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The Endocrine Society |
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Endocrine Discovery |
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 Top Endocrine Discovery US Child Obesity Rates...Metformin Equally Effective as...Guidelines Encourage Screening...Endocrine PracticeEndocrine PolicyMilestones in EndocrinologyIn the Journal 25... |
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Among 9,014 individuals with histories of coronary heart disease randomly assigned to receive either pravastatin or placebo, small rises in their cholesterol level were difficult to distinguish from an innate short-term variability of 7%. Consequently, in monitoring serum cholesterol in patients who are adhering to their medication, apparent increases in their cholesterol levels may be false positives. (Ann Intern Med [May 6, 2008] 148 (9):656)
Risk factors for low bone mineral density mediating fracture in men were body mass index less than 20 to 25 kg/m2, greater than 10% weight loss, age older than 70 years, physical inactivity, prolonged corticosteroid use, and previous osteoporotic fracture in a structured review of published data from 1990 through 2007. (Ann Intern Med [May 6, 2008] 148 (9):685)
A U.S. Preventive Services Task Force analysis of routine screening of pregnant women for gestational diabetes found very limited evidence of benefit—one randomized controlled trial of screening after 24 weeks’ gestation showing lesser serious neonatal complications and maternal hypertension. Even more limited evidence support gestational diabetes screening before 24 weeks. At the same time, available evidence suggests important maternal hypoglycemia is rare with therapy and treated mothers’ quality of life is no worse. (Ann Intern Med [May 20, 2008] 148 (10):766)
Only half of 1,169 diabetes patients with uncontrolled hypertension, i.e., blood pressure 
140/90 mm Hg, had augmentation of their anti-hypertensive therapy at a primary care provider visit.
(Ann Intern Med [May 20, 2008] 148 (10):717)
Subclinical hypothyroidism and hyperthyroidism were weakly associated with an increased risk for coronary heart disease events and mortality in a meta analysis of 10 population-based cohort studies that included 14,449 participants. No similar trends were evident for subclinical thyrotoxicosis in 5 studies examined. (Ann Intern Med [June 3, 2008] 148 (11):832)
Poor numeracy skills were associated with fewer self-management behaviors and a trend towards poorer glycemic control in a cross-sectional study. (Ann Intern Med [May 20, 2008]148 (10):737)
Retired boxers had lesser pituitary gland volume and a high rate of GH deficiency, suggesting that pituitary function should be examined in this group. (Ann Intern Med [June 3, 2008] 148 (11): 827)
Oral but not transdermal estrogen was found to increase venous thromboembolism risk in a meta analysis of observational studies and randomized trials, especially during the first year of treatment and in obese women. (BMJ [May 31, 2008]336:1227)[CrossRef]
Glucose self-monitoring was found to have no effect on glycemic control and be associated with lower scores on a well-being questionnaire in a prospective randomized trial in 184 people aged less than 70 years with newly diagnosed type 2 diabetes followed for one year. (BMJ [May 24, 2008] 336:1174)[CrossRef]
Higher oxidized LDL levels were associated with an increased incidence of metabolic syndrome in a study of 1,889 individuals for up to 20 years. (JAMA [May 21, 2008] 299 (19):2287)
Each mg/dL higher fasting plasma glucose increased diabetes risk by 6% even among 46,578 members who had fasting plasma glucose levels less than 100 mg/dL followed over a mean 7 years, (hazard ratio [HR] 1.06, 95% confidence interval [CI], 1.05–1.07, P < .0001). (Am J Med [June 2008]121 (6):519)
Initial insulin versus oral hypoglycemic agent therapy for rapid correction of hyperglycemia in 382 untreated type 2 diabetes patients was associated with a higher diabetes remission rate after 1 year (p=0.0012), better maintained β-cell function assessed by HOMA, and greater improvement and maintenance of the acute insulin response. (Lancet [May 24, 2008] 371:1753)[CrossRef]
Ablation of the GalNAc-4-sulfotransferase-1 enzyme in male and female mice resulted in precocious sexual maturation in both sexes and increased fecundity in females, indicating that terminal LH glycosylation plays a central role in regulating the hypothalamic-pituitary-gonad axis and reproductive capability. (J Clin Invest [April 21, 2008] 118 (5):1815)
