Volume 6 Issue 9, September 2010

Combination therapy with vitamins B₆, B₉ and B₁₂ is a therapeutic intervention to decrease levels of plasma homocysteine and the risk of cardiovascular disease. However, a recent trial found that cosupplementation with these vitamins exacerbated the decline in renal function and increased the risk of vascular disease in patients with diabetic nephropathy. Confidence in this high-dose vitamin supplement is shaken.

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.

Case reports published over 100 years ago suggested that high-dose sodium salicylate could reduce the symptoms of type 2 diabetes mellitus, but adverse affects precluded clinical use. Now, results from the TINSAL-T2D study that used salsalate, a salicylate prodrug, provide renewed hope for NSAID treatment of type 2 diabetes mellitus.

Lowering blood pressure to normal levels, below those currently recommended, does not reduce the risk of cardiovascular disease events in patients with type 2 diabetes mellitus. Nor does treating dyslipidemia with fibrate and statin combination therapy reduce the risk of cardiovascular disease events more than treatment with statin alone.

The development of molecular breast cancer therapies in the past few decades has considerably improved treatment of the disease. This Review chronicles these advances and discusses future treatment targets, namely steroid sulfatase and 17β-hydroxysteroid dehydrogenase type 1 (in estrogen-dependent breast cancers), and treatment strategies, including combinatory therapies and the use of techniques such as RNA silencing and functional genomics.

Systemic medications that target glycemic control and coexisting conditions in diabetes mellitus can have beneficial or deleterious effects on the onset or progression of diabetic retinopathy. This article reviews current knowledge of the ocular-specific effects of systemic medications commonly used by patients with diabetes mellitus, including those directed at control of hyperglycemia, dyslipidemia, hypertension, cardiac disease, anemia, inflammation and cancer.

Patients with phenylketonuria develop almost normally if diagnosed neonatally and treated by diet; however, executive dysfunction remains. This Review discusses the disorder's diagnosis, the outcome of traditional treatment by dietary restriction and outlines new treatment possibilities, including tetrahydrobiopterin and other chaperone proteins, enzymatic treatment, large neutral amino acid supplementation and possibly gene therapy.

This Review addresses the relative roles of growth hormone and IGF 1 in mediating their biological effects, as well as the clinical outcome of inappropriate growth hormone signaling. Furthermore, it summarizes novel information provided by transgenic mouse models and mutagenesis studies on the roles and mechanisms of activation of the growth hormone receptor in the context of related class 1 cytokine receptors.

Disorders of the thyroid gland are relatively frequent in women of childbearing age and can result in poor pregnancy outcome. The authors of this Perspective are in favor of serum TSH measurement for all pregnant women and present relevant information on analytical and clinical aspects of serum TSH determination and its usefulness to detect subtle thyroid function abnormalities associated with the pregnant state, namely overt and subclinical hypothyroidism and hyperthyroidism.