142 results on '"Kevin M. Pantalone"'
Search Results
2. Ketogenic diet improves fertility in patients with polycystic ovary syndrome: a brief report
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Yumiko Tsushima, Noura Nachawi, Kevin M. Pantalone, Marcio L. Griebeler, and Ula Abed Alwahab
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ketogenic diet ,fertility ,polycystic ovary syndrome ,obesity ,ovulation ,pregnancy ,Nutrition. Foods and food supply ,TX341-641 - Abstract
IntroductionPolycystic ovary syndrome (PCOS) affects up to 20 % of reproductive-age individuals and is strongly linked to obesity. The impacts of ketogenic diet on fertility in people with PCOS are unknown. This study aims to determine the effect of a ketogenic diet on restoration of regular menstrual cycles and fertility.MethodsAfter approval from the Institutional Review Boards of Cleveland Clinic, a retrospective analysis was conducted using the electronic health record system. We analyzed data from thirty patients (n = 30) with polycystic ovary syndrome who followed a ketogenic diet for at least 3 months at the Cleveland Clinic, Cleveland, Ohio, USA. Main outcomes were percentage of women with restoration of regular menstrual cycles and pregnancy rate.ResultsAll women (n = 30) had restoration of regular menstrual cycles. The overall pregnancy rate of women desiring pregnancy (n = 18) was 55.6% (n = 10). Pregnancy rate was 38.5% for women on metformin and 100% for those who were not (P = 0.036). Pregnancy rate was 62.5% for women using ovulation induction agents and 50.0% for those who did not (P = 0.66). Percent weight change between the pregnant and non-pregnant groups did not significantly differ [−8.1 ± 6.2, vs −6.4 ± 8.4, P = 0.64, respectively].ConclusionThis study reports a higher rate of pregnancy with the ketogenic diet in women with PCOS compared to existing literature.
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- 2024
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3. Comprehensive evaluation of adrenal cortical cancer: Single-center 22-year experience
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Basem Al Achras, Joud Zakhour, Aditya Chauhan, James Bena, Divya Yogi-Morren, Kevin M. Pantalone, and Pratibha Rao
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ACC ,Presentation ,Survival ,Incidentaloma ,Hypercortisolism ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Background: Adrenocortical carcinoma (ACC) is a rare malignancy with a reported incidence of 0.5–2 cases per million population per year. Literature is scarce on this malignancy with poor prognosis and limited treatment options. The objective of this report was to report a single-center experience of this rare malignancy. Methods: A retrospective chart review (1997–2019) was performed on patients diagnosed with ACC via surgical pathology. Data were subsequently split into two time periods defined by the date of initial presentation: 1996–2007 and 2008–2019. Results: 52 patients were identified, 55.8 % were female, and the mean age at the time of surgery was 53 years. Most common presentations (25 % each) were: incidentalomas, abdominal pain, or hormonal hypersecretion. Laboratory evidence of hormonal hypersecretion was identified in 40.4 %. Among those patients, elevated 24-hour urinary free cortisol was the most common finding in both time periods.The overall 5-year survival rate was 53.1 % and showed significant improvement in recent years when compared between the two time periods, 85.7 % vs 40.0 %. P = 0.004. Conclusion: Overall, the most common presentation of ACC was found to be equally distributed among incidentaloma, hormonal hypersecretion, and abdominal pain. Hypercortisolism, a recognized poor prognosticator, was the most frequent form of hormonal hypersecretion. The 5-year survival rate for ACC was noted to be poor in general; however, it was observed to be substantially higher in more recent years. More research is necessary to further understand this malignancy in order to optimize management and improve outcomes. Clinical relevance: This report provides a valuable contribution and expands the knowledge base for this important yet rare malignancy. The objective of this study was to report a single-center experience of ACC by characterizing patients diagnosed with this rare disease and managed at our institution and assessing their outcomes.
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- 2023
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4. Surgical Management of Giant Prolactinomas: A Descriptive Study
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Michelle D. Lundholm, Divya Yogi-Morren, Kevin M. Pantalone, Pablo F. Recinos, Varun R. Kshettry, and Pratibha P. R. Rao
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Introduction. Giant prolactinoma (GP) is a rare pituitary lactotropic cell tumor larger than 4 cm in its widest dimension, and is less likely than a smaller prolactinoma to achieve prolactin normalization on dopamine agonist (DA) monotherapy. There is a paucity of data on the circumstances and outcomes of second-line management of GP with surgery. Herein, our institution’s experience with the surgical management of GPs is described. Methods. A single-center retrospective analysis was conducted of patients who underwent surgery for giant prolactinoma from 2003 to 2018. A chart review was conducted for demographic data, clinical features, laboratory and radiographic findings, operative and pathology reports, perioperative management, and clinical outcomes in follow-up. Descriptive statistics were used. Results. Of 79 prolactinoma cases, 8 patients had GP with a median age of 38 years (range 20–53), 75% (6/8) were male, with a median largest tumor dimension of 6 cm (range 4.6–7.7), and a median prolactin level of 2,500 μg/L (range 100–>13,000). Six patients had transsphenoidal surgery for dopamine agonist (DA) resistance or intolerance. Two patients had a craniotomy for a missed diagnosis; one was due to the hook effect. No tumor resections were complete by either surgical approach; all had persistent hyperprolactinemia requiring postoperative DA therapy, and two patients had an additional craniotomy procedure for further tumor debulking. There was no recovery of pituitary axes and postoperative deficits were common. Remission as defined by prolactin normalization occurred in 63% (5/8) at a median time of 36 months (range 14–63 months) on DA therapy after surgery with a follow-up of 3–13 years. Conclusions. GPs infrequently require surgical resection, which is generally incomplete and requires adjuvant therapy. Given the rarity of surgery for GPs, multi-institutional or registry studies would yield clearer guidance on optimal management.
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- 2023
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5. CKD Progression and Economic Burden in Individuals With CKD Associated With Type 2 DiabetesPlain-Language Summary
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C. Daniel Mullins, Kevin M. Pantalone, Keith A. Betts, Jinlin Song, Aozhou Wu, Yan Chen, Sheldon X. Kong, and Rakesh Singh
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Type 2 diabetes ,chronic kidney disease ,CKD progression ,healthcare resource utilization ,healthcare costs ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Rationale & Objective: To evaluate progression patterns and associated economic outcomes, using estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) based on the Kidney Disease: Improving Global Outcomes (KDIGO) risk categories, among patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). Study Design: Patients with T2D and moderate- or high-risk CKD were selected from the Optum electronic health records database (January 2007-December 2019). Progression patterns and post-progression economic outcomes were assessed. Setting & Participants: Adults with T2D and CKD in clinical settings. Predictor: Baseline KDIGO risk categories. Outcomes: Progression to a more severe KDIGO risk category; healthcare resource utilization and medical costs. Analytical Approach: Progression probability was estimated using cumulative incidence. Healthcare resource utilization and costs were compared across progression groups. Results: Of 269,187 patients (mean age 65.6 years) with T2D and CKD of moderate or high baseline risk, 18.9% progressed to the very high-risk category within 5 years. Among moderate-risk patients, 17.8% of CKD stage G1-A2, 44.0% of stage G2-A2, and 61.3% of stage G3a-A1 patients progressed to a higher KDIGO risk category. Among high-risk patients, 63.9% of stage G3b-A1/G3a-A2 and 56.0% of stage G2-A3 patients progressed to very high risk. Within the same eGFR stage, a higher UACR stage was associated with 4- to 7-times higher risk of progressing to very high risk and faster eGFR decline. Nonprogressors had lower annual medical costs ($16,924) than patients who progressed from moderate risk to high risk ($22,117, P < 0.05), from high risk to very high risk ($32,204, P < 0.05), and from moderate risk to very high risk ($35,092, P < 0.05). Limitations: Infrequent lab testing might have caused lags in identifying progression; medical costs were calculated using unit costs. Conclusions: Patients with T2D and CKD of moderate or high risk per KDIGO risk categories had high probabilities of progression, incurring a substantial economic burden. The results highlight the value of UACR in CKD management.
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- 2022
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6. Cardiorenal Nexus: A Review With Focus on Combined Chronic Heart and Kidney Failure, and Insights From Recent Clinical Trials
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Peter A. McCullough, Alpesh Amin, Kevin M. Pantalone, and Claudio Ronco
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cardiorenal nexus ,cardiorenal syndromes ,cardiovascular disease ,chronic kidney disease ,heart failure ,type 2 diabetes ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
The cardiorenal nexus encompasses a bidirectional relationship between the heart and the kidneys. Chronic abnormalities in cardiac function can lead to progressive kidney disease, and chronic kidney disease can lead to progressively decreasing cardiac function and increasing risk of cardiovascular disease, including heart failure. About 15% of US adults have chronic kidney disease, 2% have heart failure, and 9% have cardiovascular disease. Prevalence rates of chronic kidney disease, cardiovascular disease, and associated morbidities such as type 2 diabetes are expected to increase with an aging population. Observational studies provide evidence for the cardiorenal nexus. Follow‐up data from placebo arms of clinical trials in chronic kidney disease or cardiovascular disease show higher rates of renal and cardiovascular outcome events in patient subgroups with type 2 diabetes than in those without type 2 diabetes. The cardiorenal syndromes develop along an interlinked pathophysiological trajectory that requires a holistic, collaborative approach involving a multidisciplinary team. There is now a compendium of treatment options. Greater understanding of the underlying pathophysiology of the cardiorenal nexus will support optimization of the management of these interlinked disease states.
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- 2022
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7. The importance of implementing inpatient virtual coverage in an endocrinology practice: lessons learned thus far from the COVID-19 pandemic
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Marcio L. Griebeler, Kevin M. Pantalone, Ron Gambino, David Shewmon, Jay Morrow, Daniel Mendlovic, Vinni Makin, Marwan Hamaty, Sana Hasan, M. Cecilia Lansang, Keren Zhou, and Bartolome Burguera
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COVID-19 ,telemedicine ,endocrinology ,inpatient ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Abstract The COVID-19 pandemic has rapidly changed the landscape of medical care and the healthcare system needs to quickly adapt in order to continue providing optimal medical care to hospitalized patients in an efficient, effective, and safe manner. Endocrinology diseases are commonly present in patients with COVID-19 and often are major risk factors for development of severe disease. The use of electronic consultation and telemedicine have already been well-established in the outpatient setting but yet not commonly implemented in the inpatient arena. This type of remote medical care has the potential to provide a reliable delivery of endocrine care while protecting providers and patients from spreading infection. This short review intends to provide the initial steps for the development of an inpatient telemedicine endocrine service to patients with endocrine diseases. Telehealth will become part of our daily practices and has a potential to provide a safe and efficient method of consultative service.
