bluuebunny/crossref_metadata_2025 huggingface dataset:
What is Successful Islet Transplantation in 2006?
Authors: Robertson R Paul
Published: October 2015

Pre-Edmonton Era—The Past

During the past six years, transplant teams have been intensely focused on improving the rather dismal history of pancreatic islet allograft transplantation in humans. This short review will consider the status of islet transplantation in 2006 in the context both of success rates of islet transplantation prior to 2000 and current success with whole pancreas transplantation.

Successful clinical pancreas transplantation for type 1 diabetes was first reported by the University of Minnesota in 1966 (see Figure 1). In the ensuing years, operative techniques and immunosuppressive drug regimens improved significantly.
Biphasic Insulin Aspart 30 Treatment Option in Children and Adolescents
Authors: Lemoine Patrick
Published: October 2015

Type 1 diabetes is a chronic metabolic disease that is characterized by absolute insulin deficiency, which leads to chronic hyperglycemia, as well as other metabolic disturbances. Thus, children with diabetes are at increased risk for developing progressive longterm microvascular (e.g. retinopathy, nephropathy, and neuropathy) and macrovascular (e.g. cerebral, coronary and peripheral vascular disease) complications. The importance of strict glycemic control via intensive insulin therapy has been demonstrated in children and adolescents with type 1 diabetes. Although advanced diabetic complications are rare in children and adolescents, follow-up studies from the Diabetes Control and Complications Trial Cohort have provided unquestionable evidence in support of implementing strict glycemic control in all individuals with diabetes as early as possible.
Long-term Glycemic Control in Patients with Diabetes?
Authors: Barnett Anthony H
Published: October 2015

Diabetes is at epidemic levels, with the costs of treatment placing a significant economic burden on healthcare systems worldwide. Most people with type 2 diabetes are failing to achieve optimal blood glucose control, leading to disease progression and the onset of debilitating and expensive complications, including heart disease, amputations, blindness and kidney failure. To achieve adequate blood glucose control, all patients with type 1 diabetes need exogenous insulin, and most with type 2 diabetes will also eventually require insulin replacement therapy. Despite the fact that insulin is the most effective glucose-lowering treatment available, studies using US and UK medical databases indicate that more than half of the patients who no longer achieve glycemic control with oral medications wait four years or more to initiate subcutaneous insulin therapy.
Beta-cell Defects in Type 2 Diabetes and the Possibility of Treatment Options with GLP-1-based Therapies
Authors: Gallwitz Baptist
Published: October 2015

Type 2 Diabetes as a Progressive Disease

In type 2 diabetes, beta-cell dysfunction plays a major part not only in the pathogenesis of the disease, but also in disease progression over time. Under normal conditions, blood glucose concentrations are regulated within a very tight range. After a meal, insulin secretion from the beta cell is stimulated, whereas glucagon secretion from the alpha cells is suppressed. Insulin facilitates glucose uptake into the cells, whereas glucagon stimulates glucose production in the liver.
DPP-4 Inhibition as a Newly Emerging Therapy for Type 2 Diabetes
Authors: Deacon Carolyn F , Holst Jens Juul
Published: October 2015

Type 2 diabetes mellitus (T2DM) is a progressive disease, characterized by insulin resistance, impaired glucose-induced insulin secretion, inappropriately elevated glucagon concentrations, and hyperglycemia. Many patients cannot obtain satisfactory glycemic control with current therapies, and eventually develop microvascular and macrovascular diabetic complications. New and more effective agents, targeted not only at treatment, but also at prevention of the disease, its progression, and its associated complications, are, therefore, required. One new approach focuses on the effects of the incretin hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which enhance mealinduced insulin secretion.1
Fenofibrates and the Prevention of Cardiovascular Risk
Authors: Davidson Michael H
Published: October 2015

While the primary lipid target for chronic heart disease (CHD) risk management remains low-density lipoprotein (LDL) or ‘bad’ cholesterol, the treatment of elevated triglyceride (TG) is now also recommended. Elevated TG is believed to increase cardiovascular risk because certain TG-rich lipoproteins, called remnant lipoproteins—partially degraded chylomicrons and very low density lipoproteins (VLDL)—are atherogenic. Hypertriglyceridemia, together with low levels of highdensity lipoprotein (HDL) or ‘good’ cholesterol and an increased prevalence of small, dense LDL particles, comprise a triad of lipid risk factors known as atherogenic dyslipidemia.
Attaining Treatment Goals as a Measure of Therapy Benefits in Type 2 Diabetes
Authors: Henry Robert R
Published: October 2015

Type 2 diabetes has reached epidemic proportions in the US,1and its prevalence will continue to grow unless contributory factors such as the obesity epidemic and our ever-more sedentary lifestyles are significantly addressed.2These environmental factors, together with genetic predisposition, increase the risk for insulin resistance and the development of diabetes, which in turn is associated with the development of microvascular and cardiovascular complications.
Advances in the Diagnosis, Treatment and Molecular Genetics of Pituitary Adenomas in Childhood
Authors: Margaret F Keil , Constantine A Stratakis
Published: October 2015

