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Article ; Online: Intermittent fasting and 'metabolic switch': Effects on metabolic syndrome, prediabetes and type 2 diabetes.

Rajpal, Aman / Ismail-Beigi, Faramarz

2020 Volume 22, Issue 9, Page(s) 1496–1510

Abstract: Various intermittent fasting (IF) dietary plans have gained popularity among obese individuals in recent years as a means of achieving weight loss. However, studies evaluating the effect of IF regimens in people with metabolic syndrome, prediabetes and ... ...

Abstract	Various intermittent fasting (IF) dietary plans have gained popularity among obese individuals in recent years as a means of achieving weight loss. However, studies evaluating the effect of IF regimens in people with metabolic syndrome, prediabetes and type 2 diabetes (T2D) are limited. The aim of the present review was to briefly elucidate the biochemical and physiological mechanisms underlying the positive effects of IF, especially the effect of the proposed 'metabolic switch' on metabolism. Next, we examined the efficacy and safety of IF regimens in individuals with metabolic syndrome, prediabetes and T2D. To achieve this, we performed a MEDLINE PubMed search using combinations of various IF terms, including trials in which participants met the additional criteria for metabolic syndrome, prediabetes or T2D. We found four studies in individuals with metabolic syndrome, one study in people with prediabetes, and eight studies in people with T2D evaluating the effects of different IF regimens. The limited available evidence, with small sample sizes and short trial durations, suggests that IF regimens have a similar effectiveness compared with calorie-restriction diets for weight loss and improvement in glycaemic variables. In general, most IF regimens are effective and safe. However, there is an increased risk of hypoglycaemia in patients with T2D who are treated with insulin or sulphonylureas. Moreover, long-term adherence to these regimens appears uncertain. There is a need for large controlled randomized trials to evaluate the efficacy of IF regimens, especially in individuals with metabolic syndrome and prediabetes. If proven to be sustainable and efficacious for prolonged periods, IF could offer a promising approach to improving health at the population level, and would result in multiple public health benefits.
MeSH term(s)	Diabetes Mellitus, Type 2/drug therapy ; Fasting ; Humans ; Insulin ; Metabolic Syndrome/complications ; Metabolic Syndrome/epidemiology ; Prediabetic State/complications ; Prediabetic State/drug therapy
Chemical Substances	Insulin
Language	English
Publishing date	2020-06-03
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	1454944-x
ISSN	1463-1326 ; 1462-8902
ISSN (online)	1463-1326
ISSN	1462-8902
DOI	10.1111/dom.14080
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Beta-cell function in type 2 diabetes (T2DM): Can it be preserved or enhanced?

Sayyed Kassem, Laure / Rajpal, Aman / Barreiro, Margarita Victoria / Ismail-Beigi, Faramarz

Journal of diabetes

2023 Volume 15, Issue 10, Page(s) 817–837

Abstract: Type 2 diabetes (T2DM) is a complex metabolic disorder manifested by hyperglycemia, insulin resistance, and deteriorating beta-cell function. A way to prevent progression of the disease might be to enhance beta-cell function and insulin secretion. ... ...

Abstract	Type 2 diabetes (T2DM) is a complex metabolic disorder manifested by hyperglycemia, insulin resistance, and deteriorating beta-cell function. A way to prevent progression of the disease might be to enhance beta-cell function and insulin secretion. However, most previous studies examined beta-cell function while patients were using glycemia-lowering agents without an adequate period off medications (washout). In the present review we focus on studies with a washout period. We performed a literature search (2010 to June 2021) using beta-cell function and enhancement. The evidence shows that beta-cell function can be enhanced. Bariatric surgery and very low calorie diets show improvement in beta-cell function in many individuals. In addition, use of glucagon-like peptide-1 receptor agonists for prolonged periods (3 years or more) can also lead to improvement of beta-cell function. Further research is needed to understand the mechanisms leading to improved beta-cell function and identify agents that could enhance beta-cell function in patients with T2DM.
Language	English
Publishing date	2023-07-31
Publishing country	Australia
Document type	Journal Article ; Review
ZDB-ID	2503337-2
ISSN	1753-0407 ; 1753-0393
ISSN (online)	1753-0407
ISSN	1753-0393
DOI	10.1111/1753-0407.13446
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Article ; Online: Management of diabetes in elderly patients during the COVID-19 pandemic: current and future perspectives.

