Endocrinology and Metabolism Clinics of North America RSS feed: Current Issue. Endocrinology and Metabolism Clinics of North America updates you on the latest trends in patient management; keeps you up to date on the newest advances; and provides a sound basis for choosing treatment options. Each issue focuses on a single topic in endocrinology and metabolism and is presented under the direction of an experienced guest editor. http://www.endo.theclinics.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Endocrinology and Metabolism Clinics of North America0889-8529411March 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.endo.theclinics.com/article/PIIS0889852912000175/abstract?rss=yesContributors10.1016/S0889-8529(12)00017-5Endocrinology and Metabolism Clinics of North America 41, 1 (2012)2012-03-01Endocrinology and Metabolism Clinics of North America2012-03-01411S0889-8529(11)X0006-3iiiivhttp://www.endo.theclinics.com/article/PIIS0889852912000187/abstract?rss=yesContents10.1016/S0889-8529(12)00018-7Endocrinology and Metabolism Clinics of North America 41, 1 (2012)2012-03-01Endocrinology and Metabolism Clinics of North America2012-03-01411S0889-8529(11)X0006-3vviihttp://www.endo.theclinics.com/article/PIIS0889852912000199/abstract?rss=yesForthcoming Issues10.1016/S0889-8529(12)00019-9Endocrinology and Metabolism Clinics of North America 41, 1 (2012)2012-03-01Endocrinology and Metabolism Clinics of North America2012-03-01411S0889-8529(11)X0006-3viiiviiihttp://www.endo.theclinics.com/article/PIIS0889852912000096/abstract?rss=yesThis issue, edited by Drs Leahy and Cefalu, covers a very important aspect of diabetes care, namely, insulin therapy. As the reader will perceive, the topics chosen and authors contributing bring the latest developments in our understanding of the newer developments and use of insulin in both types of diabetes.ForewordDerek LeRoith10.1016/j.ecl.2012.03.005Endocrinology and Metabolism Clinics of North America 41, 1 (2012)2012-03-30Endocrinology and Metabolism Clinics of North America2012-03-30411S0889-8529(11)X0006-3ixxihttp://www.endo.theclinics.com/article/PIIS0889852912000102/abstract?rss=yesIn 2002, the editors of this volume, Jack Leahy and Will Cefalu, edited a book entitled Insulin Therapy. It was made up of chapters from experts in the field regarding insulin physiology and therapy, and, in particular, the how to's and why's regarding insulin usage in various patient populations. We did that project because of the lack of a centralized source of up-to-date information on this key subject. Now, 10 years later, the need for a comprehensive sourcebook for insulin therapy is even greater. Much has happened in those 10 years. Insulin analogues are firmly established, and new increasingly innovative insulins and delivery devices are coming. Technology has become an everyday part of type 1 diabetes—pumps, sensors, meters with computer programs to crunch the data, and soon (hopefully) automatic suspend closed loop systems. In type 2 diabetes, insulin therapy has stood the test of time despite new classes of pharmaceuticals having tried to make it obsolete. Just the opposite! Starting insulin in patients failing other therapies is common practice for primary care providers, and numerous studies from around the world have shown insulin in type 2 diabetes is generally safe and effective, and, most importantly, well-accepted by patients. The major discussion point today is not whether to use insulin in type 2 diabetes, but how early, and what to do if the starting program—basal or premixed insulin—fails? Particularly exciting are the recent studies combining a GLP-1 receptor agonist with a basal insulin, or adding a single injection of mealtime insulin to basal insulin rather than a full basal-bolus program. Also, important studies have tested how to optimize insulin therapy in children, in pregnancy, and in hospitalized patients. And there has been enormous discussion about goals of treatment, and prevention of hypoglycemia.PrefaceJack L. Leahy, William T. Cefalu10.1016/j.ecl.2012.03.006Endocrinology and Metabolism Clinics of North America 41, 1 (2012)2012-03-01Endocrinology and Metabolism Clinics of North America2012-03-01411S0889-8529(11)X0006-3xiiixivhttp://www.endo.theclinics.com/article/PIIS0889852912000060/abstract?rss=yesThis article highlights selected milestones in insulin discovery and its continued development as a pivotal therapy for diabetes. The last 90 years have witnessed tremendous progress in insulin therapy, from the initial crude, yet life-saving, animal insulin extracts to novel human insulin analogues. Although the complete physiologic replacement of insulin is inherently difficult to achieve with open-loop subcutaneously administered insulin, the continued development of improved injectable insulin formulations with superior pharmacokinetics and pharmacodynamics will enhance