Articles in 2009

The Diabetes Control and Complications Trial (DCCT) was a landmark study that evaluated intensive versus conventional insulin therapy in patients with type 1 diabetes mellitus; the Epidemiology of Diabetes Interventions and Complications (EDIC) study continues to follow the same cohort of patients. Many of the key contributions that the DCCT and EDIC have made to our understanding of type 1 diabetes mellitus are discussed by the authors of this Review.

Early foundations of the metabolic syndrome may be laid as a consequence of changes in dietary supply to the rapidly growing fetus and/or postnatal offspring. This review highlights fetal developmental plasticity in cellular homeostasis that may manifest in adult life as the metabolic syndrome particularly if followed by a period of accelerated postnatal growth.

This review discusses newly recommended screening approaches for childhood acute malnutrition in low-income settings, using mid-upper arm circumference or weight for height Z-score and inspection for presence of bipedal edema. A treatment algorithm is provided to guide management of children with severe acute malnutrition and systemic complications who require inpatient therapy and for those with uncomplicated severe or moderate acute malnutrition who can be treated in the community using recently developed ready-to-use-therapeutic foods or other appropriately designed food blends.

Despite the increasing implementation of iodization programs, benign nodular thyroid disease will remain a prevalent therapeutic concern for decades. Recent research suggests that nonsurgical therapy, including radioactive iodine, radiofrequency thermal ablation and percutaneous laser ablation, might have a role in the treatment of symptomatic patients.

A question often asked by health-care providers is whether metformin has added benefits if continued after patients with type 2 diabetes mellitus switch to insulin. Beneficial effects on macrovascular end points observed in response to sustained metformin therapy argue in favor of this approach, according to new research from The Netherlands.

Intensive insulin therapy is extensively used to lower blood glucose concentrations in critically ill patients hospitalized within the intensive care unit. The discovery by the NICE-SUGAR study investigators that tight glucose control in this setting might actually increase mortality has generated considerable discussion about the wisdom of this approach.

Uncertainty exists about the best approach to manage levothyroxine dosage in women with hypothyroidism, once they become pregnant. The etiology of an individual's hypothyroidism might be a key determinant of the optimal time and duration of dose adjustments, say the authors of a retrospective review published in the journal Thyroid.

Exposure of the fetus to low levels of thyroid hormones for extended periods during pregnancy can lead to irreversible brain damage and potential delays in neurological and behavioral development. What are the exact mechanisms behind this abnormality, and can prompt initiation of maternal iodine supplementation prevent this adverse effect?

Knowledge of the epidemiology, natural history, diagnosis, treatment, and rates of recurrence of nonfunctioning pituitary adenomas has greatly improved over the past few years. Wass and Karavitaki now highlight some of these advances and speculate on future avenues of research. In addition, they describe their own experience in the clinical management of patients with nonfunctioning pituitary adenomas.