US ENDOCRINOLOGY – VOLUME 4 ISSUE 1 – SUMMER 2008

In addition to the worldwide pandemic of obesity and diabetes, there are an estimated 314 million people with pre-diabetes. In the US, 57 million people have pre-diabetes, defined as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT). Pre-diabetes raises the short-term absolute risk of type 2 diabetes by three- to 10-fold. In and of […]

Celebrated every year on November 14, World Diabetes Day is now an official UN World Health Day as a result of the successful Unite for Diabetes campaign. This year sees the second of a two-year World Diabetes Day campaign. The theme for the 2008 campaign is ‘Diabetes in Children and Adolescents.’ In this article, we […]

Recently updated statistics show that costs related to diabetes in the US population in 2007 reached $174 billion.1 It is estimated that the care of an individual with diabetes now costs 2.3 times as much as medical care for an individual without diabetes. The overall prevalence of diabetes in the US has now increased to […]

Recent data indicate that restoration of insulin secretion after islet cell transplantation is associated with an improvement in quality of life, with a reduction in hypoglycaemic episodes and (potentially) long-term complications of diabetes. Once clinical islet transplantation has been successfully established, this treatment could even be offered to patients with diabetes long before the onset […]

The prevalence of insulin-resistant conditions—such as obesity, the metabolic syndrome, and type 2 diabetes—is on the increase, affecting all age groups and both sexes.1 A sedentary lifestyle lies at the core of these disorders; therefore, increased physical activity is considered an integral part of lifestyle modification for the prevention and treatment of insulin resistance.2,3 There […]

Cultural sensitivity and competence have been hot topics in diabetes care for several years. Ethnic and racial disparities in healthcare have been reported in numerous studies, and the gaps in access to care, quality of care, and health status continue to widen. The fact remains that the American health system fails to provide consistent, high-quality […]

As a practicing diabetes educator for the past 15 years, the author has learned that there are a variety of reasons why DSME/T is not a universal intervention for those with diabetes. Many providers do not realize that education services are now reimbursed by Medicare and many health plans. Often, providers are not aware of […]

We now know that type 2 diabetes is preventable through a change in lifestyle (sometimes including medication). Late complications of type 1 and 2 diabetes can also be effectively avoided or delayed using active intervention and available therapies. Despite these facts, the percentage of people with diabetes following the therapy proposed by healthcare professionals (HCPs) […]

Type 2 diabetes bears significant risks of morbidity and mortality. Coronary artery disease (CAD) is the leading cause of death among patients with type 2 diabetes,1 and these patients face CAD risks as high as those of patients without diabetes who have a history of myocardial infarction.1–3 Microvascular complications such as retinopathy, nephropathy, and neuropathy […]

Diabetes Prevalence and Disease Burden

The incidence of diabetes is increasing year on year, approaching pandemic levels. Globally, the disease is estimated to affect 366 million people by 2030, an increase from the approximately 171 million people with diabetes in 2000.1 In the US, by 2050 the disease is expected to affect 48.3 million people—more than double the figure for […]

It is estimated that diabetes currently affects 195 million people worldwide. This figure is expected to rise to over 330 million by 2030.1,2 The overwhelming scale of the problem will present significant challenges to healthcare systems and clinical practices. Furthermore, the population in general is aging.

Weight, body mass index (BMI), and distribution of body fat are three of the core issues in type 2 diabetes.

The Diabetes Control and Complications Trial (DCCT)3 and the United Kingdom Prospective Diabetes Study (UKPDS)4,5 demonstrated the benefits of improving glycemic control in both type 1 and type 2 diabetes respectively. Both studies showed that improved glycemic control is associated with sustained decreased rates of microvascular and neuropathic complications.

Both insulin and glucagon levels are influenced by incretin hormones: glucagon-like peptide-1 (GLP-1), which is secreted by the intestinal glucose-responsive neuroendocrine (L) cells of the intestinal mucosa after a meal, and glucose-dependent insulinotropic polypeptide (GIP), secreted by intestinal K cells that are mainly located in the jejunum and throughout the gut. Both incretins have a […]

Type 1 Diabetes Treatment Challenge

Where type 1 diabetes is an autoimmune disease characterized by the complete destruction of pancreatic beta cells leading to biological deficiency of insulin, type 2 diabetes is a metabolic disorder of unknown etiology. Patients with type 2 diabetes often experience defects in multiple organs that can lead to a number of pathogenic factors, including reduced […]

The ‘Call to Arms’

I was recently reviewing the log book of a 72-year-old man on insulin and I noticed that he often had high glucose levels before supper. I said, “Robert, it looks like you are missing lots of lunch doses.” He replied, “Well, it is just too embarrassing taking out a syringe and vial to take insulin […]

One of the major limiting factors in achieving glycemic control is hypoglycemia.1 The causes of hypoglycemia are often multifactorial, but it is commonly caused by excess insulin administration due to either an overestimation in the dosing of insulin or active insulin stacking in patients with diabetes who require insulin.2 Other causes can include delayed gastric […]

At least two-thirds of patients with type 2 diabetes will die from cardiovascular disease, and of these two-thirds will die from the manifestations of ischemic heart disease. The National Cholesterol Education Program (NCEP) recognizes diabetes as a cardiac equivalent, which means that in the next 10 years there is at least a 20% chance (the […]

Pituitary Adenomas

Pituitary adenomas are common benign monoclonal neoplasms— accounting for 15% of intracranial neoplasms—that may be clinically silent or secrete anterior pituitary hormones such as prolactin, growth hormone (GH), adrenocorticotrophic hormone (ACTH), or, rarely, thyroid-stimulating hormone (TSH) or gonadotrophins.

A regrettable and deliberately vague definition of ‘clinically significant’ in relation to pituitary adenomas is stubbornly clinging to daily medical practice, causing irreparable harm to patients, families, and society in general. No-one is well served by language so vague that neither diagnosis nor treatment plans are possible and generations of treatable (repairable) patients are lost […]

Subclinical hypothyroidism (SCH) is defined as an above normal serum thyroid-stimulating hormone (TSH) level with normal free thyroxine (FT4) and free triiodothyronine (FT3) levels. The overall prevalence of the disease is 4–15%, and it is more common in women, the elderly, and those with a positive family history for thyroid disease.

IncidenceThe incidence of thyroid cancer has been increasing in both men and women since 1976.1 It has been estimated that there will be 37,340 new cases of thyroid cancer in the US in 2008. Despite the increasing incidence of thyroid cancer, mortality rates have declined, leading to an estimate of 1,590 deaths from the disease […]

Interpretation of Thyroid Function Tests in Pregnancy

Advances in the diagnosis and treatment of childhood, adolescent, and adult cancer have greatly enhanced the life expectancy of pre-menopausal women with the disease. As a result, there is a growing population of adolescent and adult long-term survivors of childhood malignancies.1 For the majority of women, ovarian damage caused by radiotherapy and/or chemotherapy will result […]

The most effective treatment is estrogen, which may be given alone to women without a uterus or combined with a progestogen in women with a uterus. As with any medicine, these hormone treatments are not trouble-free, but alternatives such as herbal remedies, natural foods, and neuroactive drugs are less effective. Given that estrogen with or […]

Testosterone therapy is of growing interest because of its increasingly recognized role in sexual and mental health, bone and muscle trophism, and vitality.1–4 An expanding body of evidence supports the influence of testosterone on sexuality, with the focus on desire and central (mental) arousal. This is more evident in women who have undergone oophorectomy and, […]