Reviews & Analysis

Prediabetic states that involve impairments of insulin secretion and action can be identified. Medical therapy and lifestyle modifications can be used in people with these disorders to delay or prevent the onset of type 2 diabetes. In this Review, the data on development and evaluation of diabetes-prevention strategies are discussed and some recommendations for practice are provided.

Malnutrition is common in critically ill, hospitalized patients and so represents a major problem for intensive care. Nutritional support can be beneficial in such cases and may help preserve vital organ and immune function. Energy requirements, route of delivery and potential complications of nutritional support are discussed in this Viewpoint.

Cushing's syndrome is no longer considered rare, but making a diagnosis remains challenging. Traditional tests yield variable results. Measurement of late-night serum cortisol levels can deliver excellent sensitivity and specificity but blood samples must be taken during a hospital stay. Here, Carroll et al. put forward the case for late-night salivary cortisol measurement as a simple alternative test.

Type 1 diabetes mellitus is a chronic process of many years, during which insulin production slowly decreases. This key feature makes the disease a potential candidate for treatment but also for prevention against symptoms becoming clinically overt. This Review discusses issues of diagnosis and risk stratification, and the development of prevention strategies.

Achieving biochemical remission and tumor shrinkage in acromegaly can prove difficult despite a range of available therapies. Pegvisomant seems to be useful to attain the former but certain adverse effects have raised concern. This Review rounds up the evidence on the safety and efficacy of this drug, summarizes risks and benefits and suggests therapeutic approaches.

Impaired glucose tolerance is a prediabetic condition that is a major risk factor for subsequent development of type 2 diabetes mellitus. As type 2 diabetes mellitus has become common among obese adolescents, options for the management of children with impaired glucose tolerance are discussed in this Viewpoint.

The patient described in this article had a history of hereditary primary hyperparathyroidism, which is usually treated surgically. When the patient developed a recurrent parathyroid adenoma she refused surgery and in this Case Study the authors describe, for the first time, the use of the calcimimetic cinacalcet in a patient with hereditary primary hyperparathyroidism.

Patients defined as overweight or obese on the basis of BMI have reduced mortality and cardiovascular risk when compared with their normal-weight counterparts. The authors of this Viewpoint propose that these paradoxical results might reflect how obesity is currently measured and highlight the importance of differentiating between body fat and lean mass.

Insulin resistance has a pivotal role in polycystic ovary syndrome. This Review evaluates the clinical implications of findings from several recent studies on the role of insulin-sensitizing drugs, such as metformin and thiazolidinediones in polycystic ovary syndrome, with particular regard to insulin action, cardiovascular disease, hyperandrogenism, infertility and pregnancy.

Glucocorticoids are widely used because they have potent anti-inflammatory and immunosuppressive effects, but they can lead to clinically important complications in many different body systems. In this Review, the different major complications are discussed and recommendations on dosing and durations of therapy are provided. Interactions with other drugs are also considered.

Hirsutism is a common presenting complaint in women of reproductive age and can cause significant psychological distress and embarrassment. This article describes the case of a 20-year-old woman in whom hirsutism was caused by polycystic ovary syndrome, and illustrates the clinical assessment, investigations and management of a patient with hirsutism.

Injury to the vasculature is an important adverse outcome in diabetes. In this Review, Yan et al. explore how advanced glycation end-products and their main receptor, RAGE, might have roles in the development of diabetes and some of its complications–nephropathy, atherosclerosis and inflammatory response–through activation of inflammatory signaling cascades.

Although the mechanisms of β-cell failure in type 2 diabetes mellitus remain debated, islet inflammation is implicated and the cytokine interleukin-1β has emerged as a master regulator of this process. The potential role of anakinra—a recombinant human IL-1-receptor antagonist—in the treatment of type 2 diabetes mellitus is discussed.

Statins are traditionally used in patients with hypercholesterolemia and cardiovascular disorders. More recently, however, statins have been shown to exert pleiotropic effects on cell proliferation, survival, and migration, which suggests they could have chemopreventive properties. The author of this Viewpoint proposes that statins might have therapeutic potential in thyroid proliferative disease.

Major advances have been made in defining the genes and mechanisms responsible for monogenic β-cell diabetes. This article describes how a molecular genetic classification into four main categories offers a more useful guide to clinical management and treatment than using terms such as neonatal diabetes or maturity-onset diabetes of the young.

Radioiodine is commonly used to treat differentiated thyroid carcinoma. Nonetheless, the high activities administered during therapy are potentially carcinogenic for other organs, such as the salivary glands and digestive tract. The risk of second primary malignancies after radioiodine therapy for thyroid carcinoma is discussed by the author of this Viewpoint.

Identification of easily modifiable risk factors is urgently required for primary prevention of diabetes mellitus. Optimal vitamin D homeostasis seems important for a number of non-skeletal outcomes, including insulin secretion and action. As a consequence, vitamin D insufficiency has emerged as a potential factor in diabetes risk.

Contrary to the assumption that gonadotrope pituitary adenomas are non-functioning, these tumors can be functional and lead to the development of the ovarian hyperstimulation syndrome. This article describes a patient with a 15-year history of galactorrhea and multicystic ovaries caused by a gonadotrope-secreting pituitary adenoma.

As outlined here, measurement of serum thyroglobulin poses a number of technical challenges. These include between-assay biases, sensitivity limitations, and problems caused by thyroglobulin autoantibodies and heterophilic antibodies in patients' serum. As treatment and follow-up strategies for differentiated thyroid cancer evolve, it is important that clinicians are aware of these potential pitfalls.

Polycystic ovary syndrome (PCOS) affects up to 10% of women and features a range of hormonal and metabolic abnormalities, many of which are associated with increased cardiovascular risk. The authors of this article urge clinicians to be aware of this risk when dealing with even young women who have PCOS.