US ENDOCRINE DISEASE – VOLUME 3 ISSUE 2 – WINTER 2007

Welcome to the fifth edition of US Endocrine Disease. Once again, there are many interesting articles focusing on diabetes, many discussing the management of the disease itself and several discussing the management of complications that patients suffer as a result of diabetes. We should encourage debate and discussion of these important issues.

As a practicing pediatric endocrinologist in Los Angeles, California, I have witnessed significant changes over the past 30 years. During that time, there has not been a single week in which the Center for Diabetes at the Childrens Hospital Los Angeles has not diagnosed at least three children with diabetes. Recently, that number has doubled. […]

Despite the fact that education is recognized as critical for preventing, treating, and delaying complications in serious illnesses, healthcare professionals who specialize in educating people with diabetes about effective disease management and prevention are losing their jobs.

Rosiglitazone—Association with Adverse Outcome?

We are approaching the 10th anniversary of the isolation of human embryonic stem (huES) cells,1 a seminal breakthrough that promptly germinated into one of the most prolific fields in recent scientific history. Concepts such as ‘regenerative medicine’ or ‘stem cell therapies,’ so commonly used today, did not start to appear in the scientific literature until […]

The Australian Diabetes, Obesity, and Lifestyle (AusDiab) study is an ongoing national, longitudinal, population-based study designed to examine the prevalence, natural history, and risk factors of diabetes, pre-diabetes, heart disease, and renal disease in Australia. The AusDiab study is one of the few national diabetes surveys to use an oral glucose tolerance test (OGTT), and […]

Results from large randomized, prospective trials indicate that attaining and maintaining near-normal levels of glycemia reduces the risk of long-term complications in diabetes.1–3 Nevertheless, the number of patients achieving the glycemic goals outlined in these landmark studies remains inadequate.

The prevalence of diabetes in Europe has been dramatically increasing since the early 1990s. It is estimated that in 2007, 53 million people have diabetes in Europe. Quantitively, Russia and Germany have the highest number of people with diabetes, with a combined figure of about 17 million.

Treatment of Type 1 Diabetes in Children and Adolescents

Electrical stimulation of the gastric antrum with gastric contractility modulation (GCM) by the TANTALUS II system is a new modality that shows great promise as a means of treating overweight and obese type 2 diabetic patients. Preliminary studies in several small type 2 diabetic populations in patients who are inadequately controlled with oral antidiabetic agents […]

It is estimated that diabetes, both type 1 and type 2, currently affects more than 195 million people worldwide. This figure is expected to rise to more than 330 million by 2030.1,2 The rise in type 1 diabetes has been linked to changing environmental factors,3 while the rise in type 2 diabetes is strongly associated […]

Diabetes mellitus affects an estimated 20.8 million individuals in the US, approximately 7% of the population.

History The initial patent for a practical glucose meter was issued in Elkhart, Indiana, in 1971, and the device has now evolved into a frequently used tool.

“The relatively infrequent and uneven inclusion of behavioral and social science principles in diabetes care has limited the effective use of new knowledge gained from biomedical clinical trials. A focus on biomedical intervention without integration of behavior and social science principles into clinical care severely limits the impact of biotechnology and biomedicine.”1

The optimal composition of macronutrient intake for people with type 2 diabetes has been a subject of much debate. There are differing lines of thought as to the appropriate amount of carbohydrate, protein, and fat that should be consumed to best regulate glucose control. This article will review literature on macronutrient intake in relation to […]

Diabetes and Cardiovascular Disease The increased incidence of premature coronary heart disease (CHD) continues to present a major challenge in the care of patients with type 2 diabetes.

A substantial amount of evidence has demonstrated that diabetes is highly associated with oxidative stress and endothelial dysfunction.1–3 It is also well recognised that endothelial dysfunction, which is present even in people at risk of developing diabetes, is strongly connected with oxidative stress and considered as a preliminary risk factor for the development of atherosclerosis […]

Introduction to Cardiovascular Autonomic Nerve Dysfunction Cardiovascular autonomic neuropathy (CAN), a serious complication of diabetes,1–3 is often overlooked. CAN encompasses damage to the autonomic nerve fibers that innervate the heart and blood vessels, which may result in abnormalities in heart-rate control and vascular dynamics.4 There is now an appreciation that, prior to the advent of […]

Patients with diabetes may present with an array of foot disorders that include, but are not limited to, neuropathy, ulceration, and osteomyelitis. Ischemia and infection are common clinical concerns as either, or both, may be involved in the pathogenesis of these disorders. Management choices can be difficult to make and diagnostic imaging is often sought […]

Non-alcoholic Steatohepatitis Non-alcoholic fatty liver disease (NAFLD) is a chronic liver condition frequently associated with type 2 diabetes and characterized by insulin resistance and hepatic fat accumulation. Liver fat may range from simple steatosis to severe steatohepatitis with necroinflammation and variable degrees of fibrosis (non-alcoholic steatohepatitis (NASH)).

In the 1930s a young investigator at the Mayo Clinic in Rochester, Minnesota, had a unique opportunity. Robert Costello conducted a careful and systematic analysis of pituitary glands obtained at post mortem examination from patients who had no obvious symptoms of endocrine disorders. The results were published in 1936.1 In this study of 1,000 human […]

Somatostatin analogs are novel therapeutic agents that can be employed in the management of acromegalic patients who have residual disease after surgery or radiotherapy and in those who are not candidates for surgery as a primary therapeutic intervention. The use of this class of medications has, in just over a decade, dramatically altered the landscape […]

Acromegaly is an uncommon disorder characterized by excess secretion of growth hormone (GH), resulting in the classical growth of bone and soft tissues, multi-system involvement with multiple comorbidities, and heightened risk of premature mortality. GH is produced by the somatotroph cells of the pituitary gland in a pulsatile fashion. Circulating GH stimulates hepatic secretion of […]

In the search for an imaging agent for the adrenal medulla, Wieland et al.1 evaluated several guanethidine analogs.

A convergence of societal change and new reproductive technologies has created a critical need for biomarkers that can accurately predict the duration of a young woman’s remaining fertile years. In essence, a robust marker is needed that can accurately define what might be termed ‘a woman’s functional ovarian age.’ If a woman aged 25 years […]

The past decade has seen marked fluctuations in opinions concerning the merits and risks of post-menopausal hormone therapy. In July 2002, menopause management faced a major turning point when the first data from the Women’s Health Initiative (WHI) trial were released. The study was categorized as a primary prevention trial for coronary heart disease, although […]

The physiological role of testosterone in women has been studied for over half a century and continues to stir rich debate. Historically, the principal use of female androgen therapy revolved around enhancing sexual desire and as a potential chemotherapy agent for breast cancer. These earlier studies, using supraphysiological hormone doses, did demonstrate improvement in several […]

The relative contribution of androgen and estrogen to female sexual function is controversial. Low libido, decreased wellbeing, blunted motivation, and fatigue are listed as major features of the proposed syndrome of female androgen deficiency.1,2 However, defining and elucidating this syndrome has been problematic. First, the symptoms are vague and difficult to objectify, and can all […]