Dendritic cells within the islets of Langerhans in mice express high levels of B cell-derived-peptide-MHC complexes that are presumably presented to T cells, pointing to a possible role in type 1 diabetes. (Proc Natl Acad Sci U S A [April 22, 2008] 105 (16):6121)
Transplantation of subcutaneous fat into the visceral cavity of mice caused decreased body weight, total fat mass, and glucose and insulin levels, and improved insulin sensitivity, suggesting that subcutaneous fat is intrinsically different from visceral fat and produces substances that can act systematically to improve glucose metabolism. (Cell Metab [May 7, 2008] 7 (5):410)
At initiation of oral hypoglycemic therapy for type 2 diabetes, black patients had higher average A1C values and lower average medication adherence than whites. Adjustment for adherence did not eliminate the black–white gap, suggesting that other environmental or genetic factors might be involved. (Diabetes Care [May 2008] 31 (5):916)
The Thr110Ile glucose transporter type 2 gene (GLUT2) polymorphism is associated with a higher intake of sugars, suggesting that GLUT2 may play a role in glucose sensing that affects individual food preferences. (Physiol Genomics [March 18, 2008] 33:355)[CrossRef]
After arterial bypass for lower extremity critical ischemia, patients with diabetes had lower amputation-free survival, underscoring their need for more intensified management. (Diabetes Care [May 2008] 31 (5):887)
The presence and severity of depression were associated with decreased serum 25-hydroxyvitamin D and increased serum PTH levels in a population-based cohort study of 1,282 community residents aged 65 to 95 years. (Arch Gen Psychiatry [May 2008] 65(5):508)
Intravenous ghrelin in healthy volunteers increased neural responses to food pictures in the amygdala, orbitofrontal cortex, anterior insula, and striatum, based on observations with functional magnetic resonance imaging. (Cell Metab [May 7, 2008] 7 (5):400)
In 20,124 non-diabetic first kidney transplant patients, sirolimus treatment increased risk of new-onset diabetes, whether used in combination with cyclosporine (adjusted HR:1.61), tacrolimus (adjusted HR:1.66), or an antimetabolite (mycophenolate mofetil or azathioprine; adjusted HR:1.36). (JASN [July 2008] 19 (7):1411)
Healthy volunteers given intravenous oxytocin exhibited no change in trusting behavior, while patients receiving placebo decreased their trust after being repeatedly deceived. (Neuron [May 22, 2008] 58 (4):639)
Glucose restriction in mice impaired differentiation of skeletal myoblasts through the activation of SIRT1 by the mediation of AMP-activated protein kinase on the NAD+ biosynthetic enzyme Nampt, elucidating the signaling that allows skeletal muscles to sense nutrient availability. (Dev Cell [May 13, 2008] 14 (5):661)
Delivery of antisense oligonucleotides to CD40, CD80, and CD86 to NOD mice suppressed and reversed the onset of type 1 diabetes. (Diabetes [June 2008] 57:1544)[CrossRef]
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US Child Obesity Rates Leveling Off |
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TopEndocrine DiscoveryUS Child Obesity Rates...Metformin Equally Effective as...Guidelines Encourage Screening...Endocrine PracticeEndocrine PolicyMilestones in EndocrinologyIn the Journal 25... |
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Analysis from 2003–2004 and 2005–2006 of the National Health and Nutrition Examination Survey of 8,165 children between the ages of 2 and 19 revealed no significant changes of high body mass index for either boys or girls or among racial groups. Combined, the four years indicated that 11.3% of children and adolescents were at or above the 97th percentile of the 2000 CDC BMI-for-age growth charts, 16.3% were at or above the 95th percentile, and 31.9% were at or above the 85th percentile. Moreover, over the eight years between 1999–2000 and 2005–2006 there was no significant trend in rates. This contrasts to the survey’s findings between 1980 and 1999, which showed a tripling in the rate of obesity.
It is not clear if the latest data represent just a temporary lull in the rise or a genuine shift in historical trends.
Cynthia Ogden, Ph.D., lead author of the report and an epidemiologist for the National Center for Health Statistics, remains cautious about the findings.