Rajpal, Aman / Sayyed Kassem, Laure / Aron, David C

Expert review of endocrinology & metabolism

2021 Volume 16, Issue 4, Page(s) 181–189

Abstract: ... ...

Abstract	Introduction
MeSH term(s)	Administration, Intravenous ; Aged ; Aged, 80 and over ; Blood Glucose/analysis ; Blood Glucose Self-Monitoring/methods ; COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19/mortality ; COVID-19/psychology ; Chronic Disease ; Comorbidity ; Diabetes Mellitus/diagnosis ; Diabetes Mellitus/drug therapy ; Diabetes Mellitus/epidemiology ; Disease Management ; Humans ; Hypoglycemic Agents/administration & dosage ; Hypoglycemic Agents/therapeutic use ; Inflammation/complications ; Insulin/administration & dosage ; Insulin/therapeutic use ; Patient Education as Topic/methods ; Personal Protective Equipment/ethics ; Personal Protective Equipment/standards ; Prevalence ; Risk Assessment ; SARS-CoV-2/genetics ; SARS-CoV-2/isolation & purification ; Telemedicine/methods
Chemical Substances	Blood Glucose ; Hypoglycemic Agents ; Insulin
Language	English
Publishing date	2021-06-07
Publishing country	England
Document type	Journal Article ; Review
ISSN	1744-8417
ISSN (online)	1744-8417
DOI	10.1080/17446651.2021.1927708
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Primary Hyperaldosteronism: Approach to Diagnosis and Management.

El-Asmar, Nadine / Rajpal, Aman / Arafah, Baha M

The Medical clinics of North America

2021 Volume 105, Issue 6, Page(s) 1065–1080

Abstract: Hyperaldosteronism is a relatively more common disorder than previously recognized. Patients with hyperaldosteronism are at high risk for cardiovascular events. Patients suspected of having hyperaldosteronism should undergo initial screening and ... ...

Abstract	Hyperaldosteronism is a relatively more common disorder than previously recognized. Patients with hyperaldosteronism are at high risk for cardiovascular events. Patients suspected of having hyperaldosteronism should undergo initial screening and subsequent confirmatory testing to establish a biochemical diagnosis. Although adrenal computed tomography/magnetic resonance imaging scans often define a disease's subtype, adrenal vein sampling, in order to determine lateralization, may be necessary in some patients who are surgical candidates. Medical therapy using optimal doses of mineralocorticoid receptor antagonists can control symptoms and normalize plasma renin activity. The long-term outcome of patients treated with either surgical or optimal medical therapy appears similar.
MeSH term(s)	Aldosterone/blood ; Aldosterone/metabolism ; Humans ; Hyperaldosteronism/blood ; Hyperaldosteronism/diagnosis ; Hyperaldosteronism/drug therapy ; Hyperaldosteronism/surgery ; Mineralocorticoid Receptor Antagonists/therapeutic use ; Renin/metabolism ; Renin-Angiotensin System/physiology
Chemical Substances	Mineralocorticoid Receptor Antagonists ; Aldosterone (4964P6T9RB) ; Renin (EC 3.4.23.15)
Language	English
Publishing date	2021-09-09
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	215710-x
ISSN	1557-9859 ; 0025-7125
ISSN (online)	1557-9859
ISSN	0025-7125
DOI	10.1016/j.mcna.2021.06.007
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: HYPOKALEMIC PERIODIC PARALYSIS IN A PATIENT WITH EUTHYROID GRAVES DISEASE AND CELIAC DISEASE.

Rajpal, Aman / Sood, Ajay

AACE clinical case reports

2019 Volume 5, Issue 1, Page(s) e73–e76

Abstract: Objective: Thyrotoxic periodic paralysis is a sporadic form of hypokalemic periodic paralysis (HPP) that is most commonly seen in patients with Graves disease (GD) in association with acute thyrotoxicosis. A very few cases of HPP have been reported in ... ...

