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Journal Cover The Lancet Diabetes and Endocrinology
  [SJR: 6.919]   [H-I: 27]   [132 followers]  Follow
    
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   ISSN (Online) 2213-8587
   Published by Elsevier Homepage  [3118 journals]
  • Risk of suicide and non-fatal self-harm after bariatric surgery: results
           from two matched cohort studies
    • Authors: Martin Neovius; Gustaf Bruze; Peter Jacobson; Kajsa Sjöholm; Kari Johansson; Fredrik Granath; Johan Sundström; Ingmar Näslund; Claude Marcus; Johan Ottosson; Markku Peltonen; Lena M S Carlsson
      Abstract: Publication date: Available online 9 January 2018
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Martin Neovius, Gustaf Bruze, Peter Jacobson, Kajsa Sjöholm, Kari Johansson, Fredrik Granath, Johan Sundström, Ingmar Näslund, Claude Marcus, Johan Ottosson, Markku Peltonen, Lena M S Carlsson
      Background Bariatric surgery reduces mortality, but might have adverse effects on mental health. We assessed the risk of suicide and self-harm after bariatric surgery compared with non-surgical obesity treatment. Methods Suicide and non-fatal self-harm events retrieved from nationwide Swedish registers were examined in two cohorts. The non-randomised, prospective Swedish Obese Subjects (SOS) study compared bariatric surgery (n=2010; 1369 vertical-banded gastroplasty, 376 gastric banding, and 265 gastric bypass) with usual care (n=2037; recruitment 1987–2001). The second cohort consisted of individuals from the Scandinavian Obesity Surgery Registry (SOReg; n=20 256 patients who had gastric bypass) matched to individuals treated with intensive lifestyle modification (n=16 162; intervention 2006–13) on baseline BMI, age, sex, education level, diabetes, cardiovascular disease, history of self-harm, substance misuse, antidepressant use, anxiolytics use, and psychiatric health-care contacts. Findings During 68 528 person-years (median 18; IQR 14–21) in the SOS study, suicides or non-fatal self-harm events were higher in the surgery group (n=87) than in the control group (n=49; adjusted hazard ratio [aHR] 1·78, 95% CI 1·23–2·57; p=0·0021); of these events, nine and three were suicides, respectively (3·06, 0·79–11·88; p=0·11). In analyses by primary procedure type, increased risk of suicide or non-fatal self-harm was identified for gastric bypass (3·48, 1·65–7·31; p=0·0010), gastric banding (2·43, 1·23–4·82; p=0·011), and vertical-banded gastroplasty (2·25, 1·37–3·71; p=0·0015) compared with controls. Out of nine deaths by suicide in the SOS surgery group, five occurred after gastric bypass (two primary and three converted procedures). During 149 582 person-years (median 3·9; IQR 2·8–5·2), more suicides or non-fatal self-harm events were reported in the SOReg gastric bypass group (n=341) than in the intensive lifestyle group (n=84; aHR 3·16, 2·46–4·06; p<0·0001); of these events, 33 and five were suicides, respectively (5·17, 1·86–14·37; p=0·0017). In SOS, substance misuse during follow-up was recorded in 48% (39/81) of patients treated with surgery and 28% (13/47) of controls with non-fatal self-harm events (p=0·023). Correspondingly, substance misuse during follow-up was recorded in 51% (162/316) of participants in the SOReg gastric bypass group and 29% (23/80) of participants in the intensive lifestyle group with non-fatal self-harm events (p=0·0003). The risk of suicide and self-harm was not associated with poor weight loss outcome. Interpretation Bariatric surgery was associated with suicide and non-fatal self-harm. However, the absolute risks were low and do not justify a general discouragement of bariatric surgery. The findings indicate a need for thorough preoperative psychiatric history assessment along with provision of information about increased risk of self-harm following surgery. Moreover, the findings call for postoperative surveillance with particular attention to mental health. Funding US National Institutes of Health and Swedish Research Council.

      PubDate: 2018-01-15T01:50:25Z
      DOI: 10.1016/s2213-8587(17)30437-0
       
  • Bariatric surgery: many benefits, but emerging risks
    • Authors: Matthew J Spittal; Gema Frühbeck
      Abstract: Publication date: Available online 9 January 2018
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Matthew J Spittal, Gema Frühbeck


      PubDate: 2018-01-15T01:50:25Z
      DOI: 10.1016/s2213-8587(17)30435-7
       
  • Endocrine-disrupting chemicals and the brain
    • Authors: Andrea C Gore
      Abstract: Publication date: Available online 5 January 2018
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Andrea C Gore


      PubDate: 2018-01-15T01:50:25Z
      DOI: 10.1016/s2213-8587(17)30436-9
       
  • Correction to Cover. Lancet Diabetes Endocrinol 2018; 6: (1)
    • Abstract: Publication date: Available online 3 January 2018
      Source:The Lancet Diabetes & Endocrinology


      PubDate: 2018-01-15T01:50:25Z
       
  • Diabetes: mapping the titanic struggle ahead
    • Authors: The Lancet Diabetes & Endocrinology
      First page: 1
      Abstract: Publication date: January 2018
      Source:The Lancet Diabetes & Endocrinology, Volume 6, Issue 1
      Author(s): The Lancet Diabetes & Endocrinology


      PubDate: 2017-12-21T18:10:53Z
      DOI: 10.1016/s2213-8587(17)30414-x
       
  • Is the new treatment for Cushing's disease too sweet'
    • Authors: Ashley Grossman
      Pages: 2 - 3
      Abstract: Publication date: January 2018
      Source:The Lancet Diabetes & Endocrinology, Volume 6, Issue 1
      Author(s): Ashley Grossman


      PubDate: 2017-12-21T18:10:53Z
      DOI: 10.1016/s2213-8587(17)30341-8
       
  • What research is needed to address the co-epidemics of HIV and
           cardiometabolic disease in sub-Saharan Africa'
    • Authors: Pascal Geldsetzer; Jennifer Manne-Goehler; Till Bärnighausen; Justine Ina Davies
      Pages: 7 - 9
      Abstract: Publication date: January 2018
      Source:The Lancet Diabetes & Endocrinology, Volume 6, Issue 1
      Author(s): Pascal Geldsetzer, Jennifer Manne-Goehler, Till Bärnighausen, Justine Ina Davies


      PubDate: 2017-12-21T18:10:53Z
      DOI: 10.1016/s2213-8587(17)30091-8
       
  • Iodine supplementation in pregnant women and child neurodevelopment
    • Authors: Song Mao; Liangxia Wu
      First page: 10
      Abstract: Publication date: January 2018
      Source:The Lancet Diabetes & Endocrinology, Volume 6, Issue 1
      Author(s): Song Mao, Liangxia Wu


      PubDate: 2017-12-21T18:10:53Z
      DOI: 10.1016/s2213-8587(17)30408-4
       
  • Iodine supplementation in pregnant women and child neurodevelopment
           – Author's reply
    • Authors: Michael B Zimmermann
      First page: 10
      Abstract: Publication date: January 2018
      Source:The Lancet Diabetes & Endocrinology, Volume 6, Issue 1
      Author(s): Michael B Zimmermann


