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Glomerular hyperfiltration has long been thought of as indicative of progression to albuminuria and nephropathy in type 1 diabetes mellitus. However, a new study supports other research in the past few years that has highlighted flaws in this model for kidney disease pathogenesis in type 1 diabetes mellitus.
Holman et al. describe regional variation in lower limb amputation rates across England. In addition to confirming a >20-fold increased amputation risk associated with diabetes mellitus, they also report a 10-fold difference in amputation rates in individuals with diabetes mellitus between 151 Primary Care Trusts of the National Health Service.
Type 2 diabetes mellitus (T2DM), obesity and vitamin D deficiency are pandemic. Two new studies confirm the diabetes–vitamin D connection by demonstrating a >1.4-fold increase in risk of the metabolic syndrome in vitamin-D-deficient Australians and a 62% reduction in progression of prediabetes to T2DM with vitamin D sufficiency.
BRAF mutation detection in cytological samples from thyroid nodules increases the sensitivity of cytology for the diagnosis of thyroid cancer and is believed to be a marker of aggressive disease. Lee et al. demonstrate high-sensitivity detection of the BRAF mutation with a new assay technique, but disprove the association with tumour aggressiveness.
Bone adapts to mechanical loading regularly imposed on it. The faster we move, the greater are the ground reaction impacts and the stresses on our weight-bearing bones. Deere et al. suggest that only habitual levels of high-impact activity, such as jumping, are sufficient to substantially improve hip bone strength in adolescents.
This Review discusses the effects of hypogonadal conditions, particularly anorexia nervosa and athletic amenorrhoea, on bone metabolism in female adolescents and young adults and the specific mechanisms that contribute to the degree of compromised bone. In addition, potential therapies to improve BMD in these conditions will be addressed.
Cardiovascular autonomic neuropathy is a subgroup of diabetic autonomic neuropathy that is a common complication of long-term diabetes mellitus and contributes to poor quality of life and increased morbidity and mortality. This Review discusses methods for diagnosis, epidemiology, natural history and potential causes and consequences of cardiovascular autonomic neuropathy.
Hypothyroidism has been linked with cardiac dysfunction, atherosclerosis, hypertension and coagulopathy, and this increased morbidity might be expected to shorten lifespan. However, the relationship between hypothyroidism and mortality is not clear, particularly regarding overt hypothyroidism. This Review discusses the literature on mortality in patients with hypothyroidism, appraises the weaknesses of existing studies and suggests new directions for research that could improve our understanding of the relationship between hypothyroidism and lifespan.
Continuous subcutaneous insulin infusion (CSII) or multiple daily insulin injections (MDI) are used to achieve strict glycaemic control in patients with type 1 diabetes mellitus. This Review explores the indications for the use of CSII and also outlines advantages and disadvantages of CSII versus MDI and existing and future features of insulin pumps.
The effects of iodine deficiency include mental and physical impairment, disturbed thyroid function and goitre. Emerging evidence indicates that iodine deficiency is a public health problem affecting most countries, including developed countries and island nations. This Review discusses global trends in iodine deficiency and emphasizes the importance of innovative prevention and control strategies and vigilant monitoring programmes.
