Canadian Diabetes & Endocrinology Today

Autoantibodies in Type 1 Diabetes

Robyn Houlden — 2025-10-14

Type 1 diabetes (T1D) is an autoimmune disease characterized by progressive destruction of pancreatic β cells. This process is mediated by both cellular (T lymphocyte) and humoral (autoantibody) immune responses. Although T cells play a central pathogenic role, autoantibodies are the earliest detectable markers of β cell autoimmunity and are instrumental in diagnosing and predicting disease progression. Although T1D develops on a background of genetic risk, most individuals with genetic risk never develop type 1 diabetes. In contrast, virtually all individuals with 2 or more islet autoantibodies eventually develop type 1 diabetes.

Current and Emerging Treatments For the Management of Hypoparathyroidism

Sarah Khan — 2025-10-14

Chronic hypoparathyroidism is a rare endocrine disorder marked by parathyroid hormone (PTH) deficiency, leading to hypocalcemia and its associated complications. Conventional therapy with oral calcium and active vitamin D fails to address the hormonal deficit and poses risks such as hypercalciuria and nephrocalcinosis. Recent advances in PTH replacement therapy have shifted the treatment paradigm. Palopegteriparatide, a long-acting prodrug of PTH (1–34), is now U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA)-approved, demonstrating effective calcium homeostasis, reduced reliance on conventional therapy, and potential renal benefits. Discontinuation of rhPTH (1–84) has accelerated interest in emerging alternatives such as eneboparatide, calcilytics (e.g., encaleret), MBX2109, and oral PTH1 receptor agonists. These novel therapies target PTH signalling through diverse mechanisms—offering injectable and oral options with improved safety, efficacy, and quality-of-life outcomes. This review synthesizes current evidence on approved and investigational treatments, underscoring their mechanisms, clinical impacts, and roles in personalized care for chronic hypoparathyroidism.

Vaccinating Your Adult Diabetic Patient: What Vaccines Would You Recommend?

Wayne Ghesquiere — 2025-10-14

Adults with diabetes (type 1 or type 2) are at substantially higher risk of infections and complications from vaccine-preventable diseases. As a result, persons with diabetes experience higher rates of serious illnesses such as influenza, pneumonia, and other infections. Epidemiological studies show that during flu epidemics, persons with diabetes are hospitalized at much higher rates and are more likely to suffer serious complications (e.g., myocardial infarction, heart failure, stroke) than their non‐diabetic peers. Globally, diabetes is one of the most common comorbidities among patients with severe COVID-19. In short, diabetes—especially when poorly controlled or long-standing—is a risk factor for viral, bacterial, and fungal infections. People with diabetes are more likely to be hospitalized or die from illnesses such as influenza, pneumonia, and COVID-19. Clinicians should understand that diabetes itself impairs immunity, making timely immunization critical. Notably, the Canadian Immunization Guide confirms that there is no evidence suggesting that vaccines adversely affect blood glucose control.

Thyroid Nodules: Reducing Overdiagnosis and Investigations

Vicki Munro — 2025-10-14

Thyroid nodules (TN) are incredibly common, with approximately 5% of the population presenting with palpable TN. However, the widespread utilization of sensitive imaging techniques over the past few decades has led to a rapid increase in their prevalence. Notwithstanding the clinically palpable TN, the rate of incidental nodules picked up on imaging studies varies remarkably with the underlying imaging modality. For instance, the prevalence of TNs on computed tomography (CT) scans of the neck is reported to be 16.5%,³ FDG-PET to be 2% and on neck ultrasounds (US) well over 50%. The prevalence of TN is higher in females and increases with age, and while there has been little change in the overall reported incidence of palpable TNs, the rising prevalence can be almost exclusively attributed to the expanded use of imaging, particularly the widespread availability of sensitive US. It is estimated that over 60% of the population may have at least one TN.