IntroductionTo assess the effect of exenatide and pioglitazone or basal-bolus insulin on diabetic peripheral neuropathy (DPN) in patients with poorly controlled type 2 diabetes (T2D).Research design and methodsThis is a substudy of the Qatar Study, an open-label, randomized controlled trial. 38 subjects with poorly controlled T2D were studied at baseline and 1-year follow-up and 18 control subjects were assessed at baseline only. A combination of exenatide (2 mg/week) and pioglitazone (30 mg/day) or glargine with aspart insulin were randomly assigned to patients to achieve an HbA1c <53 mmol/mol (<7%). DPN was assessed with corneal confocal microscopy (CCM), DN4, vibration perception and sudomotor function.ResultsSubjects with T2D had reduced corneal nerves, but other DPN measures were comparable with the control group. In the combination treatment arm (n=21), HbA1c decreased by 35.2 mmol/mol (3.8 %) (p<0.0001), body weight increased by 5.6 kg (p<0.0001), corneal nerve branch density increased (p<0.05), vibration perception worsened (p<0.05), and DN4 and sudomotor function showed no change. In the insulin treatment arm, HbA1c decreased by 28.7 mmol/mol (2.7 %) (p<0.0001), body weight increased by 4.6 kg (p<0.01), corneal nerve branch density and fiber length increased (p≤0.01), vibration perception improved (p<0.01), and DN4 and sudomotor function showed no change. There was no association between the change in CCM measures with change in HbA1c, weight or lipids.ConclusionsTreatment with exenatide and pioglitazone or basal-bolus insulin results in corneal nerve regeneration, but no change in neuropathic symptoms or sudomotor function over 1 year.
Hyperlipidemic pancreatitis represents one of the most acute and dramatic consequences of the chylomicronemia syndrome which, if misdiagnosed, can lead to pancreatic destruction and death.
A retrospective analysis of 16 cases admitted to Hamad General Hospital since 1990 investigated the relationship between hyperlipidemia and pancreatitis.
All the patients had discrete, recurrent episodes of acute pancreatitis with typical pain, hyperamylasemia and hypertriglyceridemia. Acute pancreatitis usually occurred when the serum triglyceride levels were above 10 mmol/L. Chylomicronemia, with the serum being visibly creamy, was a constant feature of the lipoprotein pattern of the patients during these acute episodes.
It seems that chylomicronemia is the most consistent feature of hyperlipidemic pancreatitis. Most patients respond well to a low fat diet but lipid lowering agents are generally required to prevent recurrence.
In a 45-year-old female with chronic uncontrolled hy-pertension complicated by hypokalemia, laboratory and radiological findings were consistent with an aldosterone producing adenoma (APA). Diagnosis of Conn's syndrome was confirmed by histopathology. The hypokalemia re-solved and her hypertension improved after laparoscopic adrenalectomy. Discussion of the case, diagnosis and treat-ment are presented.
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