Treatments in endocrinology
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Evidence-based medicine is the judicious, conscientious, and explicit use of the best available evidence from clinical research in making clinical decisions. This definition recognizes a hierarchy of evidence that arranges study designs by their susceptibility to bias. The top of the hierarchy includes n-of-1 trials, systematic reviews of randomized trials, and single randomized trials reporting patient-important outcomes. ⋯ Current endocrine practice may require a redesign to enhance the role of endocrinologists as information brokers for colleagues and patients. In the last 10 years, evidence-based medicine has matured as a philosophy of clinical care and medical education. An appraisal of its role in endocrinology awaits the pervasion of its principles into all of endocrine practice.
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Obesity is the most important modifiable risk factor for type 2 diabetes mellitus and most patients with diabetes are overweight or obese. It is well known that excess bodyweight induces or aggravates insulin resistance, which is a characteristic feature of type 2 diabetes. Thus, bodyweight plays a central role in the prevention and treatment of diabetes. ⋯ A large body of data suggests that such measures can be very effective in this patient group by improving metabolic disturbances and blood pressure. However, it is extremely important for the long-term outcome that the treatment is tailored to the needs and wishes of the individual patient. There is growing agreement that due to the low success rate of conventional therapies and the overwhelming benefit from weight loss, more determined and aggressive strategies may be appropriate to achieve the central goal of weight reduction in obese patients with type 2 diabetes.
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Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency in patients with diabetes mellitus. DKA most often occurs in patients with type 1 diabetes, but patients with type 2 diabetes are susceptible to DKA under stressful conditions, such as trauma, surgery, or infections. DKA is reported to be responsible for more than 100 000 hospital admissions per year in the US, and accounts for 4-9% of all hospital discharge summaries among patients with diabetes. ⋯ Since the majority of DKA cases occur in patients with a known history of diabetes, this acute metabolic complication should be largely preventable through early detection, and by the education of patients, healthcare professionals, and the general public. The frequency of hospitalizations for DKA has been reduced following diabetes education programs, improved follow-up care, and access to medical advice. Novel approaches to patient education incorporating a variety of healthcare beliefs and socioeconomic issues are critical to an effective prevention program.
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Polycystic ovary syndrome is a heterogeneous clinical syndrome, which has been defined as the association of hyperandrogenism with chronic anovulation in women without specific adrenal and pituitary gland disease. A family history of polycystic ovary syndrome may be present in a subset of patients; however, the genetic basis of the syndrome remains unclear. Most often, the age of onset is perimenarchal and it is characterized by the appearance of menstrual disturbances, hirsutism, acne, and more rarely, a male pattern of alopecia. ⋯ The therapeutic approaches to polycystic ovary syndrome include lifestyle modifications, dietary-induced weight loss, insulin-sensitizing agents, antiandrogens, and oral contraceptives. These treatments may improve the clinical manifestations of excess androgen production and normalize menses in many adolescents and young women with polycystic ovary syndrome. Early recognition of the syndrome and thus, early treatment, may prevent and possibly ameliorate all the symptoms and the potential later development of metabolic and cardiovascular complications.