bluuebunny/crossref_metadata_2025 huggingface dataset:
Familial Isolated Pituitary Adenomas
Authors: Chahal Harvinder S , Kumar VK Ajith , Korbonits Márta ,   Specialist Registrar in Endocrinology, Centre for Endocrinology, Barts and the London Medical School,   Consultant in Clinical Genetics, Clinical Genetics Department, Great Ormond Street Hospital,   Professor of Endocrinology and Metabolism, Centre for Endocrinology, Barts and the London Medical School
Published: October 2015

Over the last century several families have been described with familial isolated pituitary adenomas (FIPAs). Most commonly, family members have acromegaly or prolactinoma, but other types of pituitary adenomas can also occur. Recently, mutations in theAIP(aryl hydrocarbon receptor interacting protein) gene have been found to occur in 30–50% of FIPA patients, while for the rest of the patients the gene causing the disease is currently unknown and is a topic of intense research. Tumours in patients withAIPmutations are diagnosed at significantly younger ages and tend to be larger. Often the response to medical therapy in these patients is poor. This article discusses the clinical and genetic characteristics of this relatively recently recognised disease.
The Importance of Reducing Hyperglycemia While Preserving Insulin Secretion—The Rationale for Sodium-coupled Glucose Co-transporter 2 Inhibition in Diabetes
Authors: Jabbour Serge A ,   Associate Professor of Medicine, and Interim Director, Division of Endocrinology, Diabetes, and Metabolic Diseases, Jefferson Medical College, Thomas Jefferson University
Published: October 2015

The prevalence of type 2 diabetes continues to rise in a number of countries, presenting a need for additional effective therapeutic options to be developed. This condition has often been treated with medications that can lead to hypoglycemia (sulfonylureas), weight gain (thiazolidinediones), or other side effects, including the gastrointestinal side effects sometimes experienced with metformin. Sodium-coupled glucose co-transporter 2 (SGLT2) inhibitors are a novel class of drugs under investigation that target the kidney’s ability to reabsorb glucose into the bloodstream, improving glycemic control and aiding weight loss without inducing hypoglycemia. These compounds have shown encouraging results in several studies without any serious adverse events. They could therefore potentially become an important addition to the currently available diabetes treatments.
Mitochondrial Dysfunction in Obesity and Diabetes
Authors: Sivitz William I ,   Professor and Director, Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Iowa and Iowa City Veterans Affairs Medical Center
Published: October 2015

Mitochondrial abnormalities have been reported in both insulin-deficient and insulin-resistant states and in the related condition of obesity. The phrase ‘mitochondrial dysfunction’ is often used in this regard. However, beyond dysfunction, there is evidence for defects in mitochondrial biogenesis, number, morphology, and dynamics (fusion and fission). Diabetes and obesity are also associated with the overproduction of mitochondrial reactive oxygen species (ROS), leading to mitochondrial and cellular oxidative damage. This, in turn, contributes to the development and progression of diabetic complications and to worsening of the diabetic stateper se. Here we will review the evidence for mitochondrial abnormalities in type 2 diabetes and obesity and consider underlying mechanisms. We will also discuss potential therapeutic interventions targeted at mitochondria.
Progression of Treatment Strategies in Type 2 Diabetes
Authors: Holt Richard IG ,   Professor of Diabetes and Endocrinology, Developmental Origins of Health and Disease Division, School of Medicine, University of Southampton
Published: October 2015

There is a global pandemic of diabetes and the progression of disease and long-term complications impose a major health burden. The older diabetes treatments improve glycemic control but have minimal effect on disease progression and long-term cardiovascular complications. Additionally, comorbid hypertension, hyperlipidemia and smoking significantly contribute to morbidity and mortality. Lifestyle changes remain the cornerstone of management, particularly as a large number of people with diabetes are obese and take little physical activity. Structured education interventions, dietary advice and exercise programs form the basis of changes that are necessary. Current guidelines for the management of type 2 diabetes suggest a glycated hemoglobin (HbA1c) treatment goal of 6.5–7.0% (48–53mmol/mol). The first-line pharmacological treatment is metformin. Second-line treatment strategies are varied and the subject for debate; generally, guidelines allow the clinician much flexibility. Until the past few years, drug therapy with metformin, sulfonylureas and thiazolidinediones, followed by treatment with insulin, has been the norm, but adverse events of hypoglycemia and weight gain have limited their effectiveness. There are now a number of new agents available with differing mechanisms of action. The glucagon-like peptide-1 receptor agonists have shown effective glycemic control and may preserve beta-cell function. Recently, a once-weekly parenteral incretin mimetic was shown to be more effective than daily insulin. Dipeptidyl peptidase-4 inhibitor agents are orally administered, as effective as metformin and not associated with hypoglycemia or weight gain. Human amylin analogs are effective agents when combined with insulin therapy. Long-term studies are not yet available for these new agents, but their effect on beta-cell function preservation in animal models leads to the hope that progression of diabetes may be delayed. Initiation of more intensive treatment at an earlier stage may be associated with reduced complications, but possibly at the expense of more adverse events.
Growth Hormone Treatment in Children Born Small for Gestational Age—Adult Height and Metabolic Consequences
Authors: Klein Michelle L , Rapaport Robert ,   Fellow in Pediatric Endocrinology and Diabetes,   Professor of Pediatrics and Chief, Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Mount Sinai School of Medicine
Published: October 2015

