Pub Date : 2016-01-01DOI: 10.17925/USE.2016.12.02.78
S. Kalra
{"title":"Developments in Diabetology in 2016","authors":"S. Kalra","doi":"10.17925/USE.2016.12.02.78","DOIUrl":"https://doi.org/10.17925/USE.2016.12.02.78","url":null,"abstract":"","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"12 1","pages":"78"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67601785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.17925/USE.2016.12.01.16
E. Sellers
Youth-onset type 2 diabetes (diagnosed <18 years of age) is increasing around the world. Indigenous populations are disproportionally affected. The classic microvascular complications of diabetes are now emerging in this population and early data suggest that complications may occur early and more aggressively in youth-onset versus adult-onset disease. Of concern are the transgenerational effects of youth-onset diabetes, with increasing rates of pregestational exposure to diabetes, a potent risk factor for the development of youth-onset type 2 diabetes.
{"title":"An Advancing Avalanche—The Emergence of Complications in Indigenous Youth with Type 2 Diabetes","authors":"E. Sellers","doi":"10.17925/USE.2016.12.01.16","DOIUrl":"https://doi.org/10.17925/USE.2016.12.01.16","url":null,"abstract":"Youth-onset type 2 diabetes (diagnosed <18 years of age) is increasing around the world. Indigenous populations are disproportionally affected. The classic microvascular complications of diabetes are now emerging in this population and early data suggest that complications may occur early and more aggressively in youth-onset versus adult-onset disease. Of concern are the transgenerational effects of youth-onset diabetes, with increasing rates of pregestational exposure to diabetes, a potent risk factor for the development of youth-onset type 2 diabetes.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"7 1","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67601989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.17925/USE.2016.12.02.76
O. Hamdy
O ver the last few years, the question, “can type 2 diabetes be reversed?” came to the surface after several observations of partial or complete remission from the disease were seen in response to surgical and non-surgical interventions for weight management. This leads us to propose an alternative model for type 2 diabetes management by targeting body weight instead of our current classic model of targeting blood glucose levels by anti-hyperglycemic medications. The proposed alternative model may be successful in the early stages of type 2 diabetes as we currently have several effective tools. Untimely, this model of intervention may reduce cost and improve patients’ quality of life.
{"title":"Can Type 2 Diabetes be Reversed","authors":"O. Hamdy","doi":"10.17925/USE.2016.12.02.76","DOIUrl":"https://doi.org/10.17925/USE.2016.12.02.76","url":null,"abstract":"O ver the last few years, the question, “can type 2 diabetes be reversed?” came to the surface after several observations of partial or complete remission from the disease were seen in response to surgical and non-surgical interventions for weight management. This leads us to propose an alternative model for type 2 diabetes management by targeting body weight instead of our current classic model of targeting blood glucose levels by anti-hyperglycemic medications. The proposed alternative model may be successful in the early stages of type 2 diabetes as we currently have several effective tools. Untimely, this model of intervention may reduce cost and improve patients’ quality of life.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"12 1","pages":"76"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67601757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.17925/USE.2016.12.02.99
A. Wijesinghe, S. Gunatilake, D. Shrestha, Y. Gupta, N. Somasundaram, U. Bulugahapitiya, S. Kalra
Gestational diabetes mellitus (GDM) is a heterogeneous condition, as exemplified by our inability to agree upon screening and diagnostic criteria. Not all women with GDM carry the same long-term risk of diabetes. We therefore propose a triage system to identify women with GDM who are at higher risk of converting to diabetes mellitus, in a shorter time frame after pregnancy. Such women can be offered personalized risk assessment information.
{"title":"Gestational Diabetes Mellitus—Triage for Preventive Intervention","authors":"A. Wijesinghe, S. Gunatilake, D. Shrestha, Y. Gupta, N. Somasundaram, U. Bulugahapitiya, S. Kalra","doi":"10.17925/USE.2016.12.02.99","DOIUrl":"https://doi.org/10.17925/USE.2016.12.02.99","url":null,"abstract":"Gestational diabetes mellitus (GDM) is a heterogeneous condition, as exemplified by our inability to agree upon screening and diagnostic criteria. Not all women with GDM carry the same long-term risk of diabetes. We therefore propose a triage system to identify women with GDM who are at higher risk of converting to diabetes mellitus, in a shorter time frame after pregnancy. Such women can be offered personalized risk assessment information.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"16 1","pages":"99"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67602984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.17925/USE.2016.12.02.74
P. Camacho
T he 2016 American Association of Clinical Endocrinologists/American College of Endocrinology Guidelines for postmenopausal osteoporosis provides comprehensive guidance on the diagnosis, evaluation and treatment of postmenopausal osteoporosis. A new diagnostic criterion which expands the diagnosis to patients with osteopenia and a high Fracture Risk Assessment Tool score has been added to the old diagnostic criteria. Recommendations on duration of bisphosphonate therapy are clearly outlined and are based on fracture risk stratification. The accompanying algorithm, which goes through all the steps from diagnosis to treatment and follow up is a handy guide for clinicians.
