Among these young adults with Type 1 diabetes, glycaemic control was suboptimal and emotional distress common. They had identifiable logistical barriers to accessing and maintaining contact with diabetes care services, which can be addressed with flexible service provision. A substantial minority were discouraged by previous unsatisfactory experiences, suggesting health providers need to improve their interactions with young adults. This research will inform the design of life-stage-appropriate diabetes services targeting optimal engagement, access, attendance and ultimately improved healthcare outcomes in this vulnerable population.
Convincing evidence has identified inflammation as an initiator of atherosclerosis, underpinning CVD. We investigated (i) whether dietary inflammation, as measured by the ‘dietary inflammatory index (DII)’, was predictive of 5-year CVD in men and (ii) its predictive ability compared with that of SFA intake alone. The sample consisted of 1363 men enrolled in the Geelong Osteoporosis Study who completed an FFQ at baseline (2001–2006) (excluding participants who were identified as having previous CVD). DII scores were computed from participants’ reported intakes of carbohydrate, micronutrients and glycaemic load. DII scores were dichotomised into a pro-inflammatory diet (positive values) or an anti-inflammatory diet (negative values). The primary outcome was a formal diagnosis of CVD resulting in hospitalisation over the 5-year study period. In total, seventy-six events were observed during the 5-year follow-up period. Men with a pro-inflammatory diet at baseline were twice as likely to experience a CVD event over the study period (OR 2·07; 95 % CI 1·20, 3·55). This association held following adjustment for traditional CVD risk factors and total energy intake (adjusted OR 2·00; 95 % CI 1·03, 3·96). This effect appeared to be stronger with the inclusion of an age-by-DII score interaction. In contrast, SFA intake alone did not predict 5-year CVD events after adjustment for covariates (adjusted OR 1·40; 95 % CI 0·73, 2·70). We conclude that an association exists between a pro-inflammatory diet and CVD in Australian men. CVD clinical guidelines and public health recommendations may have to expand to include dietary patterns in the context of vascular inflammation.
The addition of a depression variable to the FRE equation improves the overall accuracy of the model for predicting 10-year CHD events in women, however may over-estimate the number of events that actually occur. This model now requires validation in larger samples as it could form a new CHD risk equation for women.
A ripiprazole is a new atypical antipsychotic agent that is increasingly prescribed due to a lower incidence of metabolic side effects compared with other agents in this class. Case reports have suggested an association between aripiprazole and drug-induced diabetic ketoacidosis (DKA) (1-4). We report the case of a 29-year-old obese man managed with aripiprazole for schizophrenia who presented unwell with DKA and a markedly elevated serum lipase.A 29-year-old male Filipino immigrant with schizophrenia presented to a hospital emergency department with a 3-day history of lethargy and a nonproductive cough. He described polyuria, polydipsia, and subjective weight loss over the preceding 4 weeks. He denied abdominal pain or vomiting.His schizophrenia had been effectively controlled with aripiprazole 20 mg twice daily for 12 months. Weight gain over this period was ϳ20 kg. There were no other medications. The patient had no family history of diabetes or autoimmune disorders. He did not drink alcohol to excess and had no other risk factors for pancreatitis.Clinical examination revealed an obese man (BMI 40 kg/m 2 ) who was disorientated to time and place. He was tachypneic and volume-depleted but afebrile and had no obvious focus of infection. Abdominal examination was unremarkable. Arterial blood gases showed a metabolic acidosis pH 7.01 (7.38 -7.44), bicarbonate 7 mmol/l (23-29 mmol/l), and base excess Ϫ22 (Ϫ3.0 to ϩ3.0). Blood glucose was 43.4 mmol/l, and ketones were Ͼ160 mg/dl. The patient received fluid resuscitation and an intravenous insulin infusion with resolution of the hyperglycemia, acidosis, and ketosis.He was subsequently found to have an A1C of 15.9% and was insulinopenic with a fasting C-peptide of 0.29 nmol/l (0.33-2.50 nmol/l) in the context of a fasting glucose of 8.1 mmol/l. GAD and IA2 autoantibodies were not elevated.Lipase was markedly elevated to 4,354 units/l (23-300 units/l), and amylase was only mildly elevated. Triglycerides were elevated to 5.9 mmol/l (Ͻ1.7 mmol/l). Ultrasonography and computerized tomography imaging showed changes consistent with fatty liver disease and no evidence of pancreatitis. The chest radiograph showed collapse at the left heart border.The aripiprazole dose was halved from admission on the advice of the psychiatry team. The pancreatic enzymes and -cell function improved over 7 days. He was discharged home on a basal bolus insulin regimen requiring a total of 330 units/day. This case suggests that aripiprazole can cause relative insulin deficiency and weight-associated insulin resistance, precipitating DKA. Serum lipase can be elevated in conditions that do not involve pancreatic inflammation, with the incidence of nonspecific lipase elevation in DKA ranging from 16 -25% (5). The etiology of this elevation remains unclear, although it is likely to be related to the degree of oxidative stress. There was no evidence of acute pancreatitis in our patient, suggesting that the elevation in serum lipase was due to DKA.This case illustrates the need for vigilance in monito...
Premature surgical menopause is becoming increasingly common in the setting of both benign and malignant disease. These women are at an increased risk of all-cause and cardiovascular mortality, cognitive dysfunction and metabolic bone disease. We present the case of a 28-year-old woman with premature surgical menopause due to bilateral oophorectomy, following ovarian torsion occurring on two separate occasions, one episode during her second trimester of pregnancy. The decision regarding hormone replacement therapy in this lady was complicated due to the presence of Factor V Leiden heterozygosity. A brief discussion and review of the literature follow.
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