      PubDate: 2017-12-21T18:10:53Z
      DOI: 10.1016/s2213-8587(17)30409-6
       
  • Questioning the safety and benefits of evolocumab
    • Authors: Luca Mascitelli; Mark R Goldstein
      First page: 11
      Abstract: Publication date: January 2018
      Source:The Lancet Diabetes & Endocrinology, Volume 6, Issue 1
      Author(s): Luca Mascitelli, Mark R Goldstein


      PubDate: 2017-12-21T18:10:53Z
      DOI: 10.1016/s2213-8587(17)30397-2
       
  • Questioning the safety and benefits of evolocumab – Authors' reply
    • Authors: Marc S Sabatine; Lawrence A Leiter; Stephen D Wiviott
      Pages: 11 - 12
      Abstract: Publication date: January 2018
      Source:The Lancet Diabetes & Endocrinology, Volume 6, Issue 1
      Author(s): Marc S Sabatine, Lawrence A Leiter, Stephen D Wiviott


      PubDate: 2017-12-21T18:10:53Z
      DOI: 10.1016/s2213-8587(17)30403-5
       
  • Linoleic acid and diabetes prevention
    • Authors: George Henderson; Catherine Crofts; Grant Schofield
      Pages: 12 - 13
      Abstract: Publication date: January 2018
      Source:The Lancet Diabetes & Endocrinology, Volume 6, Issue 1
      Author(s): George Henderson, Catherine Crofts, Grant Schofield


      PubDate: 2017-12-21T18:10:53Z
      DOI: 10.1016/s2213-8587(17)30404-7
       
  • Linoleic acid and diabetes prevention – Authors' reply
    • Authors: Jason H Y Wu; Dariush Mozaffarian
      First page: 13
      Abstract: Publication date: January 2018
      Source:The Lancet Diabetes & Endocrinology, Volume 6, Issue 1
      Author(s): Jason H Y Wu, Dariush Mozaffarian


      PubDate: 2017-12-21T18:10:53Z
      DOI: 10.1016/s2213-8587(17)30406-0
       
  • Research in brief
    • Authors: Seema Kang
      First page: 14
      Abstract: Publication date: January 2018
      Source:The Lancet Diabetes & Endocrinology, Volume 6, Issue 1
      Author(s): Seema Kang


      PubDate: 2017-12-21T18:10:53Z
      DOI: 10.1016/s2213-8587(17)30415-1
       
  • Access to diabetes technology: the role of clinician attitudes
    • Authors: Conor Farrington
      First page: 15
      Abstract: Publication date: January 2018
      Source:The Lancet Diabetes & Endocrinology, Volume 6, Issue 1
      Author(s): Conor Farrington


      PubDate: 2017-12-21T18:10:53Z
      DOI: 10.1016/s2213-8587(17)30411-4
       
  • Sugar: the prime suspect in poor health
    • Authors: Talha Khan Burki
      First page: 16
      Abstract: Publication date: January 2018
      Source:The Lancet Diabetes & Endocrinology, Volume 6, Issue 1
      Author(s): Talha Khan Burki


      PubDate: 2017-12-21T18:10:53Z
      DOI: 10.1016/s2213-8587(17)30338-8
       
  • Efficacy and safety of once-monthly pasireotide in Cushing's disease: a 12
           month clinical trial
    • Authors: André Lacroix; Feng Gu; Wilson Gallardo; Rosario Pivonello; Yerong Yu; Przemysław Witek; Marco Boscaro; Roberto Salvatori; Masanobu Yamada; Libuse Tauchmanova; Michael Roughton; Shoba Ravichandran; Stephan Petersenn; Beverly M K Biller; John Newell-Price; Giorgio Arnaldi; Hesarghatta Shyamasunder Asha; Tushar Bandgar; Ariel Barkan; Henrik Biering; Marie Bex; Marek Bolanowski; Marcello Delano Bronstein; Thierry Brue; Dario Bruera; Francesco Cavagnini; Abdurrahman Comlekci; Christophe De Block; Tuncay Delibasi; Carmen Fajardo-Montañana; Richard Abraham Feelders; Maria Fleseriu; Monica Roberto Gadelha; Eliza Brevoort Geer; Anthony Heaney; Ghislaine Houde; Atsuhiro Ichihara; Syed Ali Imran; Adriana Ioachimescu; Pinar Kadioglu; Yiming Li; Paola Loli; Mitsuru Nishiyama; Liudmila Rozhinskaya; Marek Ruchala; Youichi Saitoh; Christof Schöfl; Jochen Schopohl; Akira Shimatsu; Chikara Shimizu; Thiti Snabboon; Peter Snyder; Noriyuki Suzaki; Antoine Tabarin; Yutaka Takahashi; Susana Tara Britto; Guy T'Sjoen; Marie-Christine Vantyghem; Brigitte Velkeniers; Susan Webb; Shozo Yamada
      Pages: 17 - 26
      Abstract: Publication date: January 2018
      Source:The Lancet Diabetes & Endocrinology, Volume 6, Issue 1
      Author(s): André Lacroix, Feng Gu, Wilson Gallardo, Rosario Pivonello, Yerong Yu, Przemysław Witek, Marco Boscaro, Roberto Salvatori, Masanobu Yamada, Libuse Tauchmanova, Michael Roughton, Shoba Ravichandran, Stephan Petersenn, Beverly M K Biller, John Newell-Price
      Background Cushing's disease is a rare debilitating endocrine disorder for which few prospective interventional studies have been done. We report results of the first phase 3 trial assessing long-acting intramuscular pasireotide in patients with Cushing's disease. Methods In this phase 3 clinical trial we recruited patients aged 18 years or older with persistent, recurrent, or de-novo (non-surgical candidates) Cushing's disease who had a mean urinary free cortisol (mUFC) concentration (from three 24 h samples) of 1·5–5·0 times the upper limit of normal (ULN), a normal or greater than normal morning plasma adrenocorticotropic hormone concentration, and a pituitary source of Cushing's syndrome, from 57 sites across 19 countries. Exclusion criteria included previous pasireotide treatment, mitotane therapy within 6 months, and pituitary irradiation within 10 years. We randomly allocated patients 1:1 (block size of four) using an interactive-response-technology system to intramuscular pasireotide 10 mg or 30 mg every 4 weeks for 12 months (in the core phase). We stratified randomisation by screening mUFC concentration (1·5 to <2·0 × ULN and 2·0–5·0 × ULN). The dose could be uptitrated (from 10 mg to 30 mg or from 30 mg to 40 mg) at month 4 if the mUFC concentration was greater than 1·5 × ULN, and at month 7, month 9, or month 12 if the mUFC concentration was greater than 1·0 × ULN. Investigators, patients, site personnel, and those assessing outcomes were masked to dose group allocation. The primary endpoint was the proportion of patients in each group with an mUFC concentration of less than or equal to the ULN at month 7. Efficacy analyses were based on intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01374906. Findings Between Dec 28, 2011, and Dec 9, 2014, we randomly allocated 150 patients to receive pasireotide 10 mg (74 [49%] patients) or 30 mg (76 [51%] patients). The primary efficacy endpoint was met by 31 (41·9% [95% CI 30·5–53·9]) of 74 patients in the 10 mg group and 31 (40·8% [29·7–52·7]) of 76 in the 30 mg group. The most common adverse events were hyperglycaemia (36 [49%] in the 10 mg group and 36 [47%] in the 30 mg group), diarrhoea (26 [35%] and 33 [43%]), cholelithiasis (15 [20%] and 34 [45%]), diabetes mellitus (14 [19%] and 18 [24%]), and nausea (15 [20%] and 16 [21%]). Serious adverse events suspected to be study drug related were reported in eight (11%) patients in the 10 mg group and four (5%) in the 30 mg group. Two (3%) patients in the 30 mg group died during the study (pulmonary artery thrombosis and cardiorespiratory failure); neither death was judged to be related to the study drug. Interpretation Long-acting pasireotide normalised mUFC concentration in about 40% of patients with Cushing's disease at month 7 and had a similar safety profile to that of twice-daily subcutaneous pasireotide. Long-acting pasireotide is an efficacious treatment option for some patients with Cushing's disease who have persistent or recurrent disease after initial surgery or are not surgical candidates, and provides a convenient monthly administration schedule. Funding Novartis Pharma AG.

