Managing Cushing’s Syndrome Hyperglycemia
Managing Cushing’s Syndrome Hyperglycemia Cushing’s Syndrome is a complex hormonal disorder that can lead to various complications, including hyperglycemia. Hyperglycemia refers to high blood sugar levels, which can pose significant health risks. Steroid-induced hyperglycemia, a common occurrence in individuals with Cushing’s Syndrome, further complicates the management of this condition.
With our comprehensive insights, we aim to enhance your understanding of Cushing’s Syndrome Hyperglycemia, its symptoms, diagnosis, and the latest treatment options. We will also discuss the role of lifestyle modifications and highlight the support and resources available for individuals facing this challenge.
Throughout this article, we will focus on empowering you to take control of your health by providing information and guidance. Let’s dive into the world of managing Cushing’s Syndrome Hyperglycemia and discover the valuable contributions of Acibadem Healthcare Group in this field.
Get Free Consultation
ACIBADEM Health Point: The Future of Healthcare
We believe that everyone deserves access to quality healthcare, which is why we have established multiple branches in strategic locations. Whether you're in need of routine check-ups, specialized treatments, or emergency care, ACIBADEM Health Point is here for you.Understanding Cushing’s Syndrome Hyperglycemia
In individuals with Cushing’s syndrome, hyperglycemia, also known as high blood sugar, is a common concern. Hyperglycemia in Cushing’s disease is primarily caused by the excessive production of glucocorticoids, such as cortisol, which disrupts glucose metabolism in the body.
Glucocorticoid-induced hyperglycemia further exacerbates the already elevated blood sugar levels in individuals with Cushing’s syndrome. The prolonged exposure to high levels of cortisol leads to insulin resistance, impaired insulin production, and increased hepatic glucose production, ultimately resulting in hyperglycemia.
To better understand the relationship between Cushing’s syndrome and hyperglycemia, let’s explore the mechanisms involved:
ACIBADEM Health Point: Your Health is Our Priority!
ACIBADEM Health Point, we are dedicated to providing exceptional healthcare services to our patients. With a team of highly skilled medical professionals and state-of-the-art facilities, we strive to deliver the highest standard of care to improve the health and well-being of our patients. What sets ACIBADEM Health Point apart is our patient-centered approach. We prioritize your comfort, safety, and satisfaction throughout your healthcare journey. Our compassionate staff ensures that you receive personalized care tailored to your unique needs, making your experience with us as seamless and comfortable as possible.Impaired Glucose Tolerance
Individuals with Cushing’s syndrome often experience impaired glucose tolerance, which means that their bodies have difficulty regulating blood sugar levels after consuming carbohydrates. This can lead to consistently elevated blood sugar levels.
Increased Hepatic Glucose Production
Cortisol, in high concentrations, stimulates glucose production in the liver. In Cushing’s syndrome, the excess cortisol triggers the liver to release more glucose into the bloodstream, contributing to elevated blood sugar levels.
Insulin Resistance
Chronic exposure to high levels of cortisol can cause insulin resistance. Insulin resistance occurs when the body’s cells become less responsive to the hormone insulin, leading to impaired glucose uptake and utilization.
Impaired Insulin Secretion
Additionally, prolonged exposure to high cortisol levels can impair the secretion of insulin by the pancreas. Insufficient insulin production further hampers the body’s ability to regulate blood sugar levels efficiently.
Increased Appetite and Weight Gain
The excessive cortisol production in Cushing’s syndrome can also lead to increased appetite and weight gain. These factors contribute to the development and exacerbation of hyperglycemia.
To further explore the impact of glucocorticoid-induced hyperglycemia, let’s take a closer look at a comparative table:
Cushing’s Syndrome Hyperglycemia | Glucocorticoid-Induced Hyperglycemia | |
---|---|---|
Causes | Elevated cortisol levels in Cushing’s syndrome | Exogenous glucocorticoids (steroids) |
Mechanisms | Insulin resistance, impaired insulin secretion, increased hepatic glucose production | Insulin resistance, impaired insulin secretion, increased hepatic glucose production |
Prevalence | Common in individuals with Cushing’s syndrome | Common in patients using glucocorticoid medications |
Management | Individualized treatment plans, lifestyle modifications, medication, and close monitoring | Individualized treatment plans, lifestyle modifications, medication, and close monitoring |
Complications | Increased risk of cardiovascular disease, infections, and other complications associated with uncontrolled hyperglycemia | Increased risk of cardiovascular disease, infections, and other complications associated with uncontrolled hyperglycemia |
Symptoms of Cushing’s Syndrome Hyperglycemia
Individuals with Cushing’s syndrome hyperglycemia may experience a range of symptoms that can be indicative of elevated blood glucose levels. Recognizing these symptoms is crucial for timely management and treatment. Here are some common indications of hyperglycemia in individuals with Cushing’s syndrome:
- Frequent urination: Increased urination, especially during the night, can be a sign of high blood sugar levels.