glucose control, and represents important clinical advances in the treatment of both type 1 and type 2 diabetes.Insulins: Past, Present, and FutureCarla A. Borgoño, Bernard Zinman10.1016/j.ecl.2012.03.002Endocrinology and Metabolism Clinics of North America 41, 1 (2012)2012-04-16Endocrinology and Metabolism Clinics of North America2012-04-16411S0889-8529(11)X0006-3124http://www.endo.theclinics.com/article/PIIS0889852912000047/abstract?rss=yesAn input-output schematization of plasma glucose homeostasis provides quantitative information on glucose fluxes and their control by insulin. Insulin action is dependent on the target tissue, the route of delivery, and the kinetics of insulin activation and deactivation, which are different for glucose production and disposal and are a function of insulin resistance. Under normal conditions, the closed-loop control of minute-by-minute insulin release by arterial glucose levels protects against both hyperglycemia and hypoglycemia. Open-loop insulin therapy faces the complexities of insulin pharmacokinetics and pharmacodynamics. Insulin therapy thus remains defiantly empiric.Physiology of Glucose Homeostasis and Insulin Therapy in Type 1 and Type 2 DiabetesEle Ferrannini10.1016/j.ecl.2012.01.003Endocrinology and Metabolism Clinics of North America 41, 1 (2012)2012-04-26Endocrinology and Metabolism Clinics of North America2012-04-26411S0889-8529(11)X0006-32539http://www.endo.theclinics.com/article/PIIS0889852912000072/abstract?rss=yesRecent large clinical trials have shown that intensive glycemic control can reduce microvascular complications, but appropriate and safe glycemic goals to improve macrovascular outcomes in patients with type 2 diabetes remain poorly defined. This article surveys recent epidemiologic studies and interventional trials, examines the current understanding of the natural history of type 2 diabetes, and proposes new goals and tactics for optimizing insulin therapy.Reevaluating Goals of Insulin Therapy: Perspectives from Large Clinical TrialsMatthew C. Riddle, Kevin C.J. Yuen10.1016/j.ecl.2012.03.003Endocrinology and Metabolism Clinics of North America 41, 1 (2012)2012-04-09Endocrinology and Metabolism Clinics of North America2012-04-09411S0889-8529(11)X0006-34156http://www.endo.theclinics.com/article/PIIS0889852912000059/abstract?rss=yesHypoglycemia is the most important and common side effect of insulin therapy. It is also the rate limiting factor in safely achieving excellent glycemic control. A three-fold increased risk of severe hypoglycemia occurs in both type 1 and type 2 diabetes with tight glucose control. This dictates a need to individualize therapy and glycemia goals to minimize this risk. Several ways to reduce hypoglycemia risk are recognized and discussed. They include frequent monitoring of blood sugars with home blood glucose tests and sometimes continuous glucose monitoring (CGM) in order to identify hypoglycemia particularly in hypoglycemia unawareness. Considerations include prompt measured hypoglycemia treatment, attempts to reduce glycemic variability, balancing basal and meal insulin therapy, a pattern therapy approach and use of a physiological mimicry with insulin analogues in a flexible manner. Methods to achieve adequate control while focusing on minimizing the risk of hypoglycemia are delineated in this article.Insulin Therapy and HypoglycemiaAnthony L. McCall10.1016/j.ecl.2012.03.001Endocrinology and Metabolism Clinics of North America 41, 1 (2012)2012-04-19Endocrinology and Metabolism Clinics of North America2012-04-19411S0889-8529(11)X0006-35787http://www.endo.theclinics.com/article/PIIS0889852911001162/abstract?rss=yesThere has been a significant increase in the prevalence of type 1 diabetes mellitus and type 2 diabetes mellitus in the past decade. The International Diabetes Foundation reported that there will be more than a half-billion people with diabetes by 2030, largely in emerging economies. Improved glucose control reduces microvascular and macrovascular complications and can be accomplished with intensive diabetes management. Continuous glucose monitors allow further improvement. The best way to emulate normal physiology is the development of an artificial pancreas. Early versions of closed-loop technology may be available in the United States in the next 3 to 5 years.Intensive Insulin Therapy in Patients with Type 1 Diabetes MellitusSean M. Switzer, Emily G. Moser, Briana E. Rockler, Satish K. Garg10.1016/j.ecl.2011.12.001Endocrinology and Metabolism Clinics of North America 41, 1 (2012)2012-04-26Endocrinology and Metabolism Clinics of North America2012-04-26411S0889-8529(11)X0006-389104http://www.endo.theclinics.com/article/PIIS0889852911001186/abstract?rss=yesAdvances in diabetes technology have led to significant improvements in the quality of life and care received by individuals with diabetes. Despite this, achieving tight