Physical Activity in Youth With Type 1 Diabetes: a Review

Youth with type 1 diabetes are at risk for developing cardiovascular disease, and regular physical activity is strongly recommended as one strategy for prevention, as well as for good glycemic control. Despite recommendations, families in this pediatric population face unique barriers to physical activity, including fear of hypoglycemia. Moreover, families are not routinely counseled in the specific health and psychosocial benefits of following physical activity recommendations for youth with type 1 diabetes. To bridge this gap, the recent literature regarding physical activity in children with type 1 diabetes is reviewed with particular focus on young children. A discussion of the limitations of the current body of research, and recommendations for objectively measured physical activity are provided. Specific recommendations for clinical practice are given, including provider endorsements for regular physical activity for longer than 60 minutes, at least three times a week.     

Evaluation of Sarcopenia by DXA

There are four body composition phenotypes widely used to describe older adults: normal, sarcopenic, obese, and sarcopenic obese. In this paper, we will discuss how DXA can be used to quantify body composition and how DXA can identify patients with sarcopenia and sarcopenic obesity.     

Clinical Application of Spine Trabecular Bone Score (TBS)

Trabecular bone score (TBS) is a software program recently approved by the US Food and Drug Administration for post-acquisition processing of lumbar spine dual-energy X-ray absorptiometry images that allows assessment of bone texture as a surrogate for bone microarchitecture. Low TBS values are associated with increased risk of major osteoporotic fracture risk in postmenopausal women and men aged 40 years and older independent of BMD. TBS data can be used to adjust FRAX probability of fracture. As such, TBS data can be useful in osteoporosis treatment initiation decisions. Following treatment initiation, TBS increases are smaller than seen with BMD; at present, there is insufficient evidence that TBS can be used to monitor treatment. TBS may be particularly helpful in fracture risk prediction for those with diabetes mellitus or receiving glucocorticoid therapy, but additional validation of existing observations is needed. In summary, TBS should not be used alone to guide treatment initiation, but can be used with FRAX to estimate fracture probability in postmenopausal women and older men, thereby facilitating treatment initiation decisions.     

Future Therapy for Hepatitis B Virus and Hepatitis D Virus

Chronic delta hepatitis (CDH) represents the least encountered but the most severe form of chronic viral hepatitis. Whereas in other forms of chronic viral hepatitis breakthrough advances has occurred in the last two decades, this did not happen in CDH. The only effective treatment in CDH consists of the use of pegylated interferons. Interferon therapy has to be given at high doses, and the optimal duration is unknown although there is data to suggest that treatment has to be individualized and prolonged treatment duration beyond 1 year is necessary. Effective treatment of chronic hepatitis B (CHB) could be of value in CDH as long as it significantly decreases hepatitis B surface antigen (HBsAg) levels. However, nucleos(t)ide analogs currently in use for the treatment of CHB do not affect HBsAg levels and are not beneficial in CDH. New treatment approaches for CHB aiming for functional or complete cure in CHB are attractive but most are in the preclinical stage of drug development and are not expected to be in use in the very near future. Hence, treatment development targeting different steps of the hepatitis delta virus is rationale. These include hepatocyte entry inhibitors, nucleic acid polymers, and prenylation inhibitors. The former two approaches may also be considered for CHB mono-infection. Studies on these three approaches have reached phase 2 studies in humans. The use of the hepatocyte entry inhibitor myrcludex B, several nucleic acid polymers, and the prenylation inhibitor lonafarnib in clinical trials have displayed some promising results and further data need to be generated but there is now, after decades of silence in terms of translational activity, for the first time a hope for effective new treatments in CDH.     

Is Transforming Stem Cells to Pancreatic Beta Cells Still the Holy Grail for Type 2 Diabetes?

Diabetes is a progressive disease affecting millions of people worldwide. There are several medications and treatment options to improve the life quality of people with diabetes. One of the strategies for the treatment of diabetes could be the use of human pluripotent stem cells or induced pluripotent stem cells. The recent advances in differentiation of stem cells into insulin-secreting beta-like cells in vitro make the transplantation of the stem cell-derived beta-like cells an attractive approach for treatment of type 1 and type 2 diabetes. While stem cell-derived beta-like cells provide an unlimited cell source for beta cell replacement therapies, these cells can also be used as a platform for drug screening or modeling diseases.     

