chronic kidney disease (cKD) represents a challenge in the treatment of type 2 diabetic patients. renal impairment may affect drug clearance and other pharmacokinetic processes which can increase toxicity and drug to drug interactions or cause ineffective therapy. there are many oral glucose lowering drugs available for the treatment of type 2 diabetes mellitus (t2DM) with different mechanisms of action and different pharmacokinetic profiles. While all classes may be used in patients with mild renal impairment, therapeutic options for patients with moderate to severe cKD are still limited. this review focuses on the pharmacokinetics, metabolism, and safety of oral glucose lowering drugs in patients with t2DM and cKD.
Introduction: Bariatric surgery (BS) is an effective therapeutic approach for obese patients. It is associated with important gastrointestinal anatomic changes, predisposing these subjects to altered nutrient absorption that impact phosphocalcium metabolism. This study aims to clarify the prevalence of secondary hyperparathyroidism (SHPT) and its predictors in patients submitted to BS. Methods: Retrospective unicentric study of 1431 obese patients who underwent metabolic surgery between January/2010 and June/2017 and who were followed for, at least, a year. In this group, 185 subjects were submitted to laparoscopic adjustable gastric banding (LAGB), 830 underwent Roux-en-Y gastric bypass (RYGB) and 416 sleeve gastrectomy (SG). Data comprising 4 years of follow-up were available for 333 patients. We compared the clinical and analytical characteristics of patients with and without secondary hyperparathyroidism (considering SHPT a PTH˃69pg/mL), taking also into account the type of surgery. A multiple logistic regression was performed to study the predictors of SHPT after BS. Results: The overall prevalence of SHPT before surgery was 24.9%, 11.2% one year after surgery and 21.3% four years after surgery. At 12 months after surgery, LAGB had the highest prevalence of patients with SHPT (19.4%, N=36), RYGB had 12.8% (N=274) and SG 5.3% (N=131). At 48 months after surgery, RYGB had the highest prevalence of SHPT (27.0%, N=222), LAGB had 13.2% (N=53) and SG 6.9% (N=58). Multi-variate logistic analysis showed that increased body mass index and age, decreased levels of vitamin D and RYGB were independent predictors of SHPT one year after surgery. The only independent predictor of SHPT four years after surgery was RYGB. Conclusion: The prevalence of SHPT is considerably higher before and four years after BS than 1 year after surgery. This fact raises some questions about the efficacy of the implemented follow-up plans of vitamin D supplementation on the long term, mainly among patients submitted to RYGB.
Glucagon-like peptide-1 receptor agonists (GLP1-RA) improve cardiovascular outcomes in patients with type 2 diabetes (T2D). However, some studies suggest that their effects in patients with heart failure (HF) may be attenuated. We aimed to explore the effects of the GLP1-RA albiglutide on HF outcomes in patients with and without HF history enrolled in the Harmony Outcomes trial.
Progressive visual impairment of the right eye until amaurosis Without other neuroophthalmological changes neither hormonal dysfunction symptoms. HORMONAL EVALUATION: subclinical hypothyroidism (started on levothyroxine therapy 50µg/day). PITUITARY MRI: sellar and suprasellar cystic lesion with carotid involvement. This lesion was not completely excised, because of its adherence to internal carotid. HISTOLOGY: craniopharyngioma adamantinomatous type. 1st Endocrinology Consultation HYPOTHYROIDISM CENTRAL DIABETES INSIPIDUS Levothyroxine and desmopressin therapy (0.2mg/day). 2nd Endocrinology Consultation PANHYPOPITUITARISM Requiring adjustment of levothyroxine besides testosterone and prednisone supplementation.
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