The pituitary gland has an essential role in the maintenance of homeostasis, normal growth and reproductive function. Although pituitary tumours are rare in childhood and adolescence and are typically histologically benign, significant morbidity may result due to their location, mass effect and/or interference with normal pituitary hormone functions.1The early identification of pituitary tumours in children is necessary to avoid serious adverse effects on both physiological and cognitive outcomes as a result of pituitary hormone dysregulation during the critical periods of growth in childhood and adolescence. In this report, we review recent findings on the diagnosis, evaluation, treatment and molecular genetics of pituitary adenomas presenting in childhood.
Resistance to Thyroid Hormone and Cardiovascular Risk
Authors: Campi Irene , Mannavola Deborah , Beck-Peccoz Paolo ,   Clinical Fellow,   Research Assistant,   Full Professor of Endocrinology, and Director, School of Specialization in Endocrinology and Metabolic Diseases, Fondazione Policlinico-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University of Milan
Published: October 2015

Resistance to thyroid hormone (RTH) is a dominantly inherited syndrome of impaired tissue responsiveness to thyroid hormones (TH) characterized by high circulating TH in the presence of unsuppressed thyroid-stimulating hormone (TSH). TH achieve their action on the heart chiefly via thyroid hormone receptor alpha 1 (TR〈1), which is the TH receptor (TR) isoform predominantly expressed in such an organ. Data derived from animal models suggest that in RTH the overstimulation of the TR〈1 pathway by the high TH levels could explain the cardiovascular abnormalities seen in these animals, although the discordant cardiac gene expression profile between wild-type (wt) and transgenic mice treated with triiodothyronine (T3) imply that the effects of RTH on the heart are complex and not completely explicable by the heightened T3/TR〈1 signaling. To date, only a few studies have evaluated cardiovascular risk in RTH, with conflicting results, confirming the large variability of the RTH phenotype. In particular, some reports show that several cardiovascular parameters seem to move toward hyperthyroidism, while others show a pattern that resembles thyroid hormone deficiency. Finally, recent data suggest that in addition to reduced vascular compliance and echocardiographic abnormalities, RTH subjects may exhibit some features of metabolic syndrome, suggesting an overall increased cardiometabolic risk in this disorder.
Cardiovascular Risk in Type 2 Diabetes – Reflecting on the ADVANCE Study
Authors: Zoungas Sophia , Chalmers John , Patel Anushka ,   Senior Research Fellow, Cardiovascular and Renal Divisions, The George Institute for International Health, University of Sydney, and School of Public Health, Monash University, Melbourne,   Director, Professorial Unit, The George Institute for International Health, University of Sydney,   Director, Cardiovascular Division, The George Institute for International Health, University of Sydney
Published: October 2015

The world is facing an unprecedented increase in type 2 diabetes. Most disability and premature mortality experienced by patients with diabetes is related to vascular disease and, in particular, macrovascular disease (such as coronary heart disease and stroke) and microvascular disease (such as retinopathy, nephropathy and neuropathy). Indeed, around 1.9 million cardiovascular deaths worldwide are attributable to high blood glucose levels and diabetes, as well as to their associated dangerous companions of high blood pressure and abnormal lipid levels. The global economic costs of diabetes, including foregone economic growth and increasing healthcare expenditure, are substantial and are anticipated to grow. Therefore, strategies to reduce disease burden have continued to focus on reducing cardiovascular risk. Recently, a number of large-scale clinical trials have evaluated approaches for managing cardiovascular risk in patients with type 2 diabetes. Among them the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN MR Controlled Evaluation (ADVANCE) trial has reported the effects of blood pressure lowering and intensive glucose control on major vascular events in patients with established type 2 diabetes. In this article we summarise the findings of the ADVANCE trial and discuss its relevance to the management of cardiovascular risk in patients with type 2 diabetes worldwide.
The Importance of Good Insulin Injection Practices in Diabetes Management
Authors: Dolinar Richard ,   Clinical Endocrinologist, Arizona Endocrinology Center
Published: October 2015

Time constraints are often significant when treating patients with diabetes with insulin. In such settings, focus is often placed on the type of insulin the patient is taking, with an even greater emphasis placed on the amount. However, how much emphasis is placed on the practical aspects of insulin use? Is the patient using proper injection techniques? Are the insulin syringes or pens being cared for correctly? Are needles being quietly re-used without the medical staff’s knowledge? Are sharps being disposed of safely? Diabetes education regarding the proper use of insulin takes much time and effort. Without it, however, the appropriate type of insulin at the correct dose might not necessarily give the intended outcome. Instead, marked glycemic excursions could occur, leaving the goal of good diabetes control unachievable and the medical staff baffled.
The Incretin System and Type 2 Diabetes
Authors: Barnett Anthony H ,   Professor of Medicine, Consultant Physician, and Clinical Director of Diabetes and Endocrinology, University of Birmingham and Heart of England NHS Foundation Trust
Published: October 2015

