Tasma Harindhanavudhi

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a class of medications used to treat and manage type 2 diabetes mellitus (T2DM) and obesity. The present narrative review explores potential interactions between the gut microbiome and GLP-1 RAs. Limited research has been conducted at the intersection of the gut microbiome and GLP-1 RA therapy. Therefore, this review focuses on potential relationships among GLP-1 RA, the microbiome, body weight, dietary changes, and gastrointestinal symptoms. The review of the current literature reveals significant gaps, particularly concerning the role of diet in mediating or confounding any impact of GLP-1 RA medications on the gut microbiome. Therefore, the body of the review is structured as a series of proposed directional and causal relationships. The limited available evidence suggests changes in behavior, diet, and weight loss resulting from GLP-1 RA treatment are the primary drivers of microbiome changes observed after GLP-1 RA treatment. The review concludes by proposing directions for future studies to clarify the complex interplay between GLP-1 RAs, the gut microbiome, diet, and obesity management.

Cystic fibrosis is a multisystem disorder caused by dysfunction of the cystic fibrosis transmembrane conductance regulator (CFTR) protein, and is characterized by progressive pulmonary decline and exocrine pancreatic insufficiency. People with cystic fibrosis are at risk of multiple endocrine complications that can substantially increase morbidity and mortality, including cystic fibrosis-related diabetes (CFRD) and cystic fibrosis-related bone disease (CFBD). Children and adolescents with cystic fibrosis can also experience compromised growth and delayed puberty, although advances in clinical care and treatment have reduced rates of these complications. However, as people with cystic fibrosis live longer and healthier lives, new health challenges associated with these endocrine complications will become increasingly prevalent, including microvascular and macrovascular disease, obesity, metabolic syndrome, osteoporosis, fractures and earlier onset of perimenopause. In this Review, we summarize current knowledge on the epidemiology, pathophysiology, diagnosis and treatment of CFRD, CFBD, growth and puberty, hypogonadism and infertility, iatrogenic adrenal insufficiency and perimenopause in patients with cystic fibrosis. We also consider future research priorities in the field.

Background: The coronavirus disease (COVID‐19) outbreak in Bangkok led to a shortage of hospital capacity, and a home isolation system was set up. We described the process of diabetes self‐management education and support (DSMES) and glycemic management via telemedicine, along with outcomes in home‐isolated patients with COVID‐19 infection.Methods: A retrospective chart review of glucose values, insulin and corticosteroids use, and outcomes was performed.Results: A volunteer group of 21 endocrinologists and 21 diabetes educators/nurses formed the consultation team. Patients with diabetes or at high‐risk of diabetes and receiving corticosteroids were referred by primary volunteer physicians. Glucometers and related supplies, and insulin were donated, and delivered via same‐day delivery services. A chat group of an individual patient/their caregiver, diabetes educator, endocrinologist, and primary physician was formed (majority via LINE^® platform) to assess the patient's clinical status and need. Real‐time virtual DSMES sessions were performed and treatments were adjusted via smartphone application or telephone. There were 119 patients (1,398 service days), mean (SD) age 62.0 (13.6) years, 85.7% had a history of type 2 diabetes, and 84.0% received corticosteroids. Insulin was used in 88 patients; 69 of whom were insulin‐naïve. During the first 10 days, there were 2,454 glucose values. The mean glucose level on day 1 was 280.6 (122.3) mg/dL, and declined to 167.7 (43.4) mg/dL on day 10. Hypoglycemia occurred in 1.4% of the values. A majority of patients (79.5%) recovered at home.Conclusion: Diabetes care and DSMES delivered via telemedicine to patients on home isolation during COVID‐19 pandemic was safe and effective.

Context Body composition in total pancreatectomy with islet autotransplantation (TPIAT) has never been studied. Objective Determine whether presurgical body composition is associated with islet function and insulin sensitivity after TPIAT. Methods In 88 adults undergoing TPIAT (median age 41.0 years, IQR 32.8-48.0), beta-cell function and insulin sensitivity were assessed using mixed meal tolerance test and frequent sample intravenous glucose tolerance test before surgery and 12 and 18 months afterward. Body composition was measured by dual x-ray absorptiometry. Analyses used linear and logistic regression. Results Before surgery, 8 individuals (9.1%) were underweight, 40 (45.5%) normal weight, 20 (22.7%) overweight, and 20 (22.7%) obese. Overweight/obese patients had higher area under the curve C-peptide and lower insulin sensitivity index. Baseline body weight was positively associated with first-phase insulin secretion (AIRg) at 12 months (average 38.5 [SE 17.1] mU/L/min higher per extra kg; P = 0.03) and 18 months (38.3 [18.5]; P = 0.04), while baseline lean mass was inversely associated with AIRg at 12 months (−0.05 [0.02] per extra kg; P = 0.01) and 18 months (−0.05 [0.02]; P = 0.03). Percent gynoid fat was inversely associated with disposition index at 18 months (−206.0 [97.2] per extra percent; P = 0.04). Percent body fat and percent gynoid fat were associated with glucose effectiveness index at 18 months (1.9 × 10^-3 [0.9 × 10^-3] per extra percent; P = 0.04 and −1.96 × 10^-3 [0.8 × 10^-3]; P = 0.02, respectively). Insulin independence was not significantly associated with body weight or composition. Conclusions Half of these chronic pancreatitis patients were overweight/obese; underweight was uncommon. Preoperative body weight and composition were associated with islet function but not insulin independence after TPIAT.

Time-restricted eating (TRE) can facilitate weight loss, yet its effect on eating patterns remains unknown. Twenty adults with BMI ≥ 25 kg/m² underwent a 12-week randomized trial, examining the effect of an 8-h, time-restricted eating intervention on dietary patterns. Oral intake was documented using a smartphone. Dietary patterns, assessed as frequency of eating occasions (EOs) and types of meals/snacks and beverages, were compared between baseline (T0), early-intervention (T1), and end-intervention (T2). At T1 and T2, both groups had less EOs compared to T0, with greater reduction seen in the TRE group (−28%) than the non-TRE group (−12%) at T2 (p = 0.01 vs. non-TRE). Comparing T1 to T0, the TRE group documented less incomplete meals (−32.5%: p = 0.02), high quality snacks (−23.6%: p = 0.03), and low quality snacks (−36.6%: p = 0.004). Comparing T2 to T0, the TRE group documented less incomplete meals (−33.9%: p = 0.03), high quality snacks (−28.1%: p < 0.001) and low quality snacks (−51.2%: p < 0.001). Caffeinated beverage intake was reduced in the TRE group at T1 (−20.2%) and T2 (−28.8%) vs. T0, but remained unaltered in the non-TRE group. By using a smartphone application to document dietary intake, TRE significantly reduced the number of EOs, snacks, and caffeinated beverages, relative to baseline and relative to the non-TRE.