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.

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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.

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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.

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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?

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A1c predicts type 2 diabetes in children too

A1c has been well proven to be a useful test in predicting type 2 diabetes in adults. This longterm, impressive study reveals that A1c could be meaningfully applied in children too. In addition, the test is comparable with fasting and 2 hour load glucose tests. 

A group of 2100 children were followed for about 25 years. A1c ≥5.7% predicts 400% increased risk of diabetes in boys and 700% in girls in 10 years.

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Blood pressure in type 2 diabetes

Blood pressure (BP) control is a critical part of managing patients with type 2 diabetes. Perhaps it is the single most important aspect of diabetes care, which unlike hyperglycemia and dyslipidemia can reduce both micro- and macrovascular complications. Hypertension is more prevalent in individuals with diabetes than general population, and in most cases its treatment requires two or more pharmacological agents (about 30% of individuals with diabetes need 3 or more medications to control BP).

In this article we describe the key evidence that has contributed to our understanding that reduced BP translates into positive micro- and macrovascular outcomes. We review the data supporting current recommendation for BP target < 130/80 mmHg. Two studies suggest that a lower BP goal could be even more beneficial. We also present the comparative benefits of various antihypertensive drugs in reducing diabetes-related micro- and macrovascular complications.

Finally we propose an evidence-based algorithm of how to initiate and titrate antihypertensive pharmacotherapy in affected individuals. Overall, achieving BP < 130/80 mmHg is more important than searching for the “best” antihypertensive agent in patients with diabetes.

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