Short-term studies of children born small for gestational age (SGA) who do not adequately catch up have shown that growth hormone (GH) treatment over a range of doses is both safe and effective at increasing growth velocity and height standard deviation (SD). Long-term studies have shown an improvement in adult height compared with untreated controls. Predictors of growth response include height and weight at start of GH treatment, pre-treatment growth velocity, target height, and pre-pubertal years treated with GH. Height prediction models are being developed to help maximize GH treatment response. While some short-term studies of GH treatment in SGA children have shown abnormalities in carbohydrate metabolism, long-term studies have demonstrated that these changes were transient. GH treatment has been shown to be safe and effective in increasing adult height of children born SGA. Follow-up is needed for assessment of the long-term effects of GH treatment.
Optimal Therapy of Growth Hormone Deficiency in the Child and Adolescent
Authors: Rose Susan R ,   Professor of Endocrinology, Division of Pediatric Endocrinology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati
Published: October 2015

Optimal therapy of growth disorders depends on accurate diagnosis and clear goals for therapy. Understanding normal patterns of growth hormone (GH) and insulin-like growth factor secretion are necessary to appreciate the different hormone pattern induced by therapy. Finally, monitoring efficacy and safety, identifying interfering factors, and adjusting doses, are all part of optimizing GH therapy in childhood GH deficiency (GHD). Prevention of development of GHD would avoid the need for therapy. Options for optimizing GH therapy in childhood GHD include initiating treatment as young as possible, facilitating adherence to therapy plan, and adjusting GH dose on an individual basis to achieve ‘target’ results. In addition, there can be consideration of regulating timing of puberty, use of higher GH doses, and improving the process of transition from pediatric to adult care. Future prospects include improved depot GH preparations or alternative delivery systems. Development of depot GH-releasing hormone/peptide therapy could allow a more physiologic pattern of GH secretion. GH therapy should be targeted to yield the best growth response, best safety profile, and the best psychosocial adjustment.
Current Understanding and Treatment of Differentiated Thyroid Cancer in Children—A Review
Authors: Waguespack Steven G , Francis Gary L ,   Associate Professor, Department of Endocrine Neoplasia and Hormonal Disorders, Department of Pediatrics, University of Texas MD Anderson Cancer Center,   Professor of Pediatrics, and Chief, Division of Pediatric Endocrinology and Metabolism, Virginia Commonwealth University
Published: October 2015

Differentiated thyroid cancer (DTC) often presents in children with regional lymph node metastasis accompanied by a high risk for recurrence. However, children rarely die from DTC, even those who present with distant metastatic disease. The most common presentation for DTC in children is a thyroid nodule, approximately one quarter of which are malignant. In this manuscript, we review the differential diagnosis, approach, and treatment for DTC in children with a special emphasis on future perspectives.
Subclinical Hypothyroidism and Cardiovascular Risk—An Overview of Current Understanding
Authors: Feldt-Rasmussen Ulla ,   Professor and Chief, Department of Medical Endocrinology, Rigshospitalet, National University Hospital, Copenhagen
Published: October 2015

Subclinical or mild hypothyroidism is often associated with adverse cardiovascular risk factors, such as high cholesterol, together with hypertension, endothelial dysfunction and other atherosclerotic cardiovascular risk factors. The ischemic abnormalities are probably related to long-term consequences of a slowly progressing development of hypothyroidism. In recent years, it has become evident that a consensus on the exact limits for cut-off between normal and subclinically hypothyroid individuals is not currently possible. The main reasons for this are differences for measurement of serum thyroid-stimulating hormone (TSH), that reference populations are very different, and that a person’s intra-individual variability is much narrower than any population-based interval. Finally, the prevalence of subclinical hypothyroidism varies from 4 to 17% in different normal populations. Available evidence indicates that patients with subclinical hypothyroidism have developed or are at risk for developing an adverse cardiovascular profile, and subclinical hypothyroidism is most likely a mild variant of overt hypothyroidism. There is currently no evidence for a treatment benefit, but studies to demonstrate the expected minor improvements have not been performed on a sufficiently large scale. Patients should be informed about the disease and, based on a combined clinical and laboratory judgement, should be offered a therapeutic trial in case of even vague symptoms.
The Challenge of Managing Hypertension in Patients with Diabetes or Other Endocrine Disorders
Authors: Rosei Enrico Agabiti , Castellano Maurizio ,   Professor of Internal Medicine, and Director, Department of Medical and Surgical Sciences and Post-graduate School of Internal Medicine,   Professor of Internal Medicine, and Director, Post-graduate School of Endocrinology, Brescia University Medical School
Published: October 2015

