Volume 6 Issue 1, January 2010

A study by Lingvay et al. has compared two intensive therapies to lower blood glucose levels in patients with newly diagnosed type 2 diabetes mellitus. The findings reveal the efficacy and safety of both insulin and triple oral therapy. Given that previous studies show questionable benefit and safety of intensive strategies, however, enthusiasm for both of these treatment regimens should be tempered.

Low bone mass is common in postmenopausal women with breast cancer and is often attributed to the combined effects of estrogen depletion and age. A new study identifies high frequencies of hyperparathyroidism and vitamin D deficiency in survivors of breast cancer and recommends routine investigation for secondary causes of low bone mass.

According to a large epidemiologic study, a majority of American children are vitamin D insufficient or deficient. In addition to negative effects on bone metabolism, low vitamin D levels in the pediatric population are associated with adverse cardiovascular risk factors, including an increase in systolic blood pressure and a reduction in HDL cholesterol levels.

Congenital adrenal hyperplasia is usually treated with steroid hormones, but these can inhibit growth when administered at high doses, especially during early to mid-adolescence. A retrospective observational study identifies the dose of glucocorticoids that should be used to maximize pubertal growth while achieving desired height.

Researchers have assessed the ability of the calcium mimetic cinacalcet to reduce the levels of serum calcium in patients with intractable primary hyperparathyroidism and serum calcium levels >3.1 mmol/l. Can clinicians finally control hypercalcemia in patients with intractable primary hyperparathyroidism?

Osteoporosis is a major public health problem but is underdiagnosed and undertreated. A new randomized controlled trial indicates that population screening for osteoporosis by BMD assessment resulted in improved treatment and reduced risk of fractures in postmenopausal women.

The global burden of microvascular disease associated with type 2 diabetes mellitus continues to escalate. Furthermore, conventional standards of care do not completely abolish the risk of diabetic retinopathy, nephropathy or neuropathy in affected individuals. In this Review, the authors highlight the issue of residual microvascular risk and discuss intensive treatment with statins and/or fibrates to target atherogenic dyslipidemia, a potential trigger of the microvascular complications that can develop in patients with type 2 diabetes mellitus.

Hereditary hemochromatosis is a genetic condition leading to iron overload that can have detrimental effects on glucose metabolism and other organ systems. This review summarizes the epidemiology of hereditary hemochromatosis and iron overload and discusses possible pathophysiologic mechanisms whereby iron excess can have toxic effects on β cells.

Amiodarone is widely used for treating cardiac arrhythmias, but is associated with various adverse effects. This Review discusses how the treatment can affect thyroid function, leading to amiodarone-induced hypothyroidism or hyperthyroidism. It compares outcomes with dronedarone, a structurally similar anti-arrhythmic drug that does not contain iodine and may have fewer and less serious adverse effects.

Osteomyelitis is one of the most feared complications of ulcers associated with the foot in diabetes mellitus as it greatly increases the risk of a lower-extremity amputation. As no generally agreed protocol exists, the management of this condition is also one of the most controversial. This Review discusses the available data on surgical versus primarily nonsurgical management of osteomyelitis as a complication of the diabetic foot.

Advances in organ and tissue transplantation continue to improve the care of patients with multiple diseases. The authors present the case of a patient with hypopituitarism secondary to a suprasellar mass, in whom the first documented pituitary gland transplantation was performed. This case study illustrates Harvey Cushing's pioneering work in pituitary transplantation in the early 20th century and the essential relationship between laboratory research and clinical practice.

Many foods are marketed on the basis of a claim to reduce hunger, food intake or body weight. It is clear that any claim should be substantiated by scientific evidence. This article discusses the validity of such claims and the capacity of diet foods to influence behavior in a meaningful way in the real world.