ICE/ENDO 2014 was definitely one for the record books: it was the highest attended annual meeting in history with over 10,000 attendees descending on Chicago from all over the world. If you missed it you’re in luck; we’ve provided some research highlights from the data that was presented in Chicago.
The Endocrine Society and the International Society of Endocrinology held their joint meeting in Chicago for the first time since 1996, and ICE/ENDO 2014 attracted more registrants in the history of the Endocrine Society at over 10,000, researchers submitted a record-breaking 3,273 abstracts, and attendees sat in on more than 350 presentations.
The event, as always, featured an all-star cast of speakers, both seasoned veterans and up-and-comers, delivering a wealth of exciting new developments, groundbreaking research, and information for advancing the state of endocrinology from bench to bedside. And while it was impossible to cover everything in the massive McCormick Place, here are some of the myriad highlights from ICE/ENDO 2014.
Diabetes diagnosis and management
The day before ICE/ENDO 2014 officially kicked off , attendees gathered for the Endocrine Society’s Diabetes Diagnosis and Management (DDM), a daylong, interactive workshop that focused on current issues in clinical diabetes management, namely cardiometabolic comorbidities and new treatment options, because the “prevalence of congestive heart failure in type 2 diabetes patients is quite high,” according to Darren K. McGuire, MD, MHSc, of the University of Texas Southwestern Medical Center in Dallas. And Samuel Dagogo-Jack, MD, MSc, of the University of Tennessee Health Science Center in Memphis, says that patients with type 1 diabetes have “10 times the risk for cardiovascular disease.” The challenge, then, is that diabetic patients who develop heart conditions, or are at risk of developing these comorbidities, need to be handled differently and with greater care, and they may not always fit into neat, strict algorithms.
“We need to make good decisions based on what we know,” says Robert Eckel, MD, of the University of Colorado Anschutz Medical Campus in Aurora, in his presentation updating attendees on the ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults.
Of course, diagnosing and managing diabetes, and one of its major causes, obesity, is such a major issue in endocrinology that many of the plenary lectures, symposia, meet-the-professor sessions, and case management forums comprising ICE/ENDO 2014 were dedicated to that very issue. Diabetes and obesity once again took center stage, because the obesity epidemic is still increasing. Steven R. Smith, MD, of the Translational Research Institute for Metabolism and Diabetes in Orlando, Fla., warns that by 2030, 10% of the U.S. population will be “severely obese.” It seems like such a simple solution: Patients just need to lose weight. But as the various presentations at ICE/ENDO 2014 covering obesity proved, that solution is anything but simple.
A “losing” Battle
The battle to help obese patients lose weight starts with getting them to eat less. Weight loss comes with eating fewer calories. T e course of action usually starts conservatively, with lifestyle changes, such as a strict diet and exercise routine, and then progresses to drug therapy. New research presented at ICE/ENDO 2014 showed that the drug liraglutide, in combination with diet and exercise, led to significant weight reduction, as well as improvement in cardiovascular risk factors, based on a study of more than 3,700 overweight and obese nondiabetic adults.
Researchers led by Carel Le Roux, MD, PhD, of the Diabetes Complications Research Center at University College Dublin in Ireland, showed that on average, patients treated with 3 mg of liraglutide lost 5.4% more of their body weight than their counterparts on the placebo, achieving a total of 8%. The patients who received liraglutide also saw better improvements in their blood pressure and cholesterol. Presenting investigator David Lau, MD, PhD, of the University of Calgary, in Alberta, Canada, says that liraglutide, “as an adjunct, results in significant weight loss and cardiovascular risk improvements.”
“Current obesity options are limited,” Le Roux says. “There is a need for new treatment options for people who struggle with obesity and obesity-related diseases that can help in reducing their weight.”
But when patients don’t respond to drug therapies, surgery is the next step. Bariatric surgery, once considered extreme, is becoming more and more widely accepted as a safe and effective tool for managing obesity and even diabetes. Researchers at Brigham and Women’s Hospital in Boston showed that gastric bypass improved diabetic patients’ quality of life better than diet and exercise. Donald Simonson, MD, MPH, ScD, and his team found that weight loss surgery not only led to improvements in diabetic patients’ physical and mental health, it also led to patients reporting improvements in the adverse effects of weight on their quality of life, such as self-esteem, sex life, public distress, and work.
