January 21, 2021
4 min read
Health care inequity, changes resulting from the COVID-19 pandemic, and the future of diabetes care were just some of the topics discussed by experts in Endocrine Today’s 2020 cover stories.
Researchers discussed how insulin administration could change diabetes management in the future, the popularity of some eating plans for obesity and diabetes, the shift to telehealth in 2020, and more.
Here are some of the top Endocrine Today cover stories from 2020.
The future of insulin: Pills, patches, weekly formulation could change diabetes management
2020 marks the 100th anniversary of the discovery of insulin by the Canadian surgeon Frederick Banting and medical student Charles Best. Today, there are six main types of insulin produced by the three insulin manufacturers serving the U.S. market. However, there is still no available insulin that perfectly mimics the body’s physiologic production of the hormone, and researchers continue to seek better formulations that do not involve subcutaneous injection.
Ketogenic diet, intermittent fasting lead popular eating plans for obesity, diabetes
Lifestyle interventions are the recommended first steps for treatment of diabetes and other cardiometabolic disorders. Changes to diet and physical activity can ultimately lead to weight loss and its proven benefits. However, weight loss can sometimes be difficult to achieve. Researchers discuss the importance of choosing the right eating plan.
Telehealth shift during COVID-19 pandemic shows capacity to deliver safe, convenient care
When the COVID-19 pandemic began, clinicians around the country had to rapidly transition from in-person visits to telehealth. Endocrinologists discussed their efforts to find new ways to support people with diabetes who rely on data-driven care and multiple in-person visits each year, as well as patients with other chronic endocrine conditions that require close follow-up.
Inequities in health outcomes prompt renewed calls for change
Racial discrimination across generations has had profound consequences for the health of Black Americans and other underrepresented populations, with results seen on maps showing high rates of obesity and type 2 diabetes that overlap with areas of marginalized communities. The disproportionate rate of diabetes, particularly in Black communities, coupled with the COVID-19 pandemic, demonstrate structural inequities that providers are trying to change.
‘Metabolic syndrome’ label imprecise, but cardiometabolic risk is real
International health groups disagree about what specifically constitutes metabolic syndrome. The term could include abdominal girth, elevated triglycerides or blood pressure, low HDL cholesterol or glucose abnormalities. Individually or combined, these conditions can quintuple the risk for developing type 2 diabetes and double risk for developing cardiovascular disease in the 5 to 10 years after diagnosis.
New genetic discoveries may hold clues to predict, prevent type 1 diabetes
The etiology of type 1 diabetes continues to be debated, although experts agree it is likely a mix of genetic and environmental causes. Today, more than 50 regions of the human genome are implicated in type 1 diabetes. Within each region, researchers are identifying new genes, biological pathways and potential therapeutic targets for intervention, but a cure or way to prevent type 1 diabetes remains elusive.
Lipid management options expand with novel drugs, new targets
Management of lipids and residual cardiovascular risk has been a growing concern in endocrinology. However, new data on this area are encouraging, with studies demonstrating the effectiveness of agents such as icosapent ethyl and bempedoic acid and others in development showing similar promise in early studies. Other research has demonstrated success of PCSK9 inhibitors as adjuncts to statin therapy.
With new name, diabetes educators positioned to meet growing health challenges
The roles of diabetes educators are evolving to address the increasing prevalence of diabetes and meet new demands for population-level diabetes performance measures. The American Association of Diabetes Educators changed its name to the Association of Diabetes Care & Education Specialists to reflect this change. Diabetes care and education specialists are now working with people with diabetes in new ways.
New treatments offer ‘glimmers of optimism,’ possible cure for Cushing’s disease
More than a century has passed since Cushing’s disease was first described, but only recently have several key discoveries offered patients with the condition real hope for a cure. New targets are emerging for treatment, and newly discovered molecules show promise for reducing the secretion of adrenocorticotropic hormone, decreasing pituitary tumor size or suppressing adrenal cortisol production or action.
Advanced diabetes technology poised to play larger role in care, management
The pace of diabetes technology development continues to advance as the calendar changes to 2021. In 2020, the FDA cleared expanded indications for a smart insulin pen, a next-generation continuous glucose monitor and an interoperable insulin pump, allowing a customized automated insulin delivery system. With the COVID-19 pandemic, endocrinologists now look to diabetes devices more than ever before to help patients manage glucose levels and guide decision-making.
Common and unrecognized, primary aldosteronism warrants more screening, targeted treatment
Primary aldosteronism, an adrenal disorder and a secondary cause of hypertension, has historically been considered a rare condition. Most hypertension is considered idiopathic by many clinicians; treatment is rarely aimed at an underlying mechanism, such as primary aldosteronism. New research may change that thinking.
Controversies persist in diagnosing, treating GH deficiency, short stature in children
The diagnosis of GH deficiency in childhood — whether congenital or acquired, idiopathic or organic — remains challenging, in large part due to the lack of a true gold standard and the relatively poor performance of available diagnostic testing, according to experts. In the U.S., a lack of relevant and consistent criteria for approval of GH therapy among insurance companies has made persistence with GH therapy more difficult. Adding to the complexity are societal pressures surrounding desired height.