Viewpoint in 2008

Continuous glucose monitoring systems provide dynamic measurements of interstitial glucose levels, enabling patients with diabetes mellitus to act preemptively to reduce glycemic variability. The authors of this Viewpoint discuss the advantages of continuous glucose-monitoring systems over self-monitoring of blood glucose, as well factors that limit its availability and success.

Fine-needle aspiration cytology (FNAC) is a widely useed method for identifying malignant thyroid nodules. The main limitation of FNAC is the relatively high number of non-diagnostic specimens. The author of this Viewpoint suggests that the use of a stylet needle remarkably improves the diagnostic performance of FNAC and reduces health care costs.

FDA approval of inhaled insulin offered the possibility of a new direction in diabetes care. Nonetheless, within a year of coming to market, the first inhaled insulin product was withdrawn by the manufacturer. Here, Mitri and Pittas examine the factors behind the failure of inhaled insulin to be adopted by patients and clinicians.

Use of the second-generation (atypical) antipsychotic agents has led to concerns about possible adverse metabolic effects, including an increased risk of diabetes mellitus. The potential mechanisms underlying treatment-emergent diabetes mellitus, and strategies for effective management of affected individuals, are explored by the author of this Viewpoint.

Cystic lesions of the pituitary region are quite common but present a challenge for diagnosis and treatment. Several types of cystic lesion are recognized, including cystic pituitary adenomas, Rathke cleft cysts, arachnoid cysts, and craniopharyngiomas. The clinical symptoms and diagnosis of these lesions, and the use of endoscopy for surgical intervention, are discussed in this Viewpoint.

Current approaches to treat type 1 diabetes mellitus can be divided into three categories: insulin therapy, cell-based therapy and modification of the autoimmune process associated with type 1 diabetes mellitus. Comparing the benefits, risk and challenges of insulin therapy and cell-based therapy, the author of this Viewpoint discusses the prospects for these two therapeutic approaches.

Treatment of thyroid cancer has not changed substantially for many years; however, few effective therapies are available for tumors that are metastatic or unable to take up radioiodine. The author of this Viewpoint, therefore, argues for the need to increase individual treatment efficacy through the introduction of novel targeted therapies.

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.