Viewpoint

Some studies have reported reduced secretion of glucagon-like peptide-1 (GLP-1) in patients with type 2 diabetes mellitus; however, other studies have failed to find such an association. The evidence for, and against, reduced GLP-1 secretion in the etiology of type 2 diabetes mellitus is debated by the authors of this Viewpoint.

The global obesity epidemic shows no sign of slowing down. Primary prevention at the population level is a huge challenge, however, particularly given the sedentary lifestyle of many modern societies. Nonetheless, the authors of this Viewpoint argue that targeting physical inactivity could represent a step in the right direction.

Subclinical hyperthyroidism is a common biochemical finding, characterized by low levels of serum TSH but normal serum T₄ and T₃levels. Potential adverse consequences include increased risk of atrial fibrillation and death from vascular diseases. Whether the evidence for harm associated with subclinical hyperthyroidism is sufficient to drive the need for treatment is discussed.

In 1988, Barbara Sherwin reported that surgical menopause was associated with a marked decline in verbal memory and that treatment with estradiol immediately after surgery prevented this deficit. The author of this Viewpoint describes how our understanding of estrogen and neurocognitive function has evolved in the 20 years since that seminal report.

Transfer of adolescents from pediatric care to adult endocrinology services represents a major medical issue. Unfortunately, however, many factors prevent effective transition. The authors of this Viewpoint discuss possible strategies—such as the creation of dedicated transition clinics—that might be implemented to ensure smooth transition to adult care.

Management of diabetes mellitus is occasionally confounded by lack of understanding on the part of physicians and patients of issues surrounding the risks and benefits of antidiabetic drugs. The need for adequately powered outcome studies that minimize the effects of the unknown on prescribing habits in diabetes care is debated.

Age-related declines in dehydroepiandrosterone sulfate concentration parallel the physical and cognitive changes of aging. This observation suggests that these events are causally related and that replacement therapy might have beneficial effects in the elderly. The authors of this Viewpoint consider the evidence for, and against, such an approach.

Identification and subsequent treatment of individuals with prediabetes can prevent progression to type 2 diabetes mellitus. Although lifestyle changes are critical in this setting, the question of whether pharmacotherapy should also be used remains unanswered. The authors of this Viewpoint, therefore, discuss potential strategies for pharmacologic intervention.

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.

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.

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.

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.

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.

The use of growth hormone to treat children with idiopathic short stature remains an area of controversy. The author of this Viewpoint discusses the possible etiology of idiopathic short stature, the efficacy and safety of the treatment regimen, and which children with this condition should be selected for therapy.

Premature ovarian failure (POF) generally occurs before 40 years of age and is characterized by amenorrhea and follicle-stimulating hormone levels within the menopausal range. Variations in the endogenous estradiol levels can also occur. The potential risks and benefits of hormone replacement therapy for women with POF are discussed in this Viewpoint.

The prevalence of obesity in the US is increasing at a rapid rate. The author of this Viewpoint asks whether the government should introduce public health policies to address the obesity epidemic and, if so, what are the justifications for such intervention in the personal lifestyle choices of the American public?

Three broad recommendations have been made for the management of children with intersex conditions: halt all infant cosmetic genital surgery until evidence-based guidelines are available; conduct further research on the necessity of such surgery; and practice complete honesty with parents and patients. The authors discuss whether clinical practice has changed in response to these recommendations.

High serum fibroblast growth factor 23 (FGF-23) levels are associated with phosphaturia in several inherited and acquired human diseases. As FGF-23 actively regulates phosphate homeostasis, the author proposes that modulation of components of the FGF-23 signal transduction pathway might provide a novel therapeutic strategy for diseases of abnormal mineral ion metabolism.