EUROPEAN ENDOCRINE DISEASE – VOLUME 3 ISSUE 1 – SUMMER 2007
Foreword – European Endocrinology, 2007:12
Diabetes, like other chronic illnesses, requires patients to absorb a daunting amount of information in a limited amount of time and make significant lifestyle changes. For many patients, it is the first time they have heard of terms such as hyperglycaemia, neuropathy, microalbuminuria or even blood glucose. Despite their unfamiliarity with these terms and others, […]
A United Nations Resolution on Diabetes The Result of a Joint Effort
Resolution 61/225: ‘World Diabetes Day’ recognizes diabetes as a chronic, debilitating, and costly disease associated with major complications that pose severe risks for families, countries, and the entire world. It designates 14 November, the current World Diabetes Day, as a United Nations Day to be observed every year beginning in 2007. The Campaign for a […]
Advances in the Genetics of Type 2 Diabetes Mellitus in the Light of Personalized Healthcare
Clinical Complexity of Type 2 Diabetes
Advances in Diabetes Diagnostics
According to the last American Diabetes Association (ADA) recommendations, it is possible to demonstrate an abnormality in carbohydrate metabolism, diagnostic for diabetes, by measurement of fasting plasma glucose (glycaemia ≥126mg/dl, i.e. ≥7.0mmol/l) or after a challenge with an oral glucose load (OGTT) (glycemia ≥200mg/dl two hours post an oral 75g glucose challenge, i.e. ≥11.1mmol/l) or […]
Exenatide A Novel Treatment to Manage Type 2 Diabetes Mellitus
Unlike GLP-1, which has a halflife too short to make it viable for treatment, exenatide is resistant to degradation by the enzyme dipeptidyl peptidase-4 (DPP-4). Exenatide has shown to increase glucose-dependent insulin secretion, decrease glucose-dependent post-prandial secretion of glucagon, slow gastric emptying and reduce food intake. Furthermore, some of these effects represent mechanisms that have […]
Insulin Therapy in Uncontrolled Type 2 Diabetes
Insulin Initiation in Patients not Adequately Controlled on Oral Agents
The timely addition of insulin to an oral agent regimen along with close attention to its optimal dosing will lead to better glucose control, which will translate into better health for these patients.T2DM is associated with enormous morbidity and mortality. In the US, it contributes to more cases of adult-onset loss of vision, renal failure […]
Management of Type 2 Diabetes – The Role of Basal Insulin
Large-scale clinical trials have demonstrated the benefits of tight control in type 2 diabetes, minimising disease complications and improving quality of life.1,2 Recognising the progressive nature of type 2 diabetes, treatment programmes incorporating the use of insulin earlier in its course are receiving increasing attention.
Initiation of Insulin Treatment in Type 2 Diabetes Mellitus
However, prevention of high blood glucose (BG) and maintenance of glycated haemoglobin A1C <7.0% have been demonstrated to reduce the incidence of all complications of T2DM. Therefore, it is essential that T2DM is not only prevented (i.e. by tackling obesity and implementing an active lifestyle), but is also diagnosed early and treated aggressively from its […]
Dipeptidyl Peptidase-4 Inhibition in the Management of Type 2 Diabetes
1–3 GLP-1 and GIP also stimulate (3-cell proliferation, promote resistance to apoptosis and ncrease (3-cell survival, thus increasing (3-cell mass and function in the long term.1 Furthermore, GLP-1 inhibits glucagon secretion and reduces food intake through the inhibition of gastric emptying and through a direct hypothalamic effect.1 All of these actions of GIP and GLP-1 […]
The Function and Role of Dipeptidyl Peptidase-4 Inhibitors in the Management of Type 2 Diabetes
In addition, it delays gastric emptying4 and, when infused in pharmacological concentrations, enhances satiation and facilitates weight loss in people with T2DM.5 However, its utility as a therapeutic agent in T2DM has been limited by its extremely short half-lifeThe major form of secreted GLP-1, GLP-1-(7,36)-amide, requires the presence of the two N-terminal amino acids for […]
Diabetes and Cardiovascular Risk
Predicting and Preventing Cardiovascular Risk in Patients with Diabetes
How to Evaluate the Cardiovascular Risk in Patients with Diabetes?