Arterial hypertension is a frequent condition in the general population, but its prevalence increases in association with several endocrine diseases. Up to three-quarters of patients with diabetes are also hypertensive, and this association poses specific problems in the management of both conditions. Hypertension is a relevant condition in several other endocrinopathies and in some cases it is the main reason prompting patients to seek medical advice. Some of these endocrine diseases are frequent (primary aldosteronism) or may produce major complications (pheochromocytoma), and in any case require specific diagnostic work-ups and treatment.
Cardiovascular Consequences of a Mutant Thyroid Hormone Receptor α1
Authors: Mittag Jens ,   Assistant Professor, Department of Cell and Molecular Biology, Karolinska Institute
Published: October 2015

Thyroid hormone has long been known for its profound direct effects on the cardiovascular system, but its interactions with the autonomic nervous system controlling cardiac activity still remain enigmatic. Recently, mice heterozygous for a mutant thyroid hormone receptor 〈1 (TR〈1+/m) have been generated and their analysis has provided new insights into the actions of thyroid hormone on the cardiovascular system. The mutant TR〈1 caused many symptoms resembling hypothyroidism, such as bradycardia, as well as reduced contraction and delayed relaxation time of isolated cardiomyocytes. While no abnormalities were detected in the autonomic regulation of the basal heart rate using pharmacologic denervation, an impaired adjustment of the autonomic nervous system could be observed in TR〈1+/m mice on activity, stress, or increased temperature. The results thus confirm the important role of TR〈1 in maintaining the intrinsic properties of the heart and demonstrate a novel role for TR〈1 in the adaptations of the autonomic nervous system controlling the heart rate under non-baseline conditions.
The Hypothalamo–Pituitary–Adrenocortical Axis—An Overview of the Role of Glucocorticoids in the Pathophysiology of Endocrine Disorders and Perspectives for the Future
Authors: John Christopher D , Buckingham Julia C ,   Senior Lecturer in Pharmacology,   Pro-Rector for Education and Academic Affairs and Professor of Pharmacology, Department of Medicine, Imperial College London
Published: October 2015

Glucocorticoids (GCs) are the end products of the hypothalamo–pituitary–adrenocortical axis (HPA) and, via activation of the ubiquitously expressed GC receptor, influence numerous physiological processes. GCs are also involved in the regulation of basal homeostasis as well as mediating adaptive responses to stress that act to restore homeostasis. This article discusses the various factors that are important in regulating plasma and intracellular GC concentrations and describes the genomic and non-genomic mechanisms used by GCs to influence cellular processes. We describe the concept of allostatic overload associated with chronic HPA activation and the subsequent development of tissue dysfunction and disease. While allostasis is associated with acute stress and a restoration of homeostasis, chronic stress is likely to induce allostatic overload owing to the sustained activation of adaptive processes. Increased wear and tear in GC-sensitive tissues can eventually lead to tissue dysfunction and disease. Chronic elevations in GCs can also induce dysfunction or disease associated with decreased tissue function owing to the prolonged inhibitory effects of GCs or the redistribution of metabolic resource away from physiological systems not involved in restoring homeostasis. Numerous endocrine-related disorders are associated with aberrant GC levels and in terms of pathophysiology may be linked with chronic tissue-specific alterations in GC actions.
Lixisenatide—Once-daily Glucagon-like Peptide-1 Receptor Agonist in the Management of Type 2 Diabetes
Authors: Quianzon Celeste C L , Shomali Mansur E ,   Senior Fellow in Endocrinology, Diabetes and Metabolism,   Program Director, Endocrinology, Diabetes and Metabolism Training Program, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Union Memorial Hospital
Published: October 2015

The glucagon-like peptide-1 receptor agonist diabetes medications have become important due to their unique features, such as their potency of glycosylated hemoglobin (HbA1C) lowering, durability of effect, glucose-depending insulin secretion resulting in a low risk of hypoglycemia, glucagon suppression, and weight loss. Lixisenatide is an investigational compound in this class, exhibits all of these features, and has some unique properties, which are highlighted in this review. The pharmacology of lixisenatide, the results of recent clinical trials investigating this agent, and its potential role in the management of type 2 diabetes will be discussed.
Vitamin D and Bone Health—Discussion Points Following the Recent Institute of Medicine Recommendations
Authors: Heaney Robert P ,   Professor of Medicine, Division of Endocrinology, Creighton University School of Medicine
Published: October 2015

The 2011 Institute of Medicine recommendations for vitamin D—both the recommended daily amount (RDA) and the vitamin D status judged adequate for bone health—are too low. Calcium absorption, osteoporotic fracture risk reduction, and healing of histological osteomalacia all require values above 30 ng/ml, and probably even 40 ng/ml. Furthermore, the proposed RDA (600 international units per day up to the age of 70) is not compatible with the blood level of 25-hydroxyvitamin D (i.e., 20 ng/ml) recommended in the same report. Concerns regarding adverse consequences of higher intakes or status levels can be dismissed, in view of our extensive experience with outdoor summer workers (who regularly have values of 60 ng/ml or more) and the virtual certainty that human physiology evolved in—and is attuned to—an environment providing 10,000 IU/day or more.
Incretin-based Therapies for Type 2 Diabetes—Comparisons Between Glucagon-like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors
Authors: Bailey Timothy ,   Director, AMCR Institute, Inc., Escondido, CA
Published: October 2015