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- 2021
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8. Acromegaly: a clinical perspective
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Lima Lawrence, Kenda Alkwatli, James Bena, Richard Prayson, Varun Kshettry, Pablo Recinos, Betul Hatipoglu, Kevin M. Pantalone, Robert Weil, Amir H. Hamrahian, Laurence Kennedy, and Divya Yogi-Morren
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Acromegaly ,IGF-1 ,Growth hormone ,Pituitary adenoma ,Sparsely granulated ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Abstract Background To examine the clinical and hormonal profiles, comorbidities, treatment patterns, surgical pathology and clinical outcomes of patients diagnosed with acromegaly at the Cleveland Clinic over a 15-year period. Methods A retrospective chart review of patients with acromegaly who underwent surgical resection between 2003 and 2018. Results A total of 136 patients (62 men; mean age 48.1 years) with biochemical evidence of acromegaly were analyzed. Median insulin-like growth factor 1 (IGF-1) level at diagnosis was 769.0 ng/mL and most patients had a macroadenoma (82.2%). Immunoreactivity to growth hormone (GH) was noted in 124 adenomas, with co-staining in 89 adenomas. Complete visible tumor resection during initial surgery was achieved in 87 patients (64.0%). In this cohort, complete response to surgery alone was observed in 61 patients (70.1%), while 31 out of 65 patients (47.7%) who received additional post-surgical medications and/or radiation therapy achieved complete response. At most recent follow-up, 92 patients achieved eventual complete response by documented normalization of IGF-1 levels. Higher IGF-1 level at diagnosis (P = 0.024) and cavernous sinus invasion (P = 0.028) were predictors for failure to respond to surgery. Conclusion In this study, the majority of tumors were macroadenoma, plurihormonal, and treated effectively with surgery alone or surgery with adjuvant medical or radiation therapy. More studies are needed to identify additional molecular biomarkers, tumor characteristics and imaging findings to individualize treatment and better predict treatment outcomes.
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- 2020
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9. Association between shared medical appointments and weight loss outcomes and anti‐obesity medication use in patients with obesity
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Kelly Shibuya, Xinge Ji, Elizabeth R. Pfoh, Alex Milinovich, Wayne Weng, Janine Bauman, Rahul Ganguly, Anita D. Misra‐Hebert, Todd M. Hobbs, Michael W. Kattan, Kevin M. Pantalone, Abhilasha Ramasamy, and Bartolome Burguera
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Obesity ,weight management ,shared medical appointments ,Internal medicine ,RC31-1245 - Abstract
Summary Objective In shared medical appointments (SMAs), multiple patients with a similar clinical diagnosis are seen by a multidisciplinary team for interactive group sessions. Very few studies have specifically studied SMAs and weight loss in patients with obesity. This study compared weight loss outcomes and anti‐obesity medication (AOM) access between patients with obesity managed through (SMAs) versus individual appointments. Methods Retrospective study of adults seen for obesity between September 2014 and February 2017 at Cleveland Clinic Institute of Endocrinology and Metabolism. Percent weight loss from baseline was compared between two propensity score‐matched populations: patients who attended ≥1 SMA and patients managed with individual medical appointments. Results From all eligible patients identified (n=310 SMA, n=1,993 non‐SMA), 301 matched pairs were evaluated for weight loss. The SMA group (n=301) lost a mean of 4.2%, 5.2% and 3.8% of baseline weight over 6, 12 and 24 months; the non‐SMA group (n=301) lost significantly less weight (1.5%, 1.8% and 1.6%, respectively) (paired t‐test, P
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- 2020
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10. Testosterone replacement therapy and the risk of adverse cardiovascular outcomes and mortality
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Kevin M. Pantalone, Joyce George, Xinge Ji, Michael W. Kattan, Alex Milinovich, Janine M. Bauman, Bartolome Burguera, Robert S. Zimmerman, and Anita D. Misra-Hebert
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Testosterone replacement therapy ,Male hypogonadism ,Cardiovascular risk ,Mortality ,Medicine (General) ,R5-920 - Abstract
Résumé Contexte Le risque d’événements cardiovasculaires indésirables et de mortalité associé au traitement de substitution de la testostérone est controversé. Le but du présent article est d’évaluer chez les hommes qui présentent un hypogonadisme secondaire l’effet du traitement de substitution de la testostérone (TST) sur le risque d’infarctus du myocarde (IM), d’accident cérébrovasculaire (ACV) ou de mortalité toutes causes confondues. Patients et Méthodes Une étude de cohorte rétrospective a été menée en utilisant les dossiers de santé électroniques de la Clinique Cleveland. Ont été identifiés les hommes âgés de plus de 40 ans qui avaient au moins deux dosages de testostérone inférieurs à 220ng/dl, dont l’un obtenu le matin entre 7 et 10 heures. Ont été exclus les hommes qui présentaient un hypogonadisme primaire, un hypogonadisme secondaire lié à une pathologie hypothalamo-hypophysaire évidente, une infection par le virus de l’immunodéficience humaine, un cancer métastatique, et ceux qui présentaient des contrindications déterminées au TST. Les hommes exposés au TST ont été appariés à des témoins non exposés au TST. Une analyse de survie a été réalisée sur le paramètre composite incluant l’IM, l’AVC et la mortalité toutes causes confondues. Résultats 165 patients exposés au TST (groupe traité) ont été appariés à 210 hommes non exposés au TST (groupe de référence). La prévalence de maladie cardiovasculaire (MCV) établie était de 20.0% dans le groupe traité versus 17.1% dans le groupe de référence (P=0.478). La médiane (écart interquartile (EI)) de l’âge et de l’indice de masse corporelle (IMC) était respectivement de 55 (49, 62) ans et de 35.6 (32.1, 40.1) kg/m2 dans le groupe traité, et respectivement de 55 (49, 61.7) ans et 36.3 (32.1, 40.8) kg/m2 dans le groupe de référence. Il y eut 12 événements indésirables (7.3%) dans le groupe traité, et 16 (7.6%) dans le groupe de référence. La médiane du temps (en années) des événements composites était de 2.1 (EI 0.9, 4.6) et de 1.8 (EI 0.6, 3.4) respectivement pour les groupes traité et de référence. Aucune différence n’a été observée en ce qui concerne le risque cardiovasculaire entre le groupe traité et le groupe de référence, rapport de risque (RR) 0.81 (Intervalle de Confiance à 95% [IC]: 0.38-1.71; P = 0.57). Conclusion Chez les hommes qui présentent un hypogonadisme et une faible prévalence de maladie cardiovasculaire (MCV) établie, le TST n’apparait pas conférer un effet protecteur ou défavorable sur le risque de d’infarctus du myocarde (IM), d’accident cérébrovasculaire (ACV) ou de mortalité toutes causes confondues. Mots-clés Traitement de substitution de la testostérone, Hypogonadisme masculin, Risque cardiovasculaire, Mortalité.
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- 2019
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11. Antidiabetic treatment patterns and specialty care utilization among patients with type 2 diabetes and cardiovascular disease
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Kevin M. Pantalone, Anita D. Misra-Hebert, Todd M. Hobbs, Xinge Ji, Sheldon X. Kong, Alex Milinovich, Wayne Weng, Janine Bauman, Rahul Ganguly, Bartolome Burguera, Michael W. Kattan, and Robert S. Zimmerman
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Cardiovascular disease ,Type 2 diabetes ,Population health ,Antidiabetic therapies ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background To evaluate real-world patient characteristics, medication use, and health care utilization patterns in patients with type 2 diabetes with established cardiovascular disease (CVD). Methods Cross-sectional analysis of patients with type 2 diabetes seen at Cleveland Clinic from 2005 to 2016, divided into two cohorts: with-CVD and without-CVD. Patient demographics and antidiabetic medications were recorded in December 2016; department encounters included all visits from 1/1/2016 to 12/31/2016. Comorbidity burden was assessed by the diabetes complications severity index (DCSI) score. Results Of 95,569 patients with type 2 diabetes, 40,910 (42.8%) were identified as having established CVD. Patients with CVD vs. those without were older (median age 69.1 vs. 58.2 years), predominantly male (53.8% vs. 42.6%), and more likely to have Medicare insurance (69.4% vs. 35.3%). The with-CVD cohort had a higher proportion of patients with a DCSI score ≥ 3 than the without-CVD cohort (65.0% vs. 10.3%). Utilization rates of glucagon-like peptide-1 receptor agonists and sodium–glucose co-transporter-2 inhibitors were low in both with-CVD (4.1 and 2.5%) and without-CVD cohorts (5.4 and 4.1%), respectively. The majority of patient visits (75%) were seen by a primary care provider. During the 1-year observation period, 81.9 and 62.0% of patients with type 2 diabetes and CVD were not seen by endocrinology or cardiology, respectively. Conclusions These data indicated underutilization of specialists and antidiabetic medications reported to confer CV benefit in patients with type 2 diabetes and CVD. The impact of recently updated guidelines and cardiovascular outcome trial results on management patterns in such patients remains to be seen.
