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Diabetes and Endocrinology - Disease Topic Overview

Endocrinology is the science studying the physiology and functioning of the endocrine glands, and the hormones they secrete. This specialty also encompasses the study of endocrine diseases and their treatments.

The endocrine system consists of a group of glands that control basic functions of the human body, such as homeostasis, growth and reproduction, through the production and the secretion of hormones.¹ The major glands of the endocrine system, each of which produces one or more specific hormone, are the hypothalamus, the pituary gland, the thyroid gland, the parathyroid glands, the islets of the pancreas, the adrenal glands, the testes in men, and the ovaries in women.¹ During pregnancy, the placenta also acts as an endocrine gland.¹

Hormones are chemical messengers, carried by blood and lymph, which act in very small quantities on the cells with specific receptors.² Hormone levels in the blood are tightly controlled by various regulatory mechanisms in order to maintain homeostasis, which is necessary for the functioning of the body.² The endocrine system is a complex system involving many hormones and target cells.² Diseases affecting endocrine glands are extremely varied and strongly affect the normal functioning of the body.

In the case of diabetes, over time, high sugar levels and poor blood circulation lead severe complications in organs such as the heart (heart attack), the eyes (retinopathy), but also the nerves (neuropathy) or the extremities (gangrene).¹ Diabetes is emerging as a pandemic in developed and developing countries in the 21st century.³ According to the World Health Organisation, in 1985, approximately 30 million people worldwide had diabetes.⁴ In 2002, this was estimated at 173 million and it is expected to reach nearly 350 million by 2030.⁴

The management of diabetes and its complications, especially cardiovascular diseases, represent a huge cost in the budget allocated to health in European countries.⁵ Prevention and early detection of diabetes should be established to reduce morbidity and mortality.⁵

1. Beers M.H. et al. The Merck manual of medical information. Merck research laboratories. Second home edition. 2003 ; 937-975.
2. Kenneth L.B. et al. Principles and practice of endocrinology and metabolism. Lippincott Williams & Wilkins. Third edition. 2001.
3. Bansilal S. et al. Optimal treatment of the diabetic patient with multivessel disease. Current Cardiology Reports. 2008 ; 10 (4) : 272-284.
4. World Health Organization. Management Screening for Type 2 Diabetes: Report of a World Health Organization and International Diabetes Federation meeting. Department of Noncommunicable Disease. 2003 ; available online.
5. Jönsson B. Revealing the cost of Type II diabetes in Europe. Diabetologia. May 2002 ; 45 : S5–S12.

SGLT2-Inhibitors eCME Webcast

Type 2 Diabetes Mellitus affects approximately 20.66 million people across the UK, France, Germany, Spain and Italy¹. This leads to many complications including macrovascular and microvascular disease. Glycaemic control in diabetes is particularly important in reducing these complications; a 1% fall in HBA1C results in a 37.5% and 42.5% reduction in microvascular and peripheral vascular disease respectively².

There are numerous treatments for Type 2 Diabetes Mellitus. These act on receptors within various organs including the pancreas, muscle, adipose tissue, gastrointestinal tract and liver. A new class of drugs, SGLT2-Inhibitors act on the kidney, which itself plays an important role in glycaemic control.

The eCME webcast entitled SGLT2-Inhibitors: Assessing the Evidence and the Potential Impact on Future Clinical Practice is ACCME/EACCME accredited. This activity has been designed to inform healthcare professionals on Type 2 Diabetes Mellitus and the role of SGLT2-Inhibitors in the treatment of this disease. To access the eCME accredited webcast click here.

References
1. IDF Diabetes Atlas 2010. http://www.idf.org/atlasmap/atlasmap.
2. Stratton, I. et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000; 321: 405-412.

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The eCME webcast entitled SGLT2-Inhibitors: Assessing the Evidence and the Potential Impact on Future Clinical Practice is ACCME/EACCME accredited. This activity has been designed to inform healthcare professionals on Type 2 Diabetes Mellitus and the role of SGLT2-Inhibitors in the treatment of this disease.

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Diabetes

Diabetes is a disease that currently affects approximately 285 million people worldwide and this figure is only expected to increase1. For Europe, the IDF estimates that 55.2 million, or 8.5% of the population aged 20 to 79 years, have diabetes. This is expected to rise to 66.2 million (10.0%) by 2030. Further information on the scale of the type 2 diabetes problem can be found in the overview section of the knowledge centre.

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Diabetes is a disease that currently affects approximately 285 million people worldwide and this figure is only expected to increase1. For Europe, the IDF estimates that 55.2 million, or 8.5% of the population aged 20 to 79 years, have diabetes. This is expected to rise to 66.2 million (10.0%) by 2030. Further information on the scale of the type 2 diabetes problem can be found in the overview section of the knowledge centre.

Complications associated with diabetes mellitus include hypertension, cardiovascular disease, retinopathy, kidney damage, foot ulceration and nerve damage. Discover more about the complications connected to diabetes mellitus, as well as acceptable blood glucose and HbA1C levels and how these differ in people with diabetes mellitus here.

