EUROPEAN ENDOCRINE DISEASE – VOLUME 3 ISSUE 2 – WINTER 2007

Welcome to the fifth edition of European 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. […]

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) […]

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 […]

Several interventional studies have demonstrated that achieving near-normal glycaemic control by means of intensive insulin therapy is the best strategy to avoid and slow the progression of chronic complications in type 1 and type 2 diabetes.1–3 Interestingly, the benefits of intensive treatment seem to extend over time, at least in people with type 1 diabetes, […]

Type 2 diabetes is a growing health problem that is generating ever-increasing morbidity and economic consequences. Individuals with type 2 diabetes face insulin resistance coupled with a progressive loss of insulin production by their β cells, meaning that there is an inevitable need for replacement insulin as the disease progresses.

One of the challenges of using anti-diabetic therapy in obese or overweight patients is the prospect of substantial iatrogenic weight gain with many widely used drug classes. Since lifestyle interventions including weight loss are usually very difficult to achieve and/or sustain, the practitioner frequently is left with few options when trying to avoid adverse effects […]

There is an increased risk of bone fractures in patients with type 2 diabetes. Some—although not all—studies have shown higher rates of fracture in people with type 2 diabetes compared with normal individuals. The Health, Aging, and Body Composition (Health ABC) Study showed that elderly white women with type 2 diabetes (but not elderly men […]

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.

T2DM is a chronic metabolic disorder that is characterized by defects in insulin secretion and insulin resistance.6 Current therapeutic approaches focus on improving insulin sensitivity or preserving/augmenting β-cell function, or both, with the goal of re-establishing normal glucose homeostasis.

The prevalence of type 2 diabetes is continuously increasing, and the mean age of affected patients is decreasing. Although several antihyperglycaemic agents are available, there is an urgent need for novel agents with different mechanisms of action. Existing agents are often ineffective (even after initial effectiveness) and/or are associated with considerable side effects. Although antihyperglycaemic […]

The incidence and prevalence of diabetes (and especially type 2 diabetes) are increasing worldwide. The World Health Organization (WHO) estimates that worldwide 171 million people suffered from diabetes in 2000, and predicts that by 2030 their number will increase to more than 300 million.1 Due to the initially often silent course of the disease and […]

The incretin hormones glucagon-like peptide-1 (GLP-1) and glucosedependent insulinotropic polypeptide (GIP) are released after food intake and stimulate insulin secretion in a glucose-dependent manner.1 GLP-1 also inhibits glucagon secretion2 and, as evident from animal studies, may increase β-cell mass.3 GLP-1 also induces satiety and may reduce bodyweight.4 Therefore, GLP-1 has been developed as a novel […]

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 […]

Patients with type 2 diabetes have a well-documented increased risk of cardiovascular disease (CVD) that is more than two to three times higher than the risk seen in non-diabetic subjects.1 In spite of modern methods to treat diabetes and its complications, the increased risk is still substantial even if data on risk factor controls in […]

Cardiovascular autonomic neuropathy (CAN) is the most frequent complication of diabetes and one of the major components of diabetic dysautonomia. CAN occurs early in the course of diabetes, and several pathophysiological factors are involved. It is associated with an impairment in cardiovascular prognosis. Cardiac autonomic function should be assessed in most diabetic patients as it […]

Obstructive sleep apnoea (OSA) is a common and disabling medical condition that is part of the broad spectrum of breathing disorders associated with abnormal sleep. Many epidemiological studies have shown a clear association between type 2 diabetes, various components of the metabolic syndrome and the presence of sleep apnoea. There is clear evidence that sleep […]

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 […]

Acromegaly is an uncommon disorder, with an annual incidence of three to four cases per million.1,2 It is characterized by excessive secretion of growth hormone (GH), resulting in exaggerated growth of bone and soft tissues, multisystem involvement with multiple comorbidities, and heightened risk of premature mortality. GH is produced by the somatotroph cells of the […]

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 […]

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, […]

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 […]