New therapeutic efforts and upcoming developments in the field of diabetes medicine and endocrinology

Abstract

I welcome the readers to the newest issue of Therapeutic Advances in Endocrinology and Metabolism. In this issue, two important therapeutic fields are addressed: In the diabetes area the pharmacologic improvement of insulin therapy and a specific cellular therapy for treating severe foot ulcers as a treatment option in complicated and therapy-resistant cases; in the field of specific endocrine and metabolic disorders, the pharmacologic treatment of the syndrome of inappropriate antidiuretic hormone (SIADH) which is also called the Schwartz-Bartter-Syndrome is extensively reviewed. It is a sobering statistic: in an online survey of 500 patients with types 1 and 2 diabetes mellitus, 57% reported intentionally omitting their insulin injections. From a patient’s perspective, avoiding hypoglycemia is a major concern and this is probably one of the main causes of non-adherence to this medication, resulting in poor glycemic control. A longer-acting basal insulin should, therefore, address this problem. The review by Ammar Wakil and Stephen Atkin in this issue looks at Degludec, a new long acting insulin with a longer half-life than others, a flat time-action profile (less likely to cause hypoglycemia) and less day-to-day variability, improving glycaemic control. Degludec is made by deleting a threonine residue from human insulin and adding an acyl side chain to a lysine residue, so that injection results in self-association and the formation of large soluble multi-hexamers – a subcutaneous depot. This promises better glycemic control compared with insulin glargine and patients have more choice as to the timing of their basal insulin dose. Lower limb amputations as a result of non-healing foot ulcers in diabetic patients are regrettable, especially because they might have been avoided with more consequent and earlier treatment of the disease. In a letter to the Editor from the group of Matthias Weck, an emerging cellular therapy using platelet-rich plasma gel is described, and seems to provide previously unavailable ulcer management options to avoid limb loss. Physicians haven’t had a specific therapy for hyponatremia until the recent arrival of vasopressin receptor antagonists, the vaptans. Peter Gross contributes to the issue with a comprehensive review focusing on SIADH, accounting for one third of hyponatremia and serving as a general model for the disease. Misdiagnosis is common, and the author discusses the importance of demonstrating reduced effective serum osmolality in a given hyponatremia to exclude the possibility of a normoosmolar or hyperosmolar hyponatremia. It must be considered that a common circumstance of hyperosmolar hyponatremia is hyperglycemia. The introduction of parenteral (conivaptan) and orally available (tolvaptan) renal V-2 vasopressin receptor antagonists – collectively called vaptans - for the specific, easily titratable treatment of SIADH has been considered a breakthrough. The author gives detailed practical expert advice on their therapeutic use.