Abstract	Objective: Thyrotoxic periodic paralysis is a sporadic form of hypokalemic periodic paralysis (HPP) that is most commonly seen in patients with Graves disease (GD) in association with acute thyrotoxicosis. A very few cases of HPP have been reported in patients with GD while the patient was euthyroid. Methods: We describe a case of a 62-year-old Caucasian male with a history of GD, who presented with acute progressive bilateral lower extremity weakness. Results: The patient was found to have severe hypokalemia, with no evidence of diarrhea or increased urinary potassium excretion. He was diagnosed as having HPP. He remained clinically and biochemically euthyroid during the admission. There was no history of high-carbohydrate meal intake, intense exercise, recent steroid exposure, or unusual stress. His symptoms improved gradually over the next 3 to 4 days with potassium supplementation. Nine months later, he progressed to overt hyperthyroidism and was treated with 25 mCi of iodine-131 and following that he has been on levothyroxine replacement for post-ablative hypothyroidism. Other unusual features in this patient were hypocalcemia, hypomagnesemia, and vitamin D deficiency during the acute presentation. Serum calcium and magnesium normalized 2 days after admission, while serum vitamin D continued to be low. He was later diagnosed to have celiac disease. Conclusion: Our case adds a rare presentation of HPP in a euthyroid patient with a known history of GD with associated celiac disease, hypomagnesemia, and hypocalcemia to the literature.
Language	English
Publishing date	2019-01-30
Publishing country	United States
Document type	Case Reports
ISSN	2376-0605
ISSN (online)	2376-0605
DOI	10.4158/ACCR-2018-0206
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Glucocorticoid-Induced Fatty Liver Disease.

Rahimi, Leili / Rajpal, Aman / Ismail-Beigi, Faramarz

Diabetes, metabolic syndrome and obesity : targets and therapy

2020 Volume 13, Page(s) 1133–1145

Abstract: Glucocorticoids (GCs) are commonly used at high doses and for prolonged periods (weeks to months) in the treatment of a variety of diseases. Among the many side effects are increased insulin resistance with disturbances in glucose/insulin homeostasis and ...

Abstract	Glucocorticoids (GCs) are commonly used at high doses and for prolonged periods (weeks to months) in the treatment of a variety of diseases. Among the many side effects are increased insulin resistance with disturbances in glucose/insulin homeostasis and increased deposition of lipids (mostly triglycerides) in the liver. Here, we review the metabolic pathways of lipid deposition and removal from the liver that become altered by excess glucocorticoids. Pathways of lipid deposition stimulated by excess glucocorticoids include 1) increase in appetite and high caloric intake; 2) increased blood glucose levels due to GC-induced stimulation of gluconeogenesis; 3) stimulation of de novo lipogenesis that is augmented by the high glucose and insulin levels and by GC itself; and 4) increased release of free fatty acids from adipose stores and stimulation of their uptake by the liver. Pathways that decrease hepatic lipids affected by glucocorticoids include a modest stimulation of very-low-density lipoprotein synthesis and secretion into the circulation and inhibition of β-oxidation of fatty acids. Role of 11β-hydroxysteroid dehydrogenases-1 and -2 and the reversible conversion of cortisol to cortisone on intracellular levels of cortisol is examined. In addition, GC control of osteocalcin expression and the effect of this bone-derived hormone in increasing insulin sensitivity are discussed. Finally, research focused on gaining a better understanding of the dose and duration of treatment with glucocorticoids, which leads to increased triglyceride deposition in the liver, and the reversibility of the condition is highlighted.
Language	English
Publishing date	2020-04-16
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	2494854-8
ISSN	1178-7007
ISSN	1178-7007
DOI	10.2147/DMSO.S247379
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Factors leading to high morbidity and mortality of COVID-19 in patients with type 2 diabetes.

Rajpal, Aman / Rahimi, Leili / Ismail-Beigi, Faramarz

Journal of diabetes

2020 Volume 12, Issue 12, Page(s) 895–908

Abstract: Coronavirus disease 2019 (COVID-19) is a recent pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus. Diabetes (mostly type 2 diabetes mellitus, T2DM) and hyperglycemia are among the major comorbidities in ... ...