"Whether it’s going to keep doing this, we don’t know," she said. "It may be that some of the awareness about obesity is paying off," citing the recent surge of public health campaigns aimed at improving school nutrition and physical activity.
Alternatively, she pointed out, "it could be that you get to the saturation point where people can’t get heavier," referring to the possibility that there may be a natural leveling off of the population who are genetically susceptible to obesity.
Even if the current rates hold, they still suggest a coming wave of adults who will suffer from fatty liver, diabetes, and heart disease.
"These data don’t mean that the problem of obesity in children and adolescents is solved by any means," said Susan Z. Yanovski, M.D., director of the Obesity and Eating Disorders Program at the National Institute of Diabetes and Digestive and Kidney Disease. "Even if we are able to stabilize these rates, more than 16% of kids at or above the 95th percentile are presently on track to be obese as adults."
For physicians looking to talk to parents of obese or overweight children, Dr. Yanovski suggests that they log on to We Can!, at http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/, a NIH-sponsored national program designed to help kids maintain a healthy weight. (JAMA [May 28, 2008] 299 (20):2401)
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Metformin Equally Effective as Insulin for Treatment of Gestational Diabetes |
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TopEndocrine DiscoveryUS Child Obesity Rates...Metformin Equally Effective as...Guidelines Encourage Screening...Endocrine PracticeEndocrine PolicyMilestones in EndocrinologyIn the Journal 25... |
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Concerns previously arose about metformin possibly affecting the fetus because the drug can cross the placenta. These concerns have now been allayed by Janet Rowan, M.B., Ch.B., of the Auckland City Hospital in New Zealand and her colleagues from the Metformin in Gestational Diabetes Trial.
While effective, insulin as treatment for gestational diabetes is associated with hypoglycemia and weight gain. Metformin has the advantage of oral administration without those two insulin adverse events.
"There are a lot of logical reasons to use metformin," said Dr. Rowan, lead author of the study reported in the May 8, 2008 issue of the New England Journal of Medicine.
In this trial, 751 women with gestational diabetes mellitus at 20 to 33 weeks of gestation were randomized to receive open treatment with metformin plus supplemental insulin if needed, or insulin alone.
The study was designed to rule out a 33% increase (from 30–40%) between the two groups in a primary composite endpoint consisting of neonatal hypoglycemia, respiratory distress, need for phototherapy, birth trauma, 5-minute Apgar scores of less than 7, or prematurity. Secondary endpoints included neonatal anthropometric complications, maternal glycemic control, maternal hypertensive complications, postpartum glucose tolerance, and acceptability of treatment.
Of 363 women assigned to metformin, 93% continued to receive metformin until delivery and 46% needed supplemental insulin. Both groups experienced similar primary composite outcomes–32% in those randomized to receive metformin and 32% in those randomized to receive conventional insulin shots. The secondary endpoints were also similar in the two groups, and no serious adverse effects were associated with metformin use.
Indeed, nearly 77% of those who were on metformin said after delivery that they would prefer the pill over insulin injections if they develop diabetes during pregnancy again, compared to only 27% of those who received insulin.
"This is a landmark trial. Pregnant women have lacked the science because of the incredible amount of consent and HIPPA involved with pregnancy," said Siri Kjos, M.D., obstetrics and gynecology professor at the University of California, Los Angeles. "It’s a real liberation for patients to be able to take oral medications and accomplish the same good outcome that insulin does."
To establish long-term safety, the children born during the study are being tested until they reach their second birthday. These results are expected to come out next year.
In an editorial in the same journal issue, Drs. Jeffrey Ecker and Michael Greene, of Harvard Medical School in Boston, raise the issue of whether another generic pill, glyburide, would be better than metformin. (N Engl J Med [May 8, 2008] 358:2003)[CrossRef]
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Guidelines Encourage Screening for Osteoporosis in Men |
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TopEndocrine DiscoveryUS Child Obesity Rates...Metformin Equally Effective as...Guidelines Encourage Screening...Endocrine PracticeEndocrine PolicyMilestones in EndocrinologyIn the Journal 25... |
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The American College of Physicians unveiled their guidelines in a report in the May 6, 2008 issue of the Annals of Internal Medicine.
