A Review on Testosterone: Estradiol Ratio-Does It Matter, How Do You Measure It, and Can You Optimize It?

There is a natural balance between the major sex steroids, testosterone and estradiol, controlled by gonadal secretion and peripheral conversion by aromatase. This balance is impacted by a variety of inborn and acquired conditions, and, more recently, by a growing use of exogenous testosterone therapy and off-label aromatase use under the guise of "men's health." We summarize reported testosterone:estradiol ratios, both naturally occurring and with pharmacologic manipulation and consider the ramifications of significant changes in these ratios.

Glucose Trajectory: More than Changing Glucose Tolerance with Age?

While glucose tolerance is widely known to deteriorate with age, there are individuals whose borderline elevated glucose does not presage development of diabetes, but there are people who do develop overt diabetes. In addition, elevated glucose may also presage other morbidities, particularly for those who show progressive deterioration in glucose control over time. This concept of the glucose trajectory has taken on recent significance with sophisticated mathematical modeling that can identify several different arcs, primarily based on longitudinal changes in fasting plasma glucose.

Peyronie Disease as a Marker of Inflammation-Is There Hope on the Horizon?

Although the description of Peyronie disease, a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis, is attributed to François de la Peyronie, surgeon to Louis XV of France, there are reports previous to that time. Over the intervening 450 years, a variety of empiric treatments, varying in barbarity, have been proposed. The frequency of this condition and the etiology of the fibrosis are unknown.

Fatty Pancreas: An Underappreciated Intersection of the Metabolic Profile and Pancreatic Adenocarcinoma.

Although the prevalence of pancreatic cancer is increasing, treatment strategies remain limited, and success is rare. A growing body of evidence links pancreatic cancer to pre-existing metabolic disorders, including, but not limited to, type 2 diabetes mellitus and obesity. An infrequently described finding, fatty pancreas, initially described in the context of obesity in the early 20th century, appears to be at the crossroads of type 2 diabetes and obesity on the one hand, and the development of pancreatic cancer on the other.

Assessing the Continuation of Glucagon-Like Peptide-1 Receptor Agonists When Weight and HBA1C Are Not Reduced.

Glucagon-like peptide-1 agonists (GLP-1) reportedly lower HbA1c and promote weight reduction and improve cardiovascular outcomes. The primary objective of this study was to evaluate the use of GLP-1 agents in patients and changes in HbA1c, weight loss, blood pressure, and lipoid profiles. Patient information was extracted from a regional Veteran Affairs data mart.

The Lived Experience of Older Adults With Type 2 Diabetes Mellitus and Diabetes-Related Distress.

An older, more diverse population and longer lifespans are major contributors to the anticipated tripling of diabetes prevalence by 2050. Diabetes-related distress affects up to 40% of people with diabetes and may be a higher risk for older adults due to greater prevalence of comorbidities. The objective of the current phenomenological study was to describe how diabetes-related distress might be uniquely experienced by older adults (age ≥65) with type 2 diabetes mellitus (T2DM).

Symptom Experience of Older Adults With Type 2 Diabetes and Diabetes-Related Distress.

Background: An older, more diverse population and longer life spans are major contributors to the anticipated tripling of Type 2 diabetes prevalence by 2050. Diabetes-related distress affects up to 40% of people diagnosed with Type 2 diabetes and may be a greater risk for older adults due to greater prevalence of comorbidities.

Objective: The objective of this phenomenological study was to describe how diabetes-related distress in older adults (≥65 years) with Type 2 diabetes might be uniquely experienced.

Nonglycemic Effects of GLP-1 Agonists: From a Starling to Lizards to People.

With the approval of exenatide in 2005, physicians had a new class of hypoglycemic agents available for the treatment of type 2 diabetes-the glucagon-like peptide-1 receptor agonists (or GLP-1 receptor agonists). As of this writing, there are seven drugs in this class available in the United States. In addition to demonstrating either cardiovascular risk neutrality or overt benefit, as now mandated by the United States Food and Drug Administration (FDA), many of these drugs have other, unexpected actions.

Prevalence of Suspicious Ultrasound Features in Hot Thyroid Nodules.

Ultrasound for patients with hyperthyroidism and thyroid hot nodules is of limited value, given the high prevalence of suspicious findings, but may be useful for patients with high-risk factors.

The Effect of Proton Pump Inhibitors on Glycemic Control in Patients with Type 2 Diabetes.

Type 2 diabetes patients have decreased pancreatic beta cell mass with a decline in beta cell function. Gastrin has increased beta cell proliferation and in animal studies. High gastric acid levels inhibit gastrin secretion.

Adherence to and Persistence With Statin Therapy in a Veteran Population.

Background: A relative cardiovascular risk reduction of 25% to 35% has been reported in patients starting a statin for elevated cholesterol; yet many patients fail to consistently take these medications as directed.

Objective: To evaluate factors affecting adherence and persistence with statin therapy.

Methods: This retrospective study analyzed data from a Veterans Affairs database of facilities west of the Rocky Mountains.

