Diabetes

The growing global burden of obesity and type 2 diabetes mellitus (T2DM), commonly referred to as 'diabesity,' presents profound public health and economic concerns worldwide. Conventional treatment modalities often do not adequately address these intertwined diseases, highlighting the necessity for innovative therapeutic approaches. A recent breakthrough in this area is Tirzepatide, a dual agonist for glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptors. This paper explores the molecular structure, mechanisms of action, and clinical efficacy of Tirzepatide, particularly its superior performance in glycemic control and weight management compared to existing therapies. Additionally, Tirzepatide shows potential in ameliorating cardiovascular risk factors and metabolic dysfunction-associated steatotic liver disease (MASLD), positioning it as an effective strategy for the holistic management of diabesity

Background and Aims: Glucocorticoid-induced diabetes mellitus (GC-DM)is an underdiagnosed condition that sometimes requires urgent treatment. Indeed, the risk factors of GC-DM as well as its therapeutic management are little known. The aim of this study was to review the characteristics of the population at risk for developing GC-DM as well as its therapeutic modalities. Methods: A retrospective descriptive study was conducted at Charles Nicolle Hospital in Tunis enrolling 52 patients with GC-DM who were followed up in the Department of Endocrinology and Internal Medicine (1992-2020). Results: Mean age of patients was 47,8 ± 15,3 years. Eighteen patients (35%) had a family history of diabetes. The median body mass index (BMI) was 25.35 kg/m² [22.04-29.95]. Overweight was found in 25% and obesity in 25%. Twenty-two patients (42%) had hypertension, 21 (40%) had dyslipidaemias and 10 (19%) had IFG. The main underlying diseases requiring steroid therapy included vasculitis in 24 patients (46%) and autoimmune diseases in 15 patients (29%). In 54% of the patients, steroid therapy was administered at a high dose, in 35% at a very high dose, and in 11% at a medium dose. The median fasting blood glucose level at the time of diagnosis of GC-DM was at 14 mmol/L [9-18]. Fifteen patients (29%) developed GC-DM after 1 year. A pharmacological treatment was combined with lifestyle and dietary measures in 50 patients (96%). Oral antidiabetic agents alone were prescribed in 50% of the patients, insulin therapy: alone in 40% and in combination with oral antidiabetic agents in 6%. Methylprednisolone pulse therapy was significantly associated with initiation of insulin. Conclusion: Diabetes should not be neglected during steroid therapy. Strategies for prevention, detection and therapeutic management of GC-DM are the key elements to control the Morbi-mortality related to this condition.