      PubDate: 2017-12-21T18:10:53Z
      DOI: 10.1016/s2213-8587(17)30326-1
       
  • Aiding sleep in type 2 diabetes: therapeutic considerations
    • Authors: Xiao Tan; Lieve van Egmond; Colin D Chapman; Jonathan Cedernaes; Christian Benedict
      Pages: 60 - 68
      Abstract: Publication date: January 2018
      Source:The Lancet Diabetes & Endocrinology, Volume 6, Issue 1
      Author(s): Xiao Tan, Lieve van Egmond, Colin D Chapman, Jonathan Cedernaes, Christian Benedict
      Insomnia and obstructive sleep apnoea (OSA) are more prevalent in patients with type 2 diabetes than in the general population. Both insomnia and OSA have been linked to cardiometabolic alterations (eg, hypertension, increased activity of the sympathetic nervous system, and systemic insulin resistance) that can exacerbate the pathophysiology of type 2 diabetes. Improvement of sleep in patients with diabetes could therefore aid the treatment of diabetes. To help health practitioners choose the best clinical tool to improve their patients' sleep without detrimentally affecting glucose regulation, this Review critically analyses the effects of common treatments for insomnia and OSA on both sleep and glucose metabolism in patients with type 2 diabetes. These treatments include pharmaceutical sleep aids (eg, benzodiazepine receptor agonists, melatonin) and cognitive behavioural therapy for insomnia, continuous positive airway pressure for OSA, and lifestyle interventions.

      PubDate: 2017-12-21T18:10:53Z
      DOI: 10.1016/s2213-8587(17)30233-4
       
  • Type 2 diabetes in adolescents and young adults
    • Authors: Nadia Lascar; James Brown; Helen Pattison; Anthony H Barnett; Clifford J Bailey; Srikanth Bellary
      Pages: 69 - 80
      Abstract: Publication date: January 2018
      Source:The Lancet Diabetes & Endocrinology, Volume 6, Issue 1
      Author(s): Nadia Lascar, James Brown, Helen Pattison, Anthony H Barnett, Clifford J Bailey, Srikanth Bellary
      The prevalence of type 2 diabetes in adolescents and young adults is dramatically increasing. Similar to older-onset type 2 diabetes, the major predisposing risk factors are obesity, family history, and sedentary lifestyle. Onset of diabetes at a younger age (defined here as up to age 40 years) is associated with longer disease exposure and increased risk for chronic complications. Young-onset type 2 diabetes also affects more individuals of working age, accentuating the adverse societal effects of the disease. Furthermore, evidence is accumulating that young-onset type 2 diabetes has a more aggressive disease phenotype, leading to premature development of complications, with adverse effects on quality of life and unfavourable effects on long-term outcomes, raising the possibility of a future public health catastrophe. In this Review, we describe the epidemiology and existing knowledge regarding pathophysiology, risk factors, complications, and management of type 2 diabetes in adolescents and young adults.

      PubDate: 2017-12-21T18:10:53Z
      DOI: 10.1016/s2213-8587(17)30186-9
       
  • Good value care: when less is more
    • Authors: The Lancet Diabetes & Endocrinology
      First page: 925
      Abstract: Publication date: December 2017
      Source:The Lancet Diabetes & Endocrinology, Volume 5, Issue 12
      Author(s): The Lancet Diabetes & Endocrinology


      PubDate: 2017-12-10T10:58:57Z
      DOI: 10.1016/s2213-8587(17)30373-x
       
  • PCSK9 inhibition and type 2 diabetes
    • Authors: Luca A Lotta; Simon J Griffin
      Pages: 926 - 927
      Abstract: Publication date: December 2017
      Source:The Lancet Diabetes & Endocrinology, Volume 5, Issue 12
      Author(s): Luca A Lotta, Simon J Griffin


      PubDate: 2017-12-10T10:58:57Z
      DOI: 10.1016/s2213-8587(17)30321-2
       
  • How to address non-communicable diseases in urban Africa
    • Authors: Jo Hunter-Adams; Blaise Nguendo Yongsi; Kafui Dzasi; Susan Parnell; Jo Ivey Boufford; Edgar Pieterse; Tolu Oni
      Pages: 932 - 934
      Abstract: Publication date: December 2017
      Source:The Lancet Diabetes & Endocrinology, Volume 5, Issue 12
      Author(s): Jo Hunter-Adams, Blaise Nguendo Yongsi, Kafui Dzasi, Susan Parnell, Jo Ivey Boufford, Edgar Pieterse, Tolu Oni


      PubDate: 2017-12-10T10:58:57Z
      DOI: 10.1016/s2213-8587(17)30220-6
       
  • Atrial fibrillation and type 1 diabetes
    • Authors: Qianrui Li; Zhenmei An; Haoming Tian; Sheyu Li
      First page: 936
      Abstract: Publication date: December 2017
      Source:The Lancet Diabetes & Endocrinology, Volume 5, Issue 12
      Author(s): Qianrui Li, Zhenmei An, Haoming Tian, Sheyu Li


      PubDate: 2017-12-10T10:58:57Z
      DOI: 10.1016/s2213-8587(17)30363-7
       
  • Atrial fibrillation and type 1 diabetes
    • Authors: Ying Xiao; Lin Sun
      Pages: 936 - 937
      Abstract: Publication date: December 2017
      Source:The Lancet Diabetes & Endocrinology, Volume 5, Issue 12
      Author(s): Ying Xiao, Lin Sun


      PubDate: 2017-12-10T10:58:57Z
      DOI: 10.1016/s2213-8587(17)30365-0
       
  • Atrial fibrillation and type 1 diabetes – Authors' reply
    • Authors: Marcus Lind; Annika Rosengren
      First page: 937
      Abstract: Publication date: December 2017
      Source:The Lancet Diabetes & Endocrinology, Volume 5, Issue 12
      Author(s): Marcus Lind, Annika Rosengren


      PubDate: 2017-12-10T10:58:57Z
      DOI: 10.1016/s2213-8587(17)30364-9
       
  • transCampus London–Dresden: a new model for international
           collaborative research
    • Authors: Fiona Mitchell
      First page: 939
      Abstract: Publication date: December 2017
      Source:The Lancet Diabetes & Endocrinology, Volume 5, Issue 12
      Author(s): Fiona Mitchell