While antidiabetes therapies target glycemic control, most do not address the underlying problems of excess bodyweight and deteriorating pancreatic beta-cell function. Some therapies also provoke hypoglycemia and/or weight gain. Glucagon-like peptide-1 (GLP-1) is an incretin hormone secreted by the gut in response to nutrient intake and has a major role in the post-prandial insulin response in healthy individuals. The incretin response is, however, impaired in individuals with type 2 diabetes. There are two therapeutic approaches that target the incretin system: GLP-1 receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors. GLP-1 receptor agonists provide pharmacological levels of GLP-1 activity, while DPP-4 inhibitors restore physiological levels. The pharmacological levels of GLP-1 induced by GLP-1 receptor agonists provide effective glycemic control and weight reduction. The DPP-4 inhibitors also improve glycemic control but are weight-neutral. Pre-clinical studies in animal models andin vitrosystems suggest that incretin-based therapies have the potential to preserve beta-cell mass and improve their function. Initial clinical data show improvements in beta-cell function in patients treated with incretin-based therapies, supporting the pre-clinical observations. A further benefit of incretin-based therapies is that they provide glucose-dependent glucose control, which means that they have a low inherent risk of inducing hypoglycemia. These agents therefore look extremely promising in the management of type 2 diabetes, being efficacious and having positive benefits on weight, low risk of hypoglycemia, and the potential to improve pancreatic islet cell function in the long term.
Dipeptidyl Peptidase-4 Inhibitors and the Management of Hyperglycemia
Authors: Katz Pamela M , Leiter Lawrence A ,   Resident, Division of Endocrinology and Metabolism, University of Toronto,   Head, Division of Endocrinology and Metabolism, St Michael’s Hospital, and Professor of Medicine and Nutritional Sciences, University of Toronto
Published: October 2015

Incretin-based therapies, including both glucagon-like peptide 1 (GLP-1) analogs and dipeptidyl peptidase-4 (DPP-4) inhibitors, are increasingly being used for the treatment of type 2 diabetes. GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) are gut-derived incretin hormones that regulate glucose through co-ordinated effects on pancreatic alpha and beta cells. DPP-4 inhibitors enhance the effects of endogenous, active GLP-1 and GIP by inhibiting the enzyme responsible for their degradation. These agents lower glycated hemoglobin (HbA1c) and help patients achieve glycemic targets, yet are weight-neutral and, due to their glucose-dependant mechanism of action, carry minimal risk of hypoglycemia. Furthermore, incretin-based therapies may alter disease progression through preservation of beta-cell mass and function. Although initially recommended for use in the early stages of type 2 diabetes, DPP-4 inhibitors appear to maintain their glycemic efficacy across the continuum of disease. They can be used either as monotherapy or in dual or triple combination therapy with other oral antihyperglycemic agents, and potentially also in combination with insulin. This review will focus on DPP-4 inhibitors and current clinical trial evidence to support their use in the management of hyperglycemia in type 2 diabetes.
Sodium–Glucose Co-transporter 2 Inhibition—A Novel Strategy for Glucose Control in Type 2 Diabetes
Authors: Norton Luke , DeFronzo Ralph A , Abdul-Ghani Muhammad A ,   Instructor,   Professor of Medicine and Chief,   Assistant Professor of Medicine, Division of Diabetes, University of Texas Health Science Center at San Antonio
Published: October 2015

In addition to its central role in the development of microvascular complications, hyperglycemia plays an important role in the pathogenesis of type 2 diabetes, i.e. glucotoxicity. Thus, effective glycemic control not only reduces the incidence of microvascular complications, but also corrects the metabolic abnormalities that contribute to the progression of the disease. Progressive beta-cell failure and side effects associated with therapy, such as hypoglycemia and weight gain, present obstacles to the achievement of optimal durable glycemic control in subjects with type 2 diabetes. Most recently, inhibitors of the renal sodium glucose co-transporter have been developed to produce glucosuria and reduce the plasma glucose concentration. Because the mechanism of action of these oral antidiabetic agents is independent of beta-cell and tissue sensitivity to insulin, they improve glycemic control while avoiding hypoglycemia and promoting weight loss. In this article, we will summarize the available data concerning the mechanism of action, efficacy, and safety of this novel antidiabetic therapeutic approach.
No More Heart Disease— Addressing Major Modifiable Risk Factors in Type 2 Diabetes
Authors: Lardinois Claude K ,   Emeritus Professor of Medicine, Division of Endocrinology, University of Nevada School of Medicine
Published: October 2015