- Excessive thirst: Feeling constantly thirsty and needing to drink large amounts of fluids may be a result of hyperglycemia.
- Unexplained weight gain: Rapid weight gain, particularly in the face, abdomen, and upper back, can be seen in individuals with Cushing’s syndrome hyperglycemia.
- Difficulty losing weight: Despite efforts to manage weight through diet and exercise, individuals with Cushing’s syndrome hyperglycemia may struggle to shed excess pounds.
- Fatigue and muscle weakness: Persistent tiredness, weakness, and reduced stamina are common symptoms associated with elevated blood sugar levels.
- Infections that are slow to heal: Hyperglycemia can weaken the immune system, making it harder for the body to fight off infections and slowing down the healing process.
- Changes in mood and cognitive function: Increased irritability, anxiety, difficulty concentrating, and memory problems are often observed in individuals with elevated blood glucose levels.
- Blurred vision: High blood sugar levels can cause changes in vision, making it difficult to focus clearly.
- Skin changes: Thinning of the skin, easy bruising, and slow wound healing are common symptoms seen in individuals with Cushing’s syndrome hyperglycemia.
If you experience any of these symptoms, it is important to consult a healthcare professional for further evaluation and appropriate management. Timely diagnosis and treatment are essential for controlling hyperglycemia in individuals with Cushing’s syndrome.
Diagnosing Cushing’s Syndrome Hyperglycemia
Diagnosing Cushing’s syndrome hyperglycemia involves a comprehensive evaluation and the identification of glucocorticoid-induced hyperglycemia. Physicians utilize various tests and evaluations to confirm the presence of this condition.
Glucocorticoid-Induced Hyperglycemia
Glucocorticoid-induced hyperglycemia plays a significant role in the diagnosis of Cushing’s syndrome hyperglycemia. This condition occurs as a result of the excessive use or prolonged exposure to glucocorticoid medications, leading to elevated blood glucose levels.
When assessing a patient for Cushing’s syndrome hyperglycemia, healthcare professionals consider the patient’s medical history, including the use of glucocorticoid medications. They also evaluate the symptoms of hyperglycemia, such as increased thirst, frequent urination, and unexplained weight loss.
To confirm glucocorticoid-induced hyperglycemia, doctors may order specific laboratory tests, including:
- Oral glucose tolerance test (OGTT): This test measures blood glucose levels before and after consuming a glucose solution. It helps evaluate the body’s ability to regulate blood sugar.
- Fasting blood glucose (FBG) test: This test measures blood glucose levels after an overnight fast. Elevated levels may indicate hyperglycemia.
- Hemoglobin A1c (HbA1c) test: This test provides an average of blood glucose levels over the past three months, indicating long-term glucose control.
- Random blood glucose test: This test measures blood glucose levels at a random time. Elevated levels may suggest hyperglycemia.
In addition to these tests, healthcare professionals may perform a physical examination, assess other symptoms of Cushing’s syndrome, and order further diagnostic tests such as imaging studies, cortisol level measurements, and ACTH stimulation tests.
Laboratory Tests for Diagnosing Cushing’s Syndrome Hyperglycemia
“`
Test | Purpose |
---|---|
Oral glucose tolerance test (OGTT) | Evaluates the body’s ability to regulate blood sugar through glucose level measurements before and after consuming a glucose solution. |
Fasting blood glucose (FBG) test | Measures blood glucose levels after an overnight fast to check for elevated levels. |
Hemoglobin A1c (HbA1c) test | Provides an average of blood glucose levels over the past three months, indicating long-term glucose control. |
Random blood glucose test | Measures blood glucose levels at a random time to assess for hyperglycemia. |
“`
It is crucial to diagnose Cushing’s syndrome hyperglycemia accurately to initiate appropriate management and treatment. Early detection allows healthcare providers to develop personalized treatment plans that address both the underlying Cushing’s syndrome and the associated hyperglycemia.
