The observation that younger patients with higher levels of fasting insulin may benefit from a regimen that includes short-acting insulin targeting postprandial glycemia helps explain the heterogeneity in response and warrants further investigation.

Over 23 months, zinc toxicosis was diagnosed in 35 baboons aged 5-12 months in one galvanized metal and concrete cage complex with conditions that led to excessive exposure to environmental zinc. Clinical signs included reduced pigmentation of hair, skin, and mucous membranes (whiteness), alopecia, dehydration, emaciation, cachexia, dermatitis, diarrhea and, in six cases, severe gangrenous dermatitis of extremities. The syndrome was characterized by pancytopenia, elevated zinc and low copper serum concentrations, low vitamin D and bone-specific alkaline phosphatase levels, and atypical myelomonocytic proliferation of bone marrow. This syndrome emphasizes the importance of proper husbandry and cage design and indicates the potential of infant baboons as a model to study the effects of excessive zinc on development. This is the first report describing the epidemiologic and clinical presentation of zinc toxicosis in infant baboons in captivity.

Objective We examined whether circulating concentrations of sex hormones, including estradiol, testosterone, sex hormone-binding globulin (SHBG), and dehydroepiandrosterone sulfate (DHEAS), were associated with alcohol intake or mediated the alcohol-type 2 diabetes (T2D) association. Methods Among women not using hormone replacement therapy and free of baseline cardiovascular disease, cancer, and diabetes in the Women’s Health Study, 359 incident cases of T2D and 359 matched controls were chosen during 10 years of follow-up. Results Frequent alcohol intake (≥1 drink/day) was positively and significantly associated with higher plasma estradiol concentrations in an age-adjusted model (β=0.14, 95% CI, 0.03, 0.26), as compared with rarely/never alcohol intake. After adjusting for additional known covariates, this alcohol-estradiol association remained significant (β=0.19, 95% CI, 0.07, 0.30). Testosterone (β=0.13, 95% CI, −0.05, 0.31), SHBG (β=0.07, 95% CI, −0.07, 0.20), and DHEAS (β=0.14, 95% CI, −0.04, 0.31) showed positive associations without statistical significance. Estradiol alone or in combination with SHBG appeared to influence the observed protective association between frequent alcohol consumption and T2D risk, with a 12–21% reduction in OR in the multivariate-adjusted models. Conclusions Our cross-sectional analysis showed positive associations between alcohol intake and endogenous estradiol concentrations. Our prospective data suggested that baseline concentrations of estradiol, with or without SHBG, might influence the alcohol-T2D association in postmenopausal women.

T he meta-analysis by González Blanco et al. 1 examining pregnancy outcomes and use of insulin lispro (LP) or regular insulin (RI) in women with type 1 diabetes mellitus (T1DM) found that use of LP compared with RI was associated with higher risk of large-for-gestational age (LGA) infants (risk ratio 1.38 [95% confidence interval 1.14, 1.68]). The study's analysis of relative risk of LGA, determined from three observational studies, 2-4 did not adjust for known risk factors impacting infant birth weight. The authors' conclusions of a higher rate of LGA newborns in pregnant women treated with LP and ''no evidence of a beneficial effect of LP use during pregnancy'' should therefore be interpreted with caution.Recent literature reviews 5-7 surveyed clinical studies for comparisons of fetal overgrowth between RI and insulin analogs, including LP, in pregnancies complicated by diabetes. These qualitative reviews concluded that overall there were no relevant differences in rates of neonatal macrosomia and LGA between LP and RI treatment groups. Because of the small numbers of events in each of the studies included in our review, 6 we concluded that there were no relevant differences and presume that the other two reviews may have had the same reasoning, perhaps because each study had small numbers of such events.The known risk factors that impact infant birth weight are maternal age, body mass index, diabetes duration, parity, infant gender, and smoking status. 8 The meta-analysis by González Blanco et al. 1 noted that baseline characteristics in patients treated with LP were similar to those treated with RI; however, only two factors-age and duration of diabeteswere evaluated in all three studies' data. Availability of baseline data on known risk factors impacting infant birth weight would allow for a more appropriate meta-analysis that properly accounts for these covariates. Ideally, data analysis on the individual patient level would be most informative. It may be useful to provide a brief summary here of the individual observational studies used in the analysis by González Blanco et al. 1 of LGA and LP, all of which are based on a pregnant female patient population with T1DM:One publication that was not included in the aforementioned literature reviews, an unintentional omission in our review and probably also for the others, was that of Evers et al., 2 based on a prospective observational study in The Netherlands that included 289 patients, 11% of whom were treated with LP. The study found a high percentage of macrosomia (48.8%), defined as birth weight > 90 th percentile, despite good glycemic control in the total cohort. The authors concluded an association of LP and LGA on the basis of an odds ratio that was not statistically significant (odds ratio 3.1, 95% confidence interval 0.9-10.4). Evers et al. 2 stated that maternal age, race, and parity were not associated with macrosomia. Additionally, they reported that duration of diabetes, long-term diabetes complications, total daily insulin dosage, body mass inde...