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- 2018
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12. A Newly Devised Vasopressin Drip Protocol in the Management of Chronic Central Diabetes Insipidus During Facial Transplantation Surgery
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Khawla F. Ali, MD, Vicente T. San Martin, MD, Lea El-Hage, MD, Christine Ahrens, PharmD, RPh, Kevin M. Pantalone, DO, Robert S. Zimmerman, MD, Laurence Kennedy, MD, and Pratibha Rao, MD
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
ABSTRACT: Objective: Titration of desmopressin can be challenging during complex, lengthy surgical procedures in patients with chronic central diabetes insipidus (DI). Arginine vasopressin (AVP) may be the preferred treatment modality in these settings. No data currently exist on the use of AVP during lengthy operations.Methods: We report a novel AVP infusion protocol for the management of chronic DI during a 27-hour total facial transplantation surgery.Results: A 21-year-old woman was admitted for a total facial transplantation surgery. Her medical history was significant for severe facial injuries and panhypopituitarism, both secondary to a ballistic trauma sustained 3 years prior. For the management of her chronic central DI during the complex surgery, a unique AVP infusion protocol was developed. Intraoperatively, the infusion was adjusted hourly following an internally developed algorithm with pre-specified goal parameters for urine output (50 to 200 mL/hour) and serum sodium levels (136 to 144 mmol/L; reference range: 136 to 144 mmol/L). The short half-life of AVP provided ease of dose titration. Under this protocol, the patient's hemodynamic values and serum sodium levels remained stable throughout the 27-hour transplantation surgery.Conclusion: We describe the successful use of a novel AVP infusion protocol for the management of DI during a 27-hour facial transplantation surgery. This protocol may also be effective in managing other patients with chronic central DI during lengthy intraoperative periods.Abbreviations: AVP = arginine vasopressin; DDAVP = 1-deamino-8-D-arginine vasopressin; DI = diabetes insipidus
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- 2018
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13. Changes in Characteristics and Treatment Patterns of Patients with Newly Diagnosed Type 2 Diabetes in a Large United States Integrated Health System between 2008 and 2013
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Kevin M. Pantalone, Todd M. Hobbs, Brian J. Wells, Sheldon X. Kong, Michael W. Kattan, Jonathan Bouchard, Kevin M. Chagin, Changhong Yu, Brian Sakurada, Alex Milinovich, Wayne Weng, Janine M. Bauman, and Robert S. Zimmerman
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Published
- 2016
14. A Ketogenic Diet may Restore Fertility in Women With Polycystic Ovary Syndrome: A Case Series
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Ula Abed Alwahab, MD, Kevin M. Pantalone, DO, and Bartolome Burguera, MD, PhD
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
ABSTRACT: Objective: Polycystic ovary syndrome (PCOS) is the most common cause of infertility in women. We report the clinical course of 4 women with PCOS trying to conceive while following a ketogenic diet and assess their fecundity after a period of 6 months.Methods: The patients were followed once monthly in a shared medical appointment setting for total of 6 months. During each visit, the patients were assessed for weight loss progression, menstrual regularity, and ovulation.Results: The patients' ages ranged from 24 to 29 years old, their body mass indexes from 30.75 to 42.46 kg/m2, and their duration of infertility from 1 to 4.5 years. All patients were interested in pregnancy. The diagnosis of PCOS was confirmed by an endocrinology consultation, and the patients initiated a protein-sparing modified fast (PSMF) diet. The PSMF diet entails a maximum daily total carbohydrate intake of 20 g, fat intake up to 50 g, and an approximate protein intake of about 1.5 g for each 1 kg of ideal body weight. Metformin was continued if they were already taking it, otherwise it was initiated with the PSMF diet and titrated up to 500 mg twice daily. All 4 patients adhered to the PSMF diet and were able to lose weight (ranging from 19 to 36 lbs). All 4 also had irregular periods prior to the PSMF diet, and resumed regular menstruation shortly after starting the PSMF diet (ranging from 4 to 8 weeks). Two women were able to conceive spontaneously with no ovulation induction needed.Conclusion: The PSMF diet may have a promising benefit for women with PCOS by inducing weight loss and facilitating ovulation.Abbreviations: BMI = body mass index;HSG = hysterosalpingogram;PCOS = polycystic ovary syndrome;PSMF = protein-sparing modified fast;SMA = shared medical appointment
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- 2018
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15. Measurement of Serum Free Thyroxine Index May Provide Additional Case Detection Compared to Free Thyroxine in the Diagnosis of Central Hypothyroidism
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Kevin M. Pantalone, Betul Hatipoglu, Manjula K. Gupta, Laurence Kennedy, and Amir H. Hamrahian
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
The diagnosis of central hypothyroidism is often suspected in patients with hypothalamic/pituitary pathology, in the setting of low, normal, or even slightly elevated serum TSH and low free thyroxine (FT4). We present four cases of central hypothyroidism (three had known pituitary pathology) in whom central hypothyroidism was diagnosed after the serum free thyroxine index (FTI) was found to be low. All had normal range serum TSH and free thyroxine levels. This report illustrates that the assessment of the serum FTI may be helpful in making the diagnosis of central hypothyroidism in the appropriate clinical setting and when free T4 is in the low-normal range, particularly in patients with multiple anterior pituitary hormone deficiencies and/or with symptoms suggestive of hypothyroidism.
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- 2015
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16. An interpretable predictive deep learning platform for pediatric metabolic diseases.
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Hamed Javidi, Arshiya Mariam, Lina Alkhaled, Kevin M. Pantalone, and Daniel M. Rotroff
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- 2024
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17. Time to Reach Glycaemic and Body Weight Loss Thresholds with Tirzepatide in Patients with Type 2 Diabetes: A Pre-planned Exploratory Analysis of SURPASS-2 and SURPASS-3
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Adie Viljoen, Kevin M. Pantalone, Rodolfo J. Galindo, Xuewei Cui, Ruth Huh, Andrea Hemmingway, Laura Fernández Landó, and Hiren Patel
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Endocrinology, Diabetes and Metabolism ,Internal Medicine - Published
- 2023
18. <scp>iGlarLixi</scp> versus premixed insulin initiation in adults with type 2 diabetes advancing from basal insulin therapy: The <scp>SoliComplex</scp> real‐world study
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Rosemarie Lajara, Caroline Heller, Kevin M. Pantalone, Elisheva Lew, Xuan Li, Terry Dex, and Catherine Rachel Kilpatrick
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Endocrinology ,Endocrinology, Diabetes and Metabolism ,Internal Medicine - Published
- 2023
19. The use of virtual visits for obesity pharmacotherapy in patients with overweight or obesity compared with in‐person encounters
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Marcio L. Griebeler, W. Scott Butsch, Paloma Rodriguez, Laura Lomeli, Matthew Kampert, Vinni Makin, Ula Abed Alwahab, Elena Borukh, Erin Daigle, James Bena, Kevin M. Pantalone, and Bartolome Burguera
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Adult ,Phentermine ,Nutrition and Dietetics ,Endocrinology ,Endocrinology, Diabetes and Metabolism ,Weight Loss ,Humans ,Medicine (miscellaneous) ,Prospective Studies ,Obesity ,Overweight - Abstract
This study aimed to demonstrate noninferiority using telehealth in treating obesity with phentermine in patients with BMI ≥ 27 kg/msup2/supwith comorbidities or BMI ≥ 30 compared with the standard in-person approach over a 90-day period.A 12-week, randomized, prospective, single-center, open label trial compared the use of virtual visits versus in-person visits for the treatment of obesity using phentermine. The primary end point was percentage mean change in body weight from baseline to 12 weeks. A noninferiority approach assuming a 3% noninferiority region was used to assess effect size differences.The weight loss in the virtual visit arm was noninferior to the in-person arm at all time points. At 12 weeks, the mean change in weight was -6.5% among the virtual group and -7.7% among the in-person group. In addition, 65% of virtual patients and 71% of in-person patients demonstrated a weight reduction of at least 5%. There was no difference in medication tolerance, adherence, and compliance.These results indicate that the virtual obesity pharmacotherapy visits in adults aged 18 to 65 years prescribed phentermine are effective and noninferior in achieving meaningful weight loss after 12 weeks. Future clinical trials are needed to better assess the effectiveness of televisits for obesity pharmacotherapy.
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- 2022
20. Addressing Therapeutic Inertia: Development and Implementation of an Electronic Health Record–Based Diabetes Intensification Tool
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Kevin M. Pantalone, Swapnil Rajpathak, Xinge Ji, Jian Jin, Tracey M. Weiss, Janine Bauman, Tomas Radivoyevitch, Michael W. Kattan, Robert S. Zimmerman, Anita D. Misra-Hebert, and Jennifer Brown
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Endocrinology, Diabetes and Metabolism ,Internal Medicine - Abstract
Objective To assess whether an electronic health record (EHR)-based diabetes intensification tool can improve the rate of A1C goal attainment among patients with type 2 diabetes and an A1C ≥8%. Methods An EHR-based tool was developed and sequentially implemented in a large, integrated health system using a four-phase, stepped-wedge design (single pilot site [phase 1] and then three practice site clusters [phases 2–4]; 3 months/phase), with full implementation during phase 4. A1C outcomes, tool usage, and treatment intensification metrics were compared retrospectively at implementation (IMP) sites versus nonimplementation (non-IMP) sites with sites matched on patient population characteristics using overlap propensity score weighting. Results Overall, tool utilization was low among patient encounters at IMP sites (1,122 of 11,549 [9.7%]). During phases 1–3, the proportions of patients achieving the A1C goal ( Conclusion Utilization of a diabetes intensification tool was low and did not influence rates of A1C goal attainment or time to treatment intensification. The low level of tool adoption is itself an important finding highlighting the problem of therapeutic inertia in clinical practice. Testing additional strategies to better incorporate, increase acceptance of, and improve proficiency with EHR-based intensification tools is warranted.
- Published
- 2022
21. Perioperative management of diabetes in patients undergoing bariatric and metabolic surgery: a narrative review and the Cleveland Clinic practical recommendations
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Oscar L. Morey-Vargas, Ali Aminian, Karen Steckner, Keren Zhou, Sangeeta R. Kashyap, Derrick Cetin, Kevin M. Pantalone, Christopher Daigle, Marcio L. Griebeler, W. Scott Butsch, Robert Zimmerman, Matthew Kroh, Hussein F. Saadi, Danielle Diemer, Bartolome Burguera, Raul J. Rosenthal, and M. Cecilia Lansang
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Blood Glucose ,Diabetes Mellitus, Type 1 ,Treatment Outcome ,Diabetes Mellitus, Type 2 ,Gastrectomy ,Hyperglycemia ,Gastric Bypass ,Bariatric Surgery ,Humans ,Insulin ,Surgery ,Obesity ,Obesity, Morbid - Abstract
Bariatric and metabolic surgery is an effective treatment for patients with severe obesity and obesity-related diseases. In patients with type 2 diabetes, it provides marked improvement in glycemic control and even remission of diabetes. In patients with type 1 diabetes, bariatric surgery may offer improvement in insulin sensitivity and other cardiometabolic risk factors, as well as amelioration of the mechanical complications of obesity. Because of these positive outcomes, there are increasing numbers of patients with diabetes who undergo bariatric surgical procedures each year. Prior to surgery, efforts should be made to optimize glycemic control. However, there is no need to delay or withhold bariatric surgery until a specific glycosylated hemoglobin target is reached. Instead, treatment should focus on avoidance of early postoperative hyperglycemia. In general, oral glucose-lowering medications and noninsulin injectables are not favored to control hyperglycemia in the inpatient setting. Hyperglycemia in the hospital is managed with insulin, aiming for perioperative blood glucose concentrations between 80 and 180 mg/dL. Following surgery, substantial changes of the antidiabetic medication regimens are common. Patients should have a clear understanding of the modifications made to their treatment and should be followed closely thereafter. In this review article, we describe practical recommendations for the perioperative management of diabetes in patients with type 2 or type 1 diabetes undergoing bariatric surgery. Specific recommendations are delineated based on the different treatments that are currently available for glycemic control, including oral glucose-lowering medications, noninsulin injectables, and a variety of insulin regimens.
