Approach to the Patient using Diabetes Technology in Pregnancy.

Diabetes in pregnancy increases risk for complications for the pregnant patient and neonate. Tight glycemic control to maintain glucose levels as close to non-diabetic ranges as possible can lower risk for these complications. Achieving strict glycemic targets can be challenging and technologies including continuous glucose monitors (CGM) and hybrid closed loop (HCL) insulin pumps have the potential to improve diabetes control and pregnancy outcomes.

Bone Structural Parameters as Measured by 3-Dimensional Dual-Energy X-Ray Absorptiometry Are Superior in Black Women and Demonstrate Unique Associations With Prior Fracture Versus White Women.

Objective: Black patients fracture less often than White patients at any given bone mineral density (BMD). This may be related to superior bone structure; however, bone structure is challenging to measure in clinical practice. Advances in 3-dimensional (3D) modeling have allowed for the measurement of trabecular and cortical parameters from dual-energy x-ray absorptiometry (DXA).

An Update on the Fracture Risk Assessment Tool: What Have We Learned over 15+ years?

The Fracture Risk Assessment Tool (FRAX) was launched in 2008 and uses clinical variables to estimate 10-year fracture risk. FRAX has been incorporated into clinical treatment guidelines and is well validated in specific disease states like chronic kidney disease. However, there are risk factors which are not captured by FRAX such as diabetes and falls.

Subjective wellbeing in people living with dementia: exploring processes of multiple object handling sessions in a museum setting.

Dementia care guidance highlights the importance of supporting people living with dementia to access engaging and meaningful activities to promote their quality of life. There is a growing evidence base for the efficacy of heritage settings and arts-based interventions to provide social prescribing opportunities to help support wellbeing in this population. This study extended previous research and explored the potential processes underlying this effect in multiple small group object handling sessions in a museum setting.

Denosumab Discontinuation in Patients Treated for Low Bone Density and Osteoporosis.

Denosumab (DMAB) is a potent antiresorptive treatment used for treatment of osteoporosis and low bone mineral density (BMD) in those at high risk for fracture. In postmenopausal women with osteoporosis, DMAB treatment for 10 years has been studied, with results showing continued gains in BMD, sustained fracture risk reduction, and low risk of adverse events. However, upon discontinuation of DMAB, there is a rapid reversal of effect, with increase in bone turnover, loss of BMD, and in a subset of patients, a greater risk for multiple vertebral fractures.

Updates in Gestational Diabetes Prevalence, Treatment, and Health Policy.

Purpose Of Review: Gestational diabetes (GDM) is associated with adverse pregnancy and neonatal outcomes and increased maternal risk for subsequent type 2 diabetes. The best diagnostic strategy for GDM is debated and the role of oral antidiabetic medications (OAD) for treatment is unclear. In this paper, we review methods of GDM diagnosis, updates in GDM therapy, and interventions to reduce future type 2 diabetes in women with a history of GDM.

Management and pregnancy outcomes of women with GCK-MODY enrolled in the US Monogenic Diabetes Registry.

Aims: GCK-MODY is characterized by mild hyperglycemia. Treatment is not required outside of pregnancy. During pregnancy, insulin treatment is recommended if second trimester fetal ultrasound monitoring shows macrosomia, suggesting the fetus has not inherited the GCK gene.

Clinical Management of Women with Monogenic Diabetes During Pregnancy.

Purpose Of Review: Monogenic diabetes accounts for 1-2% of all diabetes cases, but is frequently misdiagnosed as type 1, type 2, or gestational diabetes. Accurate genetic diagnosis directs management, such as no pharmacologic treatment for GCK-MODY, low-dose sulfonylureas for HNF1A-MODY and HNF4A-MODY, and high-dose sulfonylureas for K channel-related diabetes. While diabetes treatment is defined for the most common causes of monogenic diabetes, pregnancy poses a challenge to management.

A death effector domain chain DISC model reveals a crucial role for caspase-8 chain assembly in mediating apoptotic cell death.

Formation of the death-inducing signaling complex (DISC) is a critical step in death receptor-mediated apoptosis, yet the mechanisms underlying assembly of this key multiprotein complex remain unclear. Using quantitative mass spectrometry, we have delineated the stoichiometry of the native TRAIL DISC. While current models suggest that core DISC components are present at a ratio of 1:1, our data indicate that FADD is substoichiometric relative to TRAIL-Rs or DED-only proteins; strikingly, there is up to 9-fold more caspase-8 than FADD in the DISC.

The 'complexities' of life and death: death receptor signalling platforms.

Cell death is critical to the normal functioning of multi-cellular organisms, playing a central role in development, immunity, inflammation, and cancer progression. Two cell death mechanisms, apoptosis and necroptosis, are dependent on the formation of distinct multi-protein complexes including the DISC, Apoptosome, Piddosome and Necrosome following the induction of cell death by specific stimuli. The role of several of these key multi-protein signalling platforms, namely the DISC, TNFR1 complex I/II, the Necrosome and Ripoptosome, in mediating these pathways will be discussed, as well as the open questions and potential therapeutic benefits of understanding their underlying mechanisms.