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Breaking and restoring immune tolerance to pancreatic beta-cells in type 1 diabetes
Purpose of review Type 1 diabetes (T1D) results from the loss of immune tolerance to pancreatic beta-cells leading to their destruction. Immune intervention therapies tested in T1D so far delayed progression but failed to restore tolerance, which partly explains their lack of durable clinical efficacy. Recent findings The role of beta-cells and islets themselves in dialogue with their micro- and macro-environment including the immune system and the intestinal microbiome is increasingly evident. Indeed, islets can both maintain and break immune tolerance. Some recent immune therapies in cancer that block immune r...
Source: Current Opinion in Endocrinology, Diabetes and Obesity - July 15, 2021 Category: Endocrinology Tags: DIABETES AND ENDOCRINE PANCREAS II: Edited by Peter Gottlieb Source Type: research

Insulin immunotherapy for pretype 1 diabetes
Purpose of review Loss of tolerance to insulin likely contributes to the immunopathogenesis of type 1 diabetes (T1D). Several large clinical trials and smaller mechanistic studies have failed to demonstrate the efficacy of insulin antigen therapy. The growing awareness of the heterogeneity of T1D likely affects the response to various immune therapies including insulin. Identification of biomarkers of clinical response will provide further insight into mechanisms leading to the disease and classify responders in the quest for personalized therapy. Recent findings Several biomarkers have identified subpopulations...
Source: Current Opinion in Endocrinology, Diabetes and Obesity - July 15, 2021 Category: Endocrinology Tags: DIABETES AND ENDOCRINE PANCREAS II: Edited by Peter Gottlieb Source Type: research

Bone health in diabetes: Indian perspective
Purpose of review Despite estimated 77 million people having diabetes, bone health in Asian Indians with diabetes is largely unknown. This review summarizes the published literature on fracture risk and factors affecting it in Asian Indians with diabetes. Recent findings Data on fracture prevalence in diabetes is limited; one study showed that diabetes was associated with a significantly higher number of fractures compared with subjects without diabetes (4% vs. 2.4%, P  (Source: Current Opinion in Endocrinology, Diabetes and Obesity)
Source: Current Opinion in Endocrinology, Diabetes and Obesity - July 15, 2021 Category: Endocrinology Tags: PARATHYROIDS, BONE AND MINERAL METABOLISM: Edited by Viral N. Shah Source Type: research

Treatment of bone fragility in patients with diabetes: antiresorptive versus anabolic?
Purpose of review The pathogenesis of bone fragility in diabetes has not been fully characterized. The antifracture efficacy of available therapies remains unproven in patients with diabetes. We aim to collate current evidence of the treatment of diabetic bone fragility, and to provide a rationale for considering optimal therapeutic option in patients with diabetes. Recent findings The antifracture efficacy of antiresorptive and anabolic therapies is well established in patients without diabetes. Studies in patients with osteoporosis have shown that anabolic therapies lead to faster and larger benefits to bone m...
Source: Current Opinion in Endocrinology, Diabetes and Obesity - July 15, 2021 Category: Endocrinology Tags: PARATHYROIDS, BONE AND MINERAL METABOLISM: Edited by Viral N. Shah Source Type: research

Future studies using histomorphometry in type 1 diabetes mellitus
This article reviews the current state of research in type 1 diabetes and bone, focusing on human bone turnover markers and histomorphometry. Recent findings Bone turnover markers have been used for decades to document static bone turnover status in a variety of diseases but especially in diabetes. Two new studies focus on dynamic testing conditions to examine the acute effects of insulin and exercise on bone turnover. Publications of human bone histomorphometry in type 1 diabetes are few but there are several new studies currently underway. Summary Here, we review the most recent literature on human bone tur...
Source: Current Opinion in Endocrinology, Diabetes and Obesity - July 15, 2021 Category: Endocrinology Tags: PARATHYROIDS, BONE AND MINERAL METABOLISM: Edited by Viral N. Shah Source Type: research

Advanced glycation endproducts and bone quality: practical implications for people with type 2 diabetes
Purpose of review Individuals with type 2 diabetes (T2D) are at increased risk of fracture, often despite normal bone density. This observation suggests deficits in bone quality in the setting of abnormal glucose homeostasis. The goal of this article is to review recent developments in our understanding of how advanced glycation end products (AGEs) are incorporated into the skeleton with resultant deleterious effects on bone health and structural integrity in patients with T2D. Recent findings The adverse effects of skeletal AGE accumulation on bone remodeling and the ability of the bone to deform and absorb ene...
Source: Current Opinion in Endocrinology, Diabetes and Obesity - July 15, 2021 Category: Endocrinology Tags: PARATHYROIDS, BONE AND MINERAL METABOLISM: Edited by Viral N. Shah Source Type: research

Are diabetes microvascular complications risk factors for fragility fracture?
We describe relationships between microvascular complications and bone fragility fracture in the context of diabetes. We highlight gaps in knowledge and suggest areas of further study. Recent findings Evidence in type 1 diabetes (T1D) demonstrates that low bone mineral density (BMD) is associated with microvascular complications and linked to increased fracture risk. Of note, the low BMD does not solely explain bone fragility. Microvascular disease also has been linked to compromised bone microarchitecture and poorer bone quality. Moreover, microvascular complications may indirectly increase the rate of fragility fr...
Source: Current Opinion in Endocrinology, Diabetes and Obesity - July 15, 2021 Category: Endocrinology Tags: PARATHYROIDS, BONE AND MINERAL METABOLISM: Edited by Viral N. Shah Source Type: research