Cardiovascular disease (CVD) is the leading cause of death among people with type 2 diabetes, yet much of the population remains unaware of the risk. People with diabetes are two to four times more likely to develop CVD due to a variety of risk factors. Large studies have shown that 85–90 % of patients with CVD have one or more of the traditional modifiable risk factors. Important modifiable risk factors include obesity, physical exercise, nutritional factors, alcohol consumption, tobacco smoking, vitamin D, psychosocial factors, dyslipidemia, hypertension, albuminuria, and dysglycemia. This article will review the impact that each of these modifiable factors has on CVD risk. The importance of aspirin therapy will also be addressed in light of the results of a number of studies that failed to demonstrate a convincing cardioprotective benefit of low-dose aspirin in patients with type 2 diabetes. Gene polymorphisms are also emerging as important contributors to CVD development, but will not be addressed in this article.
Management of Dyslipidemia in Patients with Diabetes
Authors: Kataoka Yu , Uno Kiyoko , Nicholls Stephen J ,   Clinical Research Fellow,   Clinical Research Fellow,   Cardiovascular Director, Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic
Published: October 2015

Cardiovascular disease is the leading cause of major morbidity and mortality in patients with type 2 diabetes. The recent focus on the apparent lack of cardiovascular benefit associated with glucose-lowering strategies has overshadowed the importance of targeting dyslipidemia for cardiovascular prevention in patients with diabetes. While lowering low-density lipoprotein (LDL) cholesterol is beneficial, diabetes is also characterized by hypertriglyceridemia, low levels of high-density lipoproteHDL-cholesterol and abundant levels of small, dense LDL particles. Accordingly, these factors represent additional targets for therapeutic modification in order to achieve more effective reductions in cardiovascular risk.
Glucagon Testing in Adult Growth Hormone Deficiency— Current Status and Future Perspectives
Authors: Yuen Kevin C J ,   Assistant Professor in Endocrinology, Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University
Published: October 2015

Growth hormone deficiency (GHD) in adults is a recognized clinical syndrome and its diagnosis is established through GH stimulation testing. The decision to perform GH stimulation testing should be based on clinical findings, medical history and using the appropriate GH stimulation test to obtain biochemical evidence. The insulin tolerance test (ITT) remains the diagnostic test of choice, but 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. The glucagon stimulation test (GST) in recent years has been increasingly used as the alternative test to the ITT in the US and Europe because of its availability, reproducibility, safety, lack of influence by gender and hypothalamic cause of GHD, and relatively few contraindications. In the article, we discuss our recommendations in performing this test, the potential drawbacks in conducting and caveats in interpreting this test, and its future perspectives.
Developments in Digestive Tract Neuroendocrine Tumors and Pheochromocytomas/Paragangliomas—A Narrative Review
Authors: Ilias Ioannis , Pacak Karel ,   Endocrinologist, Department of Endocrinology, E Venizelou Hospital, Athens,   Chief and Senior Investigator, Section on Medical Neuroendocrinology, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
Published: October 2015

Digestive neuroendocrine tumors (carcinoids) derive from serotonin-producing enterochromaffin cells. Biochemical screening (and follow-up) is performed with measurements of 5-hydroxyindoloacetic acid in urine. Other markers are also useful. Most digestive neuroendocrine tumors are better localized with functional imaging, i.e. nuclear medicine, compared with other modalities. The treatment of choice is surgical; non-resectable tumors are treated with somatostatin analogs (unlabelled and for more advanced disease radiolabelled) or chemotherapy. Most pheochromocytomas/paragangliomas are sporadic, however, and genetically caused tumors are much more common than previously thought. Biochemical proof of disease is best carried out with measurement of plasma metadrenaline. Imaging with computed tomography or magnetic resonance imaging (MRI) should be followed by functional imaging. Chromaffin tumor-specific methods are preferred.18F-fluoro-deoxyglucose positron emission tomography (18F-DOPA PET) should be used in patients with succinate-dehydrogenase-B-related metastatic pheochromocytoma/paraganglioma.18F-DOPA PET may become a modality of choice for the localization of head and neck paragangliomas. If possible, treatment is surgical. For non-operable disease, other options are available and new drugs are under investigation or in clinical trials.
Pioglitazone in Combination with Insulin—An Overview of Results from PROactive
Authors: Charbonnel Bernard ,   Professor of Endocrinology and Metabolic Diseases, University of Nantes and Department of Internal Medicine, Endocrinology and Diabetes, Hôtel Dieu, University Hospital of Nantes
Published: October 2015

Pioglitazone provides one of several add-on therapy options for patients with unsatisfactory glycemic control treated with insulin. Although pioglitazone has the beneficial feature of low hypoglycemia risk, it has an overlapping adverse event profile with insulin in terms of edema (with the potential to exacerbate heart failure) and weight gain, leading to possible concern over their use in combination. Fortunately, subgroup analyses from the Prospective pioglitazone clinical trial in macrovascular events (PROactive) have provided valuable insights into the efficacy and safety profile of pioglitazone in patients on established insulin therapy. Pioglitazone improved glycemic control and lipids, while enabling patients to reduce their insulin requirements. With the combination, edema and weight were predictable with no excess exacerbation of heart failure. Importantly, pioglitazone had a good macrovascular safety profile (with a trend toward benefit), consistent with the overall population. This article provides an overview of the results from the insulin-treated subgroup in PROactive and highlights some of the clinical implications for pioglitazone–insulin combination therapy.
Hyponatraemia—Current Treatment Strategies and Perspectives for the Future
Authors: Hannon Mark J , Thompson Christopher J ,   Endocrinology Research Fellow,   Professor, Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland Medical School
Published: October 2015