Type 2 diabetes exerts a huge toll on both morbidity and mortality, despite an expanding range of antiglycemic drugs and epidemiological evidence highlighting the benefits of effective glycemic control. Incretin-based agents offer important benefits, including a meal-dependent mode of action that may protect against hypoglycemia, and weight loss—in contrast to other antihyperglycemic drugs that cause weight gain. There are now two glucagon-like peptide-1 (GLP-1) receptor agonists and three dipeptidyl peptidase-4 (DPP-4) inhibitors approved for the management of type 2 diabetes in the US. Clinical trials have established the efficacy of incretin-based agents in controlling fasting and post-prandial blood glucose levels as well as glycosylated hemoglobin (HbA1c), both as monotherapy (including as first-line pharmacological treatment) and in combination with other antihyperglycemic treatments. GLP-1 receptor agonists and DPP-4 inhibitors have different mechanisms of action, which may explain their inconsistent efficacy results in direct comparator trials; for example, liraglutide has better efficacy than sitagliptin. However, GLP-1 receptor agonists can cause transient nausea in some patients. There is also evidence of different effects of individual agents within the same class; for example, liraglutide has shown superior efficacy to exenatide when added to metformin and/or sulfonylurea. Linagliptin is not cleared through renal mechanisms, unlike sitagliptin and saxagliptin. Isolated cases of pancreatitis led to concerns about a putative link with incretin-based therapies. However, the data currently available do not support a mechanistic or epidemiological link, although there does appear to be an increased risk of pancreatitis in people with diabetes that is independent of incretin-based treatment. Ongoing studies aim to extend our longer-term understanding of these agents, and hence, allow us to develop an optimal approach to patient management.
Advantages and Disadvantages of Realtime Continuous Glucose Monitoring in People with Type 2 Diabetes
Authors: Walker M Susan , Fonda Stephanie J , Salkind Sara , Vigersky Robert A ,   Administrative Director,   Senior Research Scientist,   Research Associate,   Director, Diabetes Institute, Walter Reed National Military Medical Center, Bethesda, Maryland, US
Published: October 2015

Previous research has shown that realtime continuous glucose monitoring (RT-CGM) is a useful clinical and lifestyle aid for people with type 1 diabetes. However, its usefulness and efficacy for people with type 2 diabetes is less known and potentially controversial, given the continuing controversy over the efficacy of self-monitoring of blood glucose (SMBG) in this cohort. This article reviews theextantliterature on RT-CGM for people with type 2 diabetes, and enumerates several of the advantages and disadvantages of this technology from the perspective of providers and patients. Even patients with type 2 diabetes who are not using insulin and/or are relatively well controlled on oral medications have been shown to spend a significant amount of time each day in hyperglycemia. Additional tools beyond SMBG are necessary to enable providers and patients to clearly grasp and manage the frequency and amplitude of glucose excursions in people with type 2 diabetes who are not on insulin. While SMBG is useful for measuring blood glucose levels, patients do not regularly check and SMBG does not enable many to adequately manage blood glucose levels or capture marked and sustained hyperglycemic excursions. RT-CGM systems, valuable diabetes management tools for people with type 1 diabetes or insulin-treated type 2 diabetes, have recently been used in type 2 diabetes patients. Theextantstudies, although few, have demonstrated that the use of RT-CGM has empowered people with type 2 diabetes to improve their glycemic control by making and sustaining healthy lifestyle choices.
Continuous Glucose Monitoring Versus Self-monitoring of Blood Glucose in Children with Type 1 DiabetesThe Pros and Cons
Authors: Patton Susana R , Clements Mark A ,   Associate Professor of Pediatrics, Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas,   Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine, Childrens Mercy Hospital, Kansas City, Missouri, US
Published: October 2015

Glucose monitoring is essential for modern diabetes treatment and the achievement of near-normal glycemic levels. Monitoring of blood glucose provides the data necessary for patients to make daily management decisions related to food intake, insulin dose, and physical exercise and it can enable patients to avoid potentially dangerous episodes of hypo- and hyperglycemia. Additionally, monitoring can provide healthcare providers with the information needed to identify glycemic patterns, educate patients, and adjust insulin. Presently, youth with type 1 diabetes can self-monitor blood glucose via home blood glucose meters, or monitor glucose concentrations nearly continuously using a continuous glucose monitor. There are advantages and disadvantages to the use of either of these technologies. This article describes the two technologies and the research supporting their use in the management of youth with type 1 diabetes in order to weigh their relative pros and cons.
Realtime Continuous Glucose Monitoring in Children and Adolescents An Overview of the Current Technology and its Impact on Patient Outcomes
Authors: Trast Jeniece , Ramchandani Neesha ,   Clinical Research Nurse and Certified Diabetes Educator,   Pediatric Nurse Practitioner and Certified Diabetes Educator, Division of Pediatric Endocrinology and Diabetes, The Childrens Hospital at Montefiore, New York, US
Published: October 2015

