Choice of estrogen and progesterone preparations: How to use judiciously?

Dr. Hurjahan Banu
Endocrinologist
Department of Endocrinology
Bangabandhu Sheikh Mujib Medical University
Dhaka, Bangladesh

Abstract

Diabetes in young individuals is a growing health concern, especially in South Asia that needs immediate attention. The cause of this early onset of diabetes is not clear as yet. Some probable mechanisms involving cytokines and genetic polymorphisms are under active investigation. Anyway, understanding the pathogenesis of the phenomenon of early onset of diabetes is important for the management of the problem. Our Study group (Study of Diabetes and Obesity in Youth – SODY) has investigated to some extent- C-peptide, autoantibodies (GAD and ZnT8 antibody), pancreatic enzymes (amylase and lipase), and HLADR-3 and DR-4 in youth-onset diabetes and compared with age-sex-matched subjects having normal glucose tolerance (NGT) without any significant difference or outcome that would help to characterize them to include into any defined class of diabetes. However, we observed a higher DPP-4 enzyme activity in young diabetes in comparison to NGT which opened a novel avenue to explore. Micronutrient like Zn was low and inflammatory marker like hs-CRP was high in youth-onset diabetes. We looked for nephropathy as a microvascular complication and observed significant albuminuria in about one in three persons with youth-onset diabetes. But, homocysteine, a known risk factor for cardiovascular events was not high in them. Adipokines are thought to have important implications in the pathogenesis of youth-onset diabetes. We observed low leptin and adiponectin as well as some genetic polymorphisms (single nucleotide polymorphisms-SNPs) related to these cytokines in youth-onset diabetes. We are investigating the genes responsible for maturity-onset-diabetes of young (MODY) and conducting a genome-wide association study (GWAS) for Type-2 DM in these young subjects in order to understand their disposition into some of the defined subclasses.

Keywords: Youth-onset diabetes; Type 1 diabetes; Adipokine