Hyponatremia is the commonest electrolyte abnormality found in hospital inpatients and is associated with a greatly increased morbidity and mortality. The management of hyponatremia is predicated on correct diagnosis of the underlying cause, which relies on accurate assessment of the patient’s volume status. The syndrome of inappropriate antidiuresis (SIAD) is the most common cause of hyponatremia and current treatments for this syndrome are poorly effective. Hypervolemic hyponatremia is also difficult to manage. The emergence of a new class of medications—the selective vasopressin-2 receptor antagonists or vaptans—gives clinicians an opportunity to target the underlying pathophysiology of these conditions, and represent an exciting new development in the management of hyponatremia. In this article we review the differential diagnosis of hyponatremia, current treatment strategies, and emerging management options.
Understanding the Immunology of Type 1 Diabetes An Overview of Current Knowledge and Perspectives for the Future
Authors: Piya Anil , Michels Aaron W ,   Pediatric Endocrinology Fellow,   Assistant Professor of Pediatrics and Medicine, Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, Colorado, US
Published: October 2015

Type 1 diabetes is a chronic autoimmune disease resulting from the immune destruction of insulin-producing β-cells in pancreatic islets. It is now a predicable disease in humans with the measurement of islet autoantibodies. Despite the ability to assess disease risk, there is no cure for type 1 diabetes and treatment requires lifelong insulin administration. Individuals with type 1 diabetes are at risk of long-term complications of the disease and the development of concomitant autoimmune disorders. Our understanding of the immunology of diabetes has increased greatly over the last decade at a basic science level, with translation to type 1 diabetes patients. Therapies are emerging to prevent beta cell destruction in these patients. This article centers around our current understanding of the immunology of type 1 diabetes, with a focus on immune intervention for the prevention and ultimate cure of the disease.
Periodontitis in Patients with Diabetes A Complication that Impacts on Metabolic Control
Authors: Sima Corneliu , Glogauer Michael ,   Post-doctoral Fellow and Senior Resident in Periodontology, Faculty of Dentistry,   Associate Professor, Faculty of Dentistry and Faculty of Medicine, University of Toronto, Ontario, Canada
Published: October 2015

Diabetes and periodontal diseases (PDs) exhibit a bidirectional relationship centered on an enhanced inflammatory response that manifests both locally and systemically. Diabetes is an established risk factor for PD, whereas the treatment of the latter has been shown to improve glycemic control in diabetic patients. Although compelling evidence fromin vitroand animal studies supports a plausible biological explanation for the relationship between the two conditions centered on systemic low-grade inflammation, the limited number of comparable large randomized clinical trials is reflected in the limited specific guidelines offered by the international organizations for diabetes and periodontitis regarding the management of the two diseases in an individual. Further understanding of the biological phenomena underlying PDs and diabetes is critical for individual therapeutic approaches to patients with both conditions by endocrinologists and periodontists.
Temozolomide in the Treatment of Aggressive Pituitary Tumors—An Overview of Existing Knowledge and Future Perspectives
Authors: McCormack Ann ,   Staff Specialist Endocrinology, St Vincent’s Hospital and Garvan Institute of Medical Research, Sydney, Australia
Published: October 2015

The management of aggressive pituitary tumors remains a challenge, however, the recent identification of temozolomide as a chemotherapeutic agent with significant efficacy against these tumors has heralded a new therapeutic era. There has been an exponential growth in the international experience with temozolomide over the past five years, now totaling 50 published cases. Overall, 67 % of cases demonstrated a response to temozolomide. Prolactin- and adrenocorticotrophic hormone (ACTH)-secreting tumors respond more frequently than non-functioning tumors. Response is typically evident in the first three months of treatment. Adverse effects occur in almost half of patients, although the majority are mild. The expression of a DNA repair enzyme, 06-methylguanine-DNA methyltransferase (MGMT), as determined by immunohistochemistry, appears to be the primary determinant of response to temozolomide in pituitary tumors. There is suggestion that MGMT may also play a role in pituitary tumorigenesis. Over the next few years we will see temozolomide used earlier in the treatment algorithm of aggressive pituitary tumors, making it imperative to collect global long-term data on its use.
Behavioral Factors Influencing Health Outcomes in Youth with Type 1 Diabetes
Authors: Kichler Jessica C , Moss Ashley , Kaugars Astrida S ,   Associate Professor of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, US,   Student, Marquette University, Milwaukee, Wisconsin, US,   Associate Professor of Psychology, Marquette University, Milwaukee, Wisconsin, US
Published: October 2015

