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Background. Inpatient diabetes treatment has become more complicated recently with the introduction of new insulin formulations and a new emphasis on tight blood glucose control. Insufficient knowledge of insulin contributes to errors in its use that may cause adverse patient outcomes. Methods. Seventy-three faculty members, 113 residents, and 191 nurses from four hospitals completed a 20-item multiple-choice questionnaire that assessed knowledge of insulin nomenclature and characteristics and inpatient insulin use. Results. The percentage of knowledge-based questions answered correctly was low: 51% for faculty, 59% for house staff, and 47% for nurses. Scores on questions testing knowledge of insulin nomenclature and characteristics were similar to scores on those addressing inpatient insulin use among faculty and house staff; however, nurses scored better on the former than the latter (60 vs. 34%, P < 0.0001). Knowledge of names and characteristics of newer insulins, such as glargine, aspart, and lispro, was poor compared to knowledge of older insulin formulations among all professional categories (46 vs. 78%, P < 0.0001). House staff performed better than faculty (62 vs. 49%, P = 0.09) and nurses (62 vs. 34%, P < 0.0001) on questions regarding inpatient diabetes management, but all groups frequently missed questions involving sliding-scale insulin use and dosing insulin in patients with type 1 diabetes. Conclusion. Educational programs teaching insulin characteristics and inpatient diabetes management are needed for all categories of health care providers. Increased knowledge may help to improve patient safety in the hospital.

Objective The aim of this study was to compare the periodontium of postmenopausal women with known low bone mineral density who are receiving long-term bisphosphonate therapy with those who are not. Methods The periodontal status of 28 white postmenopausal women with low bone density using bisphosphonate therapy for at least 2 years was compared with that of a matching group not using such therapy. All women underwent a cone-beam CT scan of the jaw and a complete periodontal examination evaluating for plaque score, periodontal probing depth, clinical attachment loss, bleeding on probing, and alveolar bone height. Results Bisphosphonate users had higher plaque score, lower probing depth, and lesser clinical attachment loss compared with the controls. These differences were determined to be significant by both t test and Wilcoxon's tests. Bleeding on probing was lower and the alveolar bone height was higher in the bisphosphonate group than in controls, but these differences were not statistically significant. Linear models showed no significant interactions between plaque score and bisphosphonate use, suggesting that the association of periodontal status and outcome measures was constant across all levels of plaque scores. Bisphosphonate use was a significant factor for probing depth but was not significant for the other parameters when adjusted for plaque score. Conclusions Long-term bisphosphonate use seems to have some beneficial effects on the periodontium of postmenopausal women with low bone density, across all levels of plaque score.

Exogenous testosterone has long been used in medicine as a pharmaceutical agent. Its use in hypogonadism is well characterized and its development as a drug has undergone several modifications in an attempt to achieve clinical success. As native testosterone is rapidly degraded, modified analogs have been developed to obtain a better pharmacokinetic profile. The developmental goals of testosterone analogs have evolved since its first introduction as an orally available form to longer acting and more stable forms such as injectables, depots and transdermal therapies. Several modalities of testosterone replacement are presently available, each differentiated by their route of delivery, half life, cost and ability to deliver physiologic levels of testosterone. As hypogonadism is often a life-long condition, physicians are compelled to use an appropriate therapy that best matches the needs of their patients. An ideal testosterone therapy should be able to deliver physiologic levels of testosterone and be safe, simple to use and cost effective. Present trends show transdermal therapies (gels and patches) along with long-acting injectables, such as Nebido, are quickly replacing intramuscular testosterone modalities. Compounds such as dihydrotestosterone, human chorionic gonadotropin, aromatase inhibitors and clomiphene are presently being studied in specific subgroups of men. Additionally, several new compounds, such as selective androgen-receptor modulators and 7-alpha-methyl-19-nortestosterone, are being developed to target androgen receptors in specific tissues. A further understanding of the androgen receptor and subsequent discovery of targeted drugs may yield more individualized treatment modalities. This will enhance the effectiveness of available therapies, while mitigating their undesirable effects.

Hormonal therapy remains the gold standard for treating menopausal symptoms. In addition, some formulations are indicated for preventing and treating bone loss. In this article, we review some of the hormonal regimens that have been approved in the past 5 years.

Several newer hormonal contraceptive agents have become available in recent years. Many of them are slight variations on previous agents. In this article, we review the advantages, side effects, and practical considerations of hormonal contraceptives approved in the last few years.

Exenatide is a synthetic peptide that belongs to a new class of antidiabetes agents known as incretin mimetics. Like the endogenous incretin hormone glucagon-like peptide 1 (GLP-1), exenatide effectively lowers blood glucose levels by stimulating insulin release, inhibiting glucagon secretion, and delaying gastric emptying. Nausea and vomiting are the most common adverse reactions, which lead to discontinuation in as many as 14% of patients in one study (1). We report on four patients (three male and one female; age 52–73 years) with exenatide-associated renal failure who presented with nausea, vomiting, or decreased fluid intake. All patients had type 2 diabetes with or without mild microalbuminuria and hypertension. They were taking …