Sleep disruptions and bone health: what do we know so far?
Purpose of review This review briefly summarizes the growing body of literature addressing the skeletal consequences of sleep and circadian disruption. Recent findings The most recent data in the field suggest that the diurnal variation in bone turnover markers are because of endogenous circadian rhythmicity linked to clock genes in all bone cells; in a small human intervention study, cumulative sleep restriction with concurrent circadian disruption negatively alter bone turnover markers in a way that could explain the lower BMD and increased fracture risk identified in some prior night shift work studies; abnor...
Source: Current Opinion in Endocrinology, Diabetes and Obesity - July 15, 2021 Category: Endocrinology Tags: PARATHYROIDS, BONE AND MINERAL METABOLISM: Edited by Viral N. Shah Source Type: research

Bone accrual in children and adolescents with type 1 diabetes: current knowledge and future directions
Purpose of review Skeletal fragility is now recognized as a significant complication of type 1 diabetes (T1D). Many patients with T1D develop the disease in childhood and prior to the attainment of peak bone mass and strength. This manuscript will review recent studies investigating the effects of T1D on skeletal development. Recent findings Mild-to-moderate deficits in bone density, structure, and mineral accrual were reported early in the course of T1D in some but not all studies. Childhood-onset disease was associated with a more severe skeletal phenotype in some adult studies. Lower than expected bone mass f...
Source: Current Opinion in Endocrinology, Diabetes and Obesity - July 15, 2021 Category: Endocrinology Tags: PARATHYROIDS, BONE AND MINERAL METABOLISM: Edited by Viral N. Shah Source Type: research

Editorial: Bone health in type 1 and type 2 diabetes: current knowledge and future direction
No abstract available (Source: Current Opinion in Endocrinology, Diabetes and Obesity)
Source: Current Opinion in Endocrinology, Diabetes and Obesity - July 15, 2021 Category: Endocrinology Tags: PARATHYROIDS, BONE AND MINERAL METABOLISM: Edited by Viral N. Shah Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Endocrinology, Diabetes and Obesity)
Source: Current Opinion in Endocrinology, Diabetes and Obesity - July 15, 2021 Category: Endocrinology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Thromboembolic disease in hypercortisolism
Purpose of review Endogenous Cushing's syndrome (CS) is associated with increased patient morbidity (hypertension, diabetes mellitus, dyslipidemia, visceral obesity, osteoporosis, cognitive alterations, and impaired quality of life). Both arterial and venous thromboembolic events (TE) due to alterations in the hemostatic system and prothrombotic state are widely reported in patients with CS, more so postoperatively. Increased mortality, if not appropriately treated, is largely due to cardiovascular events and infections. Recent findings Patients with CS have markedly increased risk of thromboembolic episodes com...
Source: Current Opinion in Endocrinology, Diabetes and Obesity - April 30, 2021 Category: Endocrinology Tags: ADRENAL CORTEX AND MEDULLA: Edited by Irina Bancos and Diane Donegan Source Type: research

Psychological complications of Cushing's syndrome
Purpose of review The aim of this article is to review and discuss recent evidence of psychological complications in Cushing's syndrome. Recent findings Recent research has described the presence of depression, anxiety, posttraumatic stress disorder, mania, bipolar disorder and psychotic symptoms in patients with Cushing's syndrome. Furthermore, the perspective of patients’ partners has also been emphasized. Summary Recent literature highlights the importance of screening for psychological alterations in Cushing's syndrome, as these alterations can be present in many patients, having a high impact in da...
Source: Current Opinion in Endocrinology, Diabetes and Obesity - April 30, 2021 Category: Endocrinology Tags: ADRENAL CORTEX AND MEDULLA: Edited by Irina Bancos and Diane Donegan Source Type: research

Clinical outcomes in 21-hydroxylase deficiency
Purpose of review The introduction of synthetic glucocorticoids 70 years ago made survival possible in classic 21-hydroxylase deficiency (21OHD). The currently used glucocorticoid therapy may lead to unphysiological dosing with negative consequencies on health in addition to the problems that may arise due to androgen over-exposure. Recent findings Fertility in females with 21OHD seemed to be impaired, especially in the salt-wasting (SW) phenotype but when pregnancies did occur there was a higher risk for gestational diabetes and cesearean section. Increased fat mass, body mass index, insulin resistance and fr...
Source: Current Opinion in Endocrinology, Diabetes and Obesity - April 30, 2021 Category: Endocrinology Tags: ADRENAL CORTEX AND MEDULLA: Edited by Irina Bancos and Diane Donegan Source Type: research

Chronic kidney disease in adrenal disorders
Purpose of review This review will focus on hypertension due to underlying adrenal disorders in chronic kidney disease (CKD). Diagnosis of adrenal hypertension and particularly primary aldosteronism (PA) in CKD is frequently not pursued. We outline limitations that advanced kidney disease poses on the diagnostic work up of these disorders and provide a framework for approaching CKD patients suspected of having an adrenal disorder. Recognition of these disorders is important as they are often underdiagnosed which leads to poorer outcomes. Recent findings Adrenal disease associated with hypertension in CKD is most...
Source: Current Opinion in Endocrinology, Diabetes and Obesity - April 30, 2021 Category: Endocrinology Tags: ADRENAL CORTEX AND MEDULLA: Edited by Irina Bancos and Diane Donegan Source Type: research