The Pediatric Self-Management Model provides an overview of how behavioral factors influence children’s chronic medical illnesses. This general framework is used to organize the present review of how self-management behaviors, contextual factors, and processes impact health outcomes for adolescent youth with type 1 diabetes. Adherence has been widely studied in the diabetes literature, and there are consistent findings demonstrating associations between aspects of self-management, adherence, and metabolic control, yet there are still equivocal approaches to adherence assessment methodology (e.g. global versus specific measures). Metabolic control is a hallmark health outcome for youth with type 1 diabetes, but additional outcomes need to be further explored. Future research should utilize the Pediatric Self-Management Model’s operational definitions to guide empirically-supported interventions for youth with type 1 diabetes.
Hypovitaminosis D and Obesity—Coincidence or Consequence?
Authors: Azevedo Fernanda Reis de , Caramelli Bruno ,   PhD Student,   Associate Professor of Medicine, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
Published: October 2015

Vitamin D has attracted much scientific interest in recent years, mostly due to its newly described roles in metabolism regulation and cell proliferation. Along with hypovitaminosis D, the incidence of obesity has risen and has become a public health concern. The association between these two conditions is not merely coincidence and is being deeply investigated regarding its prevalence, mechanism, and even a possible causal relation. The data are still inconclusive but there is important evidence indicating that vitamin D is involved with fat accumulation, the responsible mechanism however still the principal question. The three main hypotheses are: adipose tissue sequestration, genetic modulation, such as polymorphism of the vitamin D receptor (VDR), or an organism evolutionary adaptation to cold weather. In conclusion, more evidence is needed to determine what the correct direction of this connection is and the possible therapeutic strategies of vitamin D replenishment and obesity control.
A Review of Evidence that Ultraviolet-B Irradiance and Vitamin D Reduce Risk for Cancer
Authors: Grant William B ,   Director, Sunlight, Nutrition, and Health Research Center, San Francisco, CA, US.
Published: October 2015

The solar ultraviolet-B (UVB)–vitamin D–cancer hypothesis was proposed in 1980 and has been actively investigated since then. The strongest evidence is from ecologic studies that use indices of solar UVB doses with geographic data on cancer incidence and/or mortality rates. Good evidence also comes from observational studies for breast and colorectal cancer incidence as well as survival rates for several cancers. Laboratory studies have well described the mechanisms whereby vitamin D reduces risk for cancer and increases survival rates after diagnosis. The hypothesis largely satisfies Hill’s criteria for causality for breast and colorectal cancer and moderately satisfies it for several other cancers. However, only two randomized controlled trials (RCTs) found a reduction in cancer incidence for higher vitamin D3 intake. Thus, general acceptance of the UVB–vitamin D–cancer hypothesis will probably be delayed until a large-scale RCT supports it.
Insulin Therapy in Type 2 Diabetes
Authors: Moghissi Etie ,   Associate Clinical Professor of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, US
Published: October 2015

Due to the progressive nature of Type 2 diabetes, insulin therapy is often required to achieve glycemic control. When lifestyle modifications and treatment with metformin with or without other oral antidiabetic drugs (OADs) have failed to achieve normoglycemia, timely initiation of singledose basal insulin treatment is a convenient, effective, and recommended strategy. The development of the long-acting basal insulin analogs, insulin detemir (IDet) and insulin glargine (IGlar), has resulted in significant improvements in the management of Type 2 diabetes, and specifically, in reducing rates of hypoglycemia. However, hypoglycemia still remains a limiting factor in the intensification of insulin therapy. Combination regimens involving insulin and incretin-based therapies have resulted in improved glycemic control with a similar rate of hypoglycemia compared with insulin alone. Novel basal insulin analogs may also help address the unmet needs associated with basal insulin therapy. Insulin degludec (IDeg) is a basal insulin analog that offers an ultra-long duration of action of more than 42 hours in adults, more flexibility compared with other long-acting insulin analogs in terms of daily dosing times, and reduced rates of hypoglycemia. Pegylated (PEG) lispro, an agent that is currently in clinical development, also offers an extended duration of action. The potential for fewer hypoglycemic episodes offered by combined regimens and new agents may improve adherence to insulin regimens.
Implications of Somatostatin Analogs in the Treatment of Acromegaly
Authors: Gariani Karim , Meyer Patrick , Philippe Jacques ,   Chief Resident, Internal Medicine Service,   Associate Clinician,   Professor, Head, Division of Diabetology, Endocrinology and Hypertension and Nutrition, Geneva University Hospital, Switzerland
Published: October 2015

