News in brief: Low dose pasireotide for Cushing’s disease; Thrombosis and vaccination advice for people with diabetes; Lockdown does not worsen glycaemic control

Tuesday, 20 Apr 2021

Low dose pasireotide for Cushing’s disease

A lower dose of pasireotide may be effective in the long term management of Cushing’s disease and help minimise adverse effects, according to endocrinologists in Queensland.

Dr Mimi Wong and colleagues at the Department of Diabetes and Endocrinology, Townsville University Hospital, report the case of a 60-year-old female whose Cushing’s disease was successfully controlled for six years after she was inadvertently prescribed pasireotide at 360 µg twice daily, which is almost half the recommended dose.

Despite the low-dose, her urinary free cortisol (UFC) normalised within six months and Cushingoid features resolved. The patient remained in remission on the same low-dose for 6 years. However when the dosage was increased to the recommended 600 µg BID for the next 5 years, her glycaemia worsened without any changes in her UFC and residual tumour volume.

The case suggested that a low-dose regimen may be considered an option on the ground of its safety and tolerability profile, the report authors said.

No higher clot risk for people with diabetes after COVID-19 vaccination

There is no increased risk of thrombotic adverse effects from COVID-19 vaccines for people with diabetes, who are strongly advised to get vaccinated, according to the Australian Diabetes Society.

ADS President Dr Steve Stranks  said the risk of severe COVID-19 illness for people with diabetes was far greater than the very rare risk of blood clot complications with vaccination.

“The recommendation remains that adults with diabetes should get vaccinated. We encourage people with diabetes to talk to their doctor or other health professional about their personal circumstances,”

A TGA review of international data concluded there was no evidence of an increased risk of clotting problems with any COVID-19 vaccine in people with either type 1 or type 2 diabetes.

Lockdown does not worsen glycaemic control

COVID‐19 lockdowns have not significantly impacted glycaemic control in people with type 2 diabetes, according to Italian researchers. Their analysis of HbA1c levels of 141 people with type 2 diabetes who were subject to months of lockdown in 2020 found no difference in glycaemia compared to a matched control group of people with T2D who were not subject to lockdown.

The findings were consistent with results from other studies in people with insulin‐treated diabetes – and especially patients with type 1 diabetes – “suggesting that a more stable rhythm of life increases the time available to cope with daily management of diabetes,” the study investigators said.

“Thus, during the time of physical distancing and rearrangement of resources, healthcare providers could reduce the effort in following up stable patients, for example, by extending follow‐up appointments by a few months. The spared resources could then be used in the management of patients with T2D and relevant co‐morbidities who are at an increased risk of developing a poor prognosis of COVID‐19,” they suggested in Diabetes Obesity and Metabolism.

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