- Published
- 2022
22. Efficacy of tirzepatide 5, 10 and 15 mg versus semaglutide 2 mg in patients with type 2 diabetes: An adjusted indirect treatment comparison
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Karan Vadher, Hiren Patel, Reema Mody, Joshua A. Levine, Meredith Hoog, Alice YY. Cheng, Kevin M. Pantalone, and Hélène Sapin
- Subjects
Glycated Hemoglobin ,Treatment Outcome ,Endocrinology ,Diabetes Mellitus, Type 2 ,Double-Blind Method ,Endocrinology, Diabetes and Metabolism ,Body Weight ,Glucagon-Like Peptides ,Internal Medicine ,Humans ,Hypoglycemic Agents ,Gastric Inhibitory Polypeptide ,Metformin - Abstract
To conduct an adjusted indirect treatment comparison (aITC) of the efficacy of tirzepatide 5/10/15 mg versus semaglutide 2 mg in patients with type 2 diabetes.The primary analysis was a Bucher aITC of the change from baseline at week 40 in HbA1c (%) and body weight (kg). Aggregate data from the SURPASS-2 study that met the HbA1c inclusion criterion of the SUSTAIN FORTE study and from SUSTAIN FORTE metformin-only treated patients were used for primary analysis.The SURPASS-2 refined population comprised 238/245/240 and 240 participants for tirzepatide 5/10/15 mg and semaglutide 1 mg, respectively. The SUSTAIN FORTE metformin-only population comprised 222 and 227 participants for semaglutide 1 and 2 mg, respectively. In this aITC, tirzepatide 10 and 15 mg significantly reduced HbA1c versus semaglutide 2 mg with an estimated treatment difference (ETD) of -0.36% (95% confidence interval [CI] -0.63, -0.09) and -0.4% (95% CI -0.67, -0.13), respectively. Tirzepatide 10 and 15 mg significantly reduced body weight versus semaglutide 2 mg with an ETD of -3.15 kg (95% CI -4.84, -1.46) and -5.15 kg (95% CI -6.85, -3.45), respectively. There were no significant differences between tirzepatide 5 mg and semaglutide 2 mg on change from baseline in HbA1c and body weight.In this aITC, HbA1c and weight reductions were significantly greater for tirzepatide 10 and 15 mg versus semaglutide 2 mg and were similar for tirzepatide 5 mg versus semaglutide 2 mg. These findings provide comparative effectiveness insights in the absence of a head-to-head clinical trial.
- Published
- 2022
23. Design and rationale of FINE-REAL: A prospective study of finerenone in clinical practice
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Nihar R. Desai, Sankar D. Navaneethan, Susanne B. Nicholas, Kevin M. Pantalone, Christoph Wanner, Stefanie Hamacher, Alain Gay, and David C. Wheeler
- Subjects
Adult ,Kidney Disease ,Endocrinology, Diabetes and Metabolism ,Clinical Sciences ,Renal and urogenital ,Finerenone ,Endocrinology & Metabolism ,Endocrinology ,Double-Blind Method ,7.1 Individual care needs ,Clinical Research ,Chronic kidney disease ,Healthcare resource utilization ,Internal Medicine ,Diabetes Mellitus ,Humans ,Diabetic Nephropathies ,Prospective Studies ,Renal Insufficiency ,Chronic ,Metabolic and endocrine ,Mineralocorticoid Receptor Antagonists ,Diabetes ,Prescribing patterns ,Type 2 diabetes ,Good Health and Well Being ,Patient Safety ,Management of diseases and conditions ,Type 2 - Abstract
AimsContemporary patterns of care of patients with chronic kidney disease (CKD) associated with type 2 diabetes (T2D) and the adoption of finerenone are not known. The FINE-REAL study (NCT05348733) is a prospective observational study in patients with CKD and T2D to provide insights into the use of the nonsteroidal mineralocorticoid receptor antagonist (MRA) finerenone in clinical practice.MethodsFINE-REAL is an international, prospective, multicenter, single-arm study enrolling approximately 5500 adults with CKD and T2D in an estimated 200 sites across 22 countries. The study is anticipated to be ongoing until 2027.ResultsThe primary objective is to describe treatment patterns in patients with CKD and T2D treated with finerenone in routine clinical practice. Secondary objectives include assessment of safety with finerenone. Other endpoints include characterization of healthcare resource utilization and occurrence of newly diagnosed diabetic retinopathy or its progression from baseline in patients with existing disease. A biobank is being organized for future explorative analyses with inclusion of participants from the United States.ConclusionsFINE-REAL is the first prospective observational study with a nonsteroidal MRA in a population with CKD and T2D and is expected to provide meaningful insights into the treatment of CKD associated with T2D. FINE-REAL will inform decision-making with respect to initiation of finerenone in patients with CKD and T2D.
- Published
- 2023
24. Initiation of iGlarLixi Versus Basal-Bolus Insulin in Adults With Type 2 Diabetes Advancing From Basal Insulin Therapy: The SoliComplex Real-World Study
- Author
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Kevin M. Pantalone, Caroline Heller, Rosemarie Lajara, Elisheva Lew, Xuan Li, Terry Dex, and C. Rachel Kilpatrick
- Subjects
Endocrinology, Diabetes and Metabolism ,Internal Medicine - Abstract
BACKGROUND When type 2 diabetes is suboptimally controlled with basal insulin, prandial insulin injections are commonly added (i.e., a basal-bolus insulin regimen), which can increase treatment burden and hypoglycemia risk. The once-daily injectable iGlarLixi is an alternative treatment. METHODS This retrospective analysis of the U.S. Optum Clinformatics database compared outcomes in adults (≥18 years of age) with type 2 diabetes who previously received basal insulin and were newly initiated on iGlarLixi or basal-bolus insulin therapy. Cohorts were propensity score–matched in a 1:1 ratio on baseline characteristics, and imbalances were adjusted in multivariate analyses. Subgroup analyses were performed for people ≥65 years of age and those with a baseline A1C ≥9%. The primary end point was persistence with therapy at 12 months in the overall population. Secondary end points were treatment adherence, health care resource utilization (HCRU), costs, any hypoglycemia, and A1C change at 12 months. RESULTS Cohorts each comprised 1,070 participants. Treatment persistence at 12 months was statistically significantly higher for iGlarLixi versus basal-bolus insulin therapy (43.7 vs. 22.3%, hazard ratio 0.51, 95% CI 0.46–0.57, adjusted P CONCLUSION In this observational study, initiation of once-daily iGlarLixi versus basal-bolus insulin was associated with higher persistence, lower hypoglycemia, and similar A1C reduction without increasing HCRU or costs regardless of age or A1C. iGlarLixi could be an alternative to basal-bolus insulin, particularly for older adults with type 2 diabetes who require treatment simplification with lower hypoglycemia risk.
- Published
- 2023
25. Abstract #1384613: Statin Utilization Among Patients with Type 2 Diabetes with and Without Cardiovascular Disease
- Author
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Lily J. Tranchito, Huijun Xiao, James Bena, and Kevin M. Pantalone
- Subjects
Endocrinology ,Endocrinology, Diabetes and Metabolism - Published
- 2023
26. Author response for '<scp>iGlarLixi</scp> vs. premixed insulin initiation in adults with type 2 diabetes advancing from basal insulin therapy: <scp>SoliComplex</scp> real‐world study'
- Author
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null Rosemarie Lajara, null Caroline Heller, null Kevin M. Pantalone, null Elisheva Lew, null Xuan Li, null Terry Dex, and null C. Rachel Kilpatrick
- Published
- 2022
27. Associations of weight loss with obesity‐related comorbidities in a large integrated health system
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Neeraj N. Iyer, Janine Bauman, Robert S. Zimmerman, Galen Miller-Atkins, B. Gabriel Smolarz, Anita D. Misra-Hebert, Bartolome Burguera, Kevin M. Pantalone, Arshiya Mariam, Michael W. Kattan, Daniel M. Rotroff, Todd Hobbs, Abhilasha Ramasamy, Alex Milinovich, and Michelle Mocarski
- Subjects
medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Comorbidity ,Type 2 diabetes ,Disease ,Body Mass Index ,Endocrinology ,Non-alcoholic Fatty Liver Disease ,Weight loss ,Weight Loss ,Internal Medicine ,medicine ,Humans ,Obesity ,Disease burden ,Delivery of Health Care, Integrated ,business.industry ,Weight change ,medicine.disease ,Obstructive sleep apnea ,Diabetes Mellitus, Type 2 ,Case-Control Studies ,Emergency medicine ,medicine.symptom ,business - Abstract
Aims Little is known about the impact of weight loss on developing comorbidities in patients with obesity in real-world settings. Understanding health benefits and associated comorbidities with weight loss are critical to addressing the global obesity health epidemic. This study aimed to determine health outcomes associated with weight loss in individuals with obesity, and to better understand the relationship between disease burden (i.e., prior comorbidities, healthcare utilization) and weight loss in individuals with obesity. Electronic health records (EHRs) represent an important resource to investigate these impacts. Materials and methods We conducted a case-control study using deidentified EHR-derived information from 204,921 patients seen at the Cleveland Clinic between 2000-2018. Patients were ≥20 years of age with BMI ≥30 kg/m2 and ≥7 weight measurements, over ≥3 years. Thirty outcomes were investigated, including chronic and acute diseases, as well as psychological and metabolic disorders. Weight change was investigated three, five, and ten years prior to an event. Results Weight loss was associated with reduced incidence of many outcomes (e.g., type 2 diabetes, non-alcoholic steatohepatitis/non-alcoholic fatty liver disease, obstructive sleep apnea, hypertension) (P 10% was associated with increased incidence of certain outcomes including stroke and substance abuse. However, many outcomes that increased with weight loss were attenuated by disease burden adjustments. Conclusions This study provides the most comprehensive real-world evaluation of health impacts of weight change to date. After comorbidity burden and healthcare utilization adjustments, weight loss was associated with an overall reduction in risk of many adverse outcomes. This article is protected by copyright. All rights reserved.