Hyperglycemia Management in Cushing’s Syndrome
Effectively managing hyperglycemia in individuals with Cushing’s syndrome is crucial for maintaining optimal health and well-being. Given the complex nature of this condition, a personalized approach to treatment is essential.
When developing a management plan, healthcare providers consider various factors such as the severity of hyperglycemia, underlying causes, and the presence of concurrent diabetes. Tailoring treatment strategies to individual needs helps to optimize glucose control and minimize complications.
In cases where Cushing’s syndrome is accompanied by diabetes, careful monitoring and coordination of treatment plans are necessary. The management of both conditions requires close attention to diet, medication, and lifestyle modifications.
To assist healthcare professionals in devising effective hyperglycemia management strategies, the following approaches may be employed:
- Medication: Antidiabetic medications, such as metformin or insulin, may be prescribed to regulate blood sugar levels. Dosages will be adjusted based on individual responses and ongoing monitoring.
- Dietary modifications: Working with a registered dietitian, individuals can develop a balanced meal plan that helps regulate glucose levels. The plan may include portion control, carbohydrate counting, and choosing foods with a low glycemic index.
- Regular physical activity: Exercise is an important component of managing hyperglycemia in Cushing’s syndrome. It can help improve insulin sensitivity and support weight management. Healthcare providers can recommend suitable exercise programs based on individual fitness levels and limitations.
- Stress reduction techniques: Chronic stress can impact glucose control. Implementing stress reduction techniques such as meditation, yoga, or mindful practices can aid in managing hyperglycemia.
- Monitoring and tracking: Regular glucose monitoring and tracking are essential to assess the effectiveness of management strategies. Continuous glucose monitoring devices or self-monitoring may be employed to detect fluctuations and make necessary adjustments to the treatment plan.
By adopting a multidisciplinary approach and implementing these strategies, individuals with Cushing’s syndrome can effectively manage hyperglycemia and reduce the risk of complications. It is crucial to work closely with healthcare providers to develop an individualized treatment plan that addresses both the underlying cause of hyperglycemia and the presence of comorbidities such as diabetes.
Management Strategies for Hyperglycemia in Cushing’s Syndrome | Benefits |
---|---|
Medication | Regulates blood sugar levels |
Dietary modifications | Supports balanced blood glucose control |
Regular physical activity | Improves insulin sensitivity and weight management |
Stress reduction techniques | Aids in managing blood glucose levels |
Monitoring and tracking | Assesses the effectiveness of management strategies |
Latest Treatments for Cushing’s Syndrome Hyperglycemia
In recent years, significant progress has been made in developing advanced treatments for Cushing’s syndrome hyperglycemia. These innovative therapies aim to effectively manage hyperglycemia and maintain optimal glucose levels in individuals with this condition.
New Medications
One of the most exciting advancements in hyperglycemia treatment for Cushing’s syndrome is the development of new medications specifically designed to regulate glucose levels. These medications target the underlying mechanisms causing hyperglycemia and can help individuals achieve better control over their blood sugar levels.
Hormone Therapy
Certain hormone therapy options have shown promise in managing hyperglycemia in individuals with Cushing’s syndrome. By effectively balancing hormonal activity and controlling excessive cortisol production, these treatments can help stabilize blood sugar levels and reduce the risk of complications associated with hyperglycemia.
Insulin Therapy
In some cases, individuals with Cushing’s syndrome hyperglycemia may require insulin therapy to manage their blood sugar levels effectively. Insulin therapy can be tailored to meet the individual’s specific needs, ensuring optimal glucose control and minimizing the risk of hyperglycemic episodes.
Surgical Interventions
In severe cases of Cushing’s syndrome hyperglycemia, surgical interventions may be necessary to address the underlying cause of the condition. These procedures aim to remove tumors or other abnormalities that contribute to excessive cortisol production, leading to improved glucose control and overall health.
Emerging Therapies
Research in the field of Cushing’s syndrome hyperglycemia is ongoing, and exciting emerging therapies are on the horizon. These cutting-edge treatments hold the potential to revolutionize the management of hyperglycemia in individuals with Cushing’s syndrome, offering new hope for improved outcomes and quality of life.