Continuous glucose monitoring (CGM) systems, available for patient use since 1999, and realtime continuous glucose monitoring (RT-CGM) systems, available since 2006, have helped optimize diabetes management. Previously, RT-CGM studies found benefits mainly in patients with type 1 diabetes over the age of 25. Children and adolescents often present a challenge when managing type 1 diabetes. However, it is now apparent that RT-CGM has clear benefits in these age groups as well as in adults. Not only have studies shown improvements in glycemic control in this population, they have also demonstrated parental satisfaction with the technology. Challenges with RT-CGM use still exist and must be addressed. Nevertheless, RT-CGM is a beneficial tool to assist in diabetes management, and its use should be encouraged in the majority of pediatric patients with type 1 diabetes.
Growth Hormone Deficiency During the Transition Phase
Authors: Radicioni Antonio F , Spaziani Matteo , Ruga Gilda , Granato Simona , Tahani Natascia , Papi Giorgio , Isidori Andrea M , Lenzi Andrea ,   Professor,   Medical Assistant,   Medical Assistant,   Medical Assistant,   Medical Assistant,   Student,   Professor,   Professor and Chairman, Section of Medical Pathophysiology and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
Published: October 2015

The growth hormone (GH)-insulin-like growth factor-1 (IGF-1) axis has several roles. While achievement of a satisfactory height is probably the most important and well-known, it is now clear that it also affects body composition, metabolism, muscle mass, and bone density during the transition period. Recombinant-growth hormone (Rec-GH) therapy is normally administered to GH-deficient children to achieve a reasonable final height. Retesting with a provocative test (insulin tolerance test or growth-hormone-releasing hormone + arginine test) is necessary during the transition period, after measuring IGF-1 levels. If the patient is still GH-deficient, rec-GH therapy should be restarted at 0.2–0.5 mg/day up to a final dosage of 0.8–1.0 mg/day (albeit there is no general consensus on the dosage). In fact, there is widespread literature evidence of the negative impact of GH-deficiency during the transition period, which provokes increased visceral fat and waist/hip ratio, decreased muscle mass and bone density and increased cardiovascular morbidity and mortality.
The Treatment of Diabetes after an Acute Ischemic Stroke
Authors: Biessels Geert Jan , Kappelle L Jaap ,   Professor of Neurology, Department of Neurology, UMC Utrecht Stroke Center and Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands,   Professor of Neurology, Department of Neurology, UMC Utrecht Stroke Center and Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
Published: October 2015

People with diabetes are at increased risk of ischemic stroke and outcome after stroke is worse. This paper reviews the treatment of patients with diabetes after ischemic stroke. First, management of hyperglycemia in the acute stage will be addressed. We will make the point that, despite the fact that admission hyperglycemia is a common risk factor for poor outcome after ischemic stroke, there is still much uncertainty about whether intensive glucose-lowering therapy after stroke benefits clinical outcome. Secondary prevention of further cardiovascular events after stroke is the other main topic of this review. We will show that there are important opportunities for the reduction of stroke risk in diabetes, through a rigorous evaluation and treatment of associated risk factors.
Diabetes and Oral Health—Current Concepts Regarding Periodontal Disease and Dental Caries
Authors: Lamster Ira B ,   Professor, Department of Health Policy and Management, Mailman School of Public Health, and Dean Emeritus, College of Dental Medicine, Columbia University, New York, New York, US
Published: October 2015

There are a number of important oral manifestations of diabetes. Periodontal disease and dental caries are the most common oral diseases, and both are modified when diabetes is present. There is an increased prevalence of periodontal disease in patients with diabetes, and periodontal disease can adversely affect glycemic control. Root caries also is more prevalent in patients with diabetes. The sequelae of both periodontal disease and dental caries are infection, pain, tooth loss, and reduced masticatory function. Non-oral health care providers who treat patients with diabetes must be aware of the oral manifestations of the disease and inform patients that ideal oral health is part of comprehensive management of diabetes.
The Role of Low-calorie Sweeteners in Diabetes
Authors: Johnston Craig A , Stevens Brian , Foreyt John P ,   Department of Medicine, Baylor College of Medicine, Houston, TX,   United States Department of Agriculture/Agricultural Research Service (USDA/ARS) Children’s Nutrition Research Center, Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, TX,   United States Department of Agriculture/Agricultural Research Service (USDA/ARS) Children’s Nutrition Research Center, Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, TX,   Department of Medicine, Baylor College of Medicine, Houston, TX
Published: October 2015

As the incidence and prevalence of type 2 diabetes continue to rise, the identification of components that contribute to or are associated with this disease has become a priority. One of the main factors that has been linked to type 2 diabetes is excessive weight gain, and reduction in weight has been recommended for both diabetes prevention and management. Low-calorie sweeteners (LCS) provide an alternative to added sugars and may facilitate weight loss or maintenance by limiting caloric intake. Considerable attention has been given to the role of LCS and their relationship to type 2 diabetes. Research suggests that LCS can serve an important role in diabetes prevention and management. Substituting sugars with LCS provides patients with type 2 diabetes considerable flexibility in their health goals and personal dietary preferences.
Possible Impacts of New Accuracy Standards of Self-Monitoring of Blood Glucose
Authors: Garg Satish K , Reed Kathryne , Grey Jessica , Westerman Alex ,   Professor of Medicine and Pediatrics,   Professional Research Assistant, Barbara Davis Center for Childhood Diabetes, University of Colorado, Denver, Aurora, CO, US,   Professional Research Assistant, Barbara Davis Center for Childhood Diabetes, University of Colorado, Denver, Aurora, CO, US,   Professional Research Assistant, Barbara Davis Center for Childhood Diabetes, University of Colorado, Denver, Aurora, CO, US
Published: October 2015

