【正文】 Update in Endocrinology 郝 立 智 醫(yī) 師 永康榮民醫(yī)院新陳代謝科 950505 Annals of internal Medicine: 1 Nov. 2022 | Vol. 143 Issue 9 | P. 673682 HLJ 業(yè)精于勤荒于嬉 行成于思毀于隨 →【醫(yī)學生物 PPT，歡迎收藏分享】網(wǎng)友 2 Outline 1. DM 2. Thyroid Disease 3. LipidLowering Therapy 4. Adrenal Function HLJ 業(yè)精于勤荒于嬉 行成于思毀于隨 →【醫(yī)學生物 PPT，歡迎收藏分享】網(wǎng)友 3 Myocardial Perfusion Imaging Should Be Considered To Detect Silent CAD in Diabetic p39。ts (DM Care. 2022。27:195461.) ? ADA guidelines remend routine exercise ECG stress testing to detect silent CAD in diabetic p39。ts when 2 or more additional risk factors are present. The Detection of Ischemia in Asymptomatic Diabetics (DIAD) study tested the effectiveness of these guidelines. ? P39。ts with type 2 DM ranging in age from 50 to 75 years (n = 1123) with no known CAD were randomly assigned to 2 groups: One group (n = 522) underwent standard exercise ECG stress testing followed by ECGgated regional myocardial perfusion imaging by singlephoton emission puted tomography (SPECT) at rest and after exercise, whereas the second group (n = 522) did not undergo testing. Both groups were reevaluated 5 years later. HLJ 業(yè)精于勤荒于嬉 行成于思毀于隨 →【醫(yī)學生物 PPT，歡迎收藏分享】網(wǎng)友 4 ? The results indicated that 22% of the p39。ts who underwent testing (n = 113) were found to have evidence of silent coronary disease on the basis of moderate to large perfusion defects (n = 33), ventricular dilatation, ventricular dysfunction at rest, or adenosineinduced STsegment depression. ? The strongest predictors for coronary disease were male sex (odds ratio, [P ]), duration of DM (odds ratio, [P ]), and abnormal response to the Valsalva maneuver (odds ratio, [P ]). The researchers reported that 60% of the p39。t sample (n = 306) had 2 or more risk factors, which made them eligible for screening by ADA guidelines, whereas 204 p39。ts had fewer than 2 risk factors. Of these 204 p39。ts, 45 had abnormal test results. ? Thus, CAD would not have been detected in these p39。ts if their physicians used only the ADA guidelines to screen for eligibility for testing. DM Care. 2022。27:195461. HLJ 業(yè)精于勤荒于嬉 行成于思毀于隨 →【醫(yī)學生物 PPT，歡迎收藏分享】網(wǎng)友 5 ? The authors concluded that, on the basis of results of perfusion imaging, more than 20% of asymptomatic p39。ts with type 2 DM have CAD。 therefore, the current ADA screening guidelines do not sufficiently address this substantial risk. ? The findings indicate that stress myocardial perfusion imaging should be considered even in asymptomatic p39。ts on the premise that earlier detection of myocardial ischemia in p39。ts with type 2 DM could reduce morbidity and mortality. DM Care. 2022。27:195461. HLJ 業(yè)精于勤荒于嬉 行成于思毀于隨 →【醫(yī)學生物 PPT，歡迎收藏分享】網(wǎng)友 6 Insulin Lispro Was Safe and More CostEffective than Standard intensive Care for Management of DKA (Am J Med. 2022。117:2916. ) ? The aim of this study was to determine whether DKA requires Tx in an ICU. The specific question was whether Tx of DKA by SC lispro insulin on a medical ward is as safe and effective as lowdose IV insulin therapy in the ICU. ? The study was a randomized, controlled trial of therapy for 20 p39。ts with DKA. Ten p39。ts were assigned to a regular medical ward and treated with SC lispro insulin ( U/kg of BW initially, followed by U/kg /hr until plasma glucose levels decreased to 250 mg/dL or less [ 14 mmol/L], followed by to U/kg /hr until plasma pH levels increased to ). ? The 10 p39。ts randomly assigned to care in an ICU received RI IV. ( U/kg initially, followed by infusions of U/kg /hr until plasma glucose levels decreased to 250 mg/dL or less [ 14 mmol/L], then to U/kg /hr until plasma pH increased to at least and serum bicarbonate levels increased to 18 mmol/L or higher). HLJ 業(yè)精于勤荒于嬉 行成于思毀于隨 →【醫(yī)學生物 PPT，歡迎收藏分享】網(wǎng)友 7 ? The time required to correct the hyperglycemia and acidosis was the same in the 2 regimens: 7 hours (SD, 3) for the p39。ts receiving lispro insulin pared with 7 hours (SD, 2) for those receiving RI (P = ). The length of stay, incidence of hypoglycemia, and amount of administered insulin were also similar. The ICU regimen was associated with 39% higher hospitalization charges ($14429 pared with $8801). ? The researchers concluded that Tx of DKA on a routine medical ward with hourly administration of SC lispro insulin is just as safe as standard ICU management and is more costeffective. ? Their findings suggest that such strategies could prevent unnecessary use of highcost ICU beds. Although standard ward management was equally effective in this study, it may not be feasible in most general hospitals given such practical considerations as nursing shortages. Am J Med. 2022。117:2916. HLJ 業(yè)精于勤荒于嬉 行成于思毀于隨 →【醫(yī)學生物 PPT，歡迎收藏分享】網(wǎng)友 8 HbA1c Should Be Considered an independent and Progressive Risk Factor for CV Disease (Ann intern Med. 2022。141:41320. ) ? The aim of this study was to determine whether HbA1c levels are related to CVD and mortality and, consequently, whether glycosylated hemoglobin levels may serve as a predictor for CV events. The authors used an ongoing prospective munitybased study of 25623 men and women in Norfolk, United Kingdom, to analyze this relationship in 4662 men and 5570 women. ? HbA1c levels averaged % in the participants with DM pared with % in those without DM. An increase in HbA1c levels of 1 percentage point (for example, from % to %) was associated with a statistically significant increased risk for death from any cause (odds ratio, [95% CI, to ]). This risk relationship was present at all levels of HbA1c and was independent of all other known risk factors, including DM. ? Of importance, individuals with HbA1c levels in the range of % to % accounted for more than 70% of the increased CV risk attri