{"title":"2016 American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines on Postmenopausal Osteoporosis","authors":"P. Camacho","doi":"10.17925/USE.2016.12.02.74","DOIUrl":"https://doi.org/10.17925/USE.2016.12.02.74","url":null,"abstract":"T he 2016 American Association of Clinical Endocrinologists/American College of Endocrinology Guidelines for postmenopausal osteoporosis provides comprehensive guidance on the diagnosis, evaluation and treatment of postmenopausal osteoporosis. A new diagnostic criterion which expands the diagnosis to patients with osteopenia and a high Fracture Risk Assessment Tool score has been added to the old diagnostic criteria. Recommendations on duration of bisphosphonate therapy are clearly outlined and are based on fracture risk stratification. The accompanying algorithm, which goes through all the steps from diagnosis to treatment and follow up is a handy guide for clinicians.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"1 1","pages":"74"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67601747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.17925/USE.2016.12.01.31
J. T. Ilkowitz, Neesha Ramchandani
Creation of a working closed loop/artificial pancreas (CL/AP) system is one of the holy grails of type 1 diabetes mellitus (T1DM). In essence, this would be a mechanical cure for a potentially devastating chronic disease. While the CL/AP still has its limitations, the results of recent research studies are encouraging. The CL/AP system also has the attention and support of organizations such as the US Food and Drug Administration (FDA) and the Juvenile Diabetes Research Foundation (JDRF), which is a large charitable organization dedicated to funding T1DM research. The JDRF has created a six-step pathway which ends in a fully automated CL/AP system, and the FDA has created a helpful guide with recommendations and instructions for those interested in developing a CL/AP. The purpose of this paper is to discuss the components of the CL/AP system, describe its limitations, and review recent CL/AP research studies and future directions.
{"title":"Research Update—Closed Loop/Artificial Pancreas","authors":"J. T. Ilkowitz, Neesha Ramchandani","doi":"10.17925/USE.2016.12.01.31","DOIUrl":"https://doi.org/10.17925/USE.2016.12.01.31","url":null,"abstract":"Creation of a working closed loop/artificial pancreas (CL/AP) system is one of the holy grails of type 1 diabetes mellitus (T1DM). In essence, this would be a mechanical cure for a potentially devastating chronic disease. While the CL/AP still has its limitations, the results of recent research studies are encouraging. The CL/AP system also has the attention and support of organizations such as the US Food and Drug Administration (FDA) and the Juvenile Diabetes Research Foundation (JDRF), which is a large charitable organization dedicated to funding T1DM research. The JDRF has created a six-step pathway which ends in a fully automated CL/AP system, and the FDA has created a helpful guide with recommendations and instructions for those interested in developing a CL/AP. The purpose of this paper is to discuss the components of the CL/AP system, describe its limitations, and review recent CL/AP research studies and future directions.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"12 1","pages":"31"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67602131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.17925/USE.2016.12.02.90
S. Groeneweg, R. Peeters, T. Visser, W. Visser
{"title":"Diagnostic and Therapeutic Challenges in the Allan–Herndon–Dudley Syndrome","authors":"S. Groeneweg, R. Peeters, T. Visser, W. Visser","doi":"10.17925/USE.2016.12.02.90","DOIUrl":"https://doi.org/10.17925/USE.2016.12.02.90","url":null,"abstract":"","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"12 1","pages":"90"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67602915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.17925/USE.2016.12.02.102
J. Mechanick
O besity is a complex, chronic disease with a high prevalence rate that has been resistant to current preventive and therapeutic efforts. A new definition of obesity is proposed in the context of emerging information and the need for de-stigmatization. Adiposity-based chronic disease (ABCD) addresses the amount, distribution, and function of body fat. An ABCD model is best approached using structured lifestyle medicine and a focus on health promotion, rather than exclusively disease management. Future care models for ABCD will likely involve gene/genomic analyses and advanced body imaging technologies.
{"title":"Adiposity-based Chronic Disease—Obesity Re-worked","authors":"J. Mechanick","doi":"10.17925/USE.2016.12.02.102","DOIUrl":"https://doi.org/10.17925/USE.2016.12.02.102","url":null,"abstract":"O besity is a complex, chronic disease with a high prevalence rate that has been resistant to current preventive and therapeutic efforts. A new definition of obesity is proposed in the context of emerging information and the need for de-stigmatization. Adiposity-based chronic disease (ABCD) addresses the amount, distribution, and function of body fat. An ABCD model is best approached using structured lifestyle medicine and a focus on health promotion, rather than exclusively disease management. Future care models for ABCD will likely involve gene/genomic analyses and advanced body imaging technologies.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"24 1","pages":"102"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67601715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.17925/USE.2016.12.01.39
A. Bauer, G. Francis, S. Waguespack, D. Zimmerman, Sowmya Krishnan, Emily Breidbart, Pushpa Viswanathan, Ryan J. McDonough, K. Barger, Yun Yan, J. Yee, A. Bauman, Jose Jimenez-Vega, S. Rose, P. Backeljauw, R. Newfield
Background: Ultrasound reveals thyroid abnormalities in 18% of children and adolescents, of which, 22% are malignant. This creates a dilemma for practitioners who must distinguish lesions that require removal (high risk for malignancy) from lesions that can be observed (low risk for malignancy). Furthermore, treatment of children with differentiated thyroid cancer (DTC) is evolving. Previous treatments were based on adult protocols prescribing total thyroidectomy, lymph node dissection, and radioactive iodine (RAI) ablation for children with DTC, regardless of disease extent. This achieved excellent disease-free survival but high, and potentially avoidable, surgical and medical complications including an increase in secondary non-thyroid malignancies. Methods: This manuscript is a synopsis of cases presented during a symposium at the 2015 Pediatric Endocrine Society meeting (San Diego, CA) with recommendations based on the American Thyroid Association (ATA) management guidelines for children and adolescents with thyroid nodules and DTC. Results: The cases were selected to demonstrate application of the guidelines across a variety of pediatric patients with DTC highlighting key points of the ATA guidelines. The cases will assist practitioners in learning how to apply these guidelines to patient management. Conclusion: Treatment of children with thyroid nodules and DTC is evolving. Current guidelines emphasize the importance of surgery by experienced teams and deferral of RAI ablation for low-risk patients.