Octreotide has an important role in the medical management of acromegaly. Its place in the management of acromegaly as an adjuvant therapy after neurosurgery is well established with a well-demonstrated efficacy. It can also be used in certain clinical conditions as a neoadjuvant treatment. Clinicians and patients should be aware of the possible side effects of octreotide treatment.
New Treatments for Growth Hormone Deficiency
Authors: Kemp Stephen F ,   Professor of Pediatrics and Medical Humanities, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, AR, US
Published: October 2015

First recognized in the early 20th century, growth hormone deficiency (GHD) has been treated with growth hormone (GH) replacement since 1958. Initial replacement was with cadarevic GH. In 1985, GH therapy with recombinant human GH (rhGH) replaced cadaveric GH, which increased not only safety, but also efficacy (because of increased supply). Improvements in GH dosing and frequency of injection has resulted in adult heights now usually in the normal range. GHD is diagnosed from the clinical picture, along with measurement of serum insulin-like growth factor 1 (IGF-I), IGF binding protein-3, and GH response to provocative stimuli. Several long-acting GH preparations are now under development. There has been a great deal of data from databases that confirms safety of GH administration while patients are taking GH. A recent report of increased mortality risk in adults who were treated with GH as children has not been confirmed by a second similar retrospective evaluation. Additional long-term follow-up studies of adults who took GH as children are needed.
Obstructive Sleep Apnea in Pregnancy—More Questions than Answers
Authors: Patel Soha , Louis Judette M ,   Resident,   Assistant Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida, US
Published: October 2015

The role of obstructive sleep apnea (OSA) in pregnancy is not well studied, but an increasing body of literature appears to indicate that there may be adverse maternal and fetal health effects of the disease. OSA is associated with a twofold risk for pre-eclampsia. The small size of the existing investigations still leave unanswered questions about the consequences of OSA as it relates to some other clinically relevant outcomes such as eclampsia, stillbirth, and maternal mortality. A consistent body of literature has emerged demonstrating an increased risk for insulin resistance and diabetes associated with OSA. However, among pregnant women, the association appears to be related to short sleep duration. Well-designed and adequately powered studies are required to further delineate the role of OSA and sleep duration on pregnancy outcome and the mechanisms of those effects.
Hippocampal Volume in Type 1 Diabetes
Authors: Murray Michael , Stanley Molly , Lugar Heather M , Hershey Tamara ,   Undergraduate Researcher, Department of Psychiatry,   PhD Candidate, Department of Neurology,   Image Analyst, Department of Psychiatry,   Professor, Departments of Psychiatry, Neurology and Radiology, Washington University School of Medicine, St Louis, Missouri, US
Published: October 2015

The hippocampus plays an important role in human memory and is known to be vulnerable to extreme hyperglycemia and hypoglycemia in animal models of type 1 diabetes. Within humans with type 1 diabetes, exposure to glycemic extremes has been associated with alterations in hippocampal structure and in memory function, but results are inconsistent. It has been hypothesized that the effects of hypoglycemia and hyperglycemia on the hippocampus may depend on when during neurodevelopment these extremes occur, possibly explaining some of these inconsistencies. However, data addressing this concept are limited. We review here the existing literature on this complex topic and suggest future avenues of required research.
Exercise is Medicine—The Importance of Physical Activity, Exercise Training, Cardiorespiratory Fitness, and Obesity in the Prevention and Treatment of Type 2 Diabetes
Authors: Lavie Carl J , Johannsen Neil , Swift Damon , Sénéchal Martin , Earnest Conrad , Church Timothy , Hutber Adrian , Sallis Robert , Blair Steven N ,   Professor of Medicine, Medical Director, Cardiac Rehabilitation and Prevention Director, Stress Testing Laboratory, Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, and Department of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, Louisiana, US,   Assistant Professor, School of Kinesiology, Louisiana State University and Department of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, Louisiana, US,   Postdoctoral Researcher, Department of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, Louisiana, US,   Postdoctoral Researcher, Manitoba Institute of Child Health, Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,   Professor, Department for Health, University of Bath, UK and Pennington Biomedical Research Center, Baton Rouge, Louisiana, US,   Pennington Biomedical Research Center, Baton Rouge, Louisiana, US,   Vice President, Exercise is Medicine, American College of Sports Medicine, Indianapolis, Indiana, US,   Department of Family Medicine, Fontana Medical Center, Kaiser Permanente, Southern California, California, US,   Professor, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, US
Published: October 2015