A Perspective on Reagent Diversity and Non-covalent Binding of Reactive Carbonyl Species (RCS) and Effector Reagents in Non-enzymatic Glycation (NEG): Mechanistic Considerations and Implications for Future Research.

This perspective focuses on illustrating the underappreciated connections between reactive carbonyl species (RCS), initial binding in the nonenzymatic glycation (NEG) process, and nonenzymatic covalent protein modification (here termed NECPM). While glucose is the central species involved in NEG, recent studies indicate that the initially-bound glucose species in the NEG of human hemoglobin (HbA) and human serum albumin (HSA) are non-RCS ring-closed isomers. The ring-opened glucose, an RCS structure that reacts in the NEG process, is most likely generated from previously-bound ring-closed isomers undergoing concerted acid/base reactions while bound to protein.

Diabetes Management and Cardiovascular Risk: Are SGLT-2 Inhibitors the Safest?

For five millennia, diabetes management has focused on controlling blood sugar and efforts to minimize the complications of this disease have depended on normalizing glucose. Since the 1970's, however, a growing awareness of the adverse effect of hypoglycemic agents on cardiac health has led to an increasing focus on the effect of diabetes management on cardiac risk. This was brought into focus in the early years of this century with issues around rosiglitazone and resulted in the United States Food and Drug Administration, mandating that new drug applications for diabetes include documentation of no adverse effect on cardiac health.

Evaluating Vitamin D Repletion Regimens and Effects in Veteran Patients.

Background: There are wide variations in recommended dosing for vitamin D repletion. The identification of specific dosing thresholds to optimize repletion of 25-hydroxyvitamin D3 (also known as 25(OH)D) may help narrow the wide spectrum of vitamin D dosing.

Objective: The primary objective of this study was to evaluate vitamin D treatment regimens and their dose response effect on vitamin D serum levels.

The Novel Role of the Kidney in Diabetes Management: Sodium-Glucose Co-Transporter 2 Inhibitors.

The global epidemic of diabetes continues to progress, despite efforts of public health agencies and health care systems to identify and treat impacted patients. Although lifestyle is the cornerstone of treatment, there is an array of pharmacologic agents now available, many in classes that did not exist a few years ago. In addition to insulin and its secretogogues, such as sulfonylureas, there are agents that improve insulin action, reduce gastric emptying, reduce glucagon concentrations, and sympathetic nervous system activity.

Comparing fracture absolute risk assessment (FARA) tools: an osteoporosis clinical informatics tool to improve identification and care of men at high risk of first fracture.

Background: Fracture absolute risk assessment (FARA) is recommended for guiding osteoporosis treatment decisions in males. The best strategy for applying FARA in the clinic setting is not known.

Objectives: We compared 2 FARA tools for use with electronic health records (EHRs) to determine which would more accurately identify patients known to be high risk for fracture.

Hypothalamic-Pituitary-Adrenal Suppression and Iatrogenic Cushing's Syndrome as a Complication of Epidural Steroid Injections.

Epidural steroid injections are well accepted as a treatment for radicular back pain in appropriate candidates. While overall incidence of systemic side effects has not been well established, at least five biochemically proven cases of iatrogenic Cushing's Syndrome have been reported as complications of epidural steroid treatment. We present an additional case of iatrogenic Cushing's Syndrome and adrenal suppression in a middle-aged woman who received three epidural steroid injections over a four-month period.

Plasma testosterone is associated with Framingham risk score.

Introduction: The Framingham risk score predicts a patient's 10-year risk of developing cardiovascular disease. Many risk factors included in its calculation influence or are influenced by circulating testosterone. To investigate the possible association between testosterone and cardiovascular risk, as defined by the Framingham score, a Veterans Affairs (VA) database was analyzed.

Pharmacotherapy for the metabolic syndrome.

The Metabolic Syndrome (MetS) confers a greater risk for both diabetes and cardiovascular diseases. Both insulin resistance and low grade inflammation appear to be pivotal in the pathogenesis of this disorder. The cornerstone of treatment presently is therapeutic lifestyle change with the emphasis on weight loss by diet and exercise.

Docosahexaenoic acid supplementation improved lipocentric but not glucocentric markers of insulin sensitivity in hypertriglyceridemic men.

Background: Increase in obesity and metabolic syndrome are associated with increases in insulin resistance (IR) and type 2 diabetes mellitus. Results from animal intervention studies and human epidemiological studies suggest that n-3 polyunsaturated fatty acids can prevent and reverse IR, but results from human intervention studies have varied. Results from some human and animal studies suggest that docosahexaenoic acid (22:6n-3; DHA) may be more effective than eicosapentaenoic acid (20:5n-3; EPA) in the prevention of IR.

Long-term maintenance of glucose control in veterans with type 2 diabetes mellitus using oral agents.

Purpose Of Study: The aim of this study was to evaluate long-term glycemic control in individuals with type 2 diabetes mellitus on oral hypoglycemic agents.

Methods: We identified the cohort of veterans prescribed hypoglycemic agents every year from July, 1992, through June, 2007 (n=191). Glycosylated hemoglobin (HbA1c) was used to assess glycemic control.