Review: Developing therapies for the metabolic syndrome: challenges, opportunities, and. . . the unknown

Metabolic syndrome refers to a clustering of established and emerging cardiovascular disease risk factors within a single individual. The established risk factors, such as obesity, diabetes, dyslipidaemia and hypertension, and other emerging risk factors are closely related to central obesity (especially intra-abdominal adiposity) and insulin resistance. However, debate continues about the very existence of the metabolic syndrome. Despite the controversies, many existing and new therapies are targeting the metabolic syndrome and component risk factors. To date, no therapies have been approved specifically for treating the metabolic syndrome. In this article some of the challenges and opportunities in developing therapies for the metabolic syndrome are discussed

Endocrine and metabolic emergencies: hypocalcaemia

Hypocalcaemia is a common electrolyte disturbance, especially in the inpatient setting. There are a wide variety of causes of hypocalcaemia and correct management depends on the underlying diagnosis. However, acute hypocalcaemia is associated with significant morbidity and mortality and should be managed as a medical emergency. Chronic care of the hypocalcaemic patient is also briefly described, as this is an important opportunity to reduce further admissions related to both hypocalcaemic and hypercalcaemic presentations

Review: Endocrine and metabolic emergencies: thyroid storm

Thyrotoxicosis is a common endocrine condition that may be secondary to a number of underlying processes. Thyroid storm (also known as thyroid or thyrotoxic crisis) represents the severe end of the spectrum of thyrotoxicosis and is characterized by compromised organ function. Whilst rare in the modern era, the mortality rate remains high, and prompt consideration of this endocrine emergency, with specific treatments, can improve outcomes

Review: Endocrine and metabolic emergencies: hypercalcaemia

Hypercalcaemia is commonly seen in the context of parathyroid dysfunction and malignancy and, when severe, can precipitate life-threatening sequelae. The differential of hypercalcaemia is broad and can be categorized based on parathyroid hormone (PTH) levels. The acute management of severe hypercalcaemia is discussed along with a brief review of therapeutic advances in the field

Advances in the treatment of prediabetes

Type 2 diabetes mellitus (T2DM) is epidemic in most developed and many developing countries. Owing to the associated morbidity, mortality and high costs of care, T2DM is an important global public health challenge and target for prevention. Patients at high risk for T2DM (referred to as having prediabetes) can be easily identified based on fasting glucose levels or responses to an oral glucose tolerance test (OGTT). More recently, glycosylated hemoglobin (i.e. HbA1c, which is also termed A1C in the US) has also been introduced as a diagnostic tool for both prediabetes and diabetes. Such patients are also at risk for cardiovascular disease (CVD). Since obesity and physical inactivity are important risk factors for T2DM, lifestyle interventions, emphasizing modest weight loss and increases in physical activity, should be recommended for most patients with prediabetes. Such interventions are safe and effective and also reduce risk factors for CVD. A number of oral antidiabetic agents have been shown to be effective at delaying onset of T2DM in patients with prediabetes. Thiazolidinediones (TZDs) are the most effective, reducing incident diabetes by up to 80%. Metformin, acarbose and orlistat also reduce incident diabetes, but their efficacy is much lower than the TZDs. Pharmacologic interventions may be appropriate for patients at particular risk for developing diabetes, but the benefits of treatment need to be balanced against the safety and tolerability of the intervention. If pharmacologic treatment is warranted, metformin should be considered first because of its favorable overall safety, tolerability, efficacy and cost profile