"Osteoporosis is a very important and major public health issue. It’s significantly underdiagnosed, undertreated, and underreported," said Amir Qaseem, M.D., Ph.D., MHA, senior medical associate at the American College of Physicians and lead guideline author.
Dr. Qaseem and his colleagues culled data from over 200 scientific studies in order to come up with his guidelines conclusions.
They found that osteoporosis strikes 6% of men by the age of 65 and thus recommended screening start at that age. This is a decade more than the recommendation for women in which their risk for osteoporosis starts at around menopause, usually at age 50 or older.
Risk factors for osteoporosis include low body weight (BMI<20–25), weight loss (>-10%), physical inactivity (no regular walking, climbing stairs, carrying weights, housework, or gardening), use of oral coritcosteroids, and previous fragility fracture.
Men who take antiandrogen drugs, like Lupron, to treat prostate cancer are also at risk for osteoporosis, the report states.
The guidelines also suggest that doctors order dual-energy X-ray absorptiometry for those men found to be at risk and are candidates for drug therapy. To view this guideline, see http://www.acponline.org/clinical_information/guidelines/.
In February, the National Osteoporosis Foundation released its "Clinician’s Guide to Prevention and Treatment of Osteoporosis," which included for the first time treatment guidelines for men age 50 and older. The guideline features the World Health Organization’s newly released algorithm on absolute fracture risk called FRAX®, which estimates the likelihood of a person to break a bone due to low bone mass or osteoporosis over a period of 10 years.
"Our guideline suggests that routine screening for men should be at age 70 and above. That is based on prevalence of the disease at that group and cost-effectiveness," said Felicia Cosman, M.D., clinical director of the National Osteoporosis Foundation and professor of clinical medicine at Columbia University, who added that those who have clinical risk factors such as prior fractures, family history of the disease, or underlying diseases such as rheumatoid arthritis, irritable bowel syndrome, celiac disease, or hyperthyroidism, should not wait until that age.
Stated in its "5 Steps to Bone Health", the paper advises adults over the age of 50 to get 1,200 mg of calcium and 800–1,000 IU of vitamin D3 daily, engage in regular weight-bearing and muscle-strengthening exercise, avoid smoking and excessive alcohol, talk to their healthcare provider about bone health, and have a bone density test and take medication when appropriate.
To view this guideline, see http://www.nof.org/professionals/clinical.htm. (Ann Intern Med [May 6, 2008] 148 (9):680)
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Endocrine Practice |
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TopEndocrine DiscoveryUS Child Obesity Rates...Metformin Equally Effective as...Guidelines Encourage Screening...Endocrine PracticeEndocrine PolicyMilestones in EndocrinologyIn the Journal 25... |
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Among 1,486 community-dwelling men with androgen deficiency, 88% did not receive testosterone therapy despite adequate access to care in an observational study. (Arch Intern Med [May 26, 2008] 168 (10):1070)
Among 661 Americans aged 45 years and older, 40% of women and 60% of men in the survey had little or no concern about bone health and 80% were unaware that osteoporosis placed a person at risk of broken bones. This is despite the fact that an estimated 55% of individuals in this age group have or are at risk for osteoporosis. For more information, see: http://www.nof.org/news/pressreleases/2008_may_ropersurvey.htm.
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Endocrine Policy |
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TopEndocrine DiscoveryUS Child Obesity Rates...Metformin Equally Effective as...Guidelines Encourage Screening...Endocrine PracticeEndocrine PolicyMilestones in EndocrinologyIn the Journal 25... |
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Milestones in Endocrinology |
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TopEndocrine DiscoveryUS Child Obesity Rates...Metformin Equally Effective as...Guidelines Encourage Screening...Endocrine PracticeEndocrine PolicyMilestones in EndocrinologyIn the Journal 25... |
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In the Journal 25 Years Ago |
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TopEndocrine DiscoveryUS Child Obesity Rates...Metformin Equally Effective as...Guidelines Encourage Screening...Endocrine PracticeEndocrine PolicyMilestones in EndocrinologyIn the Journal 25... |
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"The observation that testosterone binds less avidly than dihydrotestosterone to the androgen receptor may explain the role of dihydrotestosterone in androgen physiology."
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Footnotes |
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