News & Views in 2010

A new study shows that serum vitamin D concentration is inversely associated with HbA_1c levels among adults in the US aged 35–74 years, in line with results from other observational studies. Should adults with diabetes mellitus or at risk of developing this disease take vitamin D to improve glycemia or reduce this risk?

Developments in treatment modalities and assays over the past 10 years warranted a new consensus on the criteria for cure of acromegaly, which was reached at a meeting of the Acromegaly Consensus Group, in April 2009. The novel consensus statement highlights current analytical pitfalls and the need to optimize disease control in acromegaly.

A review of amputation rates in England documents that in patients without diabetes mellitus amputation rates seem to be falling, but not in patients with diabetes mellitus. The burden of foot disease in patients with diabetes mellitus is rising but evidence suggests this increase might be masking improvements in the quality of its management.

Appropriate diagnosis and clinical management of patients with acute suppurative thyroiditis, an endocrine emergency, presents a major challenge, with no consensus guidelines currently available. Could the novel algorithm proposed by John Paes and colleagues provide a solution?

To successfully tailor glycemic therapies to each patient with type 2 diabetes mellitus, the heterogeneity of the clinical features, pathogenesis and causative genetic factors of this disorder must be considered. A new study has summarized the potential of individualized treatment for type 2 diabetes mellitus on the basis of phenotypes and genotypes.

A recent article by Bushnell et al. confirms and reassures what neuroendocrine tumor specialists have witnessed and believed for some time: radionuclide therapy using somatostatin analogs labeled with radioactive yttrium-90 alleviates symptoms of metastatic neuroendocrine tumors, reduces or stabilizes tumor burden and improves quality of life.

Evidence indicates that flutamide, a specific and potent androgen-receptor blocker, when given in low dose (∼1 mg/kg daily), confers a first-choice balance between antiandrogenic efficacy and hepatic safety for women and adolescent girls with hirsutism or other androgen-related symptoms.

The contribution of secondary causes to low bone mass in postmenopausal women with osteoporosis is unknown. A study by Cerdá Gabaroi et al. aimed to fill this gap. While the researchers found a high prevalence of secondary causes, the importance of clinical risk factors should not be underestimated in the primary care setting.

To address concerns about the long-term safety of using dopamine agonists to treat patients with hyperprolactinemia Valassi and colleagues carried out a systematic review of the literature. Although the results show no increased risk of valvular heart disease, lengthy prospective follow-up studies are needed in patients requiring long-term high dose regimens.

A novel study published in The Lancet suggests a U-shaped association between HbA_1c levels and mortality in patients with type 2 diabetes mellitus. But is a revision of current guidelines to include a minimum HbA_1c target advisable on the basis of these findings?

Hyperandrogenism is the key pathologic feature of polycystic ovary syndrome, but diagnostic assessment of androgen excess in women is problematic, and the biochemical assays in routine clinical practice are largely considered uninformative. Is it time to add new diagnostic modalities to the clinical toolbox and perhaps measure levels of estrogen instead?

Exercise has undisputed benefits for patients with type 2 diabetes mellitus, as it helps improve glycemic control, cardiovascular disease risk and body weight. In healthy people, regular exercise also improves mental health and mood, but the assumption that a similar improvement occurs in patients with type 2 diabetes mellitus has now been challenged.

An HbA_1c level ≥6.5% is recommended as a criterion for the diagnosis of diabetes mellitus. A recent study has assessed the sensitivity and specificity of HbA_1c levels for distinguishing between new onset type 1 diabetes mellitus and transient hyperglycemia in children. Do the results have implications for current pediatric clinical practice?

Surgical resection of pheochromocytoma is associated with a high risk of intraoperative hemodynamic instability owing to abrupt changes in tumoral catecholamine secretion. A study by Bruynzeel et al. has now assessed preoperative risk factors and the efficacy of presurgical treatment with two different α-adrenergic receptor antagonists.

In a recent study, Valassi et al. describe a subset of patients with Cushing disease with delayed remission after transsphenoidal adenomectomy. The investigators suggest that expectant management and close observation could eliminate unnecessary interventions in these patients. Could their findings change the clinical management of patients with hypercorticism after transsphenoidal adenomectomy?

A study of nearly 55,000 children finds that growth hormone therapy is generally very safe, but orthopedic problems can occur, and survivors of childhood cancer are at an increased risk of a new neoplasm. Do current treatment strategies for some targeted patient groups need reevaluation?

Smoking is known to be associated with an increased risk of type 2 diabetes mellitus. The effect of smoking cessation on diabetes risk, however, is not fully understood. Yeh et al. prospectively assessed the effect of quitting smoking on diabetes incidence and potential mediating factors.

Two new studies highlight the fact that pregnancies in women with type 1 diabetes mellitus are still associated with substantial obstetric and perinatal complications. Most marked and also surprising was a high incidence of offspring who were large for their gestational age.

True resistant hypertension is relatively frequent, yet effective treatment is often difficult to identify. In a new study, de Souza and colleagues demonstrate the potent blood pressure lowering effect of low-dose spironolactone in patients with evident resistant hypertension. This finding should have broad clinical implications in the effective management of a notoriously challenging condition.

Results of the ARBITER 6–HALTS trial indicate a superiority of the lipid-modifying agent nicotinic acid over ezetimibe for the treatment of atherosclerotic lesions. These findings could have substantial implications for patients worldwide who remain at moderate to high risk of cardiovascular complications because of low levels of HDL cholesterol. But is the evidence substantiated?