      PubDate: 2017-12-10T10:58:57Z
      DOI: 10.1016/s2213-8587(17)30371-6
       
  • Correction to Lancet Diabetes Endocrinol 2018; 6: 17–26
    • Abstract: Publication date: January 2018
      Source:The Lancet Diabetes & Endocrinology, Volume 6, Issue 1


      PubDate: 2017-12-21T18:10:53Z
       
  • Sucrose octasulfate dressing versus control dressing in patients with
           neuroischaemic diabetic foot ulcers (Explorer): an international,
           multicentre, double-blind, randomised, controlled trial
    • Authors: Michael Edmonds; José Luis Lázaro-Martínez; Jesus Manuel Alfayate-García; Jacques Martini; Jean-Michel Petit; Gerry Rayman; Ralf Lobmann; Luigi Uccioli; Anne Sauvadet; Serge Bohbot; Jean-Charles Kerihuel; Alberto Piaggesi
      Abstract: Publication date: Available online 20 December 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Michael Edmonds, José Luis Lázaro-Martínez, Jesus Manuel Alfayate-García, Jacques Martini, Jean-Michel Petit, Gerry Rayman, Ralf Lobmann, Luigi Uccioli, Anne Sauvadet, Serge Bohbot, Jean-Charles Kerihuel, Alberto Piaggesi
      Background Diabetic foot ulcers are serious and challenging wounds associated with high risk of infection and lower-limb amputation. Ulcers are deemed neuroischaemic if peripheral neuropathy and peripheral artery disease are both present. No satisfactory treatment for neuroischaemic ulcers currently exists, and no evidence supports one particular dressing. We aimed to assess the effect of a sucrose octasulfate dressing versus a control dressing on wound closure in patients with neuroischaemic diabetic foot ulcers. Methods We did a randomised, double-blind clinical trial (Explorer) in 43 hospitals with specialised diabetic foot clinics in France, Spain, Italy, Germany, and the UK. Eligible participants were inpatients or outpatients aged 18 years or older with diabetes and a non-infected neuroischaemic diabetic foot ulcer greater than 1 cm2 and of grade IC or IIC (as defined by the University of Texas Diabetic Wound Classification system). We excluded patients with a severe illness that might lead to them discontinuing the trial and those who had surgical revascularisation in the month before study entry. We randomly assigned participants (1:1) via a computer-generated randomisation procedure (concealed block size two); stratified by study centre and wound area (1–5 cm2 and 5–30 cm2), to treatment with either a sucrose octasulfate wound dressing or a control dressing (the same dressing without sucrose octasulfate) for 20 weeks. Both groups otherwise received the same standard of care for a 2-week screening period before randomisation and throughout the 20-week trial. Dressings were applied by nursing staff (or by instructed relatives for some outpatients). Frequencies of dressing changes were decided by the investigator on the basis of the clinical condition of the wound. Patients were assessed 2 weeks after randomisation, then monthly until week 20 or occurrence of wound closure. The primary outcome, assessed by intention-to-treat, was proportion of patients with wound closure at week 20. This trial is registered with ClinicalTrials.gov, number NCT01717183. Findings Between March 21, 2013, and March 31, 2016, we randomly assigned 240 individuals to treatment: 126 to the sucrose octasulfate dressing and 114 to the control dressing. After 20 weeks, wound closure occurred in 60 patients (48%) in the sucrose octasulfate dressing group and 34 patients (30%) in the control dressing group (18 percentage points difference, 95% CI 5–30; adjusted odds ratio 2·60, 95% CI 1·43–4·73; p=0·002). In both groups, the most frequent adverse events were infections of the target wound: 33 wound infections in 25 (20%) patients of 126 in the sucrose octasulfate dressing group and 36 in 32 (28%) patients of 114 in the control dressing group. Minor amputations not affecting the wound site were also reported in one (1%) patient in the sucrose octasulfate dressing group and two (2%) patients in the control dressing group. Three (2%) patients assigned to the sucrose octasulfate dressing and four (4%) assigned to the control dressing died, but none of the deaths were related to treatment, procedure, wound progression, or subsequent to amputation. Interpretation A sucrose octasulfate dressing significantly improved wound closure of neuroischaemic diabetic foot ulcers without affecting safety after 20 weeks of treatment along with standard care. These findings support the use of sucrose octasulfate dressing as a local treatment for neuroischaemic diabetic foot ulcers. Funding Laboratoires Urgo Medical.

      PubDate: 2017-12-21T18:10:53Z
      DOI: 10.1016/s2213-8587(17)30438-2
       
  • Treatment strategies for neuroischaemic diabetic foot ulcers
    • Authors: Fran Game
      Abstract: Publication date: Available online 20 December 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Fran Game


      PubDate: 2017-12-21T18:10:53Z
      DOI: 10.1016/s2213-8587(17)30439-4
       
  • Autoimmune thyroid disease during pregnancy
    • Authors: Simone De Leo; Elizabeth N Pearce
      Abstract: Publication date: Available online 12 December 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Simone De Leo, Elizabeth N Pearce
      Understanding of changes in thyroid function and the consequences of thyroid disease during pregnancy has rapidly grown in the past two decades, and revised American Thyroid Association guidelines on this topic were published in 2017. This Review explores the association between thyroid autoimmunity and complications during and after pregnancy. Thyroid autoimmunity refers to the presence of antibodies to thyroperoxidase or thyroglobulin, or thyroid-stimulating hormone receptor antibodies (TRAbs), or a combination of these, and is present in up to 18% of pregnant women. Thyroid antibodies in pregnant women with normal functioning thyroids (ie, euthyroid) have been associated with several complications, including miscarriage and premature delivery. Treatments to improve pregnancy outcomes are being studied. Whether thyroid antibodies are associated with infertility and assisted reproductive technology outcomes is unclear; although, treatment with low doses of levothyroxine, which is usually used to treat hypothyroidism, can be considered in such situations. Additionally, thyroid antibodies have been associated with other neonatal and maternal complications. All these associations require confirmation in larger prospective studies, and their pathogenic mechanisms need to be better understood. Post-partum thyroiditis is substantially more frequent in women who have thyroid antibodies during pregnancy than in those who do not have thyroid antibodies; however, whether treatment can prevent post-partum thyroiditis in women who are or have been antibody positive is unknown. Finally, TRAbs cross the placenta from the mother to the fetus and can cause fetal or neonatal hyperthyroidism. Therefore, women who are positive for TRAbs during pregnancy should be monitored.

      PubDate: 2017-12-21T18:10:53Z
      DOI: 10.1016/s2213-8587(17)30402-3
       
  • Advanced neuroendocrine tumours of the small intestine and pancreas:
           clinical developments, controversies, and future strategies
    • Authors: Christoph J Auernhammer; Christine Spitzweg; Martin K Angele; Stefan Boeck; Ashley Grossman; Svenja Nölting; Harun Ilhan; Thomas Knösel; Julia Mayerle; Martin Reincke; Peter Bartenstein
      Abstract: Publication date: Available online 8 December 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Christoph J Auernhammer, Christine Spitzweg, Martin K Angele, Stefan Boeck, Ashley Grossman, Svenja Nölting, Harun Ilhan, Thomas Knösel, Julia Mayerle, Martin Reincke, Peter Bartenstein
      In this Review, we discuss clinical developments and controversies in the treatment of neuroendocrine tumours (NETs) that are relevant for clinicians and clinical researchers. We describe advances in genetics, blood-based biomarkers, functional imaging, and systemic therapy of advanced NETs and discuss results of recent phase 3 studies, systemic treatment of advanced disease with peptide receptor radionuclide therapy, biotherapy, chemotherapy, and molecularly targeted therapy, and the potential role of immunotherapy in the treatment of NETs. Suggested treatment algorithms for NETs of ileal or jejunal origin and of pancreatic origin are presented.

