US ENDOCRINE DISEASE – VOLUME 2 ISSUE 2 – WINTER 2006
An in-depth, thought-provoking and informative report and supporting website focusing on the latest scientific, clinical and practice management issues influencing the growth and development of the US endocrinology market.
Adding to the Armamentarium for the Treatment of Diabetes Mellitus
It is now well established that improving glycemic control reduces the risk of microvascular complications, but optimal glycemic control has been elusive.
What is Successful Islet Transplantation in 2006?
Three general transplantation approaches are most common, namely, simultaneous pancreas and kidney (SPK); pancreas after kidney (PAK); and pancreas transplant alone (PTA). The one-year, post-transplant pancreas survival rates for these procedures are 79%, 69%, and 69%, respectively, while the five-year organ survival rates are 70%, 45%, and 45%, respectively.The one- and five-year patient survival rates […]
Diabetes Management & Glycemic Control
Hypoglycemia The Major Barrier to Good Glycemic Control
Risk factors have been identified for iatrogenic hypoglycemia, and physiologic studies have revealed the mechanisms of many of these risk factors. Predictors of severe (requiring assistance) hypoglycemia identified through the DCCT include prior history of severe hypoglycemia, longer duration of diabetes, higher baseline glycosylated hemoglobin (HbA1c), and lower treatment HbA1c in type 1 diabetes. The […]
Intensive Treatment of Type-1 Diabetes The Balance of Benefits and Risks in the DCCT/EDIC Study
In brief, 1,441 type-1 diabetic individuals were recruited into two cohorts: 726 in a primary prevention cohort with no retinopathy and an albumin excretion rate (AER) of <40mg per 24 hours; and 715 in a secondary intervention cohort with mild to moderate retinopathy and AER 40–200mg per 24 hours. Both genders were equally represented and […]
Biphasic Insulin Aspart 30 Treatment Option in Children and Adolescents
It is more difficult to implement this goal in the pediatric population, especially due to the increased risk for hypoglycemia in preschool children, as well as fluctuations in insulin requirements caused by exercise, variable carbohydrate intake, and physiological changes due to puberty and age. The possible reduction of hypoglycemia is especially important in children as […]
Investigating Inhaled Insulin
In order for a particle to be inhaled into the deep lung for transport across the alveolar membrane, it must be of a certain size—between one and three micrometres (μm). Smaller than 1μm, the particle is so light in weight that it will be deposited in the upper airway or exit during exhalation; larger than […]
What Breathing Insulin Means for Diabetes Treatment
Although there are many oral hypoglycemic agents to stimulate insulin secretion, reduce insulin resistance, and slow glucose absorption, even combinations of multiple agents often fail to achieve normal HbA1c.2 Perhaps, more important, multiple oral agents (OAs) do not sufficiently reduce postprandial hyperglycemia.3,4 The most effective means of lowering blood sugar is externally administered insulin, particularly […]
Long-term Glycemic Control in Patients with Diabetes?
Fear of needles and the burden associated with multiple daily injections remain among the most significant barriers to initiating and maintaining insulin therapy. Inhaled human insulin (Exubera® (insulin human (rDNA origin)) Inhalation Powder) is a novel, rapid-acting, insulin formulation administered by inhalation before meals. An extensive clinical trial program including studies for up to two […]
Islet Cell Function in Type 2 Diabetes
Islet Cell Function Its Role in the Onset and Progression of Type 2 Diabetes
Immediately these data raise questions: • How much loss of islet cell function can be tolerated without elevation of blood glucose levels? • What was happening in the islets during and beyond the phase leading up to diabetes? • Are these processes modifiable?
Beta-cell Defects in Type 2 Diabetes and the Possibility of Treatment Options with GLP-1-based Therapies
In the development of type 2 diabetes, environmental influences (most importantly diet and sedentary lifestyle) and genetic factors lead to the development of insulin resistance (i.e.
Diabetes and the Alpha Cell
In the post-absorptive period (overnight fast), a quasisteady state exists in which the rate of glucose release into plasma approximates its removal. Under these conditions, most of glucose removal from plasma is independent of insulin (i.e. it is largely determined by obligatory tissue demands). For example, glucose uptake by the brain, the formed elements of […]
DPP-4 Inhibition as a Newly Emerging Therapy for Type 2 Diabetes
In addition, GLP-1 has a spectrum of effects thought to be desirable in an antidiabetic agent, including trophic effects on β-cells, inhibition of glucagon secretion, and suppression of food intake and appetite.2,3 The native peptides cannot be used therapeutically because they are rapidly degraded and inactivated by the enzyme, dipeptidyl peptidase-4 (DPP-4). Two strategies have […]
Vildagliptin An Oral Dipeptidyl Peptidase-4 Inhibitor for Type 2 Diabetes
Whether vildagliptin or other agents of this class can modify underlying disease course by improving or preserving α- and β-cell function remains to be determined.
