presented at the meeting:

Bionic Pancreas Success

Among patients with type 1 diabetes, use of the Minimed 670G hybrid closed-loop system in auto-mode was associated with lowered HbA1c (7.45% versus 7.03%, P=0.003) and reduced time spent in hyperglycemia (36.96% versus 25.79%, P=0.003) compared with use in manual mode. Notably, Chinenyenwa Usoh, MD, of Wake Forest Baptist Medical Center in Winston-Salem, NC, and colleagues also found that these patients did not experience any increase in time spent in hypoglycemia (1.46% versus 1.21%, P=0.372) and actually spent more time in the target range (61.57% versus 73.00%, P=0.003).

The study included 28 patients between the ages of 11 and 64 who were seen at an outpatient endocrine clinic. Most had previously used an insulin pump prior to using the closed-loop system, while three patients were having multiple daily injections. After a 2-week run-in period in manual mode, the patients were able to switch into auto-mode on the device after demonstrating proficiency with carbohydrate counting, correcting high blood glucose levels, calibrating the sensor three times a day, and downloading into CareLink.

"There were no unexpected patient outcomes such as development of DKA [diabetic ketoacidosis], and no adverse events were noted during the observation period," Usoh's group reported in their late-breaking poster.

'Hungry Tumor Syndrome'?

New proposed diagnostic criteria were presented for "Hungry Tumor Syndrome," by Rami Alrezk, MD, of the National Institutes of Health's Section of Medical Neuroendocrinology in Bethesda, Md.

A case study of a 72-year-old woman with a history of Lynch syndrome, he noted, revealed that the patient had several of the features associated with the syndrome -- i.e., symptomatic, persistent, and refractory hypocalcemia, hypophosphatemia, and hypomagnesemia. This situation has not been previously reported in the literature, Alrezk said. The patient did not have the "classic" presentation of the condition, but did have metastatic extensive osteoblastic cancer to the skeleton that was unresponsive to chemotherapy and immunotherapy. The woman's newly osteoblastic lesions were consuming very large amounts of calcium and phosphate, thereby inducing the triad of symptomatic hypocalcemia, hypophosphatemia, and hypomagnesemia.

"Naming this new syndrome is important to be recognized by doctors, because once it is recognized, it will require special attention and careful management, including aggressive and prolonged replacement of calcium, phosphate, magnesium, vitamin D, and active vitamin D," Alrezk told 乌鸦传媒. "Failing to recognize this syndrome could lead to prolonged or severe hypocalcemia, which could lead to serious consequences if not treated adequately, and there is also a risk of cardiac arrest and seizures."

Digital Management of Pregestational Diabetes

In a group of 30 pregnant women with pregestational diabetes on insulin, the web-based glucose monitoring system helped to improve glycemic control. The patients utilized the Telcare glucose monitor, which automatically uploads glucose readings to a secure, online portal.

After the women used the system for 2 months, the median HbA1c significantly decreased from 6.8% (IQR 6.1-7.7) to 5.9% (IQR 5.5-6.7%, P<0.01). The system also received high marks in patient satisfaction, with 90% of the women saying that they preferred the Telcare system over their previous recording method. Half of the patients also reported that they thought it was either "convenient" or "very convenient" to log glucose readings with the system, while only 23.3% of women thought their previous method of logging values was convenient. The number of weekly glucose readings did not increase with use of the system.

"Larger studies using web-based glucose monitoring systems are needed to evaluate if these findings translate into improved compliance, glycemic control, and perinatal outcomes," reported M. Vengrove, DO, of Lehigh Valley Health Network in Pennsylvania, and colleagues in their late-breaking poster study. The researchers added, however, that since some patients felt uncomfortable with the ability of their healthcare provider to view the blood glucose readings in real time, future studies should explore the reasons behind this.

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