      PubDate: 2017-12-10T10:58:57Z
      DOI: 10.1016/s2213-8587(17)30401-1
       
  • Turning back the clock on adrenal insufficiency
    • Authors: Gudmundur Johannsson
      Abstract: Publication date: Available online 8 December 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Gudmundur Johannsson


      PubDate: 2017-12-10T10:58:57Z
      DOI: 10.1016/s2213-8587(17)30431-x
       
  • Effect of once-daily, modified-release hydrocortisone versus standard
           glucocorticoid therapy on metabolism and innate immunity in patients with
           adrenal insufficiency (DREAM): a single-blind, randomised controlled trial
           
    • Authors: Andrea M Isidori; Mary Anna Venneri; Chiara Graziadio; Chiara Simeoli; Daniela Fiore; Valeria Hasenmajer; Emilia Sbardella; Daniele Gianfrilli; Carlotta Pozza; Patrizio Pasqualetti; Stefania Morrone; Angela Santoni; Fabio Naro; Annamaria Colao; Rosario Pivonello; Andrea Lenzi
      Abstract: Publication date: Available online 8 December 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Andrea M Isidori, Mary Anna Venneri, Chiara Graziadio, Chiara Simeoli, Daniela Fiore, Valeria Hasenmajer, Emilia Sbardella, Daniele Gianfrilli, Carlotta Pozza, Patrizio Pasqualetti, Stefania Morrone, Angela Santoni, Fabio Naro, Annamaria Colao, Rosario Pivonello, Andrea Lenzi
      Background Conventional treatment of patients with adrenal insufficiency involves administration of glucocorticoids multiple times a day and has been associated with weight gain and metabolic impairment. The optimal glucocorticoid replacement therapy for these patients is highly debated because of the scarcity of evidence from randomised trials. We aimed to establish whether the timing and pharmacokinetics of glucocorticoid replacement therapy affect the metabolism and immune system of patients with adrenal insufficiency. Methods We did a single-blind randomised controlled trial at two reference university hospitals in Italy. Eligible patients (aged 18–80 years) with adrenal insufficiency were on conventional glucocorticoid therapy and had been stable for at least 3 months before enrolment. Patients were randomly assigned (1:1) with a computer-generated random sequence stratified by type of adrenal insufficiency and BMI to continue conventional glucocorticoid therapy (standard treatment group) or to switch to an equivalent dose of once-daily, modified-release oral hydrocortisone (switch treatment group). Outcome assessors were masked to treatment allocation. The primary outcome was bodyweight change from baseline to 24 weeks. Secondary outcomes included immune cell profiles, susceptibility to infections, and quality of life. Efficacy analyses included all patients who received at least one dose of the study drug. This trial is registered with ClinicalTrials.gov, NCT02277587. Findings Between March 1, 2014, and June 30, 2016, 89 patients with adrenal insufficiency were randomly assigned to continue standard glucocorticoid therapy (n=43) or to switch to once-daily, modified-release hydrocortisone (n=46). At 24 weeks, bodyweight reduction was superior in patients in the once-daily hydrocortisone group compared with those in the standard treatment group (–2·1 kg [95% CI −4·0 to −0·3] vs 1·9 kg [–0·1 to 3·9]; treatment difference −4·0 kg, 95% CI −6·9 to −1·1; p=0·008). Additionally, patients in the once-daily hydrocortisone group had more normal immune cell profiles, reduced susceptibility to infections, and improved quality of life compared with the standard glucocorticoid therapy group. We observed no difference in frequency or severity of adverse events between the two intervention groups, although a lower cumulative number of recurrent upper respiratory tract infections was observed with once-daily hydrocortisone than with standard treatment (17 vs 38; p=0·016). Most adverse events were mild; three serious adverse events occurred in each group, of which one adverse advent (arthritis) in the switch treatment group could be considered drug related. Interpretation Patients with adrenal insufficiency on conventional glucocorticoid replacement therapy multiple times a day exhibit a pro-inflammatory state and weakened immune defence. Restoration of a more physiological circadian glucocorticoid rhythm by switching to a once-daily, modified-release regimen reduces bodyweight, normalises the immune cell profile, reduces recurrent infections, and improves the quality of life of patients with adrenal insufficiency. Funding Italian Ministry of University and Research.

      PubDate: 2017-12-10T10:58:57Z
      DOI: 10.1016/s2213-8587(17)30398-4
       
  • GLP-1 receptor agonists: differentiation within the class
    • Authors: Simeon I Taylor
      Abstract: Publication date: Available online 6 December 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Simeon I Taylor


      PubDate: 2017-12-10T10:58:57Z
      DOI: 10.1016/s2213-8587(17)30413-8
       
  • Cardiovascular outcomes with glucagon-like peptide-1 receptor agonists in
           patients with type 2 diabetes: a meta-analysis
    • Authors: M Angelyn Bethel; Rishi A Patel; Peter Merrill; Yuliya Lokhnygina; John B Buse; Robert J Mentz; Neha J Pagidipati; Juliana C Chan; Stephanie M Gustavson; Nayyar Iqbal; Aldo P Maggioni; Peter Öhman; Neil R Poulter; Ambady Ramachandran; Bernard Zinman; Adrian F Hernandez; Rury R Holman
      Abstract: Publication date: Available online 6 December 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): M Angelyn Bethel, Rishi A Patel, Peter Merrill, Yuliya Lokhnygina, John B Buse, Robert J Mentz, Neha J Pagidipati, Juliana C Chan, Stephanie M Gustavson, Nayyar Iqbal, Aldo P Maggioni, Peter Öhman, Neil R Poulter, Ambady Ramachandran, Bernard Zinman, Adrian F Hernandez, Rury R Holman
      Background Glucagon-like peptide-1 (GLP-1) receptor agonists are effective glucose-lowering drugs. Findings from cardiovascular outcome trials showed cardiovascular safety of GLP-1 receptor agonists, but results for cardiovascular efficacy were varied. We aimed to examine overall cardiovascular efficacy for lixisenatide, liraglutide, semaglutide, and extended-release exenatide. Methods In this systematic review and meta-analysis, we analysed data from eligible trials that assessed the safety and efficacy of GLP-1 receptor agonists compared with placebo in adult patients (aged 18 years or older) with type 2 diabetes and had a primary outcome including, but not limited to, cardiovascular mortality, non-fatal myocardial infarction, and non-fatal stroke. We searched PubMed and MEDLINE without language restrictions up to Sept 18, 2017, for eligible trials. We did a meta-analysis of available trial data using a random-effects model to calculate overall hazard ratios (HRs) for cardiovascular efficacy outcomes and odds ratios for key safety outcomes. Findings Of 12 articles identified in our search and screened for eligibility, four trials of cardiovascular outcomes of GLP-1 receptor agonists were identified: ELIXA (lixisenatide), LEADER (liraglutide), SUSTAIN 6 (semaglutide), and EXSCEL (extended-release exenatide). Compared with placebo, GLP-1 receptor agonist treatment showed a significant 10% relative risk reduction in the three-point major adverse cardiovascular event primary outcome (cardiovascular mortality, non-fatal myocardial infarction, and non-fatal stroke; HR 0·90, 95% CI 0·82–0·99; p=0·033), a 13% RRR in cardiovascular mortality (0·87, 0·79–0·96; p=0·007), and a 12% relative risk reduction in all-cause mortality (0·88, 0·81–0·95; p=0·002), with low-to-moderate between-trial statistical heterogeneity. No significant effect of GLP-1 receptor agonists was identified on fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, hospital admission for unstable angina, or hospital admission for heart failure. Overall, no significant differences were seen in severe hypoglycaemia, pancreatitis, pancreatic cancer, or medullary thyroid cancer reported between GLP-1 receptor agonist treatment and placebo. Interpretation Our findings show cardiovascular safety across all GLP-1 receptor agonist cardiovascular outcome trials and suggest that drugs in this class can reduce three-point major adverse cardiovascular events, cardiovascular mortality, and all-cause mortality risk, albeit to varying degrees for individual drugs, without significant safety concerns. GLP-1 receptor agonists have a favourable risk–benefit balance overall, which should allow the choice of drug to be individualised to each patient's needs. Funding Amylin Pharmaceuticals (AstraZeneca).

