The World Health Organization estimates that at least 2.8 million adults die each year due to being overweight or obese. This is has resulted in a large proportion of the global burden of diabetes, ischaemic heart disease and certain cancers. In response to this global problem, large funding bodies are investing into understanding the diagnosis, treatment and prevention of these medical conditions. New research developments in noncommunicable diseases including diabetes were discussed at the recent Endocrine Society Meeting (ENDO 2013) where BMC Medicine joined over 9000 delegates that attended to hear about advances in the field from the bench to bedside perspective.
One topic that generated much debate at the meeting, was on the benefits and drawbacks of measuring glucose versus HbA1c in the diagnosis of Type 2 diabetes. The recommendation made indicated that both should be used, but caution is required as many factors including red blood cell life span heterogeneity, ethnicity and cigarette smoking can alter HbA1c test results. The current limitations of guidelines for managing Type 2 diabetes is no doubt a problem, and in a recent opinion article published in BMC Medicine, Stavroula Paschou and Richard David Leslie recommend that a personalized approach will be more effective by taking multiple targets and therapies into account.
The need to individualize therapy was also apparent at ENDO 2013, where emerging therapies for diabetes focusing on incretins, oral drugs and novel insulin analogs were presented and discussed. However, as there are risks associated with the former two treatment types, there is need for the development of a “glucostatin”. A number of clinical trials for diabetes therapy are underway, which includes potential stem cell therapies. In a recent research article published in BMC Medicine, evidence from a phase I/II clinical trial shows promising results for patients with Type 2 diabetes by using cord blood stem cells to ‘re-educate’ mononuclear cells before returning them to the patient’s circulation, resulting in improved long term metabolic control. Given the initial promising results, further developments on this stem cell educator therapy are going to be of interest.
Research in obesity is also a popular topic, as understanding dysregulation of metabolic pathways in obesity will help identify therapeutic strategies. An entire symposium at ENDO 2013 addressed pharmacotherapy in obese patients based on clinical trial evidence. The combination of phentermine and topiramate (the CONQUER study) has shown to be safe for treating obesity in adults and two other drugs, naltrexone-bupropion and liraglutide are being tested in such patients. Other treatment strategies were discussed including the long term safe use of bisphosphonate therapy in women over 65 years with bone mineral density problems, denosumab treatment of atypical factures in postmenopausal women with osteoporosis (FREEDOM trial) and the safe use of lomitapide and mipomersin for lipid disorders in adults with severe hypercholesterolemia and familial hypercholesterolaemia, respectively.
On the topic of lipid disorders Robert Eckel gave an excellent overview on the cardiovascular risk factor markers (lipoproteins and pro-inflammatory factors) in patients with hypertriglyceridemia. The evaluation and treatment of hypertriglyceridemia was discussed by Lars Berglund based on published clinical guidelines. This focused on the primary and secondary causes of hypertriglyceridemia and recommendations of lifestyle and drug therapy. Other clinical practice guidelines discussed at ENDO 2013 included diagnosis and treatment of polycystic ovary syndrome by Richard Legro who described several recommendations for patients from adolescence to menopause and highlighted comorbidities with other disorders and controversies of treatment.
The strength of the arguments made during the clinical guideline presentations was apparent in the pre- and post presentation voting sessions, as many delegates changed their initial clinical decisions for the best form of therapy in specific patient cases.
The development of improved therapies for obesity, Type 2 diabetes and lipid disorders seems promising given the focus on research and several large clinical trials that are ongoing. The results of these trials will be valuable in the next few years as ultimately the collective goal is to prevent progression of disease by offering patients the best form of therapy.