The majority of patients with type 2 diabetes are obese and/or have an increased proportion of visceral fat, factors which in themselves are associated with insulin resistance. Other risk factors include increasing age and sedentary lifestyle. There is also a strong genetic predisposition to type 2 diabetes².

Chronic hyperglycaemia of diabetes is associated with long-term damage, dysfunction and failure of various organ systems. Early diagnosis, adequate treatment to control hyperglycaemia, and management of associated risk factors and complications therefore are all essential to reduce the burden of diabetes. Effective screening strategies are therefore of particular importance in reducing this burden. Discover the diagnostic tests necessary to diagnose type 2 diabetes mellitus and intermediate hyperglycaemia or pre-diabetes.

The early and aggressive treatment and management of diabetes mellitus is important for a successful long term outcome in patients with diabetes mellitus. The use of oral agents and lifestyle changes are the generally accepted early treatments followed later by insulin therapy. Current treatment algorithms and IDF guidelines should be used to find the appropriate treatment regime for individual patients.

As with many diseases, our knowledge of diabetes mellitus is increasing through research. Recent developments include the use of new treatments and guidelines in clinical practice. There has been an update to the IDF guidelines concerning GLP-1 agonists. DPP-4 inhibitors are now used in the treatment of diabetes, and SGLT-2 inhibitors are being investigated for this use.

References

1. Unwin, N. et al. The IDF Diabetes Atlas: Providing Evidence, Raising Awareness and Promoting Action. Diabetes Res Clin Pract 87, 2-3 (2010).

2. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 33 Suppl 1, S62-9 (2010).

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Men's Health
This resource is aimed at physicians who are involved in the diagnosis, treatment and monitoring of men with hypogonadism. It aims to provide a better understanding of the epidemiology and etiology of male hypogonadism, the diagnostic procedures and the available treatment options for hypogonadal men.

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As a disease topic Men's Health covers a broad set of issues affecting men of all ages. Some of the issues requiring greater focus and more thorough dissemination of information amongst the healthcare community, are those that have the potential to go undetected in the early stages. Diseases where early detection and more regular health checks not only improve prognosis and efficacy of treatment outcomes, but also quality of life.

These include:

Erectile Dysfunction (ED)

Erectile dysfunction is characterized by the regular or repeated inability to obtain or maintain an erection. Although not considered a part of the aging process, it is associated with certain physiologic and psychological changes related to age. ED is most common in men between 40-70 years of age. However incidence is also higher amongst men with certain medical conditions which include, diabetes, heart disease, and hypertension. ED can also be a warning sign/symptom of these underlying conditions. ¹

Hypogonadism (low testosterone)

Testosterone is an essential male hormone produced in the testes that plays a crucial role in the health and well being of male bodies. It is responsible for typical male sexual characteristics and is required by all men for a healthy life physically and psychologically.

Low testosterone, clinically known as hypogonadism, consists of decreased functional activity of the testes with diminished production and action of testosterone. Although there is a progressive decline in testosterone levels as men age, hypogonadism can occur in men of any age.

Men with low testosterone are also at increased risk of cardiovascular disease, diabetes and metabolic syndrome and osteoporosis.

For your information, the Mens Health knowledge centre concentrates on the understanding, management and treatment of erectile dysfunction and hypogonadism. The website also provides extensive details on up-coming conferences as well as an extensive library of useful resource. You can also access the knowledge centre via www.menshealthfocus.com.

Enter the Men's Health Knowledge Centre

What’s in the Men's Health Knowledge Centre?
References

1. McVary, Kevin T. Erectile. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL et al., editors. Harrison's Internal Medicine. 16th ed. New York: McGraw-Hill; 2005. p. 272-274

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Latest Multi Media

An Overview of Pancreatic NET and the Available Treatments

Diabetes and Endocrinology Drug Data - A-Z English

Drug Updates

Glibenclamide 2.5mg Tablets

Glibenclamide is a hypoglycaemic agent indicated in the treatment of non-insulin dependent diabetes in patients who respond inadequately to dietary measures alone.

Hypurin Bovine Isophane Cartridges

The treatment of insulin dependent diabetes mellitus.

Hypurin Bovine Protamine Zinc

The treatment of insulin dependent diabetes mellitus.

Latest Drug News

Epanova (Omthera) has better bioavailability than Lovaza - 14-02-2012

Omthera Pharmaceuticals has reported positive data showing that its prescription-grade omega-3 fatty acid candidate, Epanova, has better bioavailability than Lovaza (omega-3 ethyl esters) – the only FDA-approved omega-3 acid drug on the US market from GSK. The latest reported data from a 52-patient pharmacokinetic study showed that after 14 days of dosing and with a low fat diet, plasma EPA and DHA levels were 5.8 fold higher in patients treated with Epanova compared with those receiving Lovaza(Omacor in Europe). Additionally, Epanova increased steady state plasma levels of EPA plus DHA by 448%, compared to 90% for Lovaza. Omthera plans to file at the FDA this year based on the pivotal Phase III EVOLVE trial, from which top-line results are expected in the first half of 2012.