      PubDate: 2017-12-10T10:58:57Z
      DOI: 10.1016/s2213-8587(17)30412-6
       
  • Repaglinide versus insulin for newly diagnosed diabetes in patients with
           cystic fibrosis: a multicentre, open-label, randomised trial
    • Authors: Manfred Ballmann; Dominique Hubert; Baroukh M Assael; Doris Staab; Alexandra Hebestreit; Lutz Naehrlich; Tanja Nickolay; Nicole Prinz; Reinhard W Holl; Ute Staden; Martin Claßen; Antje Schuster; Uwe Mellies; Hans-Georg Posselt; Matthias Wiebel; Ernst Rietschel; Martin Stern; Helmut Teschler; Christina Smaczny; Thomas Köhnlein; Vera Wienhausen-Wilke; Andreas Claaß; Thomas Biedermann; Gerd Dockter; Holger Köster; Helge Hebestreit; Ernst-Hinrich Ballke; Hans-Eberhard Heuer; Wolfgang Kamin; Peter Küster; Rüdiger Szczepanski; Klaus-Michael Keller; Horst Generlich; Hans-Georg Bresser; Matthias Kopp; Egbert Herting; Hans-Joachim Feickert; Jürgen Hautz; Birgit Schilling; Egbert Meyer; Marcus A Mall; Wolfram Wiebicke; Friedrich-Karl Tegtmeyer; Marguerite Honer; Helen Mosnier-Pudar; Gérard Lenoir; Jean-Jacques Robert; Laurence Kessler; Laurence Weiss; Raphaële Nove-Josserand; Marie-Christine Vantyghem; Anne Munck; Nathalie Wizla; Sylvie Leroy; Guy-André Loeuille; Raphaël Serreau; Fawzia Aissat; Gabriela H Thalhammer; Isidor Huttegger; Irmgard Eichler; Manfred Götz
      Abstract: Publication date: Available online 5 December 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Manfred Ballmann, Dominique Hubert, Baroukh M Assael, Doris Staab, Alexandra Hebestreit, Lutz Naehrlich, Tanja Nickolay, Nicole Prinz, Reinhard W Holl
      Background As survival among patients with cystic fibrosis has improved in recent decades, complications have become increasingly relevant. The most frequent complication is cystic-fibrosis-related diabetes. The recommended treatment is injected insulin, but some patients are treated with oral antidiabetic drugs to ease the treatment burden. We assessed the efficacy and safety of oral antidiabetic drugs. Methods We did a multicentre, open-label, comparative, randomised trial in 49 centres in Austria, France, Germany, and Italy. Eligible patients had cystic fibrosis, were older than 10 years, and had newly diagnosed diabetes. We used a central randomisation schedule derived from a Geigy random number table to assign patients 1:1 to receive insulin or repaglinide, stratified by sex and age (10–15 years or >15 years). The primary outcome was glycaemic control assessed by mean change in HbA1c concentration from baseline after 24 months of treatment. Differences between groups were assessed by linear models. The primary and safety analyses were done in the modified intention-to-treat population (including patients who stopped treatment early because of lack of efficacy). This trial is registered with ClinicalTrials.gov, number NCT00662714. Findings We enrolled 34 patients in the repaglinide group and 41 in the insulin group, of whom 30 and 37, respectively, were included in the analyses. At 24 months, glycaemic control was similar in the repaglinide and insulin groups (mean change in HbA1c concentration from baseline 0·2% [SD 0·7%], 1·7 mmol/mol [8·1 mmol/mol] with repaglinide vs −0·2% [1·3%], −2·7 mmol/mol, [14·5 mmol/mol] with insulin; mean difference between groups −0·4%, (95% CI −1·1 to 0·2 [−4·4 mmol/mol, −11·5 to 2·7], p=0·15). The most frequent adverse events were pulmonary events (43 [40%] of 107 in the repaglinide group and 60 [45%] of 133 in the insulin group), and the most frequent serious adverse events were pulmonary events leading to hospital admission (five [50%] of ten and seven [54%] of 13, respectively). Interpretation Repaglinide for glycaemic control in patients with cystic-fibrosis-related diabetes is as efficacious and safe as insulin. Funding Mukoviszidose eV, Vaincre la Mucoviscidose, ABCF Association, and Novo Nordisk.

      PubDate: 2017-12-10T10:58:57Z
      DOI: 10.1016/s2213-8587(17)30400-x
       
  • Fat: so much more than just fat
    • Authors: Robert Stirrups
      Abstract: Publication date: December 2017
      Source:The Lancet Diabetes & Endocrinology, Volume 5, Issue 12
      Author(s): Robert Stirrups


      PubDate: 2017-12-10T10:58:57Z
       
  • Correction to Lancet Diabetes Endocrinol 2017; 5: 864–76
    • Abstract: Publication date: December 2017
      Source:The Lancet Diabetes & Endocrinology, Volume 5, Issue 12


      PubDate: 2017-12-10T10:58:57Z
       
  • Correction to Lancet Diabetes Endocrinol 2016; 4: 963–64
    • Abstract: Publication date: December 2017
      Source:The Lancet Diabetes & Endocrinology, Volume 5, Issue 12


      PubDate: 2017-12-10T10:58:57Z
       
  • Correction to Lancet Diabetes Endocrinol 2016; 4: 1004–16
    • Abstract: Publication date: December 2017
      Source:The Lancet Diabetes & Endocrinology, Volume 5, Issue 12