Treatment | Description |
---|---|
New Medications | Target the underlying mechanisms causing hyperglycemia and regulate blood sugar levels. |
Hormone Therapy | Balance hormonal activity and control excessive cortisol production to stabilize blood sugar levels. |
Insulin Therapy | Tailored approach to meet individual needs, ensuring optimal glucose control. |
Surgical Interventions | Remove tumors or abnormalities causing excessive cortisol production, leading to improved glucose control. |
As research continues to advance, it is essential for individuals with Cushing’s syndrome hyperglycemia to stay informed about the latest treatment options and consult with healthcare professionals to determine the most suitable approach for their specific needs.
Acibadem Healthcare Group: Leaders in Cushing’s Syndrome Hyperglycemia Care
Acibadem Healthcare Group is at the forefront of providing exceptional care and treatment for patients with Cushing’s syndrome hyperglycemia. With their comprehensive approach and expertise in this field, they have become leaders in managing this complex condition.
At Acibadem Healthcare Group, the team of experienced healthcare professionals understands the unique challenges faced by individuals with Cushing’s syndrome hyperglycemia. They are dedicated to providing personalized and compassionate care to ensure the best possible outcomes for their patients.
The healthcare group offers a range of specialized services for Cushing’s syndrome hyperglycemia, tailored to meet the individual needs of each patient. Their multidisciplinary team collaborates closely to develop personalized treatment plans that address both the underlying causes of hyperglycemia and its associated symptoms.
Expertise and Advancements
Acibadem Healthcare Group combines their expertise with the latest advancements in the management of Cushing’s syndrome hyperglycemia. They stay at the forefront of medical research and technology, continuously striving to improve patient outcomes and quality of life.
Their team of specialists utilizes state-of-the-art diagnostic tools and cutting-edge treatments to accurately diagnose and effectively manage hyperglycemia in individuals with Cushing’s syndrome. By focusing on evidence-based practices, they offer innovative and targeted therapies that can effectively control glucose levels.
Comprehensive Care Approach
What sets Acibadem Healthcare Group apart is their holistic and comprehensive approach to Cushing’s syndrome hyperglycemia care. They understand that managing this condition goes beyond treating hyperglycemia alone, taking into account the individual as a whole.
Their care teams work closely with patients to address not only the physical aspects but also the emotional and psychological impact of living with Cushing’s syndrome hyperglycemia. This patient-centric approach ensures that individuals receive the support they need to cope with the challenges associated with the condition.
Exemplary Patient Care
Acibadem Healthcare Group is committed to providing exemplary patient care throughout the entire treatment journey. They prioritize open communication, active collaboration, and extensive patient education to empower individuals with the knowledge and tools needed to manage their condition effectively.
By offering comprehensive support services and resources, Acibadem Healthcare Group helps patients navigate the complexities of Cushing’s syndrome hyperglycemia, ensuring they receive the highest possible standard of care.
Key Highlights: |
---|
Specialized services tailored to meet individual needs |
Utilization of cutting-edge technologies and treatments |
Comprehensive and holistic care approach |
Emphasis on patient education and support |
Lifestyle Modifications for Cushing’s Syndrome Hyperglycemia
Managing hyperglycemia associated with Cushing’s syndrome requires a holistic approach that includes lifestyle modifications. By making certain changes to your diet, exercise routine, and stress management practices, you can positively impact your glucose levels and improve overall health.
Dietary Changes
Eating a balanced diet is essential for managing hyperglycemia in Cushing’s syndrome. Here are some dietary recommendations:
- Limit your intake of sugary foods and beverages.
- Choose complex carbohydrates over refined ones.
- Incorporate plenty of fruits and vegetables into your meals.
- Opt for lean proteins and healthy fats.
- Monitor portion sizes to maintain stable blood sugar levels.
Exercise Recommendations
Regular physical activity can help regulate blood glucose levels. Consider the following exercise recommendations:
- Aim for at least 150 minutes of moderate-intensity aerobic exercise per week.
- Incorporate strength training exercises into your routine to build muscle mass and improve insulin sensitivity.
- Consult with a healthcare professional to develop an exercise plan that suits your individual needs and capabilities.
