The electronic medical dictionary of the French National Academy of Medicine is available in open access on the internet, comprising approximately 60,000 definitions. An established editorial board meets twice a month in order to standardize and approve the modifications to the entries. The dictionary is accessed by at least 65,000 visits per month by people from over 120 countries.
The role of sugars, in particular in the form of soft drinks, in the development of obesity and its metabolic and cardiovascular comorbidities is increasingly recognized. The mechanisms involved are probably multiple, but the energy content, the glycemic load and the liquid consistence play probably a more important role than the fructose content. The present recommendations encourage to limit the amount of added or free sugars to 10% maybe 5% of the daily energy intake. The replacement of sugars with sweeteners may be helpful. On a broader scale, education to a less intensely sweet taste is paramount.
In diabetic patients, lipid-lowering drug therapy is almost always necessary, even when the lipid profile is seemingly unremarkable. This treatment is primarily aimed at reaching the target LDL cholesterol level (<70 mg/dL or <100 mg/dL, depending on prior cardiac or renal diseases, age, or concomitant risk factors) by prescribing a statin, with or without ezetimibe. Thereafter, adding a fibrate or including omega-3 fatty acid supplementation should be considered in patients whose triglyceride levels remain high, so as to target non-HDL cholesterol (<100 mg/dL or <130 mg/dL, depending on age or concomitant risk factors).
The assessment of the "diabetic health" of an individual includes: (i) contemporary and secular values of HbA1c; (ii) occurrence of hypoglycemia; (iii) time spent in the glucose target range; (iv) history of ketoacidosis; (v) history of severe hypoglycemia; (vi) presence or risk of incident micro/macrovascular complications; (vii) associated cardiometabolic comorbidities; (viii) psychological issues (anxiety/depression); and (ix) occupational issues.
Obesity and Type 2 diabetes are both associated with low-grade inflammation. Among the possible pathomechanisms, their link to intestinal bacteria is becoming increasingly convincing. Evidence suggests that gut microbiota plays a key role in triggering inflammation and insulin resistance through various mechanisms, such as the translocation of bacteria or bacterial components that induces metabolic endotoxemia. Certain intestinal bacteria may also be either deleterious or beneficial to glucose homeostasis. Among these, the specific role of Akkermansia muciniphila is currently being investigated.
This article aims to discuss the diagnostic approach to increased serum parathyroid hormone (PTH) levels in normocalcemic, normophosphatemic patients. This biological disorder is commonly detected in routine practice, especially given that the established PTH reference values used by clinical laboratories refer to subjects with adequate vitamin D levels and a normal renal function. The first diagnostic step consists in ruling out a cause of secondary hyperparathyroidism (SHPT). Among these, the most frequent include vitamin D deficiency, very low calcium intake, impaired renal function, malabsorption, drugs interfering with calcium/bone metabolism (e.g., lithium salts and antiresorptive therapies for osteoporosis), and renal leak hypercalciuria. If no cause of SHPT is found, the diagnosis of normocalcemic primary hyperparathyroidism (PHPT) should be considered. A calcium load test is a very useful tool for diagnosing this condition, which is characterized by a serum PTH being not sufficiently decreased while calcemia rises frankly above the upper normal limit. In normocalcemic patients with hypercalciuria and high serum PTH levels, a thiazide challenge test may help differentiate SHPT due to a renal calcium leak from normocalcemic PHPT. In addition to these diagnostic considerations, the article also discusses the advantages and difficulties of measuring and interpreting ionized calcemia and 24-hour calciuria.
The new published guidelines on the management of the thyroid nodule have greatly improved the management of the disorder. Despite current guidelines, thyroid nodule management remains controversial and varies in different continents and countries. A difference between USA and Europe is in the iodine status and explains why the thyroid scintigraphy is more often prescribed in Europe than in USA. New recommendations are often applied in function of the easy access to complementary exams, the performance of other physicians, their personal experience and their medical habits. It is the reason why the guidelines are not always strictly followed.
Ultrasound plays a key role in the management of thyroid nodules, from diagnosis to follow-up. The Thyroid Imaging Reporting And Data System (TI-RADS) classification is a standardized system for analyzing and reporting thyroid ultrasound data in order to improve nodule management. This 6-grades score is based on ultrasound criteria (shape, contour, aspect, and structure) and aimed at categorizing and depicting carcinomas in a simple and reproducible way. Based on operator-dependent ultrasound examination, the TI-RADS classification has both strengths and limitations.
Cytology plays a key role in the management of thyroid nodules. This technique may prove to be a valuable diagnostic tool for differentiating benign lesions from malignant ones, enabling us to better select those nodules that warrant surgery. The middle cytology liquid allows us to complete this process by adding immunocytochemical or molecular biology tests, as necessary. In the event of nodules presenting atypia of undetermined significance, recent studies have revealed that genome sequencing for detecting BRAF or RAS mutations may permit to assess the risk for malignancy of these thyroid nodules. It should yet be mentioned that only a close collaboration with the clinicians in charge of the patient, in addition to a sound correlation with clinical-radiological data, allows the cytological thyroid examination to prove well-performing.
GLP-1 analogs are nowadays a validated treatment in type 2 diabetes, due to both their glycemic and extraglycemic effects. Dulaglutide (Truliciy®) is a new long-acting analog. Treatment pattern is characterized by once-weekly injection of 1.5 (or 0.75) mg. The aim of this article is to review recent results of the AWARD program and to discuss the position of this new agent in a modern therapeutic approach of type 2 diabetes.