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AIM: There is a bidirectional relationship between glucose control of and sleep quality and timing in type 1 diabetes (T1D). The aim was to investigate the sleep quality and the glucose metrics in people with T1D at the seasonal clock adjustment. METHODS: This observational study retrospectively compared the continuous glucose monitoring (CGM) derived metrics and sleep quality observed before (Time 0) and after (Time 1) transition in autumn and before (Time 2) and after (Time 3) transition in spring. We included adults with T1D, treated with CGM systems, who completed the Pittsburgh Sleep Quality Index questionnaire. The main outcome measure was the change in glucose monitoring indicator (GMI), time in range (TIR), time above range (TAR) and time below range. RESULTS: Sixty-two participants showed no changes in sleep quality at time transitions. GMI values increased during both time transitions and the percentage of TIR decreased from Time 0 to Time 1 and from Time 2 to Time 3. The percentage of level 2 TAR increased during the observation. CONCLUSIONS: At similar level of sleep quality, adults with T1D underwent the worsening of most of CGM-derived glucose control metrics during the transition time.
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INTRODUCTION: Klinefelter syndrome (KS), also known as 47, XXY, shows increased mortality when compared with mortality rates among the general population. Cardiovascular, hemostatic, metabolic diseases are implicated. Moreover, cardiac congenital anomalies in KS can contribute to the increase in mortality. AREAS COVERED: In this study, we have systematically reviewed the relationships between KS and the cardiovascular system and the management of cardiovascular complication. In summary, patients with KS display increased cardiovascular risk profile, characterized by increased prevalence of metabolic alterations including dyslipidemia, diabetes mellitus (DM), and abnormalities in biomarkers of cardiovascular disease. KS subjects are characterized by subclinical abnormalities in endothelial function and in left ventricular (LV) systolic and diastolic function, which - when associated with chronotropic incompetence - may negatively influence cardiopulmonary performance. Moreover, KS patients appear to be at a higher risk for cardiovascular disease, due to thromboembolic events with high prevalence of recurrent venous ulcers, venous insufficiency, recurrent venous and arterial thromboembolism leading to deep venous thrombosis or pulmonary embolism. EXPERT OPINION: Considering the unequivocal ï¬nding of increased mortality of KS patients, we suggest a periodic cardiovascular follow up in specialized centers with multidisciplinary care teams that comprise endocrinologists and cardiologists dedicated to KS syndrome.
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Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/terapia , Síndrome de Klinefelter/complicaciones , Enfermedades Cardiovasculares/metabolismo , Manejo de la Enfermedad , Terapia de Reemplazo de Hormonas/efectos adversos , Humanos , Síndrome de Klinefelter/metabolismo , Factores de Riesgo , Testosterona/efectos adversosRESUMEN
Traumatic brain injury (TBI) has been recently recognized as a common cause of pituitary dysfunction. However, there are not sufficient numbers of prospective studies to understand the natural history of TBI induced hypopituitarism. The aim was to report the results of five years' prospective follow-up of anterior pituitary function in patients with mild, moderate and severe TBI. Moreover, we have prospectively investigated the associations between TBI induced hypopituitarism and presence of anti-hypothalamus antibodies (AHA) and anti-pituitary antibodies (APA). Twenty five patients (20 men, five women) were included who were prospectively evaluated 12 months and five years after TBI, and 17 of them also had a third-year evaluation. Growth hormone (GH) deficiency is the most common pituitary hormone deficit at one, three, and five years after TBI. Although most of the pituitary hormone deficiencies improve over time, there were substantial percentages of pituitary hormone deficiencies at the fifth year (28% GH, 4% adrenocorticotropic hormone [ACTH], and 4% gonadotropin deficiencies). Pituitary dysfunction was significantly higher in strongly AHA- and APA-positive (titers ≥1/16) patients at the fifth year. In patients with mild and moderate TBI, ACTH and GH deficiencies may improve over time in a considerable number of patients but, although rarely, may also worsen over the five-year period. However in severe TBI, ACTH and GH status of the patients at the first year evaluation persisted at the fifth year. Therefore, screening pituitary function after TBI for five years is important, especially in patients with mild TBI. Moreover, close strong associations between the presence of high titers of APA and/or AHA and hypopituitarism at the fifth year were shown for the first time.