- Published
- 2021
28. Addressing Therapeutic Inertia: Development and Implementation of an Electronic Health Record–Based Diabetes Intensification Tool
- Author
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Anita D Misra-Hebert, Robert S Zimmerman, Michael W. Kattan, Tomas Radivoyevitch, Janine Bauman, Tracey Weiss, Jian Jin, Xinge Ji, Swapnil Rajpathak, and Kevin M. Pantalone
- Abstract
Objective. To assess whether an electronic health record (EHR) based diabetes intensification tool can improve the rate of A1C goal attainment among patients with type 2 diabetes and an A1C ≥8%. Methods. An EHR-based tool was developed and sequentially implemented in a large, integrated health system using a four-phase, stepped-wedge design (single pilot site [phase 1] and then three practice site clusters [phases 2–4]; 3 months/phase), with full implementation during phase 4. A1C outcomes, tool usage, and treatment intensification metrics were compared retrospectively at implementation (IMP) sites versus nonimplementation (non-IMP) sites with sites matched on patient population characteristics using overlap propensity score weighting. Results. Overall, tool utilization was low among patient encounters at IMP sites (1,122 of 11,549 [9.7%]). During phases 1–3, the proportions of patients achieving the A1C goal (P = 0.02). Implementation was not associated with mean A1C improvement from baseline (range −0.88 to −1.08%, IMP sites vs. non-IMP sites P ≥0.093). Times to intensification were similar between IMP and non-IMP sites. Conclusion. Utilization of a diabetes intensification tool was low and did not influence rates of A1C goal attainment or time to treatment intensification. The low level of tool adoption is itself an important finding highlighting the problem of therapeutic inertia in clinical practice. Testing additional strategies to better incorporate, increase acceptance of, and improve proficiency with EHR-based intensification tools is warranted.
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- 2022
29. Impacts of COVID-19 on Glycemia and Risk of Diabetic Ketoacidosis
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Anukriti Sharma, Anita D. Misra-Hebert, Arshiya Mariam, Alex Milinovich, Anthony Onuzuruike, Wilhemina Koomson, Michael W. Kattan, Kevin M. Pantalone, and Daniel M. Rotroff
- Subjects
Endocrinology, Diabetes and Metabolism ,Internal Medicine - Abstract
Reports indicate that coronavirus disease 2019 (COVID-19) may impact pancreatic function and increase type 2 diabetes (T2D) risk, although real-world COVID-19 impacts on HbA1c and T2D are unknown. We tested whether COVID-19 increased HbA1c, risk of T2D, or diabetic ketoacidosis (DKA). We compared pre– and post–COVID-19 HbA1c and T2D risk in a large real-world clinical cohort of 8,755 COVID-19(+) patients and 11,998 COVID-19(−) matched control subjects. We investigated whether DKA risk was modified in COVID-19(+) patients with type 1 diabetes (T1D) (N = 701) or T2D (N = 21,830), or by race and sex. We observed a statistically significant, albeit clinically insignificant, HbA1c increase post–COVID-19 (all patients ΔHbA1c = 0.06%; with T2D ΔHbA1c = 0.1%) and no increase among COVID-19(−) patients. COVID-19(+) patients were 40% more likely to be diagnosed with T2D compared with COVID-19(−) patients and 28% more likely for the same HbA1c change as COVID-19(−) patients, indicating that COVID-19–attributed T2D risk may be due to increased recognition during COVID-19 management. DKA in COVID-19(+) patients with T1D was not increased. COVID-19(+) Black patients with T2D displayed disproportionately increased DKA risk (hazard ratio 2.46 [95% CI 1.48–6.09], P = 0.004) compared with White patients, suggesting a need for further clinical awareness and investigation.
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- 2022
30. Obesity Medical Therapy: It Is Time to Take the Bull by the Horns
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Bartolome Burguera, Kevin M. Pantalone, and Marcio L. Griebeler
- Subjects
Pediatrics ,medicine.medical_specialty ,business.industry ,medicine ,General Medicine ,medicine.disease ,business ,Obesity ,Medical therapy - Published
- 2021
31. A Survey of U.S. Endocrinology Fellow Engagement in Professional Medical Societies
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Michelle D. Lundholm, Saif M. Borgan, and Kevin M. Pantalone
- Subjects
Endocrinology ,Surveys and Questionnaires ,Endocrinology, Diabetes and Metabolism ,Humans ,Societies, Medical - Published
- 2022
32. RF28 | PSUN182 Risk of Pancreatitis After Glp-1 Receptor Agonist in Individuals With Known History of Pancreatitis
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Alimitha M Kodali, Kevin M Pantalone, and Yumiko Tsushima
- Subjects
Endocrinology, Diabetes and Metabolism - Abstract
Introduction Randomized clinical trials identified a small increased risk of acute pancreatitis in patients using glucagon-like peptide-1 receptor agonist (GLP1- RA) therapy. As a result, GLP-1RA therapy is generally avoided in patients with a history of acute pancreatitis. The aim of this report was to evaluate the real-world experience of GLP-1RA therapy in patients with a history of acute pancreatitis. Methods A retrospective chart review was conducted (2010-2019) using the enterprise-wide electronic health record (EHR) system. Patients with a history of acute pancreatitis and a subsequent encounter diagnosis of acute pancreatitis (ICD-9/ ICD-10 codes), after exposure to GLP-1R, were identified. Exposure to GLP-1RA was defined as a documented prescription for GLP-1RA in the EHR. Patients were followed until the date of recurrent acute pancreatitis (RAP) or censoring. Categorical and continuous variables were summarized using N (%) and mean (SD), respectively. Results A total of 161 patients were identified, 50.9% were female, 56.6% Caucasian, with mean age (years) 54 (±13) and mean BMI 35 kg/m2 (±8). Type 2 diabetes, hypertension, and obesity were present in 92.5% (N=149), 86.3% (N=139), and 73.9% (N=119), respectively. The mean duration of follow-up for all patients was 28.2 months (±24.6). The etiologies of the first documented episode of pancreatitis prior to GLP-1RA exposure were gall stones (N=49, 30.4%), alcoholism (N=21, 13%), hypertriglyceridemia (N=9, 5.6%), medication-induced N=5 (3.1%), and the remaining cases (N=77, 47.8%) were classified as idiopathic. Among these 161 patients, N=16 (9.9%) had a second episode of pancreatitis after GLP1-RA exposure. The mean duration of exposure to GLP-1RA prior to RAP was 10.8 months (±7.2). RAP was attributed to GLP 1-RA exposure N=6 (37.5%), alcohol intake N=2 (12.5%), hypertriglyceridemia N=3 (18.8%), oral hypoglycemic agent N=1 (6.2%), ampulla stenosis N=1 (6.2%), and the remaining N=3 (18.8%) were considered idiopathic. Conclusions Among 161 patients with a history of acute pancreatitis exposed to GLP-1RA, a total of 16 (9.9%) cases of RAP were identified, but only N=6 (4%) of these were determined attributable to GLP-1RA exposure. The overall rate of RAP among our cohort of GLP-1RA exposed patients (9.9%) is similar to the overall rate of RAP reported in the literature (12.7%), regardless of the underlying etiology or drug exposure.1 Acute pancreatitis related to drug exposure is a diagnosis of exclusion; thus, it is certainly possible that some of the cases in our report considered idiopathic were actually related to GLP-1RA exposure. While caution needs to be exercised, our data would support the use of GLP-1RA in patients with a history of acute pancreatitis, on an individualized basis, where the benefits are considered to outweigh the risks. References 1) Mallick et al. Differences between the outcome of recurrent acute pancreatitis and acute pancreatitis. JGH Open. 2018 Jun 6;2(4): 134-138. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 12:30 p.m. - 12:35 p.m.
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- 2022
33. PMON152 In Patients with Cushing's Disease and a Visible Tumor on MRI, IPSS does not Add to the Accuracy of Predicting Tumor Lateralization
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Michelle D Lundholm, Kevin M Pantalone, Pratibha Rao, Amir H Hamrahian, and Divya Yogi-Morren
- Subjects
Endocrinology, Diabetes and Metabolism - Abstract
Introduction There is controversy surrounding the value of bilateral inferior petrosal sinus sampling (BIPSS) for tumor lateralization in Cushing's disease (CD). We compare lateralization results between BIPSS and pituitary imaging against gold-standard surgical localization. Methods A retrospective chart review was conducted in patients with pathology-confirmed CD, visible tumor on MRI (with and without contrast), and who underwent BIPSS at our institution between 2003-2020. An inferior petrosal sinus to peripheral (IPS/P) prolactin ratio >1.8 was used to confirm appropriate IPS sampling. An inter-sinus ACTH gradient ratio greater than 1.4, adjusted for prolactin where available, was used to determine lateralization. In each case, the neurosurgeon performed a full pituitary gland exploration to avoid missing any tumors despite visible tumor on MRI. Descriptive statistics were used. Results Of 32 patients with CD, visible tumor on MRI, and BIPSS testing, 27 (84%) patients had technically successful bilateral IPSS catheterization and are the subjects of this study. All 27 of these patients had IPS/P ACTH ratio greater than 2 at baseline or 3 after CRH stimulation, consistent with CD, and all 27 lateralized. The median age at diagnosis was 42 years (range 21-69 years) and 85% were female (N=23). The median tumor size on MRI was 5 mm (range 3-8 mm). In 22/27 (81%) patients, the result of the IPSS lateralization was concordant with MRI findings. When MRI and BIPSS lateralization agreed, 21/22 (95%) were confirmed by surgical pathology. Of the 5 cases where MRI and BIPSS disagreed on laterality, the operative report was consistent with MRI lateralization in 3/5 cases, and bilateral disease in the remaining 2 cases. There were no cases where BIPSS lateralization was correct when MRI lateralization was incorrect. Overall, MRI correctly lateralized 26/27 cases (96%), whereas BIPSS correctly lateralized 23/27 (85%). In the subset of 13 patients with tumors measuring Conclusion When a tumor is visible on MRI, regardless of its size (≥ 3mm), BIPSS does not add to the accuracy of determining tumor lateralization. BIPSS may best be reserved for situations where the diagnosis of CD is in question. Further studies are required to determine the value of BIPSS in lateralizing the source of CD in patients without visible tumor. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
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- 2022
34. Lack of Bone Mineral Density Testing in Men With Hypogonadism: A Clinical Conundrum
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Travis Goettemoeller, James Bena, and Kevin M Pantalone
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Endocrinology, Diabetes and Metabolism - Abstract
Context The 2012 Endocrine Society Clinical Practice Guidelines recommend that men aged 50 years or older with a diagnosis of hypogonadism undergo bone mineral density (BMD) testing. Objective The objective of this study was to determine the frequency at which men aged 50 years or older with a diagnosis of hypogonadism undergo BMD testing, and if found to have low BMD, are subsequently treated with an osteoporosis medication. Methods A retrospective chart review was conducted at a large academic medical center. Inclusion requirements were an International Classification of Diseases (ICD)-9 or -10 code for hypogonadism at any time between July 1, 2012 and September 30, 2020. Patients were followed until the date of BMD assessment or censoring (September 30, 2021). BMD results and treatment with osteoporosis medication were recorded. Results A total of 10 169 men with hypogonadism were identified, of whom the mean age was 63.4 (± 9.2), 86.3% White, mean body mass index 31.3 with prevalence of chronic kidney disease, type 2 diabetes, and hypertension of 20.6%, 36.9%, and 68.2%, respectively. The percentage that underwent BMD testing was 7.2%, of which 352 (48.4%) and 87 (12.0%) had osteopenia and osteoporosis, respectively. Among the 87 patients with osteoporosis, 57.5% were treated with an osteoporosis medication. Conclusion Only 7.2% of hypogonadal men underwent BMD testing, and among them, 12.0% were found to have osteoporosis. Among those with osteoporosis, 57.5% underwent treatment with osteoporosis medication. Further studies are needed to determine why so few men with hypogonadism undergo BMD assessment and what systems can be put in place to overcome this clinical conundrum.