Halting the Progression of Diabetic Nephropathy
Therapies that are proved to delay or prevent this outcome will clearly be of major benefitThe aetiology of DN is unknown. Hyperglycaemia is necessary but not sufficient to develop this complication, as is well demonstrated by observations in subjects with T1DM.
Overt Diabetic Nephropathy and Mineralocorticoid Receptor Antagonism
Diabetic nephropathy-characterized by hypertension, macro-albuminuria, progressive loss of renal function, and a high incidence of cardiovascular morbidity and mortality-is the leading cause of end-stage renal failure in the US.1-5 The predictive power of proteinuria for progressive renal function loss has been demonstrated in patients with and without diabetic nephropathy.6,7 It has been suggested, therefore, that […]
Diabetes & Sleep Apnoea
The Impact of Treatment of Obstructive Sleep Apnoea Syndrome on Glycaemic Control in Patients with Diabetes Mellitus
These findings suggest a significant overlap between the two diseases, but this clinic-based sample of obese patients (body mass index (BMI) 30.6±0.2) had been selected on the basis of presentation with typical symptoms of OSAS.
Testosterone Replacement Therapy
Testosterone Clinical Associations with the Metabolic Syndrome and Type 2 Diabetes Mellitus
Such beneficia therapeutic effects on CV risk factors now need to be confirmed in larger, longer term trials, as does safety. The diagnosis of clinically relevant hypogonadism will be discussed in the light of the recent evidence and current clinical guidelinesLow circulating levels of testosterone are frequently found in men with the metabolic syndrome and […]
Management of Patients with Differentiated Thyroid Cancer
Questions remain unanswered concerning differentiated-thyroid carcinoma • What is the role and optimal extent of surgery? • What is the role of adjuvant therapy? • What is the role of thyroid hormone therapy? • What is the optimal monitoring therapy?
Advances in the Treatment of Differentiated Thyroid Cancer
In both papers, new tools introduced in the last 10 years have been integrated Both the American and European expert panels propose a risk-dependent strategy:• recombinant human thyroid-stimulating hormone (rhTSH) as an alternative for the withdrawal (WD) of thyroid hormone in order to obtain a high thyroid-stimulating hormone (TSH);6 and
Medical Management of Hyperthyroidism
Hyperthyroidism mainly affects the female population, occurring in around 2% of women and 0.2% of men.1 The majority of patients with hyperthyroidism have Graves’ disease (GD) and, less often, solitary toxic nodule or toxic multinodular goitre. Other causes of hyperthyroidism are relatively rare and are summarised in Table 1.
How Iodide Reaches its Site of Utilisation in the Thyroid Gland Involvement of Solute Carrier 26A4 (Pendrin) and Solute Carrier 5A8 (Apical Iodide Transporter)
This concentration gradient may be more than 100:1 in a hyperactive thyroid, as seen in patients with Graves’ disease. The daily intake of an adult human varies from less than 10mg in areas of extreme iodine deficiency to several hundred milligrams for some people receiving medicinal iodine.
Safety and Security of Menopausal Therapies
Premature Menopause and Sexual Outcomes
PM may be iatrogenic, i.e. secondary to surgical remova of both ovaries (bilateral oophorectomy), or to the irreversible ovarian damage caused by chemotherapy or radiotherapy, either pelvic or total body irradiation.1–9 POF currently encompasses all modalities of ovarian exhaustion when the ovaries remain on-siteSurgical menopause suddenly deprives the woman of total ovarian hormone production. POF, […]
An Update on Polycystic Ovary Syndrome
Obtaining a Diagnosis of the Patient with Possible Polycystic Ovary SyndromeWhenever attempting to diagnose PCOS, it is important to define the population at high risk for having the syndrome. Women with unwanted hair growth7,8 or menstrual disturbances9,10 are highly likely to have PCOS.11,12
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