Summary Objective TSH receptor antibodies (TRAb) are responsible for autoimmune hyperthyroid disease (Graves’ disease; GD) with TRAb levels tending to decrease following treatment. Measurement of TRAb activity during follow‐up could prove valuable to better understand treatment effectiveness. Study design TRAb concentration and stimulating (TSAb) and blocking (TSBAb) activity of patient serum were assessed following different treatment modalities and follow‐up length. Methods Sixty‐six subjects were recruited following treatment with carbimazole (n = 26), radioiodine (n = 27) or surgery (n = 13). TRAb, TPOAb, TgAb and GADAb were measured at a follow‐up visit as well as bioassays of TSAb and TSBAb activity. Results Forty‐five per cent of all patients remained TRAb‐positive for more than one year and 23% for more than 5 years after diagnosis, irrespective of treatment method. Overall, TRAb concentration fell from a median (IQR) of 6.25 (3.9‐12.7) to 0.65 (0.38‐3.2) U/L. Surgery conferred the largest fall in TRAb concentration from 11.4 (6.7‐29) to 0.58 (0.4‐1.4) U/L. Seventy per cent of TRAb‐positive patients were positive for TSAb, and one patient (3%) was positive for TSBAb. TRAb and TSAb correlated well (r = 0.83). In addition, 38/66 patients were TgAb‐positive, 47/66 were TPOAb‐positive and 6/66 were GADAb‐positive at follow‐up. Conclusions TRAb levels generally decreased after treatment but persisted for over 5 years in some patients. TRAb activity was predominantly stimulatory, with only one patient demonstrating TSBAb. A large proportion of patients were TgAb/TPOAb‐positive at follow‐up. All treatment modalities reduced TRAb concentrations; however, surgery was most effective.
Sodium glucose cotransporter-2 inhibitors (SGLT-2i) are increasingly used in the management of type 2 diabetes (T2DM) because of their
Background It is not clear whether pre-existing macrovascular complications (ischemic heart disease, stroke or peripheral artery disease) are associated with health outcomes in people with diabetes mellitus hospitalized for COVID-19. Methods We conducted cohort studies of adults with pre-existing diabetes hospitalized for COVID-19 infection in the UK, France, and Spain during the early phase of the pandemic (between March 2020—October 2020). Logistic regression models adjusted for demographic factors and other comorbidities were used to determine associations between previous macrovascular disease and relevant clinical outcomes: mortality, intensive care unit (ICU) admission and use of invasive mechanical ventilation (IMV) during the hospitalization. Output from individual logistic regression models for each cohort was combined in a meta-analysis. Results Complete data were available for 4,106 (60.4%) individuals. Of these, 1,652 (40.2%) had any prior macrovascular disease of whom 28.5% of patients died. Mortality was higher for people with compared to those without previous macrovascular disease (37.7% vs 22.4%). The combined crude odds ratio (OR) for previous macrovascular disease and mortality for all four cohorts was 2.12 (95% CI 1.83–2.45 with an I2 of 60%, reduced after adjustments for age, sex, type of diabetes, hypertension, microvascular disease, ethnicity, and BMI to adjusted OR 1.53 [95% CI 1.29–1.81]) for the three cohorts. Further analysis revealed that ischemic heart disease and cerebrovascular disease were the main contributors of adverse outcomes. However, proportions of people admitted to ICU (adjOR 0.48 [95% CI 0.31–0.75], I2 60%) and the use of IMV during hospitalization (adjOR 0.52 [95% CI 0.40–0.68], I2 37%) were significantly lower for people with previous macrovascular disease. Conclusions This large multinational study of people with diabetes mellitus hospitalized for COVID-19 demonstrates that previous macrovascular disease is associated with higher mortality and lower proportions admitted to ICU and treated with IMV during hospitalization suggesting selective admission criteria. Our findings highlight the importance correctly assess the prognosis and intensive monitoring in this high-risk group of patients and emphasize the need to design specific public health programs aimed to prevent SARS-CoV-2 infection in this subgroup.
IntroductionDiabetic ketoacidosis (DKA) remains a frequent and life threatening complication in type 1 diabetes. In England, more than 11% of people with type 1 diabetes had an episode of DKA in the years between 2004 and 2009. 1 Mortality rates have now fallen significantly in the last 20 years from 7.96% to 0.67%. 2 In 2010, the Joint British Societies Inpatient Care Group developed and approved guidelines on a weight-based, fixedrate intravenous insulin infusion regimen for the management of DKA in adults. 3 These were based on the systematic review of current evidence and accumulated professional experience. Some changes were made to these guidelines in 2011, 4 and they were introduced in September 2012 at a hospital in south east Wales. Junior doctors were educated about them in the educational programmes and they are also available on the trust intranet but were not a part of the junior doctor's induction. These guidelines were then audited on 24 patients between October 2012 and March 2013. Audit results obtained through personal communication showed 16% of the patients were not started on the weight-based, fixed-rate regimen. This led us to conduct a survey on junior doctors' knowledge of these guidelines. AimsOur aims were to assess junior doctors' knowledge of the weightbased, fixed-rate insulin regimen in the management of DKA in adults based on the trust protocol. MethodologyA survey was conducted on a random day of a week in July 2013 at a hospital in south east Wales. Data were collected by using a questionnaire consisting of eight questions (see Box 1) designed on the basis of the trust guidelines for DKA. This questionnaire was distributed to junior doctors working on that day (house officers, senior house officers and registrars) in medical and surgical specialties in July 2013. Consultants were excluded from this survey as more often the initial management of DKA is done by junior doctors. Data were analysed in Microsoft Excel format. ResultsThe questionnaire (Box 1) was distributed to 56 junior doctors. A total of 53 (95%) responses were received of which 34 were from medical doctors and 19 were from surgical doctors. The following results are numbered in relation to the questions posed in the questionnaire. 1. Thirty-five percent of medical and 63% of surgical doctors were not aware of the guidelines. AbstractDiabetic ketoacidosis (DKA) is a common medical emergency. In recent years a weight-based, fixed-rate intravenous insulin infusion regimen has replaced the conventional sliding scale regimen for effective management of DKA. These guidelines have come into effect from 2012 at a hospital in south east Wales.A survey was conducted to assess the junior doctors' (medical and surgical) knowledge of these guidelines as per trust protocol. The results of this survey clearly show that a significant number of doctors (35% of medical and 63% of surgical doctors) were not aware of these guidelines; 15% of medical and 22% of surgical doctors were not aware of the criteria for the diagnosis of DKA.
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