Stress Reduction Strategies
Stress can contribute to elevated blood glucose levels. Practice stress reduction techniques such as:
- Engage in relaxation techniques like deep breathing exercises and meditation.
- Try incorporating activities that bring you joy and promote relaxation, such as yoga or spending time in nature.
- Ensure you get adequate sleep to support your body’s stress response.
Summary
Lifestyle modifications play a crucial role in managing hyperglycemia associated with Cushing’s syndrome. By making dietary changes, engaging in regular exercise, and reducing stress levels, individuals can take control of their glucose levels and improve their overall well-being.
Lifestyle Modifications | Benefits |
---|---|
Dietary Changes | Stabilizes blood sugar levels |
Exercise Recommendations | Improves insulin sensitivity |
Stress Reduction Strategies | Reduces stress-induced hyperglycemia |
Support and Resources for Individuals with Cushing’s Syndrome Hyperglycemia
Living with Cushing’s syndrome hyperglycemia can pose unique challenges. Connecting with others who understand your experiences and having access to reliable information are crucial for managing this condition effectively. Fortunately, there are several support groups, online communities, and resources available to individuals with Cushing’s syndrome hyperglycemia.
Support Groups
Support groups provide a safe and understanding space for individuals with Cushing’s syndrome hyperglycemia to share their stories, exchange tips, and offer emotional support. Joining a support group can help you feel less alone in your journey and provide valuable insights from others who have firsthand experience dealing with this condition.
Here are a few support groups that you may find helpful:
- Cushing’s Support and Research Foundation
- Cushing’s Help and Support
- Cushing’s Syndrome Support Group (on Facebook)
Online Communities
Online communities offer a convenient way to connect with others and access information about Cushing’s syndrome hyperglycemia. These communities typically have forums, discussion boards, and chat groups where you can interact, ask questions, and seek advice. Engaging with online communities can provide a valuable sense of belonging and empower you with knowledge.
Here are some popular online communities for individuals with Cushing’s syndrome hyperglycemia:
- The Cushings-Help.com Forum
- The RareConnect Cushing’s Syndrome Community
- The Cushing’s Syndrome Support and Information Group (on Facebook)
Additional Resources
In addition to support groups and online communities, there are various resources available to help you navigate the challenges of Cushing’s syndrome hyperglycemia. These resources can provide you with comprehensive information, tips on self-care, and updates on the latest advancements in treatment.
Here are some reliable resources you may want to explore:
- Endocrine Society – The Endocrine Society offers educational materials and resources on Cushing’s syndrome hyperglycemia.
- Acibadem Healthcare Group – Acibadem Healthcare Group, a renowned healthcare provider, offers comprehensive information and treatment options for Cushing’s syndrome hyperglycemia.
Comparison of Support Groups and Online Communities
Support Group/Online Community | Key Features | Contact Information |
---|---|---|
Cushing’s Support and Research Foundation | – Regular support group meetings – Educational resources – Opportunities to participate in research studies |
Website: www.CSRF.net |
Cushing’s Help and Support | – Online support platform – Discussion forums – Personal stories and experiences shared by community members |
Website: www.cushings-help.com |
Cushing’s Syndrome Support Group (on Facebook) | – Active Facebook group – Peer-to-peer support – Resources and information sharing |
Facebook Group: Cushing’s Syndrome Support Group |
The Cushings-Help.com Forum | – Dedicated online forum – Topics on Cushing’s syndrome and related conditions – Expert advice from medical professionals |
Website: www.cushings.invisionzone.com |
The RareConnect Cushing’s Syndrome Community | – Global online community – Multilingual platform – Expert-led discussions and webinars |
Website: www.rareconnect.org |
The Cushing’s Syndrome Support and Information Group (on Facebook) | – Engaging Facebook group – Peer support – Recent news and updates |
Facebook Group: The Cushing’s Syndrome Support and Information Group |
Remember, reaching out for support and accessing relevant resources can make a significant difference in your journey with Cushing’s syndrome hyperglycemia. By connecting with others who understand your experiences and staying informed, you can navigate this condition more effectively and improve your overall well-being.
Conclusion: Taking Control of Cushing’s Syndrome Hyperglycemia
In conclusion, effective management of Cushing’s syndrome hyperglycemia is crucial for individuals living with this condition. By implementing appropriate strategies, individuals can take control of their health and minimize the impact of hyperglycemia on their daily lives.
