Volume 5 Issue 10, October 2009

Much attention has focused on the increasing prevalence of childhood type 2 diabetes mellitus. However, considerable evidence suggests that the incidence of childhood type 1 diabetes mellitus is also increasing. The results of a multicenter registration study from Europe confirm this alarming trend, which has important health-care implications.

Numerous risk-group stratification, staging and scoring systems exist to stratify patients with differentiated thyroid cancer into prognostic risk groups that guide patient management decisions. The tumor–node–metastasis staging system is the most widely adopted despite its relative complexity, but could a simplified, quantitative alternative to the system provide superior prognostic value?

Diabetes mellitus is associated with cognitive decrements and alterations on brain imaging. However, important questions remain concerning risk factors and mechanisms for cerebral damage in patients with this condition. Data from two new studies shed new light on the relationship between hypoglycemia and cognitive dysfunction in older people with type 2 diabetes mellitus.

Vitamin D deficiency is widespread among women with breast cancer. Guidelines currently recommend daily supplementation with 400 IU vitamin D₃; however, attainment of a circulating level of 25-hydroxyvitamin D defined as sufficient (that is, ≥75 nmol/l) might not be possible with this level of supplementation, according to data published in the Journal of Clinical Oncology.

The Diabetes Control and Complications Trial (DCCT) was a landmark study that evaluated intensive versus conventional insulin therapy in patients with type 1 diabetes mellitus; the Epidemiology of Diabetes Interventions and Complications (EDIC) study continues to follow the same cohort of patients. Many of the key contributions that the DCCT and EDIC have made to our understanding of type 1 diabetes mellitus are discussed by the authors of this Review.

Biochemical control cannot be achieved by the use of somatostatin analogs alone in a large number of patients with acromegaly. Combination therapy with somatostatin analogs and the growth-hormone-receptor antagonist pegvisomant is, however, highly effective at normalizing levels of insulin-like growth factor I. In this Review, the efficacy and safety of somatostatin analog–pegvisomant combination therapy as a potential tool for the medical management of patients with acromegaly is discussed.

Very little is known about how the changes in body composition that occur around the time of menopause might affect subsequent risk of new-onset diabetes mellitus, as well as the management of pre-existing disease, in postmenopausal women. Here, Emily D. Szmuilowicz and colleagues discuss the potential relationship between menopause, diabetes mellitus and the use of postmenopausal hormone therapy.

Aromatase deficiency is an extremely rare syndrome that is characterized by congenital estrogen deprivation. Early diagnosis is a key consideration, and estrogen therapy should be initiated as soon after puberty as possible in order to avoid the skeletal complications associated with this disorder. Here, Rochira and Carani review the presentation, diagnosis and treatment of aromatase deficiency in men.

Mutations in a number of genes have been identified in patients as the primary genetic cause of idiopathic hypogonadotropic hypogonadism. These genes encode proteins that regulate gonadotropin-releasing hormone (GnRH) neuron development, migration from the nasal placode to the hypothalamus, GnRH secretion or GnRH action. This Review discusses genes associated with hypogonadotropic disorders and the molecular mechanisms by which mutations in these genes may result in idiopathic hypogonadotropic hypogonadism.

Charcot arthropathy of the neuropathic foot and ankle is characterized by bone and joint destruction and deformities that may lead to ulcer, soft tissue infection, osteomyelitis and amputation. This article reviews the evaluation and treatment of this condition, highlighted by a clinical case of a man with type 2 diabetes mellitus who had Charcot collapse of the longitudinal arch, rocker bottom deformity and plantar ulcer.