Abstract	Coronavirus disease 2019 (COVID-19) is a recent pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus. Diabetes (mostly type 2 diabetes mellitus, T2DM) and hyperglycemia are among the major comorbidities in patients with COVID-19 leading to poor outcomes. Reports show that patients with diabetes and COVID-19 are at an increased risk for developing severe complications including acute respiratory distress syndrome, multi-organ failure, and death. Here we explore potential mechanistic links that could explain the observed higher morbidity and mortality in this patient population. Patients with T2DM have an underlying increased level of inflammation associated with obesity and insulin resistance in addition to other comorbidities including hypertension, obesity, cardiovascular disease, dyslipidemia, and being older. We review evidence that T2DM with hyperglycemia are among factors that lead to elevated expression of angiotensin-converting enzyme 2 (ACE2) in lungs and other tissues; ACE2 is the cellular "receptor" and port of viral entry. The preexisting chronic inflammation with augmented inflammatory response to the infection and the increasing viral load leads to extreme systemic immune response ("cytokine storm") that is strongly associated with increased severity of COVID-19. Based on the available evidence, it is recommended by a panel of experts that safe but stringent control of blood glucose, blood pressure, and lipids be carried out in patients with T2DM, measures that could potentially serve to decrease the severity of COVID-19 should these patients contract the viral infection. Once the infection occurs, then attention should be directed to proper glycemic control with use of insulin and frequent monitoring of blood glucose levels.
MeSH term(s)	COVID-19/complications ; COVID-19/mortality ; COVID-19/virology ; China/epidemiology ; Diabetes Mellitus, Type 2/epidemiology ; Diabetes Mellitus, Type 2/mortality ; Diabetes Mellitus, Type 2/virology ; Humans ; Inflammation/physiopathology ; Insulin Resistance ; Morbidity ; Obesity/physiopathology ; Prognosis ; SARS-CoV-2/isolation & purification ; Survival Rate
Keywords	covid19
Language	English
Publishing date	2020-09-02
Publishing country	Australia
Document type	Journal Article ; Review
ZDB-ID	2503337-2
ISSN	1753-0407 ; 1753-0393
ISSN (online)	1753-0407
ISSN	1753-0393
DOI	10.1111/1753-0407.13085
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Factors leading to high morbidity and mortality of COVID ‐19 in patients with type 2 diabetes

Rajpal, Aman / Rahimi, Leili / Ismail‐Beigi, Faramarz

Journal of Diabetes ; ISSN 1753-0393 1753-0407

2020

Keywords	Endocrinology, Diabetes and Metabolism ; covid19
Language	English
Publisher	Wiley
Publishing country	us
Document type	Article ; Online
DOI	10.1111/1753-0407.13085
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Factors leading to high morbidity and mortality of COVID-19 in patients with type 2 diabetes

Rajpal, Aman / Rahimi, Leili / Ismail-Beigi, Faramarz

J. diabetes (Online)

Abstract	Coronavirus disease 2019 (COVID-19) is a recent pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus. Diabetes (mostly type 2 diabetes mellitus, T2DM) and hyperglycemia are among the major comorbidities in patients with COVID-19 leading to poor outcomes. Reports show that patients with diabetes and COVID-19 are at an increased risk for developing severe complications including acute respiratory distress syndrome, multi-organ failure, and death. Here we explore potential mechanistic links that could explain the observed higher morbidity and mortality in this patient population. Patients with T2DM have an underlying increased level of inflammation associated with obesity and insulin resistance in addition to other comorbidities including hypertension, obesity, cardiovascular disease, dyslipidemia, and being older. We review evidence that T2DM with hyperglycemia are among factors that lead to elevated expression of angiotensin-converting enzyme 2 (ACE2) in lungs and other tissues; ACE2 is the cellular "receptor" and port of viral entry. The preexisting chronic inflammation with augmented inflammatory response to the infection and the increasing viral load leads to extreme systemic immune response ("cytokine storm") that is strongly associated with increased severity of COVID-19. Based on the available evidence, it is recommended by a panel of experts that safe but stringent control of blood glucose, blood pressure, and lipids be carried out in patients with T2DM, measures that could potentially serve to decrease the severity of COVID-19 should these patients contract the viral infection. Once the infection occurs, then attention should be directed to proper glycemic control with use of insulin and frequent monitoring of blood glucose levels.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #646850
Database	COVID19

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Article ; Online: The Value of Perioperative Levels of ACTH, DHEA, and DHEA-S and Tumor Size in Predicting Recurrence of Cushing Disease.