FDA approves Jentadueta(Boehringer/Eli Lilly) for Type 2 Diabetes - 31-01-2012

Boehringer Ingelheim and Eli Lilly and Company announced the FDA has approved Jentadueto (linagliptin/metformin hydrochloride) tablets, a new tablet combining the dipeptidyl peptidase-4 (DPP-4) inhibitor, linagliptin, and metformin. Jentadueta provides a new, single-tablet treatment option, taken twice-daily, for patients who need to control their blood sugar. Linagliptin (5 mg, once-daily) is marketed in the U.S. as Tradjenta (linagliptin) tablets.

Latest Social Media

Sobering up a patient rapidly
on doc2doc

Sobering up a patient rapidly Never heard of it, kirked. Insulin/glucose infusion is routine management of periop. starvation in diabetics ...

Sobering up a patient rapidly
on doc2doc

... of Consultants in Emergency Care who prescribed IV Dextrose with Insulin with the aim of speeding up the process of sobering a drunken patient ...

Have you ever responded to "is there a doctor in the house/on the plane?"
on doc2doc

... of drink. Got out of him he an insulin-dependent diabetic, been drinking all night, no grub, and took his usual insulin dose. Opened the bag. Flight ...

Latest Journal Publications

The British Journal of Ophthalmology

Aim: To detect early nerve fibre layer (NFL) changes around the optic disc and macula in diabetic patients using Cirrus HD-optical coherence tomography (OCT). Methods: Forty normal patients without any optic nerve or retinal disease, 37 patients with diabetes with no diabetic retinopathy (NDR) and 89 patients with diabetic retinopathy (DR) of differing severity were enrolled. The NFL thickness around the optic disc was measured using Cirrus HD-OCT. The NFL thickness at the macula was also determined by scanning the macula with the optic disc scanning technique. Results: The NFL thickness around the optic disc differed statistically among all groups and tended to become thinner as the degree of DR progressed. The mean, superior and inferior peripapillary NFL thickness differed among groups. As the severity of DR progressed, the mean, superior, temporal, inferior and nasal macular NFL thickness tended to become thinner. However, only the macular NFL thickness of the superior sector differed significantly among the groups and especially between the control and NDR groups. Conclusion: The difference in NFL was first detected in the superior macular region, which differed significantly between the control group and diabetic group without clinical DR. This could be detected simply by modifying the Cirrus HD-OCT scan technique to detect the NFL thickness in the macular area.

Heart

Objective: Telmisartan is a peroxisome proliferator-activated receptor-γ activator with potent anti-inflammatory and antiatherogenic effects. The authors compared the effects of telmisartan and valsartan on neointima volume, atherosclerosis progression and brachial-ankle pulse wave velocity (baPWV) after stenting in hypertensive type 2 diabetes. Design: This was a prospective, randomised, 8-month follow-up study that included patients with significant coronary stenosis who received telmisartan (n=36) or valsartan (n=37). Setting: University hospital. Main outcome measures: Neointima volume and atherosclerosis progression 10 mm proximal and distal to the stented segment were analysed using repeat intravascular ultrasonography. baPWV and inflammatory markers such as interleukin 6, tumour necrosis factor α, C-reactive protein and adiponectin were compared. Results: Neointima volume at 8 months was significantly lower in the telmisartan group than the valsartan group (1.9±1.0 vs 2.6±1.4 mm3/1 mm, p=0.007, respectively). Total plaque volumes 10 mm proximal (7.1±1.5 vs 7.8±1.6 mm3/1 mm, p=0.032, respectively) and distal (3.5±1.4 vs 4.1±1.3 mm3/1 mm, p=0.028, respectively) to the stent were significantly lower in the telmisartan group than the valsartan group at 8 months. The decrease from baseline in baPWV was significantly greater in the telmisartan group than the valsartan group (−52±104 vs 30±113 cm/s, p=0.002, respectively). The increase from baseline in adiponectin levels and the decreases from baseline in interleukin 6 and tumour necrosis factor α levels were significantly greater in the telmisartan group at 8 months. Retinol-binding protein-4, homeostasis model of assessment index, hemoglobin A1c and low-density lipoprotein cholesterol levels decreased significantly in both groups without differences in changes from baseline between the two groups. Conclusions: Telmisartan reduced neointima volume; atherosclerosis progression 10 mm proximal and distal to the stented segment and baPWV independent of blood pressure, glucose and lipid control in hypertensive type 2 diabetes.

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Tradjenta launch for Type 2 Diabetes delayed in Germany Diabetes and Endocrinology Page

Boehringer Ingelheim and Eli Lilly announced a delay to the German launch of their novel DPP-IV inhibitor Tradjenta (linagliptin) because of the anticipated difficulty in agreeing a suitable price with the German regulators.

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