CONTEXTWhether subclinical hypothyroidism (SCH) is associated with cardiometabolic abnormalities is uncertain.OBJECTIVETo examine diverse cardiometabolic biomarkers across euthyroid, SCH, and overt hypothyroidism (HT) in women free of cardiovascular disease (CVD).DESIGNCross-sectional adjusted associations for lipids, lipoprotein subclasses, lipoprotein insulin resistance score, inflammatory, coagulation, and glycemic biomarkers by ANCOVA for thyroid categories or TSH quintiles on a Women's Health Study subcohort.SETTINGOutpatient.PATIENTS OR OTHER PARTICIPANTSRandomly sampled 3,914 middle-aged and older women for thyroid function analysis (thyroid-stimulating hormone [TSH], free T4), of whom 3,321 were not on lipid lowering therapy.INTERVENTIONNone.MAIN OUTCOME MEASUREAssociations of SCH and HT with cardiometabolic markers.RESULTSGoing from euthyroid to HT, the lipoprotein subclasse profiles were indicative of insulin resistance [respective values and p for trend]: larger VLDL size (nm)[51.5 (95%CI51.2, 51.8) to 52.9 (51.8, 54.1) p=0.001]; higher LDL particles concentration (nmol/L)[1283 (95%CI1267, 1299) to 1358 (1298, 1418) p=0.004] and smaller LDL size. There was worsening lipoprotein insulin resistance score from euthyroid 49.2 (95%CI 48.3, 50.2) to SCH 52.1 (95%CI 50.1, 54.0), and HT 52.1 (95%CI 48.6, 55.6), p for trend 0.008. Of the other biomarkers, SCH and HT were associated with higher hs-CRP and HbA1c. For increasing TSH quintiles results were overall similar.CONCLUSIONSIn apparently healthy women, SCH cardiometabolic profiles indicated worsening insulin resistance and higher CVD risk markers compared with euthyroid individuals, despite similar LDL and total cholesterol. These findings suggest that cardiometabolic risk may increase early in the progression towards SCH and OH.

01 Dec 2012·Diabetology & Metabolic SyndromeQ4 · MEDICINE

Differentiating among incretin-based therapies in the management of patients with type 2 diabetes mellitus

Q4 · MEDICINE

ArticleOA

Author: Cobble, Michael

The glucagon-like peptide-1 receptor (GLP-1R) agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors have become important options for the management of patients with type 2 diabetes mellitus. While the GLP-1R agonists and DPP-4 inhibitors act on the incretin system to regulate glucose homeostasis, there are important clinical differences among the five agents currently available in the U.S. For example, the GLP-1R agonists require subcutaneous administration, produce pharmacological levels of GLP-1 activity, promote weight loss, have a more robust glucose-lowering effect, and have a higher incidence of adverse gastrointestinal effects. In contrast, the DPP-4 inhibitors are taken orally, increase the half-life of endogenous GLP-1, are weight neutral, and are more commonly associated with nasopharyngitis. Differences in efficacy, safety, tolerability, and cost among the incretin-based therapies are important to consider in the primary care management of patients with type 2 diabetes mellitus.

01 Jan 2009·American Journal of TherapeuticsQ4 · MEDICINE

Initiating and Intensifying Insulin Therapy for Type 2 Diabetes: Why, When, and How

Q4 · MEDICINE

Review

Author: Cobble, Michael E

With the exception of insulin, all diabetes medications have limited glucose-lowering capacity. Therefore, as type 2 diabetes progresses, insulin is often needed to achieve near-normal glycemic targets and avoid complications. Concerns about the initiation of insulin by both clinicians and patients play a major role in poor glycemic control. This article discusses current guidelines for treating type 2 diabetes, exploring when and how insulin therapy should be initiated and intensified, and how barriers to insulin use may be overcome. Advances include the development of novel long-acting, premixed, and rapid-acting insulin analogues and delivery devices. These agents have near-physiological time-action profiles that allow safer, flexible, and more convenient dosing. Many patients find using an insulin pen device easier, more convenient, and more discreet than using a vial and syringe. Nurses and medical assistants can be trained to understand the glucose-lowering capacities and limitations of each class of diabetes medications, including recognizing when insulin therapy is necessary. In addition, by showing patients how easy insulin pens are to use, clinic staff can help empower, educate, and encourage patients with type 2 diabetes to optimize their glycemic control with insulin once oral antidiabetic agents alone have become inadequate.

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