      PubDate: 2017-12-10T10:58:57Z
       
  • Cardiometabolic outcomes and mortality in medically treated primary
           aldosteronism: a retrospective cohort study
    • Authors: Gregory L Hundemer; Gary C Curhan; Nicholas Yozamp; Molin Wang; Anand Vaidya
      Abstract: Publication date: Available online 9 November 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Gregory L Hundemer, Gary C Curhan, Nicholas Yozamp, Molin Wang, Anand Vaidya
      Background Mineralocorticoid receptor (MR) antagonists are the recommended medical therapy for primary aldosteronism. Whether this recommendation effectively reduces cardiometabolic risk is not well understood. We aimed to investigate the risk of incident cardiovascular events in patients with primary aldosteronism treated with MR antagonists compared with patients with essential hypertension. Methods We did a cohort study using patients from a research registry from Brigham and Women's Hospital, Massachusetts General Hospital, and their affiliated partner hospitals. We identified patients with primary aldosteronism using International Classification of Disease, 9th and 10th Revision codes, who were assessed between the years 1991–2016 and were at least 18 years of age. We excluded patients who underwent surgical adrenalectomy, had a previous cardiovascular event, were not treated with MR antagonists, or had no follow-up visits after study entry. From the same registry, we identified a population with essential hypertension that was frequency matched by decade of age at study entry. We extracted patient cohort data and collated it into a de-identified database. The primary outcome was an incident cardiovascular event, defined as a composite of incident myocardial infarction or coronary revascularisation, hospital admission with congestive heart failure, or stroke, which was assessed using adjusted Cox regression models. Secondary outcomes were the individual components of the composite cardiovascular outcome, as well as incident atrial fibrillation, incident diabetes, and death. Findings We identified 602 eligible patients with primary aldosteronism treated with MR antagonists and 41 853 age-matched patients with essential hypertension from the registry. The two groups of patients had comparable cardiovascular risk profiles and blood pressure throughout the study. The incidence of cardiovascular events was higher in patients with primary aldosteronism on MR antagonists than in patients with essential hypertension (56·3 [95% CI 48·8–64·7] vs 26·6 [26·1–27·2] events per 1000 person-years, adjusted hazard ratio 1·91 [95% CI 1·63–2·25]; adjusted 10-year cumulative incidence difference 14·1 [95% CI 10·1–18·0] excess events per 100 people). Patients with primary aldosteronism also had higher adjusted risks for incident mortality (hazard ratio [HR] 1·34 [95% CI 1·06–1·71]), diabetes (1·26 [1·01–1·57]), and atrial fibrillation (1·93 [1·54–2·42]). Compared with essential hypertension, the excess risk for cardiovascular events and mortality was limited to patients with primary aldosteronism whose renin activity remained suppressed (<1 μg/L per h) on MR antagonists (adjusted HR [2·83 [95% CI 2·11–3·80], and 1·79 [1·14–2·80], respectively) whereas patients who were treated with higher MR antagonist doses and had unsuppressed renin (≥1 μg/L per h) had no significant excess risk. Interpretation The current practice of MR antagonist therapy in primary aldosteronism is associated with significantly higher risk for incident cardiometabolic events and death, independent of blood pressure control, than for patients with essential hypertension. Titration of MR antagonist therapy to raise renin might mitigate this excess risk. Funding US National Institutes of Health.

      PubDate: 2017-11-11T17:30:42Z
      DOI: 10.1016/s2213-8587(17)30367-4
       
  • Cardiovascular events and target organ damage in primary aldosteronism
           compared with essential hypertension: a systematic review and
           meta-analysis
    • Authors: Silvia Monticone; Fabrizio D'Ascenzo; Claudio Moretti; Tracy Ann Williams; Franco Veglio; Fiorenzo Gaita; Paolo Mulatero
      Abstract: Publication date: Available online 9 November 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Silvia Monticone, Fabrizio D'Ascenzo, Claudio Moretti, Tracy Ann Williams, Franco Veglio, Fiorenzo Gaita, Paolo Mulatero
      Background There is conflicting evidence, relying on heterogeneous studies, as to whether aldosterone excess is responsible for an increased risk of cardiovascular and cerebrovascular complications in patients with primary aldosteronism. We aimed to assess the association between primary aldosteronism and adverse cardiac and cerebrovascular events, target organ damage, diabetes, and metabolic syndrome, compared with the association of essential hypertension and these cardiovascular and end organ events, by integrating results of previous studies. Methods We did a meta-analysis of prospective and retrospective observational studies that compared patients with primary aldosteronism and essential hypertension, to analyse the association between primary aldosteronism and stroke, coronary artery disease (as co-primary endpoints), atrial fibrillation and heart failure, target organ damage, metabolic syndrome, and diabetes (as secondary endpoints). We searched MEDLINE and Cochrane Library for articles published up to Feb 28, 2017, with no start date restriction. Eligible studies compared patients with primary aldosteronism with patients with essential hypertension (as a control group) and reported on the clinical events or endpoints of interest. We also compared primary aldosteronism subtypes, aldosterone-producing adenoma, and bilateral adrenal hyperplasia. Findings We identified 31 studies including 3838 patients with primary aldosteronism and 9284 patients with essential hypertension. After a median of 8·8 years (IQR 6·2–10·7) from the diagnosis of hypertension, compared with patients with essential hypertension, patients with primary aldosteronism had an increased risk of stroke (odds ratio [OR] 2·58, 95% CI 1·93–3·45), coronary artery disease (1·77, 1·10–2·83), atrial fibrillation (3·52, 2·06–5·99), and heart failure (2·05, 1·11–3·78). These results were consistent for patients with aldosterone-producing adenoma and bilateral adrenal hyperplasia, with no difference between these subgroups. Similarly, primary aldosteronism increased the risk of diabetes (OR 1·33, 95% CI 1·01–1·74), metabolic syndrome (1·53, 1·22–1·91), and left ventricular hypertrophy (2·29, 1·65–3·17). Interpretation Diagnosing primary aldosteronism in the early stages of disease, with early initiation of specific treatment, is important because affected patients display an increased cardiovascular risk compared with patients with essential hypertension. Funding None.

      PubDate: 2017-11-11T17:30:42Z
      DOI: 10.1016/s2213-8587(17)30319-4
       
  • Primary aldosteronism and cardiovascular risk, before and after treatment
    • Authors: John W Funder
      Abstract: Publication date: Available online 9 November 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): John W Funder


      PubDate: 2017-11-11T17:30:42Z
      DOI: 10.1016/s2213-8587(17)30368-6
       
  • Research digest: hypoglycaemia and glucose variability
    • Authors: Naveed Sattar; David Preiss
      Abstract: Publication date: Available online 8 November 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Naveed Sattar, David Preiss