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- 2022
35. 739-P: iGlarLixi vs. Premixed Insulin Initiation in Adults with Type 2 Diabetes (T2D) Advancing from Basal Insulin (BI) Therapy: SoliComplex Real-World Study
- Author
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ROSEMARIE LAJARA, CAROLINE HELLER, KEVIN M. PANTALONE, ELISHEVA LEW, XUAN LI, TERRY A. DEX, and RACHEL KILPATRICK
- Subjects
Endocrinology, Diabetes and Metabolism ,Internal Medicine - Abstract
Aim: Premixed insulin (premix) , conventionally administered twice daily, is often used in the US to treat T2D that is suboptimally controlled with BI, particularly for people with consistent eating patterns who require affordable treatment. This analysis evaluated use of once daily iGlarLixi vs. premix on T2D outcomes. Method: This retrospective analysis of the US Optum Clinformatics database compared outcomes in adults (≥18 y) with T2D who previously received BI and newly initiated iGlarLixi or premix. Persistence (primary endpoint) , adherence, healthcare resource utilization (HRU) , costs, any hypoglycemia, and HbA1c change were assessed at 12 months. Results: After propensity score matching, cohorts (n=834 each) were well balanced with respect to age, HbA1c, use of oral agents, BI, and HRU. The primary endpoint was met with persistence being statistically significantly higher for iGlarLixi vs. premix at 12 months. Adherence and HbA1c reduction were similar between groups, whereas hypoglycemia rates, HRU, and costs were numerically lower for iGlarLixi (Table) . Conclusion: In this observational study, once daily iGlarLixi was an effective post-BI treatment with higher treatment persistence than premixed insulin, with similar adherence and HbA1c reduction, and numerically lower hypoglycemia rates, HRU, and costs. Disclosure R.Lajara: None. C.Heller: Consultant; Sanofi, Employee; Aetion. K.M.Pantalone: Consultant; AstraZeneca, Bayer AG, Corcept Therapeutics, Diasome, Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk, Sanofi, Research Support; Bayer AG, Merck & Co., Inc., Novo Nordisk, Speaker's Bureau; AstraZeneca, Corcept Therapeutics, Merck & Co., Inc., Novo Nordisk. E.Lew: Employee; Sanofi. X.Li: Employee; Eisai Co., Ltd., Sanofi. T.A.Dex: Employee; Sanofi, Stock/Shareholder; Pfizer Inc., Teva Pharmaceutical Industries Ltd., Viatris Inc. R.Kilpatrick: Speaker's Bureau; Abbott Diabetes, Amgen Inc., Novo Nordisk, Sanofi. Funding Sanofi
- Published
- 2022
36. 733-P: Initiation of iGlarLixi vs. Basal-Bolus Insulin (BB) in Adults with Type 2 Diabetes (T2D) Advancing from Basal Insulin (BI) Therapy: The SoliComplex Real-World Study
- Author
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KEVIN M. PANTALONE, CAROLINE HELLER, ROSEMARIE LAJARA, ELISHEVA LEW, XUAN LI, TERRY A. DEX, and RACHEL KILPATRICK
- Subjects
Endocrinology, Diabetes and Metabolism ,Internal Medicine - Abstract
Aim: When T2D is suboptimally controlled with BI, 1-3 daily injections of prandial insulin are commonly added (BB regimen) . Once daily iGlarLixi is an alternative treatment. This analysis evaluated the use of iGlarLixi vs. BB on T2D outcomes. Methods: This retrospective analysis of the US Optum Clinformatics database compared outcomes in adults (≥18 y) with T2D who previously received BI and newly initiated iGlarLixi or BB between Jan 1, 2017, and Jun 30, 2020. Persistence (primary endpoint) , adherence, healthcare resource utilization (HRU) , costs, any hypoglycemia, and HbA1c change were assessed at 12 months. Results: Propensity score matching generated cohorts (n=1070 each) that were well balanced with similar mean ± SD age (iGlarLixi: 63.9 ± 11.0 y; BB: 64.5 ± 11.3 y) , HbA1c (iGlarLixi: 9.2 ± 1.7%; BB: 9.2 ± 1.8%) , oral agent use, BI use, and HRU. The primary endpoint was met with treatment persistence being statistically significantly higher for iGlarLixi vs. BB at 12 months. Adherence was numerically higher for iGlarLixi, and hypoglycemia rates, HRU and costs, numerically lower. HbA1c reduction was similar between groups (Table) . Conclusions: In this observational study, initiation of once daily iGlarLixi vs. BB insulin was associated with higher persistence and similar HbA1c reduction without increasing HRU or costs. Disclosure K.M. Pantalone: Consultant; AstraZeneca, Bayer AG, Corcept Therapeutics, Diasome, Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk, Sanofi. Research Support; Bayer AG, Merck & Co., Inc., Novo Nordisk. Speaker's Bureau; AstraZeneca, Corcept Therapeutics, Merck & Co., Inc., Novo Nordisk. C. Heller: Consultant; Sanofi. Employee; Aetion. R. Lajara: None. E. Lew: Employee; Sanofi. X. Li: Employee; Eisai Co., Ltd., Sanofi. T.A. Dex: Employee; Sanofi. Stock/Shareholder; Pfizer Inc., Teva Pharmaceutical Industries Ltd., Viatris Inc. R. Kilpatrick: Speaker's Bureau; Abbott Diabetes, Amgen Inc., Novo Nordisk, Sanofi. Funding Sanofi
- Published
- 2022
37. 732-P: Patients with Type 2 Diabetes Reach Glycemic Targets Faster with Tirzepatide Compared with Semaglutide and Titrated Insulin Degludec
- Author
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KEVIN M. PANTALONE, ADIE VILJOEN, RODOLFO J. GALINDO, XUEWEI CUI, RUTH HUH, LAURA FERNANDEZ LANDO, and HIREN PATEL
- Subjects
Endocrinology, Diabetes and Metabolism ,Internal Medicine - Abstract
Tirzepatide (TZP) is a novel dual GIP/GLP-1 receptor agonist in development for treatment of type 2 diabetes (T2D) . TZP 5 mg, mg, and 15 mg demonstrated superiority versus semaglutide 1 mg (SEMA) and titrated insulin degludec (iDeg) in HbA1c change from baseline and proportion of patients reaching HbA1c Disclosure K.M. Pantalone: Consultant; AstraZeneca, Bayer AG, Corcept Therapeutics, Diasome, Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk, Sanofi. Research Support; Bayer AG, Merck & Co., Inc., Novo Nordisk. Speaker's Bureau; AstraZeneca, Corcept Therapeutics, Merck & Co., Inc., Novo Nordisk. A. Viljoen: Advisory Panel; Eli Lilly and Company, Mundipharma. Consultant; Amgen Inc., Daiichi Sankyo. Research Support; Eli Lilly and Company, Novo Nordisk. Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Novartis AG, Novo Nordisk A/S, Sanofi. R.J. Galindo: Advisory Panel; Sanofi, WW International, Inc. Research Support; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk. X. Cui: Employee; Eli Lilly and Company. R. Huh: None. L. Fernandez Lando: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. H. Patel: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. Funding Eli Lilly and Company
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- 2022
38. Unmet needs and opportunities for optimal management of patients with type 2 diabetes and chronic kidney disease
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Kevin M. Pantalone, Xinge Ji, Sheldon X. Kong, Jay C. Elliott, Alex Milinovich, Anita D. Misra-Hebert, Ryan Farej, Rakesh Singh, Janine M. Bauman, Robert S. Zimmerman, Tushar J. Vachharajani, Jamie Partridge, Jennifer Cameron, Todd Williamson, and Michael W. Kattan
- Subjects
Endocrinology ,Endocrinology, Diabetes and Metabolism ,Internal Medicine - Published
- 2023
39. Results of a 24-Week Trial of Technosphere Insulin Versus Insulin Aspart in Type 2 Diabetes
- Author
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David M. Kendall, Byron J. Hoogwerf, Marshall Grant, Marina Basina, Marisa C. Jones, and Kevin M. Pantalone
- Subjects
Adult ,Blood Glucose ,Male ,medicine.medical_specialty ,Adolescent ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Insulin Glargine ,030209 endocrinology & metabolism ,Type 2 diabetes ,Gastroenterology ,Insulin aspart ,Young Adult ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Endocrinology ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Hypoglycemic Agents ,Insulin ,030212 general & internal medicine ,Insulin Aspart ,Aged ,Aged, 80 and over ,Glycated Hemoglobin ,Glycemic efficacy ,business.industry ,Insulin glargine ,Middle Aged ,medicine.disease ,Insulin, Long-Acting ,Diabetes Mellitus, Type 2 ,chemistry ,Cohort ,Glycated hemoglobin ,business ,medicine.drug - Abstract
Objective To compare glycemic efficacy of Technosphere insulin (TI) versus that of insulin aspart (IA), each added to basal insulin, in type 2 diabetes. Methods This randomized, 24-week trial included subjects aged from 18 to 80 years who were treated with subcutaneous insulin for 3 months and had glycated hemoglobin (HbA1C) levels of 7.0% to 11.5%. After receiving stabilized insulin glargine doses during a 4-week lead in, the subjects were randomized to TI or IA. The primary end point was an HbA1C change from baseline, with the differences analyzed by equivalence analyses. Results In the overall cohort (N = 309; males, 23.3%), mean (SD) age was 58.5 (8.4) years, body mass index was 30.8 (4.7) kg/m2, weight was 82.2 (13.6) kg, and duration of diabetes was 12.2 (7.1) years. An intention-to-treat cohort had 150 subjects randomized to TI (mean [SD] HbA1C: 8.9% [1.1%]) and 154 randomized to IA (mean [SD] HbA1C: 9.0% [1.3%]). At 24 weeks, mean (SD) HbA1C value declined to 7.9% (1.3%) and 7.7% (1.1%) in the TI and IA cohorts, respectively. A treatment difference of 0.26% was not statistically significant, but the predefined equivalency margin was not met. Subjects receiving TI lost 0.78 kg compared to baseline; subjects receiving IA gained 0.23 kg (P =.0007). The incidence of mild/moderate hypoglycemia was lower for the TI cohort, though not statistically significant. Conclusion Both TI and IA resulted in significant and clinically meaningful HbA1C reductions. TI also resulted in significant and clinically meaningful weight reductions. These data support the use of inhaled insulin as a treatment option for individuals with type 2 diabetes.