Anti-diabetic Treatment in Obese Patients with Type 2 Diabetes Effects of Medication on Body Weight
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 […]
Diabetes & Cardiovascular Risk
Fenofibrates and the Prevention of Cardiovascular Risk
The significance of hypertriglyceridemia as a cardiovascular risk factor is further highlighted by its inclusion as a component of the metabolic syndrome, a cluster of metabolic abnormalities, related to insulin resistance. The other criteria for metabolic syndrome include low HDL cholesterol, central obesity, elevated blood pressure, and abnormal fasting glucose. People with metabolic syndrome are […]
Management of Cardiovascular Risk Factors in Racial and Ethnic Minorities with Type-2 Diabetes
Racial and ethnic minorities in the US are disproportionately afflicted with diabetes (see Figure 1 and Table 1) and type-2 diabetes is considerably more common in African-Americans than in whites.3–5 In the Atherosclerosis Risk in Communities Study, the incidence of diabetes was 2.4 times greater in African- American women and 1.5 times greater in African- […]
Diabetic Neuropathy & The Diabetic Foot
The Problem of the Aggressive Pituitary Tumor
Invasion, proliferation, and metastatic ability are three ways in which tumors take root, grow, and advance. Although proliferative tumors can be invasive, and invasion is a prerequisite to metastasis, none of these qualities automatically links to the others in a given tumor.Thus, each should be considered as sufficient, but not necessary, for a tumor to […]
Hypothyroidism Talking Points 2006
Much has happened since then. Kendall discovered thyroxine in 1914. Dietary iodine supplementation followed Marine and Kimball’s work on the role of iodine in the treatment of goiter in 1920. Harrington worked out the structure of thyroxine (T4) and synthesized it in 1926. A second and more potent thyroid hormone, triiodothyronine (T3), was discovered and […]
Salmon Calcitonin in the Treatment of Osteoporosis
Calcitonin is a polypeptide hormone produced by the thyroid gland, and regulates plasma calcium concentration. Calcitonin inhibits the activity of osteoclasts by binding to osteoclast receptors. The net result is an increase in bone mass density (BMD). Calcitonin is US Food and Drug Administration (FDA)-approved for the treatment of postmenopausal osteoporosis in women greater than […]
Salmon Calcitonin and the Treatment of Acute Osteoporosis
It has been approved for administration by subcutaneous, intramuscular, and intranasal routes.1,3-8 Because nasal spray calcitonin has been available in the US since 1995 it is extremely rare to use the subcutaneous route for therapy, as it is so much less convenient. Only if there were severe nasal congestion or an underlying condition making spray […]
Treatment of Osteoporosis in Postmenopausal Women Who Are At Risk of Fracture
All postmenopausal women should be advised to avoid smoking and excessive alcohol intake, exercise regularly, and take calcium (1,200–1,500mg daily from food and supplements) and vitamin D (800–1,200 international units (IU) daily). The guidelines for pharmacologic treatment of postmenopausal osteoporosis are not uniform among medical organizations. The pharmacologic options fall into two main categories: antiresorptive […]
The onset of puberty is caused by the secretion of highamplitude pulses of gonadotropin-releasing hormone (GnRH) by the hypothalamus. Pulsatile release of GnRH will increase pituitary secretion of lutenizing hormone (LH) and follicle-stimulating hormone (FSH). The hypothesized mechanisms that suppress onset of puberty until the appropriate age include: the hypothalamic-pituitary-gonadal (HPG) axis, which is highly […]
An Update on Female Puberty
The PROS study led to pediatric endocrinologists, i.e. Lawson Wilkins Pediatric Endocrine Society, proposing new definitions of precocious puberty, viz precocious onset (of puberty) occurs when it is noted at less than six years of age in African-American females and less than seven years in white American otherwise healthy girls. Initiation of Puberty and Pubertal […]
Female Sexual Dysfunction
Womens Sexual Health Update on Testosterone Therapy
Healthcare, including sexual healthcare, is a fundamental human right.1 Multiple population-based studies reveal a high prevalence of sexual-health concerns in women of all ages.2 A woman’s sexual problems can cause significant personal distress, including a diminution of selfworth and self-esteem, a reduction in life satisfaction and a decline in the quality of her relationship with […]
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