Self-monitoring of blood glucose (SMBG) was an integral part of reduction of complication rates in the landmark Diabetes Control and Complications Trial (DCCT) in Type 1 diabetes. However, the accuracy and standardized reporting of SMBG devices remains a key concern, with the 2003 version of International Organization for Standardization (ISO) 15197 standards allowing for 5 % of readings to fall outside of the acceptable ranges. A recently revised 2013 version of the ISO 15197 standards includes stricter accuracy standards, with a 36-month transition period recommended before compliance becomes mandatory. These new accuracy standards will have implications not only for manufacturers of currently available and future devices but also for the end-users, who may face rising costs and necessary measures to improve patient error rates associated with SMBG in routine clinical practice.
The Importance of Energy Balance
Authors: Hill James O , Wyat Holly R , Peters John C ,   Anschutz Health & Wellness Center, University of Colorado, Aurora, CO,   Anschutz Health & Wellness Center, University of Colorado, Aurora, CO,   Anschutz Health & Wellness Center, University of Colorado, Aurora, CO
Published: October 2015

Globally, bodyweight and obesity are rising in both the developing and developed world. To maintain a stable bodyweight, energy intake must, over time, exactly equal energy expenditure, a state known as energy balance. An understanding of the physiologic control of energy balance may be useful for designing interventions to tackle the obesity epidemic worldwide. Obesity occurs when the body’s energy balance is positive (i.e. when energy intake exceeds energy expenditure). Human physiology is biased toward maintaining energy balance at high levels of energy intake and expenditure. As a result, strategies to combat obesity should include a focus on increasing physical activity along with strategies for modifying food intake. An understanding of energy balance leads to the conclusion that prevention of weight gain should be easier than treatment of obesity. Components of energy balance are interdependent, and weight loss requires major behavior changes, which trigger compensatory decreases in energy expenditure that facilitate weight regain. Prevention of weight gain can be accomplished by smaller behavior changes. In addition to being easier to sustain than larger behavior changes, smaller ones produce less compensation by the energy balance regulatory system. It has been estimated that relatively small changes in energy intake and expenditure totaling 100 kcal per day could arrest weight gain in most people. Interventions that advocate small changes have shown promising levels of success.
EPODE—A Model for Reducing the Incidence of Obesity and Weight-related Comorbidities
Authors: Borys J-M , Valdeyron L , Levy E , Vinck J , Edell D , Walter L , Plessis H Ruault du , Harper P , Richard P , Barriguette A ,   EPODE European Network Coordinating Team, Proteines, Paris, France,   EPODE European Network Coordinating Team, Proteines, Paris, France,   Sainte-Justine Hospital, Montreal, Canada,   University of Hasselt, Diepenbeek, Belgium,   EPODE International Network, Brussels, Belgium,   EPODE European Network Coordinating Team, Proteines, Paris, France,   EPODE European Network Coordinating Team, Proteines, Paris, France,   EPODE European Network Coordinating Team, Proteines, Paris, France,   EPODE European Network Coordinating Team, Proteines, Paris, France,   EPODE International Network, Brussels, Belgium
Published: October 2015

Obesity is a global epidemic: it is estimated that the majority of the world’s adults will be overweight or obese by 2030. It is therefore important to reverse trends toward increasing childhood obesity by interventions at the community level. Ensemble Prévenons l’Obésité Des Enfants (EPODE, Together Let’s Prevent Childhood Obesity) is a large-scale, coordinated, capacity-building approach for communities to implement effective and sustainable strategies to address this challenge. EPODE comprises four critical components: political commitment, public and private partnerships, community-based actions, and evaluation. The multistakeholder approach promoted through the EPODE methodology has already shown encouraging results in preventing childhood obesity in France and Belgium and has reduced the socioeconomic gap in obesity prevalence in France. The EPODE methodology has now been implemented in a number of countries worldwide, and provides a valuable model that may be applicable to other lifestyle-related diseases.
The Role of Anti-obesity Drugs in Patients with Type 2 Diabetes
Authors: Hollander Priscilla ,   Medical Director, Ruth Collins Diabetes Center, Baylor University Medical Center, Dallas, Texas, US
Published: October 2015