Type 2 diabetes has reached epidemic proportions worldwide and is associated with increased risk for cardiovascular diseases and premature mortality. Diet and physical activity (PA)-based lifestyle interventions have been shown to prevent progression to type 2 diabetes in patients at high risk. Regular PA substantially reduces the risk for type 2 diabetes and a high level of PA is associated with a substantial reduction in type 2 diabetes risk. In addition, there is strong evidence suggesting a steep inverse relationship between both PA and cardiorespiratory fitness (CRF) and mortality in patients with type 2 diabetes. Of particular concern is the dramatic, steep increase in mortality among patients with low CRF. An important point is that obese individuals who are at least moderately fit have a lower mortality risk than those who are normal weight but unfit. A large body of evidence demonstrates that exercise improves glycemic control in type 2 diabetes; the greatest improvements are achieved with combined aerobic and resistance training. A primary goal of public health strategies is to promote PA and move patients out of the least fit, high-risk cohort by increasing PA among the least active. Any plan to deal with the global epidemic of type 2 diabetes must give major attention to low PA and how this can be reversed in the general population.
Nutrition Therapy in Diabetes ManagementAn Overview of the Recent American Diabetes Association Position Statement
Authors: Evert Alison B ,   Coordinator, Diabetes Education Programs and Diabetes Nutrition Educator, University of Washington Medical Center, Diabetes Care Center, Seattle, Washington, US
Published: October 2015

The 2013 American Diabetes Association position statement on nutrition therapy for adults living with diabetes replaces previous position statements, the last of which was published in 2008. This article reviews highlights of the recently published recommendations. Following a healthful eating plan, along with physical activity and often diabetes medicine, is an essential component of the overall treatment plan for the management of diabetes. It is important that all members of the health care team be knowledgeable about diabetes nutrition therapy and supports its implementation.
Improving Quality of Life in Patients with Pituitary Tumours
Authors: Crespo Iris , Santos Alicia , Resmini Eugenia , Valassi Elena , Martínez-Momblán Maria Antonia , Webb Susan M ,   Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autonoma de Barcelona,   Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autonoma de Barcelona,   Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autonoma de Barcelona,   Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autonoma de Barcelona,   Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autonoma de Barcelona,   Escola Universitària dInfermeria, Hospital Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain,   Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autonoma de Barcelona
Published: October 2015

Evaluation of health-related quality of life (QoL) in people with pituitary tumors has received much attention over the last 10–15 years. Most of them show impaired QoL, but little is known about how to prevent impairment or how to improve QoL. Our aim is to review what is known about QoL in pituitary tumors patients and to highlight the areas worth improving, for the patient’s well-being. The article has four sections: acromegaly, Cushing’s syndrome, prolactinomas, and non-functioning adenomas. Control of comorbidities is usually an important factor to prevent QoL impairment; however, each disease has specific characteristics that should be properly addressed in order to obtain full patient recovery after successful therapy
Osteoporosis in Human Immunodeficiency Virus Patients  An Emerging Clinical Concern
Authors: Maffezzoni Filippo , Porcelli Teresa , Karamouzis Ioannis , Quiros-Roldan Eugenia , Castelli Francesco , Mazziotti Gherardo , Giustina Andrea ,   Clinical Fellow, Division of Endocrinology,   Endocrinologist, Division of Endocrinology,   Endocrinologist, Division of Endocrinology,   Clinical Researcher, Division of Infectious Diseases,   Full Professor, Division of Infectious Diseases,   Assistant Professor, Division of Endocrinology,   Full Professor, Division of Endocrinology, Department of Clinical and Experimental Sciences, University of Brescia, Italy
Published: October 2015

The advent of highly active anti-retroviral therapy (HAART) has significantly improved the survival of human immunodeficiency virus (HIV)- infected patients transforming the HIV infection from a fatal illness into a manageable chronic disease. As the number of older HIV-infected individuals increases, several aging-related co-morbidities including osteopenia/osteoporosis and fractures have emerged. Patients exposed to HIV infection and its treatment may develop fragility fractures with potential significant impact on quality of life and survival. However, the awareness of HIV-related skeletal fragility is still relatively low and most HIV-infected patients are not investigated for osteoporosis and treated with anti-osteoporotic drugs in daily clinical practice. This article reviews the literature data on osteoporosis and osteopenia in HIV infection, focusing on the pathophysiological, clinical, and therapeutic aspects of fragility fractures.
Sugar-sweetened Beverages and Chronic Kidney Disease
Authors: Wang Ke , Upadhyay Ashish ,   Hospitalist, Department of Medicine, Boston Medicine Center and Boston University School of Medicine, Maryland, US,   Assistant Professor of Medicine, Renal Section, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Maryland, US
Published: October 2015

Increasing consumption of sugar-sweetened beverages has occurred in parallel with the increasing prevalence of chronic kidney disease (CKD) in the US. Consumption of sugar-sweetened beverages, particularly with fructose, has been shown to play an important role in the pathogenesis of obesity, diabetes, hypertension, hyperuricemia, and nephrolithiasis, all of which are risk factors for CKD. However, the direct role of sugarsweetened beverages in the progression of CKD remains unclear. To date, five epidemiologic studies have examined the association between sugar consumption and kidney outcomes, with two showing statistically significant positive associations between higher sugar intake and adverse kidney outcomes. Even though the direct causal relationship between sugar-sweetened beverages and CKD has not been definitely established, it is advisable to counsel individuals with CKD and those at risk for CKD to limit the intake of sugar-sweetened beverages in light of its known detrimental effects on CKD risk factors.