Insulin remains an important diabetes treatment, with 150–200 million people worldwide requiring insulin therapy.1 While insulin is vital for managing type 1 diabetes, basal insulin is typically recommended for type 2 diabetes when non-insulin therapies are not enough to achieve glycaemic targets.2 Several barriers related to basal insulin therapy for type 2 diabetes contribute to non-achievement of glycaemic targets, including delay of insulin initiation or titration, needle phobia with daily injections, missed insulin doses, insulin discontin ..read more

Thyrotoxicosis refers to the signs and symptoms derived from excess circulating thyroid hormones in the body,1 which must be differentiated from hyperthyroidism, in which there is an increase in the synthesis and secretion of hormones by the thyroid gland.2 Approximately 1% of patients with thyrotoxicosis develop thyrotoxic cardiomyopathy (TCM), which is a rare but potentially lethal form of dilated cardiomyopathy that causes severe impairment of left ventricular function and leads to cardiogenic shock.3,4 Early diagnosis is crucial as the patient is critically ill and needs urg ..read more

Hypothyroidism usually presents with subtle signs and symptoms. Rarely, longstanding juvenile hypothyroidism can manifest as a syndromic diagnosis of Van Wyk–Grumbach syndrome (VWGS).1 VWGS presents as early menarche, thelarche, galactorrhoea, delayed bone ageing and multi-cystic ovaries, along with long-standing primary hypothyroidism.2 Reversal to the prepubertal state is typically seen following the appropriate treatment with levothyroxine. The present case series describes three patients with VWGS referred for evaluation of precocious puberty to the Division of Diabetes and Endoc ..read more

Thyrolipomatosis is a rare condition defined as a diffuse non-neoplastic infiltration of fatty tissue in the thyroid gland.1 Although fatty infiltration is common in other glands (e.g. salivary glands, parathyroids, thymus and pancreas), it is rare in the thyroid gland.2 If present, it is most frequently nodular (i.e. thyrolipoma) rather than diffuse (i.e. thyrolipomatosis).3 Thus, since the first case of thyrolipomatosis was reported in 1942 by Dhayagude,4 only about 30 cases have been published worldwide.5–7 In addition, few of these cases showed concurrency of thyrolipom ..read more

Bladder cancer (BC) is the second most commonly diagnosed urological neoplasm worldwide.1 Approximately 10–15% of patients already have metastases in lymph nodes, lungs, liver and bones at diagnosis.2,3 Metastatic BC has a poor prognosis, with a 5-year overall survival (OS) rate of 10% and median OS of only 15 months.4–6 The vast majority (>90%) of BCs are urothelial carcinomas (UCs). Around 70% of these newly diagnosed UCs are categorized as superficial disease, with the remaining 30% representing muscle-invasive disease.7 The latter, after treatment with radical cystec ..read more

Type 2 diabetes mellitus (T2DM) is a severe public health issue notably impacting human life and health expenditure. Around 9.3% (463 million people) of the global population were living with diabetes in 2019, and this is projected to increase to 10.2% (578 million people) by 2030 and 10.9% (700 million people) by 2045.1,2 Diabetes impacts functional capacity and quality of life, and ultimately causes significant morbidity and premature mortality. In 2019, diabetes was the tenth biggest cause of death worldwide, directly causing an estimated 1.5 million deaths.3 Despite lifestyle tre ..read more

Worldwide prevalence of type 2 diabetes mellitus (T2DM) is steadily increasing due to rising levels of obesity over the past 40 years caused by sedentary lifestyles and unhealthy eating habits. Diabetes now ranks ninth among the top ten causes of death worldwide, and the disability adjusted life years (DALYs) has increased more than 80% between 2010 and 2019.1,2 While much research has been conducted on the pharmacological management of T2DM, there is a growing body of evidence for diabetes remission without pharmacotherapy through intense behavioural interventions such as dietary modific ..read more

Welcome to the latest edition of touchREVIEWS in Endocrinology, which includes a broad range of articles selected for their evaluation of current practices and research that directly affect endocrinologists as well as being of interest to the wider biomedical community. We begin with an editorial from Robert Hegele on the subject of targeted reduction of apolipoprotein C-III, a promising new approach for the treatment of familial chylomicronaemia syndrome. Establishing a prompt diagnosis of growth hormone deficiency during childhood is essential, but current diagnostic procedures have lim ..read more

Recent advances in technology have changed the landscape for managing diabetes treatment. Thanks to innovations such as connected insulin pens, sensor-augmented pump systems, automated insulin delivery, integrated mobile applications and continuous glucose monitoring (CGM) systems, people with diabetes now have access to devices that are easier to use and far less invasive than those available previously. Although CGM is now a standard of care for people living with diabetes, its use – especially in older populations – is under-appreciated. The benefit of CGM in adults with diabetes has been r ..read more

Over 37 million people in the USA live with diabetes mellitus, equating to over 11% of the population.1 The large majority of these individuals (around 90–95%) have type 2 diabetes (T2D).1 Approximately 40% of patients T2D develop chronic kidney disease (CKD), with CKD in diabetes being the leading cause of kidney failure and need for kidney-replacement therapy in the USA.2 CKD in diabetes is additionally associated with increased risk of heart failure (HF), infections and all-cause and cardiovascular-related death.2–6 The presence of either HF or CKD in diabetes is independentl ..read more