- Published
- 2021
40. Author response for 'Efficacy of tirzepatide 5, 10, and 15 mg versus semaglutide 2 mg in patients with type 2 diabetes: an adjusted indirect treatment comparison'
- Author
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null Karan Vadher, null Hiren Patel, null Reema Mody, null Joshua A. Levine, null Meredith Hoog, null Alice YY. Cheng, null Kevin M. Pantalone, and null Hélène Sapin
- Published
- 2022
41. Approach to the Patient with MODY-Monogenic Diabetes
- Author
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Kevin M. Pantalone, Louis H. Philipson, Sangeeta R. Kashyap, and David T. Broome
- Subjects
Male ,0301 basic medicine ,medicine.medical_specialty ,Pediatrics ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Urinary system ,Clinical Biochemistry ,030209 endocrinology & metabolism ,Physical examination ,Biochemistry ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Patient-Centered Care ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Hypoglycemic Agents ,Genetic Testing ,Family history ,Genetic testing ,Type 1 diabetes ,medicine.diagnostic_test ,business.industry ,Insulin ,Biochemistry (medical) ,medicine.disease ,HNF1A ,030104 developmental biology ,Diabetes Mellitus, Type 2 ,Approaches to the Patient ,business - Abstract
Maturity-onset diabetes of the young, or MODY-monogenic diabetes, is a not-so-rare collection of inherited disorders of non-autoimmune diabetes mellitus that remains insufficiently diagnosed despite increasing awareness. These cases are important to efficiently and accurately diagnose, given the clinical implications of syndromic features, cost-effective treatment regimen, and the potential impact on multiple family members. Proper recognition of the clinical manifestations, family history, and cost-effective lab and genetic testing provide the diagnosis. All patients must undergo a thorough history, physical examination, multigenerational family history, lab evaluation (glycated hemoglobin A1c [HbA1c], glutamic acid decarboxylase antibodies [GADA], islet antigen 2 antibodies [IA-2A], and zinc transporter 8 [ZnT8] antibodies). The presence of clinical features with 3 (or more) negative antibodies may be indicative of MODY-monogenic diabetes, and is followed by genetic testing. Molecular genetic testing should be performed before attempting specific treatments in most cases. Additional testing that is helpful in determining the risk of MODY-monogenic diabetes is the MODY clinical risk calculator (>25% post-test probability in patients not treated with insulin within 6 months of diagnosis should trigger genetic testing) and 2-hour postprandial (after largest meal of day) urinary C-peptide to creatinine ratio (with a ≥0.2 nmol/mmol to distinguish HNF1A- or 4A-MODY from type 1 diabetes). Treatment, as well as monitoring for microvascular and macrovascular complications, is determined by the specific variant that is identified. In addition to the diagnostic approach, this article will highlight recent therapeutic advancements when patients no longer respond to first-line therapy (historically sulfonylurea treatment in many variants). LEARNING OBJECTIVES: Upon completion of this educational activity, participants should be able to: Identify risk factors and learn when to suspect MODY-monogenic diabetes. Obtain appropriate diagnostic testing and evaluation prior to treatment. Determine appropriate monitoring and treatment for microvascular and macrovascular comorbidities. Recognize the recommended approach to treatment and monitoring that was performed in a patient with MODY-monogenic diabetes. TARGET AUDIENCE: This continuing medical education activity should be of substantial interest to endocrinologists and all health care professionals who care for people with diabetes mellitus.
- Published
- 2020
42. Cardiovascular outcomes trials with glucagon‐like peptide‐1 receptor agonists: A comparison of study designs, populations and results
- Author
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Kevin M. Pantalone, Juan M. Maldonado, Oralee J. Varnado, Clinton M. Hasenour, Kashif M. Munir, Charles Atisso, and Manige Konig
- Subjects
endocrine system ,medicine.medical_specialty ,cardiovascular diseaseGLP‐1type 2 diabetes ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Review Article ,Type 2 diabetes ,Disease ,030204 cardiovascular system & hematology ,Glucagon-Like Peptide-1 Receptor ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Risk Factors ,Weight loss ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,medicine ,Humans ,Hypoglycemic Agents ,Receptor ,Review Articles ,business.industry ,Clinical study design ,medicine.disease ,Glucagon-like peptide-1 ,Metformin ,Diabetes Mellitus, Type 2 ,Pharmaceutical Preparations ,Cardiovascular Diseases ,medicine.symptom ,business ,medicine.drug - Abstract
Despite treatment advances leading to improved outcomes over the past 2 decades, cardiovascular (CV) disease (CVD) remains the leading cause of morbidity and mortality in people with diabetes. People with type 2 diabetes (T2D) have a 2‐ to 4‐fold increased risk of CVD and CV death. Individuals with T2D have not seen the same improvements in CV morbidity and mortality as those without T2D. Given this, it is important to understand the CV impact of drugs used to treat T2D. In patients with T2D, glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) have shown a reduction in HbA1c and body weight regardless of their differences in chemical structure and pharmacokinetic variables. Glycaemic efficacy, accompanied by the potential for weight reduction and a low risk of hypoglycaemia, has moved GLP‐1 RAs to the first treatment of choice following metformin monotherapy in the latest American Diabetes Association treatment guidelines. Additionally, all GLP‐1 RAs have shown CV safety and several have proven CV benefit. GLP‐1 RAs have been evaluated in cardiovascular outcomes trials (CVOTs) of varying sizes, designs and patient populations with differing reported effects on CV outcomes. The purpose of this article is to review the completed GLP‐1 RA CVOTs with special attention to how their design, size, patient populations and conduct may influence the interpretation of results.
- Published
- 2020
43. The Probability of A1C Goal Attainment in Patients With Uncontrolled Type 2 Diabetes in a Large Integrated Delivery System: A Prediction Model
- Author
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Sheldon X. Kong, Todd Hobbs, Kevin M. Pantalone, Alex Milinovich, Paul Petraro, Rahul Ganguly, Janine Bauman, Bartolome Burguera, Robert S. Zimmerman, Michael W. Kattan, Xinge Ji, Wayne Weng, and Anita D. Misra-Hebert
- Subjects
Adult ,Male ,Research design ,medicine.medical_specialty ,Cardiovascular and Metabolic Risk ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Glycemic Control ,Type 2 diabetes ,Disease ,Patient Care Planning ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,medicine ,Humans ,Hypoglycemic Agents ,Treatment Failure ,030212 general & internal medicine ,Aged ,Probability ,Retrospective Studies ,Glycated Hemoglobin ,Advanced and Specialized Nursing ,Delivery of Health Care, Integrated ,business.industry ,nutritional and metabolic diseases ,Retrospective cohort study ,Middle Aged ,Prognosis ,medicine.disease ,Obesity ,United States ,Goal attainment ,Metformin ,Diabetes Mellitus, Type 2 ,Female ,business ,medicine.drug - Abstract
OBJECTIVE To assess patient characteristics and treatment factors associated with uncontrolled type 2 diabetes (T2D) and the probability of hemoglobin A1c (A1C) goal attainment. RESEARCH DESIGN AND METHODS This was a retrospective cohort study using the electronic health record at Cleveland Clinic. Patients with uncontrolled T2D (A1C >9%) were identified on the index date of 31 December 2016 (n = 6,973) and grouped by attainment (n = 1,653 [23.7%]) or nonattainment (n = 5,320 [76.3%]) of A1C RESULTS For the entire population, median age at index date was 57.7 years (53.3% male), and the majority were white (67.2%). Median A1C was 10.2%. Obesity (50.6%), cardiovascular disease (46.9%), and psychiatric disease (61.1%) were the most common comorbidities. Metformin (62.7%) and sulfonylureas (38.7%) were the most common antidiabetes medications. Only 1,653 (23.7%) patients achieved an A1C CONCLUSIONS A minority of patients with an A1C >9% achieved an A1C
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- 2020
44. Natural Language Processing Improves Detection of Nonsevere Hypoglycemia in Medical Records Versus Coding Alone in Patients With Type 2 Diabetes but Does Not Improve Prediction of Severe Hypoglycemia Events: An Analysis Using the Electronic Medical Record in a Large Health System
- Author
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Wayne Weng, Rahul Ganguly, Kevin M. Pantalone, Todd D. Hobbs, Alex Zajichek, Michael W. Kattan, Paul Petraro, Xinge Ji, Alex Milinovich, Anita D. Misra-Hebert, Michelle Mocarski, Sheldon X. Kong, Janine Bauman, and Robert S. Zimmerman
- Subjects
Research design ,Adult ,Male ,Endocrinology, Diabetes and Metabolism ,Information Storage and Retrieval ,030209 endocrinology & metabolism ,Type 2 diabetes ,Hypoglycemia ,computer.software_genre ,Severity of Illness Index ,Community Health Planning ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,International Classification of Diseases ,Predictive Value of Tests ,Diabetes mellitus ,Clinical Decision Rules ,Internal Medicine ,medicine ,Electronic Health Records ,Humans ,030212 general & internal medicine ,Aged ,Natural Language Processing ,Advanced and Specialized Nursing ,Aged, 80 and over ,business.industry ,Medical record ,Hazard ratio ,Middle Aged ,medicine.disease ,United States ,Novel Communications in Diabetes ,Diabetes Mellitus, Type 2 ,Female ,Diagnosis code ,Artificial intelligence ,business ,computer ,Natural language processing ,Algorithms ,Coding (social sciences) - Abstract
OBJECTIVE To determine if natural language processing (NLP) improves detection of nonsevere hypoglycemia (NSH) in patients with type 2 diabetes and no NSH documentation by diagnosis codes and to measure if NLP detection improves the prediction of future severe hypoglycemia (SH). RESEARCH DESIGN AND METHODS From 2005 to 2017, we identified NSH events by diagnosis codes and NLP. We then built an SH prediction model. RESULTS There were 204,517 patients with type 2 diabetes and no diagnosis codes for NSH. Evidence of NSH was found in 7,035 (3.4%) of patients using NLP. We reviewed 1,200 of the NLP-detected NSH notes and confirmed 93% to have NSH. The SH prediction model (C-statistic 0.806) showed increased risk with NSH (hazard ratio 4.44; P < 0.001). However, the model with NLP did not improve SH prediction compared with diagnosis code–only NSH. CONCLUSIONS Detection of NSH improved with NLP in patients with type 2 diabetes without improving SH prediction.
