Bihormonal Bionic Pancreas – using both insulin and glucagon

This study demonstrates a great advancement in the field of type 1 diabetes. A full artificial pancreas, called “bihormonal bionic” shows superior results compared to the traditional CGM-assisted insulin pump.

The bihormonal system utilizes both insulin and glucagon to maintain steady blood glucose levels, resulting in better glycemic control with less hypoglycemia. No carbohydrate counting is needed by the patient. Although of short duration, 11 days, the results are very promising.

GT

Hyperthyroidism in the womb – a rare case.

This publication reports a rare and counterintuitive case of neonatal hyperthyroidism: mother has underactive thyroid, while the unborn baby has an overactive one. Although the mother has hypothyroidism from hashimoto’s thyroiditis, she produces TSI (thyroid stimulating immunoglobulin) triggering excessive thyroid hormone formation by the fetus.

Paradoxically the mother was treated with both medications; levothyroxine for her hypothyroidism and methimazole for her fetus’ hyperthyroidism.

GT

Semi-artificial pancreas shows positive outcomes.

Although of short duration, this well designed study shows that semi-artificial pancreas helps in reducing A1c and preventing hypoglycemia more than the usual insulin pump. A group of 29 individuals with type 1 diabetes and A1c < 7.5% were randomized to receive hybrid closed-loop system or the traditional pump therapy. Participants were followed for 4 weeks and then crossed over for another 4 weeks.

GT

Low-risk thyroid cancer: surgery or no surgery?

This original study suggests thyroidectomy for low-risk cancers measuring >1.5 cm rather >1.0 cm as currently recommended by ATA; to avoid unnecessary surgeries, cost and complications. 

In stead, authors propose “active surveillance” in carcinomas <1.5 cm. About 700 thyroid cancer patients were analyzed over a 10 year period.

GT

2016 Endocrine Society Guidelines: CENTRAL Adrenal Insufficiency

Adrenal Insufficiency (AI) is defined by low cortisol production.  It could be due to failure, infection, injury, bleeding or inflammation of the adrenal glands, or from limited production of ACTH hormone by the pituitary.  

Adrenal Insufficiency as a result of low ACTH is called “central” or “secondary”. These guidelines were developed by Endocrine Society to address specifically Central AI. They were released in November 2016.

Please find below excerpts with slightly modified wording for easier and succinct reading.

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Diabetes drug, risk of pancreatitis and pancreatic cancer

Initial analysis of TECOS trial showed that Januvia/Sitagliptin does not increase the risk of cardiovascular disease, heart failure and death from any cause. 

Further investigation, just published in Diabetes Care reveals that Januvia has slight tendency to protect from pancreatic cancer but cause more pancreatitis, although these contributions were not statistically convincing. Important to be aware that baseline pancreatic cancer or pancreatitis are rare and multifactorial. 

About 15,000 patients with type 2 diabetes and cardiovascular disease were randomized to receive Sitagliptin or placebo for 3 years.

GT

2017 ATA Guidelines: Thyroid & Pregnancy (part 1)

ATA has “developed evidence-based recommendations to inform clinical decision making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders”

Part 1 of recommendations are listed with slightly modified wording for easier and succinct reading:

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NASH can raise risk of colorectal cancer

Non-alcoholic fatty liver disease, NAFLD or NASH is a manifestation of advanced obesity. It can lead to liver inflammation, cirrhosis and even malignancy. This association study suggests it can also increase the risk of colorectal cancer. The bigger the severity of liver disease, the higher the chance of colorectal carcinoma. A group of 26,000 asymptomatic patients were analyzed.

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Obesity 2017

A great review article on the current state of obesity. Increased adiposity or high BMI is a cause or great contributor to multiple of conditions; such as metabolic syndrome, insulin resistance, diabetes, hypertension, high cholesterol, osteoarthritis, impaired renal function, kidney stones, gout and even cancer.

Aspiration therapy for obesity – a possible Intervention?

Aspiration therapy was implemented in 25 adults with average body mass index 40. BMI decreased to 32 in one year and 31 in two years. No electrolyte anomalies or major side effects were noted. Stomach was drained 20 min after each meal, 3 times a day. Adherence to procedure was 80% in 12 months and 60% in 24 months.

Could this be a future viable therapy for obesity?

GT