Browsing by Author "Behnke, Andrew J."

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    C-reactive Protein Levels in Patients With Autoimmune Hypothyroidism Before and After Levothyroxine Treatment
    Vudu, Stela; Behnke, Andrew J. (Springer, 2023-12-20)
    Background: Hypothyroidism is one of the most common endocrine disorders. Most patients with hypothyroidism have autoimmune thyroiditis (Hashimoto's), characterized by elevated concentrations of anti-thyroperoxidase (ATPO) antibodies. Both overt hypothyroidism (OH) and subclinical hypothyroidism (SH) have been associated with cardiovascular risk factors, including markers of inflammation. High-sensitivity C-reactive protein (hs-CRP) is a veridical marker of systemic inflammation. Even a minor increase in hs-CRP is considered a cardiovascular risk; therefore, evidence of a beneficial effect of levothyroxine treatment on hs-CRP could be an argument in favor of therapy for SH. Aim: To assess hs-CRP levels in patients with hypothyroidism and evaluate levothyroxine treatment's effect on hs-CRP. Study design: This is a cohort study in which patients with hypothyroidism were evaluated before and after treatment with levothyroxine. Methods: 37 patients (17 with OH and 20 with SH) and 38 healthy controls were included in the study. hs-CRP was measured at the baseline visit, then after 2 and 4 months of levothyroxine therapy at a dose necessary to achieve euthyroidism as evidenced by a normal level of thyroid-stimulating hormone (TSH). Results: hs-CRP was significantly increased in OH (p < 0.001) and SH (p = 0.001) at baseline as compared to controls. hs-CRP significantly decreased in SH (2.2±1.6 mg/L at baseline visit, 1.4±1.1 mg/L after 2 months of levothyroxine treatment, P = 0.017) and tended to decrease in OH (2.3±1.6 mg/L at baseline visit, 1.6±1.1 mg/L after 4 months of levothyroxine treatment, P = 0.067*). Conclusions: Patients with hypothyroidism have increased hs-CRP levels compared to a healthy control group and, thereby, a moderately increased cardiovascular risk. Achievement of euthyroidism by levothyroxine treatment decreased the levels of hs-CRP in patients with hypothyroidism.
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    Digital biomarkers: 3PM approach revolutionizing chronic disease management — EPMA 2024 position
    Smokovski, Ivica; Steinle, Nanette; Behnke, Andrew J.; Bhaskar, Sonu M. M.; Grech, Godfrey; Richter, Kneginja; Niklewski, Gunter; Birkenbihl, Colin; Parini, Paolo; Andrews, Russell J.; Bauchner, Howard; Golubnitschaja, Olga (2024-05-11)
    Non-communicable chronic diseases (NCDs) have become a major global health concern. They constitute the leading cause of disabilities, increased morbidity, mortality, and socio-economic disasters worldwide. Medical condition-specific digital biomarker (DB) panels have emerged as valuable tools to manage NCDs. DBs refer to the measurable and quantifiable physiological, behavioral, and environmental parameters collected for an individual through innovative digital health technologies, including wearables, smart devices, and medical sensors. By leveraging digital technologies, healthcare providers can gather real-time data and insights, enabling them to deliver more proactive and tailored interventions to individuals at risk and patients diagnosed with NCDs. Continuous monitoring of relevant health parameters through wearable devices or smartphone applications allows patients and clinicians to track the progression of NCDs in real time. With the introduction of digital biomarker monitoring (DBM), a new quality of primary and secondary healthcare is being offered with promising opportunities for health risk assessment and protection against health-to-disease transitions in vulnerable sub-populations. DBM enables healthcare providers to take the most cost-effective targeted preventive measures, to detect disease developments early, and to introduce personalized interventions. Consequently, they benefit the quality of life (QoL) of affected individuals, healthcare economy, and society at large. DBM is instrumental for the paradigm shift from reactive medical services to 3PM approach promoted by the European Association for Predictive, Preventive, and Personalized Medicine (EPMA) involving 3PM experts from 55 countries worldwide. This position manuscript consolidates multi-professional expertise in the area, demonstrating clinically relevant examples and providing the roadmap for implementing 3PM concepts facilitated through DBs.
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    Intensive Management of Poorly Controlled Type 2 Diabetes Using a Multidisciplinary Approach and Continuous Glucose Monitoring
    Behnke, Andrew J.; Woodfield, David (Elmer Press, 2023-06)
    Background: The purpose of this study was to examine the effects of a weekly monitoring interaction using continuous glucose monitoring (CGM) in a population of poorly controlled type 2 diabetes patients. Methods: This study was conducted in the outpatient clinical setting and examined levels of hemoglobin A1c (HbA1c) and time in range (TIR) glucose levels for 16 patients with poorly controlled type 2 diabetes as indicated by an HbA1c level of greater than 10%. The intervention included use of a continuous glucose monitor and weekly interactions either virtually or by telephone by one of the team members. Results: After a 3-month period, HbA1c levels reduced from 11.79% to 7.88% (P < 0.01) with 100% of the subjects achieving HbA1c of less than 10%. There were no significant changes in the amount of additional diabetes medication or insulin dose. Conclusions: The combination of CGM and frequent interaction in a brief (3 months) time frame may be a significant tool to improve glucose control in this high-risk population.
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    A Therapeutic Approach to Primary Hyperparathyroidism: A Collaborative Evaluation Between Endocrinology and Surgery
    Behnke, Andrew J.; Tershak, Daniel R.; Abel, William F.; Bankole, Adegbenga A. (Cureus, 2023-01-24)
    Introduction: Primary hyperparathyroidism (PHPT) is a disorder in which one or more parathyroid glands overproduce parathyroid hormone, leading to hypercalcemia. It may present with symptoms like constipation, abdominal pain, psychiatric complaints as well as signs of nephrolithiasis, and osteoporosis that may need surgical treatment. PHPT is often underdiagnosed and undertreated. Our study aimed to review hypercalcemia in a single center to evaluate for undiagnosed PHPT. Methods: A group of 546 patients from Southwest Virginia was selected using the EMR Epic (Epic Systems, Verona, USA) who had a diagnosis of hypercalcemia in the previous six months. Charts were manually reviewed, and patients were excluded based on the lack of hypercalcemia as well as previous testing of parathyroid hormone (PTH) levels. One hundred and fifty patients were excluded because of a lack of documented hypercalcemia. Letters were sent to the patients advising the patients to discuss whether a PTH would be indicated with their primary care provider (PCP). These patients’ charts were re-examined six months later and a determination of whether a PTH level was performed as well as any referrals explicitly for hypercalcemia or PHPT was done. Results: A total of 20 (5.1%) patients had a new PTH test during the time assessed. Of these patients, five received referrals to surgical treatment and six received referrals to endocrinology for treatment (no patients received referrals to both). Of those who obtained a PTH level, 50% of them had significantly elevated PTH levels consistent with the diagnosis of primary hyperparathyroidism. An additional 45% had levels of parathyroid hormone that were in the normal range but or most likely inappropriately normal for the concurrent level of calcium. Only one patient (5%) had a suppressed PTH level. Conclusion: The impact of an intervention on clinician evaluation and treatment of patients with hypercalcemia has been previously tested and shown to be beneficial. In this study, the method of directly sending a letter to patients yielded clinically significant results, with 20 patients out of 396 (5.1%) having a PTH level tested. A majority had an overt or suspected parathyroid disease, and out of them, 11 underwent referral for treatment.