{"title":"How can we apply the new american thyroid association treatment guidelines for children and adolescents with thyroid cancer to improve patient management? Novel insights into clinical experience","authors":"A. Bauer, G. Francis, S. Waguespack, D. Zimmerman, Sowmya Krishnan, Emily Breidbart, Pushpa Viswanathan, Ryan J. McDonough, K. Barger, Yun Yan, J. Yee, A. Bauman, Jose Jimenez-Vega, S. Rose, P. Backeljauw, R. Newfield","doi":"10.17925/USE.2016.12.01.39","DOIUrl":"https://doi.org/10.17925/USE.2016.12.01.39","url":null,"abstract":"Background: Ultrasound reveals thyroid abnormalities in 18% of children and adolescents, of which, 22% are malignant. This creates a dilemma for practitioners who must distinguish lesions that require removal (high risk for malignancy) from lesions that can be observed (low risk for malignancy). Furthermore, treatment of children with differentiated thyroid cancer (DTC) is evolving. Previous treatments were based on adult protocols prescribing total thyroidectomy, lymph node dissection, and radioactive iodine (RAI) ablation for children with DTC, regardless of disease extent. This achieved excellent disease-free survival but high, and potentially avoidable, surgical and medical complications including an increase in secondary non-thyroid malignancies. Methods: This manuscript is a synopsis of cases presented during a symposium at the 2015 Pediatric Endocrine Society meeting (San Diego, CA) with recommendations based on the American Thyroid Association (ATA) management guidelines for children and adolescents with thyroid nodules and DTC. Results: The cases were selected to demonstrate application of the guidelines across a variety of pediatric patients with DTC highlighting key points of the ATA guidelines. The cases will assist practitioners in learning how to apply these guidelines to patient management. Conclusion: Treatment of children with thyroid nodules and DTC is evolving. Current guidelines emphasize the importance of surgery by experienced teams and deferral of RAI ablation for low-risk patients.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"12 1","pages":"39-51"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67601704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.17925/USE.2016.12.01.18
E. Stein, F. Raal
There remains an unmet need for patients, many at high CVD risk, who are unable to achieve ‘optimal’ LDL-C targets with statin therapy, or are intolerant to statins. Two new drugs were approved in 2013–2014 both of which inhibit production of LDL, or its precursor very (V)LDL; mipomersen, an apolipoprotein B antisense agent, and lomitapide, an inhibitor of microsomal triglyceride transport protein.9 However their use is strictly limited to the rare orphan population with homozygous familial hypercholesterolemia (HoFH) with prescribing controlled by a Risk Evaluation and Monitoring Strategy in the USA and a ‘named patient’ program in other countries.9 Thus the proprotein convertase subtilisin/ kexin type 9 (PCSK9) monoclonal antibodies (mAbs), alirocumab and evolocumab, approved in late 2015, now provide a new class of drugs which substantially and safely decrease LDL-C.
{"title":"Update on PCSK9 Inhibitors and New Therapies","authors":"E. Stein, F. Raal","doi":"10.17925/USE.2016.12.01.18","DOIUrl":"https://doi.org/10.17925/USE.2016.12.01.18","url":null,"abstract":"There remains an unmet need for patients, many at high CVD risk, who are unable to achieve ‘optimal’ LDL-C targets with statin therapy, or are intolerant to statins. Two new drugs were approved in 2013–2014 both of which inhibit production of LDL, or its precursor very (V)LDL; mipomersen, an apolipoprotein B antisense agent, and lomitapide, an inhibitor of microsomal triglyceride transport protein.9 However their use is strictly limited to the rare orphan population with homozygous familial hypercholesterolemia (HoFH) with prescribing controlled by a Risk Evaluation and Monitoring Strategy in the USA and a ‘named patient’ program in other countries.9 Thus the proprotein convertase subtilisin/ kexin type 9 (PCSK9) monoclonal antibodies (mAbs), alirocumab and evolocumab, approved in late 2015, now provide a new class of drugs which substantially and safely decrease LDL-C.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"12 1","pages":"18"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67602005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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