US ENDOCRINOLOGY – VOLUME 4 ISSUE 2 – WINTER 2008

In his foreword to a previous edition of European Endocrinology, my colleague and friend Sir George Alberti recalled that a mutual friend, Paul Zimmet, had referred to the current pandemic of diabetes as a ‘tsunami.’ One year later, I believe that one should reflect for a moment on the theme. We all have in mind […]

Importantly, such interventions must also have the potential to be put into clinical practice in a range of settings and to be widely disseminated to people with diabetes and their communities. These projects fall into the category of ‘translational research’: they provide the opportunity to ‘translate’ the lessons learned from clinical research into benefits – […]

While much of the work in improving diabetes outcomes has focused on clinical care, there is growing recognition that improving diabetes prevention and control also requires public health approaches that are complementary to what can be achieved in clinical care.3,4 Glasgow et al.5 defined a public health approach to diabetes as “a broad, multidisciplinary perspective […]

IGT is defined by a plasma glucose level of 140–199mg/dl two hours following ingestion of a 75g oral solution; IFG is defined by a fasting plasma glucose value that lies between 100 and 125mg/dl.1 Estimates from the Centers for Disease Control and Prevention (CDC)2 indicate that in 1988–1994, among US adults 40–74 years of age […]

In 1996 Eaton and his colleagues at Johns Hopkins published a study suggesting that Willis might have been right after all, at least when it comes to a person’s risk of developing type 2 diabetes.9 This study was followed several years later by one conducted in Japan by Kawakami and colleagues.10 This study also supported […]

Insulin resistance in skeletal muscle and the liver is a central feature of type 2 diabetes.1 Insulin resistance is also believed to be the underlying mechanism responsible for the metabolic syndrome. Insulin-stimulated glucose disposal in skeletal muscle is reduced in insulin-resistant individuals due to impaired insulin signalling and multiple intracellular defects in glucose metabolism (reviewed […]

Hypoglycemia is not limited to patients with type 1 diabetes, but frequently occurs in patients with type 2 diabetes as well.4,5 As the ratelimiting step for insulin therapy in diabetes, hypoglycemia precludes the maintenance of long-term euglycemia and the long-term benefits associated with tight glucose control. Recognizing the impact of hypoglycemia and the development of […]

In order to overcome the barriers to better health outcomes while improving the balance between patient education and pharmacotherapy, a high-level systems approach to healthcare needs to be addressed. This article will focus on the role of self-management education and its position in pharmacotherapy within the healthcare delivery systems. Barriers

The incidence of type 2 diabetes has increased dramatically in recent years,11–13 and evidence-based treatment algorithms have encouraged the utilization of IT earlier in the course of the disease when glycemic control is inadequate.14 More than half of all patients diagnosed with type 2 diabetes will require insulin for effective glucose management due to β-cell […]

Furthermore, as most medical insurance companies do not typically cover obesity medications or weight-management programs, physicians often perceive weight management as an impractical and costly approach. Adding to these paradoxes, ingesting a higher percentage of calories from carbohydrates (currently 50–55% of total caloric intake) in a disease that is still defined as a carbohydrate intolerance […]

Insulin in the Brain

This so-called ‘incretin effect’ explains why a greater amount of insulin is released in response to an oral glucose load compared with that elicited by an isoglycaemic intravenous glucose challenge,1 and in healthy subjects it accounts for up to 70% of glucose-induced insulin secretion.1 The two incretin hormones have effects on the β-cell in addition […]

Post-prandial blood glucose levels are generally <120mg/dl in healthy nondiabetic subjects and rarely exceed 140mg/dl, which reflects the World Health Organization (WHO) definition.2 Post-prandial hyperglycemia is defined as a plasma glucose level exceeding 140mg/dl.3 Development of post-prandial hyperglycemia coincides with an impairment or absence of the first-phase insulin response, a decrease in insulin sensitivity in […]

Glycemic variability is typically measured by self-monitoring of blood glucose (SMBG),10–16 although continuous glucose monitoring (CGM) systems are now a US Food and Drug Administration (FDA)-approved alternative.17 SMBG is a well-established blood glucose monitoring system10–16 and can be performed in the clinic or at home.18,19 It involves intermittent fingerstick measurements to obtain immediate blood glucose […]

Guidelines for the care of children and adolescents with diabetes provide comprehensive information concerning the clinical and developmental needs of children at varying stages of maturity and development (see Silverstein et al.4 for guidelines on the care of children and adolescents with type 1 diabetes, and see the American Diabetes Association [ADA]5 and Rosenbloom et […]

A second incretin hormone was discovered showing 50% homology with glucagon, and named glucagon-like peptide-1 (GLP-1).

Cardiovascular Disease and Its Risk Factors in Adults with Diabetes

Regardless of what the condition is called, and contrary to the common misperception, autonomic dysfunction is treatable. However, the earlier the autonomic dysfunction is detected, the greater the number of therapy options (see Table 1). Therefore, DAN or advanced autonomic dysfunction may be more difficult to treat. In other words, it is easier to correct […]

Pathogenesis of Diabetic Retinopathy Diabetes-associated Retinal Dysfunctions Before the Onset of Clinical Diabetic Retinopathy

In 1962, Dr Jacqueline Noonan presented at the Midwest Pediatric Research Meeting a clinical study on associated non-cardiac anomalies in children with congenital heart disease, in which nine patients—six males and three females—with distinctive facies and pulmonary stenosis were identified.6 The facies were remarkably similar and included hypertelorism, a relatively short neck, low-set posteriorly rotated […]

Clinical Features

NFPAs are usually asymptomatic until they become large enough to cause mass effects. Diagnosis is frequently made when they are at the macro-adenoma stage. Visual deficit is the most frequent symptom that leads a patient to discover a pituitary mass. Patients often show bi-temporal hemianopsia secondary to compression of the optic chiasm by suprasellar extension […]

The gene encoding hGRα (hGR gene) is one locus on the long arm of chromosome 5 (q31.3), and consists of nine exons spanning over 150kb. Expressed hGRα is a panel of eight amino terminal translational isoforms of varying lengths, each of which consists of three subdomains: the N-terminal (NTD), the DNA-binding (DBD) and the ligand-binding […]

The evaluation of a patient with a palpable solitary nodule is generally straightforward and usually will include a fine-needle aspiration (FNA) biopsy with or without US guidance.

Despite an increasing incidence, the mortality from thyroid cancer in general and from papillary thyroid cancer in particular remained stable (0.5 deaths per 100,000 in both 1973 and 2002).1

Hyperthyroidism is an important cause of secondary osteoporosis2 and the relationship between the hypothalamic–pituitary– thyroid (HPT) axis and bone is an important factor to consider in the management of sub-clinical hyperthyroidism and differentiated thyroid cancer. This article discusses animal models that provide insight into the underlying mechanisms that result in hyperthyroidism-associated bone loss. It will […]

Although much attention has been given to the study of post-menopause and the options in hormone replacement treatment (i.e. oestrogens and progestins), relatively little attention and awareness has been focused on the activity of endogenous or exogenous androgens in women. In fact, the life of a middle-aged woman is characterised by the co-existence of menopause […]