The prevalence of diabetes continues to rise, following the rising rates of obesity. Obesity is not only associated with an increased risk for developing type 2 diabetes but also an elevated probability of developing long-term complications associated with the disease. Weight gain is also an important concern as a potential side effect of therapies that improve glycemic control in diabetes, including insulin therapy. As a result, patients with type 2 diabetes are at risk for a vicious circle of increasing weight and increasing insulin resistance, thus requiring further intensification of glycemic treatment. It is therefore important to address the problem of obesity in patients with type 2 diabetes. In 2012, the US Food and Drug Administration (FDA) approved two new anti-obesity medications: lorcaserin and phentermine/topiramate extended-release. Both agents have demonstrated clinically meaningful weight reduction as well as significant improvements in glycemic control in obese patients with diabetes. Liraglutide has also shown weight loss and improvements in glycemic control in patients with diabetes. Anti-obesity drugs, in conjunction with lifestyle changes, may play a valuable role in the management of diabetes.
Deployment of an mHealth Patient Monitoring Solution for Diabetes—Improved Glucose Monitoring Leads to Reduction in Medical Expenditure
Authors: Javitt Jonathan C , Reese C Shane , Derrick Michael K ,   Adjunct Professor, School of Medicine, Johns Hopkins University, Baltimore, Maryland, US,   Professor, Department of Statistics, Brigham Young University, Provo, Utah, US,   Research Assistant, Department of Mathematics, Brigham Young University, Provo, Utah, US
Published: October 2015

Although there is ample evidence that improved glucose control prevents long-term complications of diabetes, few reports have addressed the effect of improved control on short-term healthcare costs. Methods: A mobile health (mHealth)-enabled glucose meter combined with a disease management call center was deployed in 143 employees as part of an employer-sponsored diabetes disease management intervention. The program cost was approximately $50 per member per month over and above the cost of standard care. Results: Overall, on an intention-to-treat basis, this program was associated with an annual reduction of $1,595 (95% confidence interval [CI] –$2,827 to +$181) per person in incurred medical claims. A subanalysis documented that those who actively participated in the program (50 %) incurred a year-over-year claims cost decrease of $3,384 (95 % CI $643 to $5,149) compared with an increase of $282 among those who did not participate. Conclusions: These findings suggest that even partial improvement of diabetes testing adherence within an employed population may result in substantial attenuation of employee medical expense. The reduction in healthcare costs, even when considering those who did not comply, outweighed the program costs by several-fold.
The Role of Phentermine/Topiramate Extended-release in the Treatment of Obesity and Obesity-related Adverse Health Consequences
Authors: Gavin James R ,   Clinical Professor of Medicine, Emory University School of Medicine, Atlanta, Georgia, US
Published: October 2015

Long-term pharmacologic strategies that may be used in conjunction with lifestyle changes to combat the obesity epidemic have, until recently, been an unmet clinical need. In 2012, the US Food and Drug Administration (FDA) approved two new drugs for chronic weight management in obese adults in conjunction with a reduced-calorie diet and increased physical activity: phentermine/topiramate extended-release (PHEN/TPM ER) and lorcaserin. The efficacy and safety of PHEN/TPM ER has been studied in clinical trials. PHEN/TPM ER had a substantial impact on weight loss with the National Institutes of Health (NIH) National Heart, Lung, and Blood Institute (NHLBI) target of 10 % weight loss from baseline being achieved in almost half of patients receiving PHEN/TPM ER 15/92. Furthermore, PHEN/TPM ER was associated with improvement in obesityrelated adverse health consequences, including hyperglycemia, dyslipidemia, and hypertension, and a reduction in the rate of progression to type 2 diabetes. This clinical evidence supports PHEN/TPM ER as an efficacious, well-tolerated anti-obesity agent that may also have a significant impact on obesity-related adverse health consequences.
The Impact of Vitamin D on Weight Loss
Authors: Thomson Rebecca L ,   Research Fellow, Nutritional Physiology Research Centre, School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
Published: October 2015

The incidence of vitamin D deficiency is increasing and 25-hydroxyvitamin D (25OHD) levels, which are inversely associated with measures of obesity, are lower in overweight and obese populations. There have been several studies that have investigated the effect of vitamin D supplementation on weight loss, and studies combining weight loss interventions with increased vitamin D intake, either through supplementation or foods fortified with vitamin D. 25OHD levels have also been measured before and after weight loss to see if they improve and if the changes in 25OHD levels are related to the degree of weight loss. Some studies have suggested that vitamin D status is associated with weight loss success, with supplementation resulting in weight loss, or higher baseline 25OHD or greater increases in 25OHD levels associated with greater weight loss, although this has not been shown in all studies.
Current and Future Perspectives in Thyroid Carcinoma Treatment
Authors: Gómez-Sáez José Manuel ,   Chief Clinician, Endocrinology and Nutrition Service, Bellvitge University Hospital, Barcelona and Professor, University of Barcelona, Barcelona, Spain
Published: October 2015

