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Researchers have randomly assigned 811 overweight adults to low-calorie diets with differing percentages of energy derived from protein, carbohydrate, and fat; participants were followed up for 2 years. All groups experienced modest weight loss and improvements in cardiac and diabetes risk factors. Does this finding mean that clinicians can finally advise their patients on the best way to lose weight?
Parathyroidectomy is curative in primary hyperparathyroidism, but elderly patients are often denied this treatment owing to concerns over operative risks and doubts over efficacy of the intervention in improving symptoms. This view is changing, however, as evidence accumulates of the efficacy and safety of the procedure in the aged.
Previous randomized, controlled studies of growth hormone supplementation in the elderly have reported body-composition improvements but no beneficial effect on strength or physical function. The findings of a new study, however, hint at a potential benefit from the treatment for elderly individuals with functional decline.
Response to medical therapy for acromegaly is highly variable, with few predictive factors available to help clinicians make informed treatment choices. Researchers in the UK now suggest that prior radiotherapy might influence an individual's response to secondary therapy with dopamine agonists or somatostatin analogs.
This case illustrates some of the difficulties in treating anovulatory women with polycystic ovary syndrome, which is the most common cause of anovulatory infertility. Insulin resistance is a contributing factor to the pathogenesis of the syndrome. Assisted conception therapy is an effective treatment for women with polycystic ovary syndrome who are refractory to standard ovulation induction therapies or who have co-existing infertility factors. However, women with polycystic ovaries are particularly sensitive to stimulation with gonadotropins and have an increased risk of developing ovarian hyperstimulation syndrome.
The progressive increase in the incidence of both type 1 diabetes mellitus (T1DM) and T2DM, which is associated with changing environmental conditions, highlights overlapping clinical and pathogenetic features of these diabetes stereotypes. The article proposes that the common thread is a proinflammatory environment that activates innate immunological and inflammatory pathways, which lead to β-cell dysfunction in T2DM, insulin resistance in both T1DM and T2DM, and enhanced adaptive immunity that kills β cells in T1DM.
When patients treated with HMG-CoA reductase inhibitors exhibit residual risk—including low levels of high-density lipoprotein cholesterol and elevated triglycerides—adjunctive therapy with a fibric-acid derivative (i.e. fibrate) may be appropriate. However, given the prospect of statin–fibrate-associated myopathy, major factors affecting the question of which fibrate to choose in this setting have not been systematically evaluated. This article discusses available pharmacokinetic, pharmacodynamic, clinical pharmacologic, and postmarketing surveillance issues that may inform such decision making.
Currently, controversy reigns over the effects of different antidiabetic agents on cardiovascular outcomes in type 2 diabetes mellitus (T2DM). This article reviews the findings of recent cardiovascular outcome trials that assessed the safety of various glucose-lowering strategies. Multifactorial interventions to improve glycemic control, hypertension, and dyslipidemia enhance survival and reduce macrovascular events in T2DM. Insulin-sensitization regimens may be preferred in patients with T2DM who have coronary disease.
Aspirin is probably the most commonly used drug worldwide and has major analgesic, antipyretic and antiplatelet activities. Data from the Physicians' Health Study now suggest that regular use of low-dose aspirin might help reduce the risk of type 2 diabetes mellitus by around 14% in otherwise healthy men.
Traditional methods of male contraception, such as condoms and vasectomy, are unacceptable to many couples as they can be unreliable or the effects not easily reversed. Depot administration of male hormonal contraception could provide a safe, effective, reliable and reversible alternative, report researchers in China.
Evidence of gradual increases in serum concentration of C-peptide as pregnancy progresses in women with type 1 diabetes mellitus provides novel insight into mechanisms of β-cell failure and regeneration, and the potential role of C-peptide in diabetes mellitus and health.
The traditional view of nonclassic congenital adrenal hyperplasia is that affected individuals are not glucocorticoid-deficient. The results of a French study now cast doubts on this assumption, however, and raise important issues for classification and management of patients with this common genetic disorder.
Intensive insulin therapy to maintain tight glucose control is associated with reduced morbidity and mortality in adult patients hospitalized with critical illnesses. Can the same rationale also be applied to critically ill children admitted to the pediatric intensive-care unit?
Although previous studies unequivocally demonstrated that type 2 diabetes mellitus (T2DM) has a strong genetic component, the genes that contribute to the risk of this disease were largely unknown until recently, owing to the complexity of genetic and environmental interactions that are involved in T2DM. Genome-wide association studies, which provide global searches throughout the entire genome, have greatly improved our understanding of the genetic background of diabetes mellitus. Here, the authors discuss the currently available findings of diabetes-related genome-wide association studies and examine the utility of the genetic loci identified in these studies as predictors of T2DM.
Whilst less than 5% of pituitary tumors are familial, identification of familial pituitary tumor syndromes is important owing to the associated pathologies that might occur and the important implications for family members. Advances have been made in our understanding of these syndromes in the past decade and four genes have now been identified as being associated with familial pituitary tumors:MEN1, CDKN1B, PRKAR1A and AIP. This article reviews the current state of knowledge of familial pituitary tumor syndromes.
Noninvasive imaging modalities are increasingly used to study various aspects of diabetes mellitus. The authors of this article focus on the application of MRI, a modality that can provide not only anatomical and functional but also molecular information, for monitoring islet transplantation. Potential causes of islet graft failure, and novel technologies for the simultaneous imaging and delivery of experimental therapies to prevent such failure are also discussed.
The role of sex steroids in the regulation of bone metabolism has been extensively studied in women; however, less is known about their skeletal effects in men. On the basis of associations between serum estradiol levels, bone metabolism and fracture risk in adult men and skeletal symptoms in young men with estrogen resistance or aromatase deficiency, the authors suggest a crucial role for estradiol in regulating skeletal growth and health in men.
An organism's ability to adjust its phenotypic development to the environment is partly determined by epigenetic changes that are established in early life and modulate gene expression during development and maturity. A mismatch between the inducing and the mature environment may result in inappropriate patterns of epigenetic marks and of gene expression that increase the organism's susceptibility to chronic noncommunicable disease. The authors review the relationships between environmental influences during mammalian development, epigenetic changes and metabolic and cardiovascular diseases, and discuss the implications for prevention and treatment.
Physical or emotional effects that potentially threaten homeostasis activate various compensatory mechanisms coordinated by the stress system. This article provides an overview of the conceptual evolution and current understanding of homeostasis and stress, the main effectors and targets of the stress response and the effects of stress on the organism.