Early diagnosis plays a key role in the successful management of Cushing’s syndrome hyperglycemia. Recognizing the symptoms, such as increased thirst, frequent urination, and fatigue, is essential for timely intervention.
Staying informed about the latest treatments is important as new advancements continue to emerge. With individualized treatment plans, including lifestyle modifications, medication, and ongoing monitoring, individuals can effectively manage their hyperglycemia.Managing Cushing’s Syndrome Hyperglycemia
Moreover, seeking support from organizations and communities dedicated to Cushing’s syndrome hyperglycemia can provide invaluable resources and connections to others facing similar challenges. By sharing experiences and knowledge, individuals can navigate their journey with confidence and find the support they need.
FAQ
How does Cushing's syndrome contribute to hyperglycemia?
Cushing's syndrome can lead to hyperglycemia due to the excessive production of cortisol, a hormone that increases blood sugar levels. It can also cause insulin resistance, further exacerbating the hyperglycemic state.
What is the role of glucocorticoid-induced hyperglycemia in Cushing's syndrome?
Glucocorticoid-induced hyperglycemia is a common occurrence in individuals with Cushing's syndrome. This type of hyperglycemia is mainly caused by the administration of glucocorticoid medications used in the treatment of Cushing's syndrome and other conditions.
What are the symptoms of hyperglycemia in individuals with Cushing's syndrome?
Symptoms of hyperglycemia in Cushing's syndrome may include increased thirst, frequent urination, fatigue, blurred vision, and slow wound healing. It is crucial to recognize these symptoms and seek medical attention for proper management.
How is Cushing's syndrome hyperglycemia diagnosed?
To diagnose hyperglycemia in individuals with Cushing's syndrome, healthcare professionals may perform blood tests to measure fasting glucose levels, oral glucose tolerance tests, and assess glycosylated hemoglobin (HbA1c) levels. In some cases, additional diagnostic imaging may be required.
How is hyperglycemia managed in individuals with Cushing's syndrome?
The management of hyperglycemia in Cushing's syndrome requires a multi-faceted approach. It may involve lifestyle modifications such as dietary changes and regular exercise, medications such as insulin or oral glucose-lowering agents, and close monitoring of blood glucose levels.
What are the latest treatments available for Cushing's syndrome hyperglycemia?
Research and advancements in the field of Cushing's syndrome hyperglycemia have led to the development of novel treatment options. These may include targeted therapies, glucocorticoid receptor antagonists, and other medications aimed at improving glucose control in affected individuals.
How does the Acibadem Healthcare Group specialize in the care of Cushing's syndrome hyperglycemia?
Acibadem Healthcare Group is renowned for its expertise in managing Cushing's syndrome hyperglycemia. With a multidisciplinary approach, they offer personalized treatment plans, access to cutting-edge therapies, and comprehensive support for individuals with this condition.
What lifestyle modifications can help manage hyperglycemia in Cushing's syndrome?
Making certain lifestyle modifications can be beneficial in managing hyperglycemia associated with Cushing's syndrome. These may include adopting a balanced diet, engaging in regular physical activity, managing stress levels, and getting adequate sleep.
Are there any support resources available for individuals with Cushing's syndrome hyperglycemia?
Yes, there are various support groups, online communities, and resources available for individuals living with Cushing's syndrome hyperglycemia. These platforms provide a supportive environment, information, and opportunities to connect with others going through similar experiences.
ACIBADEM Healthcare Group Hospitals and Clinics
With a network of hospitals and clinics across 5 countries, including 40 hospitals, ACIBADEM Healthcare Group has a global presence that allows us to provide comprehensive healthcare services to patients from around the world. With over 25,000 dedicated employees, we have the expertise and resources to deliver unparalleled healthcare experiences. Our mission is to ensure that each patient receives the best possible care, supported by our commitment to healthcare excellence and international healthcare standards. Ready to take the first step towards a healthier future? Contact us now to schedule your Free Consultation Health session. Our friendly team is eager to assist you and provide the guidance you need to make informed decisions about your well-being. Click To Call Now !*The information on our website is not intended to direct people to diagnosis and treatment. Do not carry out all your diagnosis and treatment procedures without consulting your doctor. The contents do not contain information about the therapeutic health services of ACIBADEM Health Group.