- Published
- 2020
45. Association between shared medical appointments and weight loss outcomes and anti‐obesity medication use in patients with obesity
- Author
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Janine Bauman, Rahul Ganguly, Todd Hobbs, Abhilasha Ramasamy, Bartolome Burguera, Elizabeth R. Pfoh, Alex Milinovich, Anita D. Misra-Hebert, Michael W. Kattan, Kelly Shibuya, Xinge Ji, Kevin M. Pantalone, and Wayne Weng
- Subjects
0301 basic medicine ,lcsh:Internal medicine ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,shared medical appointments ,030209 endocrinology & metabolism ,03 medical and health sciences ,0302 clinical medicine ,Weight loss ,Internal medicine ,Weight management ,medicine ,In patient ,Obesity ,lcsh:RC31-1245 ,Medication use ,030109 nutrition & dietetics ,Nutrition and Dietetics ,business.industry ,Retrospective cohort study ,Original Articles ,SMA ,medicine.disease ,weight management ,Anti obesity ,Original Article ,medicine.symptom ,business - Abstract
Summary Objective In shared medical appointments (SMAs), multiple patients with a similar clinical diagnosis are seen by a multidisciplinary team for interactive group sessions. Very few studies have specifically studied SMAs and weight loss in patients with obesity. This study compared weight loss outcomes and anti‐obesity medication (AOM) access between patients with obesity managed through (SMAs) versus individual appointments. Methods Retrospective study of adults seen for obesity between September 2014 and February 2017 at Cleveland Clinic Institute of Endocrinology and Metabolism. Percent weight loss from baseline was compared between two propensity score‐matched populations: patients who attended ≥1 SMA and patients managed with individual medical appointments. Results From all eligible patients identified (n=310 SMA, n=1,993 non‐SMA), 301 matched pairs were evaluated for weight loss. The SMA group (n=301) lost a mean of 4.2%, 5.2% and 3.8% of baseline weight over 6, 12 and 24 months; the non‐SMA group (n=301) lost significantly less weight (1.5%, 1.8% and 1.6%, respectively) (paired t‐test, P
- Published
- 2020
46. Type 1 diabetes, overweight and obesity: The overlooked epidemic
- Author
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Ella Burguera-Couce, Alex Milinovich, Xinge Ji, Michael W. Kattan, Marcio L. Griebeler, and Kevin M. Pantalone
- Subjects
Endocrinology, Diabetes and Metabolism ,Public Health, Environmental and Occupational Health ,Internal Medicine - Published
- 2022
47. Association between first-line monotherapy with metformin and the risk of atrial fibrillation (AMRAF) in patients with type 2 diabetes
- Author
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Anira Iqbal, Zehra Tekin, Michael W. Kattan, Xinge Ji, Alex Milinovich, Kevin M. Pantalone, Robert S. Zimmerman, Mina K. Chung, and Sangeeta R. Kashyap
- Subjects
Adult ,Heart Failure ,Endocrinology ,Diabetes Mellitus, Type 2 ,Endocrinology, Diabetes and Metabolism ,Atrial Fibrillation ,Internal Medicine ,Humans ,Insulin ,Hypoglycemic Agents ,Metformin ,Retrospective Studies - Abstract
Type 2 diabetes (T2D) has a strong association with atrial fibrillation (AF) which increases risk of thromboembolic events, heart failure, and frequent hospitalizations. Metformin is the first-line medication for T2D with proposed anti-inflammatory, pro-metabolic, and cardio-protective benefits. Our objective was to investigate if initial therapy with metformin is associated with reduced incidence of AF in comparison to other non-insulin anti-hyperglycemic agents in patients with newly diagnosed T2D.This retrospective cohort analysis included adults with a new diagnosis of T2D who were started on monotherapy (except insulin) between 2007 and 2017, without prior anti-hyperglycemic agent use, history of arrhythmias, or estimated GFR (eGFR) ≤ 30 ml/min. A multivariate analysis was performed using a fine-gray regression competing risk analysis to control for confounding variables after which pooled hazard ratios and 95 % confidence intervals were reported. Patients were followed until the end of study date, development of AF, addition of more anti-hyperglycemic agents, or death, whichever occurred first.Among 4584 metformin initiators compared to 1080 non-metformin monotherapy initiators, 10-year cumulative incidence of AF in metformin group was 5.2 % as compared to 8.1 % with other agents which was not statistically significant. Competing risk analysis did not demonstrate reduced rates of AF with metformin use (HR 0.92, 95 % CI 0.69 to 1.21; P = 0.55). Increased age and the presence of congestive heart failure were associated with significantly higher risk of AF in both groups (HR: 1.29, 95 % CI: 1.21 to 1.37; P ≤ 0.001; HR: 2.73, 95 % CI: 1.62 to 4.61; P ≤ 0.001, respectively).Initiation of metformin as a first line monotherapy for T2D, when compared to other non-insulin monotherapies, was not associated with decreased risk of developing AF in this retrospective observational study.
- Published
- 2022
48. A model-based simulation of glycaemic control and body weight when switching from semaglutide to 3.0- and 4.5-mg doses of once-weekly dulaglutide
- Author
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Kashif M. Munir, Kathleen Dungan, Manige Konig, Lai San Tham, Anita Y. M. Kwan, Cheng Cai Tang, and Kevin M. Pantalone
- Subjects
Endocrinology, Diabetes and Metabolism ,Recombinant Fusion Proteins ,Glucagon-Like Peptides ,Once weekly ,Glycemic Control ,Body weight ,Endocrinology ,Animal science ,Pharmacokinetics ,Weight loss ,Weight Loss ,Internal Medicine ,medicine ,Humans ,Hypoglycemic Agents ,Glycemic ,Glycated Hemoglobin ,business.industry ,Semaglutide ,Immunoglobulin Fc Fragments ,Diabetes Mellitus, Type 2 ,Pharmacodynamics ,Dulaglutide ,medicine.symptom ,business ,medicine.drug - Abstract
Aims To evaluate HbA1c and body weight changes when semaglutide 0.5 mg or 1.0 mg once weekly (QW) is switched to dulaglutide 3.0 mg or 4.5 mg QW via exposure-response modelling. Materials and methods HbA1c and body weight time-course models were developed and validated with data from SUSTAIN 1 to 10 trials for semaglutide and AWARD-11 trial for dulaglutide. Simulations were conducted for HbA1c and body weight over 52 weeks. In the initial 26 weeks, semaglutide was initiated at 0.25 mg and titrated to 0.5 or 1.0 mg QW via 4-weekly stepwise titration, followed by 26 weeks of dulaglutide initiated at 0.75 or 1.5 mg QW and escalated to 3.0 or 4.5 mg QW via 4-weekly stepwise titration. Results At 26 weeks, model-predicted mean changes from baseline in HbA1c and weight for semaglutide 0.5 mg were up to -1.55% and -3.44 kg, respectively. After switching to dulaglutide 3.0 mg, further reductions were 0.19% and 1.40 kg, respectively, at 52 weeks. Predicted mean HbA1c and weight changes for semaglutide 1.0 mg at 26 weeks were -1.84% and -4.96 kg, respectively; after switching to dulaglutide 4.5 mg, HbA1c was maintained with additional weight reduction of up to 0.57 kg at 52 weeks. Glycemic control was preserved switching from semaglutide 1.0 mg to dulaglutide 3.0 mg. Conclusions Switching from semaglutide 0.5 mg to dulaglutide 3.0 or 4.5 mg with dose escalation potentially yields additional HbA1c and weight reductions; switching from semaglutide 1.0 mg to dulaglutide 4.5 mg may enhance weight loss. This article is protected by copyright. All rights reserved.
- Published
- 2021
49. Ketogenic diets in the management of type 1 diabetes: Safe or safety concern?
- Author
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Dawn Noe, Shannon Knapp, Diana Isaacs, Kevin M. Pantalone, and Lauren Anne Buehler
- Subjects
Type 1 diabetes ,medicine.medical_specialty ,Diabetic ketoacidosis ,business.industry ,Insulin ,medicine.medical_treatment ,General Medicine ,Ketosis ,Hypoglycemia ,medicine.disease ,Increased risk ,Diabetes Mellitus, Type 1 ,Weight loss ,Weight Loss ,Medicine ,Humans ,medicine.symptom ,business ,Intensive care medicine ,Diet, Ketogenic ,Dyslipidemia ,Glycemic - Abstract
The jury is still out on whether a low-carbohydrate, ketosis-inducing diet is an effective and safe adjunctive therapy to insulin in type 1 diabetes. The limited published literature reports an association with weight loss and improved glycemic control and may, over the long-term, lead to reduced macrovascular and microvascular harm. However, the attendant increased risk of dyslipidemia, diabetic ketoacidosis, and hypoglycemia warrant caution, close monitoring of patients who embark on the diet, and further research.
- Published
- 2021
50. Author response for 'Associations of Weight Loss with Obesity‐Related Comorbidities in a Large Integrated Health System'
- Author
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Bartolome Burguera, Michael W. Kattan, Anita D. Misra-Hebert, Arshiya Mariam, Neeraj N. Iyer, Abhilasha Ramasamy, Galen Miller-Atkins, Janine Bauman, Robert S. Zimmerman, Todd Hobbs, Alex Milinovich, Michelle Mocarski, Kevin M. Pantalone, B. Gabriel Smolarz, and Daniel M. Rotroff
- Subjects
Gerontology ,Weight loss ,business.industry ,medicine ,medicine.symptom ,business ,medicine.disease ,Obesity - Published
- 2021
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