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Scientific highlights: Advances and challenges in the management of diabetes and thyroid disorders

Scientific highlights: Advances and challenges in the management of diabetes and thyroid disorders
  • Endocrinology and metabolism
  • Thyroid disorder

Resource type

Publication

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Advances and challenges in the management of diabetes and thyroid disorders (Sao Paulo Brazil 2014)
CVD risk factors
cardiovascular risk factors
Nephropathy
Diabetes management
Thyroid disorder management
Latin America
Iodine deficiency Adherence in diabetes
Graves' disease
thyroid cancer
Managing hypothyroidism
hypothyroidism
MNG
Multinodular goitre
subclinical hypothyroidism
TSH
Managing thyroid disorders

Scientific highlights from Advances and challenges in the management of diabetes and thyroid disorders, 10-11 October 2014 - Sao Paulo, Brazil

Nephropathy – a major cause of morbidity and mortality

‘Diabetic nephropathy is still a major cause of morbidity and mortality today,’ said Luis Henrique Canani (Brazil), who told participants that there has been a steep rise in new cases of dialysis due to diabetes over the last 30 years, especially in developing countries.

Controlling CVD risk factors in diabetes

‘Prevention is better than cure when it comes to cardiovascular disease in type 2 diabetes mellitus (T2DM),’ was the message from Sergio A. Dib (Brazil), who focused on both traditional and non-traditional risk factors for cardiovascular disease (CVD) in the settings of T2DM or T1DM. Diabetes and cardiovascular diseases share common pathways of inflammation and oxidative stress and, in addition to hyperglycemia, several factors in diabetes can accelerate atherosclerosis, such as hyperinsulinemia and insulin resistance, dyslipidemia, endothelial dysfunction, hypertension, nephropathy and neuropathy.

He showed how coronary heart disease has become the main cause of death in T1DM, with women having a 10 to 30 fold risk and men 4 to 10 fold compared with the general population.2 Diabetes increases the mortality for CVD by each point of increment of HbA1c, and this seems worse for patients with T2DM at young onset than for T1DM patients. Further, the composition of the atherosclerotic plaque appears to be different and more dangerous in diabetes than in non-diabetic patients, so increasing the risk of CVD events. ‘Screening for cerebral and coronary artery disease should be regularly performed when risk factors exist, and the use of provocative tests or cardiac invasive procedures is justified in these circumstances, said Dib. ‘The good news is that intensive treatment to maintain good glycaemic control can reduce many of these risks,’ he said, ‘particularly if intervention is started early in the natural history of the disease.’

Adherence

Adherence to therapy in diabetes is a challenge for health care givers, reducing the outcomes of their interventions and increasing the incidence of comorbidities and complications of the disease. Mónica Manrique (Chile) explored ways to improve adherence among patients with T2DM. She reviewed the causes of non-adherence to treatment (Figure 3) and then went on to look at new tools that are available to assist with care for patients with diabetes, such as the use of fixed-dose combination pills or the use of technological devices for monitoring therapy and glucose levels, including new mobile applications. ‘Patients with chronic illnesses and their families need to have a better understanding of various aspects of their condition,’ she explained, particularly symptoms, potential outcomes, the emotional impact of the condition, complex therapeutic schemes, difficulties adjusting their lifestyles, and how to obtain medical information.

Encouraging patient self-care through counselling and coaching can give them the answers they need about their disease and make them take responsibility for it, increasing their self-confidence and daily life. This approach should also improve communication between doctors and patients and help resolve problems, including psychological issues.

From iodine deficit to thyroid autoimmune diseases

Consequences of iodine deficiency in Latin America today were explored in sessions throughout the meeting, covering Graves’ disease, thyroid cancer, and guidelines for managing hypothyroidism.

Treating multinodular goiter

Multinodular goitre (MNG) is a very common problem, especially in the adult-elderly population and in iodine-deficiency areas of the world. Eduardo A. Pretell (Peru) explained how, until as recently as the 1960s, endemic goitre was synonymous with iodine deficiency. What begins as a diffuse goitre can develop into MNG, including toxic nodular goitre and thyroid cancer (Figure 4). Hans Graf (Brazil) explained that, apart from local symptoms caused by the nodules, possible hormonal dysfunction, and aesthetic discomfort, the most important aspect of MNG is to be able to determine when the nodules pose a real risk of thyroid cancer. The risk of malignancy is in the region of 6.3%.4

Managing subclinical hypothyroidism – what the guidelines tell us

In a session on managing hypothyroidism, Mario Vaisman (Brazil) reviewed local and international guidelines. He began by asking, ‘What is a normal TSH measurement?’ and explored the variations and distributions across the population, in which the prevalence of hypothyroidism is estimated at 4‑8% and is mostly caused by chronic autoimmune thyroiditis, particularly in younger people and in women. However, subclinical forms, with elevated TSH but normal free thyroid hormones, are equally frequent, and the distribution is skewed in certain populations, particularly the elderly

Diagnosing hypothyroidism is easy with laboratory testing,’ M. Vaisman told participants, while emphasising the importance of considering specific reference values of TSH to establish a correct diagnosis, since normal levels increase with age and decrease during pregnancy. Screening is also necessary in newborns to avoid problems in the future, and ideally also during pregnancy, when risk factors are present. Subclinical hypothyroidism is an additional risk factor for coronary artery calcification and cardiovascular mortality, while detection of autoimmune autoantibodies suggests overt disease, and indicates initiation of substitutive therapy with levothyroxine.

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Target audience
diabetologists, Endocrinologists, General practitioners, Healthcare professionals
EACCME®
by Excemed
Cardiometabolic, Endocrinology and metabolism