Thyroid nodules are a common clinical problem and evaluation with neck and thyroid ultrasound and fine-needle aspiration biopsy are the most accurate methods for evaluating and identifying those that require surgical resection. The surgical treatment of differentiated thyroid carcinoma is the most common and recommended approach. Postoperative131I remnant ablation is used to eliminate the postsurgical thyroid remnant and may facilitate the early detection of recurrence. The conclusion of two important recent studies is that the use of recombinant human thyrotropin and low131I dose, 30 mCi, for postoperative ablation may be sufficient for the management of low-risk thyroid cancer. Recently, multitargeted kinase inhibitors have emerged as promising treatments for metastatic differentiated thyroid cancers based on mutation detection in samples from thyroid cancer. Motesanib, sorafenib, vandetanib, sunitinib, lenvatinib, imatinib, and cabozantinib are multikinase inhibitors that have the ability of inhibiting the rearranged during transection (RET) and vascular endothelial growth factor receptor (VEGFR), and other kinases, and have been used in advanced differentiated thyroid carcinoma. By contrast, axitinib and pazopanib seem to act only as anti-angiogenic agents. Anaplastic thyroid carcinoma is often advanced and metastatic at diagnosis. Patients with localized disease not amenable to surgical resection can be treated with adjuvant chemoradiotherapy.
Diabetic RetinopathyUpdate on Prevention Techniques, Present Therapies, and New Leads
Authors: Marozas Lauren M , Fort Patrice E ,   Undergraduate Student,   Assistant Professor, Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, US
Published: October 2015

Diabetic retinopathy is the major ocular complication associated with diabetes, and represents the leading cause of legal blindness in the working-age population of developed countries. Although classically diagnosed based on abnormalities of the retinal microvasculature, diabetic retinopathy is now widely recognized as a neurovascular disease. While all patients with diabetes are at increased risk for eye disease including diabetic retinopathy, proactive measures, and timely intervention can prevent or delay subsequent vision loss. Systemic management of diabetes by combined control of glycemia, blood pressure, and serum lipid levels remains the most important method of preventing diabetic retinopathy onset and progression. Once detected, surgical and medical interventions including photocoagulation, vitrectomy, and intravitral drug injection can help preserve vision. However, the need for improved detection methods and therapies that will allow earlier diagnosis and treatment remains apparent. This review summarizes current techniques for the prevention and intervention for diabetic retinopathy, and examines ongoing developments in the search for new endpoints and therapies as they apply to preventing vision loss associated with diabetes.
The Impact of Exercise on DNA Methylation of Genes Associated with Type 2 Diabetes and Obesity in Human Adipose Tissue
Authors: Rönn Tina , Ling Charlotte ,   Associate Researcher,   Associate Professor, Department of Clinical Sciences, Malmö, Epigenetics and Diabetes Unit, Lund University Diabetes Centre, Malmö, Sweden
Published: October 2015

It is well established that exercise promotes health, and reduces people’s risks for developing type 2 diabetes and becoming obese. But just how exercise performs this, at a cellular level, and what molecular and physiologic steps are involved and in what order, are still not fully understood. Metabolic disorders are often influenced by interactions between genetic and environmental factors. One possible explanation for how the environment may influence the genome is through epigenetic mechanisms–that is–chemical modifications to the DNA itself. Epigenetic factors include, for example, DNA methylation, histone modifications, and different RNA-mediated processes, which all have the ability to bind to DNA or affect the chromatin structure and thereby change how specific genes are interpreted and expressed. In this short review, we focus on describing how exercise influences the genome-wide DNA methylation pattern, including candidate genes for obesity and type 2 diabetes, in human adipose tissue.
Glucagon Stimulation Testing in Adult Growth Hormone Deficiency A 2014 Update
Authors: Yuen Kevin C J ,   Associate Professor in Endocrinology, Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University, Portland, Oregon, US
Published: October 2015

Growth hormone deficiency (GHD) is a well-recognized clinical syndrome in adults, and its diagnosis is established through one or more GH stimulation tests. The decision to perform GH stimulation testing should be based on medical history and clinical findings, and using appropriate GH stimulation test/s for biochemical confirmation. The insulin tolerance test (ITT) remains the diagnostic test of choice; however, this test is labor intensive, contraindicated in the elderly and in adults with seizure disorders and ischemic heart disease, can be unpleasant for the patient, and is potentially hazardous. With the discontinuation of the growth hormone releasing hormone (GHRH) analog (Geref®) in the US in 2008, the glucagon stimulation test (GST) has gained increasing popularity as the alternative test to the ITT because of its availability, reproducibility, safety, lack of influence by gender and hypothalamic cause of GH deficiency (GHD), and relatively few contraindications. In this article, recommendations for performing this test, the potential drawbacks in conducting and caveats in interpreting this test, and its future perspectives are discussed.
Nutrition Revolution—The End of the High Carbohydrates Era for Diabetes Prevention and Management
Authors: Hamdy Osama ,   Medical Director, Obesity Clinical Program, Joslin Diabetes Center; Assistant Professor of Medicine, Harvard Medical School, Boston, US
Published: October 2015

Increased dietary carbohydrates contributed to the escalating prevalence of obesity and type 2 diabetes. From the late seventies, several medical societies recommended reducing fat intake and replaced it with carbohydrates. These mistaken recommendations contributed to poor diabetes control, abnormal lipid profile, and increasing insulin resistance without reduction in cardiovascular mortality. Over the last few years, strong evidence suggest reducing carbohydrates intake for patients with type 2 diabetes to less than 40%. The era of high carbohydrates came to an end.