Extrahepatic Manifestations of Chronic Hepatitis C Infection: a Review and Update

Hepatitis C virus (HCV) has become an increasingly concerning global disease. While it is well known to causes a chronic hepatitis that can be largely asymptomatic until the development of cirrhosis and/or hepatocellular carcinoma (HCC), chronic HCV can also lead to extrahepatic manifestations (EHMs) which can contribute to further morbidity and mortality. This chapter will discuss the pathophysiology and data supporting the causal relationship between chronic HCV infection and its EHMs as well as address the influence of HCV treatment on these disorders, particularly in the age of direct-acting antiviral agents.     

Impact of Systemic Inflammation on the Progression of Gestational Diabetes Mellitus

With increasing rates of obesity and new diagnostic criteria for gestational diabetes mellitus (GDM), the overall prevalence of GDM is increasing worldwide. Women with GDM have an increased risk of maternal and fetal complications during pregnancy as well as long-term risks including higher prevalence of type 2 diabetes mellitus and cardiovascular disease. In recent years, the role of immune activation and inflammation in the pathogenesis of GDM has gained increasing attention. This monograph explores the current state of the literature as regards the expression of markers of inflammation in the maternal circulation, placenta, and adipose tissue of women with GDM.     

What Does Diabetes “Taste” Like?

The T1R2 (taste type 1 receptor, member 2)/T1R3 (taste type 1 receptor, member 3) sweet taste receptor is expressed in taste buds on the tongue, where it allows the detection of energy-rich carbohydrates of food. This single receptor responds to all compounds perceived as sweet by humans, including natural sugars and natural and artificial sweeteners. Importantly, the T1R2/T1R3 sweet taste receptor is also expressed in extra-oral tissues, including the stomach, pancreas, gut, liver, and brain. Although its physiological role remains to be established in numerous organs, T1R2/T1R3 is suspected to be involved in the regulation of metabolic processes, such as sugar sensing, glucose homeostasis, and satiety hormone release. In this review, the physiological role of the sweet taste receptor in taste perception and metabolic regulation is discussed by focusing on dysfunctions leading to diabetes. Current knowledge of T1R2/T1R3 inhibitors making this receptor a promising therapeutic target for the treatment of type 2 diabetes is also summarized and discussed.     

Caring for People with Diabetes at the End of Life

End-of-life care planning is assuming global significance. While general end-of-life care guidelines apply to diabetes, there are some diabetes-specific issues that need to be considered. These include the usual long trajectory to end-of-life care that enables clinicians and people with diabetes to proactively discuss when to change the focus of care from preventing diabetes complications (tight control) to a palliative approach. Palliative care aims to promote comfort and quality of life and reduce the unnecessary burden of care on individuals and their families. The aim of this paper is to discuss common disease trajectories and their relationship to diabetes care, outline strategies for proactively discussing these issues and suggest indications that palliative care is warranted.     

Systemic and organ involvement in monogenic autoinflammatory disorders: a global review filtered through internists’ lens

Monogenic autoinflammatory disorders (AIDs) are rare diseases driven by cytokine-mediated extraordinary sterile inflammation that results from the activation of innate immune pathways. The clinical hallmark of these diseases is the recurrence of stereotyped episodes of systemic- and organ-specific inflammation; the most common systems involved being the skin, musculoskeletal system, gastrointestinal tract, and central nervous system. The autoinflammatory disorders may have a profound impact on the quality of life of the affected patients, and a delayed diagnosis may lead to severe complications, the most dreadful of which is AA-Amyloidosis. This review gives an overview on the four main AIDs, namely familial Mediterranean fever, tumor necrosis factor receptor-associated periodic syndrome, cryopyrinopathies, and mevalonate kinase deficiency, focusing on their clinical phenotype in adults and differential diagnosis, suggesting a diagnostic algorithm, and reviewing the available treatments.