El Asmar, Nadine / Rajpal, Aman / Selman, Warren R / Arafah, Baha M

The Journal of clinical endocrinology and metabolism

2018 Volume 103, Issue 2, Page(s) 477–485

Abstract: Context and objectives: Despite the development of hypocortisolemia after corticotroph surgical adenomectomy, 15% to 20% patients have recurrence of Cushing disease (CD). In this study, we investigated the effect of tumor size and the value of ... ...

Abstract	Context and objectives: Despite the development of hypocortisolemia after corticotroph surgical adenomectomy, 15% to 20% patients have recurrence of Cushing disease (CD). In this study, we investigated the effect of tumor size and the value of perioperative assessment of corticotropin (ACTH) and adrenal steroid levels in predicting recurrence. Design: Perioperatively, no glucocorticoids were administered until the serum cortisol was ≤3 μg/dL. Blood samples were obtained before and repeatedly after adenomectomy in 79 patients with CD. Of these, 66 had a nadir serum cortisol of ≤3.0 μg/dL and clinical and biochemical remissions. During a median follow-up of 131 months, 11 of 66 had disease recurrence (REC), whereas 55 of 66 did not (NO-REC). Results: Preoperative hormone levels in the REC and NO-REC groups were similar. After adenomectomy, a brief and similar increase in ACTH, cortisol, and dehydroepiandrosterone (DHEA) levels was observed in both groups followed by gradual decline in those levels. Although REC and NO-REC patients had similar cortisol levels (3.4 ± 1.7 μg/dL vs 2.9 ± 2.2 μg/dL) at the 36th postoperative hour, their respective ACTH (33 ± 7.1 ng/L vs 12.1 ± 5.4 ng/L; P < 0.0001), DHEA (3.8 ± 1.7 ng/mL vs 1.2 ± 1.1 ng/mL; P = 0.005), and dehydroepiandrosterone sulphate (DHEA-S) (143.9 ± 45.2 μg/dL vs 48.9 ± 38.2 μg/dL; P < 0.0001) were higher. At nadir hypocortisolemia, perioperative ACTH levels were >20 in all REC patients and <20 ng/L in the NO-REC group. Patients with REC had larger tumors than those with NO-REC. Conclusion: Recurrent CD is characterized by persistent perioperative ACTH secretion after adenomectomy. Higher perioperative levels of ACTH, DHEA, and DHEA-S are highly predictive of future disease recurrence, particularly in those with profound hypocortisolemia.
MeSH term(s)	ACTH-Secreting Pituitary Adenoma/complications ; ACTH-Secreting Pituitary Adenoma/diagnosis ; ACTH-Secreting Pituitary Adenoma/pathology ; ACTH-Secreting Pituitary Adenoma/surgery ; Adenoma/complications ; Adenoma/diagnosis ; Adenoma/pathology ; Adenoma/surgery ; Adrenocorticotropic Hormone/blood ; Adult ; Cushing Syndrome/blood ; Cushing Syndrome/diagnosis ; Cushing Syndrome/etiology ; Cushing Syndrome/surgery ; Dehydroepiandrosterone/blood ; Dehydroepiandrosterone Sulfate/blood ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Perioperative Period ; Predictive Value of Tests ; Prognosis ; Recurrence ; Tumor Burden
Chemical Substances	Dehydroepiandrosterone (459AG36T1B) ; Dehydroepiandrosterone Sulfate (57B09Q7FJR) ; Adrenocorticotropic Hormone (9002-60-2)
Language	English
Publishing date	2018--01
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	3029-6
ISSN	1945-7197 ; 0021-972X
ISSN (online)	1945-7197
ISSN	0021-972X
DOI	10.1210/jc.2017-01797
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