glycemic control through intensive insulin therapy and modern insulin regimens is challenging because of the barrier of hypoglycemia, the most feared complication of insulin therapy as reported by patients, caregivers, and physicians. This article outlines the individual components of the closed-loop system together with the existing clinical evidence. The artificial pancreas prototypes currently used in clinical studies are reviewed as well as obstacles and limitations facing the technology.Closed-Loop Insulin Delivery in Type 1 DiabetesHood Thabit, Roman Hovorka10.1016/j.ecl.2011.12.003Endocrinology and Metabolism Clinics of North America 41, 1 (2012)2012-03-01Endocrinology and Metabolism Clinics of North America2012-03-01411S0889-8529(11)X0006-3105117http://www.endo.theclinics.com/article/PIIS0889852912000084/abstract?rss=yesHealth care providers and patients have lots of choice to treat type 2 diabetes, but the blood glucose improvement is limited. The one therapy with unlimited potential (at least theoretically) is insulin. Many studies show that glucose control is achievable with insulin safely in most patients with type 2 diabetes. Effective diabetes management at the primary care or specialty level requires a belief in the importance of insulin therapy in uncontrolled patients with type 2 diabetes. This review details the theories, observed outcomes, and how-tos regarding insulin use in type 2 diabetes.Insulin Therapy in Type 2 Diabetes MellitusJack L. Leahy10.1016/j.ecl.2012.03.004Endocrinology and Metabolism Clinics of North America 41, 1 (2012)2012-03-01Endocrinology and Metabolism Clinics of North America2012-03-01411S0889-8529(11)X0006-3119144http://www.endo.theclinics.com/article/PIIS0889852912000035/abstract?rss=yesInsulin therapy is the mainstay of treatment in children and adolescents with type 1 diabetes (T1D) and is a key component in the treatment of type 2 diabetes (T2D) in this population as well. A major aim of current insulin replacement therapy is to simulate the normal pattern of insulin secretion as closely as possible. This aim can best be achieved with basal-bolus therapy using multiple daily injections (MDI) or continuous insulin infusion (CSII) pump therapy. Only a few years ago, options for insulin formulations were limited. There are now more than 10 varieties of biosynthetic human and analogue insulin.Insulin Therapy in Children and AdolescentsWilliam V. Tamborlane, Kristin A. Sikes10.1016/j.ecl.2012.01.002Endocrinology and Metabolism Clinics of North America 41, 1 (2012)2012-02-27Endocrinology and Metabolism Clinics of North America2012-02-27411S0889-8529(11)X0006-3145160http://www.endo.theclinics.com/article/PIIS0889852911001174/abstract?rss=yesInsulin therapy is essential for optimal glycemic control during pregnancy in women with type 1 diabetes and is frequently required to optimize control in women with type 2 diabetes. Less commonly, women with gestational diabetes mellitus (GDM) require insulin for glycemic control. However, because of its greater prevalence, GDM is the most common reason for insulin use in pregnancy. The most frequently used insulin regimen in pregnancy is a basal/bolus combination of long- and short-acting insulin preparations. There is no evidence base to support one treatment regimen over another. Therapy should be individualized and based on local expertise.Insulin Therapy in PregnancyAidan McElduff, Robert G. Moses10.1016/j.ecl.2011.12.002Endocrinology and Metabolism Clinics of North America 41, 1 (2012)2012-01-06Endocrinology and Metabolism Clinics of North America2012-01-06411S0889-8529(11)X0006-3161173http://www.endo.theclinics.com/article/PIIS0889852912000023/abstract?rss=yesIt has long been established that hyperglycemia with or without a prior diagnosis of diabetes increases both mortality and disease-specific morbidity in hospitalized patients and that goal-directed insulin therapy can improve outcomes. This article reviews the pathophysiology of hyperglycemia during illness, the mechanisms for increased complications and mortality due to hyperglycemia and hypoglycemia, and beneficial mechanistic effects of insulin therapy and provides updated recommendations for the inpatient management of diabetes in the critical care setting and in the general medicine and surgical settings.Insulin Therapy for the Management of Hyperglycemia in Hospitalized PatientsMarie E. McDonnell, Guillermo E. Umpierrez10.1016/j.ecl.2012.01.001Endocrinology and Metabolism Clinics of North America 41, 1 (2012)2012-02-20Endocrinology and Metabolism Clinics of North America2012-02-20411S0889-8529(11)X0006-3175201http://www.endo.theclinics.com/article/PIIS0889852912000205/abstract?rss=yesIndex10.1016/S0889-8529(12)00020-5Endocrinology and Metabolism Clinics of North America 41, 1 (2012)2012-03-01Endocrinology and Metabolism Clinics of North America2012-03-01411S0889-8529(11)X0006-3203230