      PubDate: 2017-11-11T17:30:42Z
      DOI: 10.1016/s2213-8587(17)30374-1
       
  • Moderate salt restriction with or without paricalcitol in type 2 diabetes
           and losartan-resistant macroalbuminuria (PROCEED): a randomised,
           double-blind, placebo-controlled, crossover trial
    • Authors: Aneliya Parvanova; Matias Trillini; Manuel A Podestà; Ilian Petrov Iliev; Barbara Ruggiero; Manuela Abbate; Annalisa Perna; Francesco Peraro; Olimpia Diadei; Nadia Rubis; Flavio Gaspari; Fabiola Carrara; Nadia Stucchi; Antonio Belviso; Antonio C Bossi; Roberto Trevisan; Giuseppe Remuzzi; Martin de Borst; Piero Ruggenenti; Norberto Perico; Piero Ruggenenti; Giuseppe Remuzzi; Stefano Rota; Matias Trillini; Barbara Ruggiero; Maria Carolina Aparicio; Silvia Prandini; Daniela Cugini; Giulia Gherardi; Manuel A Podestà; Roberto Trevisan; Anna Corsi; Antonio C. Bossi; Aneliya Parvanova; Ilian Petrov Iliev; S Yakymchuk; Veruscka Lecchi; Antonio Belviso; Ruggero Mangili; Nadia Rubis; Wally Calini; Olimpia Diadei; Bogdan Ene-Iordache; Sergio Carminati; Davide Martinetti; Giovanni Antonio Giuliano; Annalisa Perna; Francesco Peraro; Angela Russo; Flavio Gaspari; Fabiola Carrara; Silvia Ferrari; Nadia Stucchi; Antonio Nicola Cannata; Paola Boccardo; Sara Peracchi; Martin De Borst; Serena Bettoni; Irene Cattaneo; Davide Franchina; Haian Ha Phan; Grace Igiraneza; Tamas Kaucsár; Sergio Luis Lima; Meg Lunney; Huong Tran
      Abstract: Publication date: Available online 2 November 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Aneliya Parvanova, Matias Trillini, Manuel A Podestà, Ilian Petrov Iliev, Barbara Ruggiero, Manuela Abbate, Annalisa Perna, Francesco Peraro, Olimpia Diadei, Nadia Rubis, Flavio Gaspari, Fabiola Carrara, Nadia Stucchi, Antonio Belviso, Antonio C Bossi, Roberto Trevisan, Giuseppe Remuzzi, Martin de Borst, Piero Ruggenenti
      Background Macroalbuminuria predicts renal and cardiovascular events in patients with type 2 diabetes. We aimed to assess the albuminuria-lowering effects of salt restriction, paricalcitol therapy, or both, in this population. Methods In this randomised, double-blind, placebo-controlled, crossover trial, we recruited adult patients with type 2 diabetes from six diabetology outpatient clinics in northern Italy, with 24 h albuminuria of more than 300 mg despite 100 mg per day losartan therapy, blood pressure of less than 140/90 mm Hg, serum creatinine concentration of less than 2 mg/dL, stable renal function on stable renin-angiotensin system inhibitor therapy with a fixed dose of losartan, parathyroid hormone concentration of 20 pg/mL to <110 pg/mL, serum calcium concentration of less than 9·5 mg/dL, and serum phosphate concentration of less than 5 mg/dL, who had been more than 80% compliant with placebo treatment during a 1 month placebo run-in. We allocated patients 1:1 with computer-generated randomisation to an open-label 3 month high-sodium (>200 mEq [4·8 g] per day) or low-sodium (<100 mEq [2·4 g] per day) diet and, within each diet group, to a 1 month double-blind treatment period of oral paricalcitol (2 μg per day) or placebo, followed by 1 month of placebo washout and then a further 1 month double-blind treatment period of paricalcitol or placebo in which patients crossed over to the opposite treatment period. The primary outcome was 24 h albuminuria (median of three consecutive measurements). Analyses were modified intention-to-treat (including all randomly allocated patients who took at least one dose of study drug and had an efficacy measurement after the first treatment period). Patients and investigators were masked to paricalcitol and placebo assignment. Those assessing outcomes were masked to both study drug and diet assignment. This study is registered with ClinicalTrials.gov, number NCT01393808, and the European Union Clinical Trials Register, number 2011-001713-14. Findings Between Dec 13, 2011, and Feb 17, 2015, we randomly allocated 57 (50%) patients to a low-sodium diet (28 [49%] to paricalcitol then placebo and 29 [51%] to placebo then paricalcitol) and 58 (50%) to a high-sodium diet (29 [50%] to paricalcitol then placebo and 29 [50%] to placebo then paricalcitol). In the low-sodium group (30 mEq of daily sodium intake reduction, equivalent to approximately 1·7–1·8 g per day), 24 h albuminuria was reduced by 36·6% (95% CI 28·5–44·9) from 724 mg (441–1233) at baseline to 481 mg (289–837) at month 3 (p<0·0001), but no significant change occurred in the high-sodium group (from 730 mg [416–1227] to 801 mg [441–1365]; 2·9% [–16·8 to 16·4] increase; p=0·50). Changes between diet groups differed by 32·4% (17·2–48·8; p<0·0001) and correlated with changes in natriuresis (r=0·43; p<0·0001). On the high-sodium diet, paricalcitol reduced the salt-induced albuminuria increase by 17·8% (3·9–32·3) over the month of treatment compared with placebo (p=0·02), whereas on the low-sodium diet, paricalcitol did not have a significant effect versus placebo (increase of 4·1% [–9·3 to 21·6]; p=0·59). During placebo treatment, albuminuria decreased with the low-sodium diet (p=0·0002) and did not significantly change with the high-sodium diet, but changes were significantly different between diet groups (p=0·0004). Treatment was well tolerated and no patients withdrew from the study because of treatment-related effects. 67 adverse events occurred in 52 (45%) patients during paricalcitol treatment and 44 events occurred in 36 (31%) patients during placebo treatment. During paricalcitol therapy, 14 cases of hypercalciuria, six cases of hypercalcaemia, and five cases of hyperphosphataemia were reported in one patient each, all of which were possibly treatment related. One case of hypercalciuria was reported in one patient during the placebo treatment period. One stroke and one coronary event occurred during paricalcitol therapy. No patients died during the study.
      PubDate: 2017-11-11T17:30:42Z
      DOI: 10.1016/s2213-8587(17)30359-5
       
  • Paricalcitol and albuminuria: tread carefully
    • Authors: Beatriz Fernandez-Fernandez; Alberto Ortiz
      Abstract: Publication date: Available online 2 November 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Beatriz Fernandez-Fernandez, Alberto Ortiz


      PubDate: 2017-11-05T17:04:26Z
      DOI: 10.1016/s2213-8587(17)30361-3
       
  • Cardiovascular risk after cessation of growth hormone treatment in people
           born small for gestational age
    • Authors: Rosario Pivonello; Carolina Di Somma; Annamaria Colao
      Abstract: Publication date: Available online 1 November 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Rosario Pivonello, Carolina Di Somma, Annamaria Colao


      PubDate: 2017-11-05T17:04:26Z
      DOI: 10.1016/s2213-8587(17)30323-6
       
  • Top ten research priorities for type 2 diabetes: results from the Diabetes
           UK–James Lind Alliance Priority Setting Partnership
    • Authors: Sarah Finer; Paul Robb; Katherine Cowan; Ann Daly; Elizabeth Robertson; Andrew Farmer
      Abstract: Publication date: Available online 30 October 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Sarah Finer, Paul Robb, Katherine Cowan, Ann Daly, Elizabeth Robertson, Andrew Farmer


      PubDate: 2017-11-05T17:04:26Z
      DOI: 10.1016/s2213-8587(17)30324-8
       
  • How can we optimise diabetes care in real-world practice'
    • Authors: Juliana C N Chan
      Abstract: Publication date: Available online 24 October 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Juliana C N Chan


      PubDate: 2017-10-25T15:51:29Z
      DOI: 10.1016/s2213-8587(17)30356-x
       
  • Linoleic acid and risk of type 2 diabetes
    • Authors: Gabriele Riccardi
      Abstract: Publication date: Available online 12 October 2017
      Source:The Lancet Diabetes & Endocrinology
      Author(s): Gabriele Riccardi


      PubDate: 2017-10-14T15:06:22Z
      DOI: 10.1016/s2213-8587(17)30322-4
       
 
 
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