Roux-en-Y gastric bypass (RYGB) surgery is also an acceptable therapeutic option for reducing the risk of heart disease in obese patients with T2D, according to researchers at the Joslin Diabetes Center in Boston. Su Ann Ding, MBBS, a research fellow at the Center, and her team found that patients who had RYGB surgery lost more weight than their counterparts in a lifestyle and medical modification group. The surgical group also saw better improvements in their blood sugar control, blood pressure, and cholesterol levels.
“There is emerging evidence highlighting the potential health benefits of bariatric surgery in managing obese patients with type 2 diabetes,” says Ding. “In the past, lifestyle advice and medications provided the mainstay of treatment for this group of patients, but despite the substantial improvements in pharmacotherapy for adults with type 2 diabetes, many patients still do not achieve targeted health goals.”
Hormones and pregnancy
But what about obese patients for whom surgery is not an option, but have health goals they’d like to reach? Investigators in China showed that pregnant women who engage in an intensive lifestyle modification program early, in their first trimester, gain less weight and experience fewer pregnancy complications like gestational diabetes and preeclampsia, for which obesity is a risk factor.
The study’s lead researcher, Guanghui Li, MD, PhD, of Capital Medical University in Beijing touched on the fact that obesity is now a global problem. “In the past,” she says, “Chinese people were mostly thin, but now more and more are becoming obese.” Li also pointed out that they found how hard it is for obese women to modify their lifestyles. “Healthcare providers should pay more attention to make practical and effective intervention strategies for obese pregnant women to enhance their compliance with the recommendations,” she says.
Indeed, pregnant women may experience a variety of complications during their terms, but perhaps the most devastating is miscarriage. Researchers in the U.K. may have found a way to effectively predict a woman’s risk of miscarriage by measuring blood kisspeptin levels.
Ali Abbara, MBBS, BSc, MRCP, a clinical research fellow in the Department of Investigative Medicine at Imperial College in London, presented findings of the first study showing that a single plasma kisspeptin level test during pregnancy can identify the risk for miscarriage in asymptomatic women. The investigators found that women who miscarried during the study had 60% lower kisspeptin levels than their healthy counterparts.
According to the authors of the study, miscarriage (pregnancy loss prior to 24 weeks of gestation) is the most common complication of pregnancy, affecting one in five pregnancies. Abbara says, “Being able to identify women at high risk of miscarriage may allow for improved monitoring and management of these pregnancies.” However, Abarra warned against administering kisspeptin to at-risk women to prevent miscarriage, saying that may be something available “very far in the future.”
An issue that is certainly at hand right now is the call for the elimination of endocrine-disrupting chemicals (EDCs), which, as their moniker suggests, can cause damaging health effects by disrupting hormone function in the body.
Hydraulic fracking, a process of injecting numerous chemicals and millions of gallons of water deep underground to extract natural gas, has been repeatedly shown to cause adverse health effects in people, but as research presented at ICE/ENDO 2014 showed, the endocrine-disrupting activity of those chemicals may be worse than previously thought.
Chris Kassotis, a PhD student at the University of Missouri in Columbia, and his team studied 24 fracking chemicals found in water samples collected from documented fracking spills in Garfield County, Colo. Many of the chemicals were found to block the estrogen receptor, androgen receptor, progesterone receptor, glucocorticoid receptor, and thyroid hormone receptor, all of which are necessary to stay healthy.
But many of these EDCs aren’t just found around spill sites; they’re found in consumer plastics, especially ones with hard plastics, and more and more research is pointing to their detrimental effects. The industrial chemical in question is bisphenol A (BPA), which has been shown to cause all kinds of health problems, and now research is incriminating these chemicals in even more diseases and disorders.
BPA exposure can hinder the effectiveness of a drug designed to target inflammatory breast cancer, an aggressive form of breast cancer with one of the worst survival outcomes. Gayathri Devi, PhD, an associate professor at Duke University in Durham, NC, explains that the reason for these poor outcomes is the high rate of treatment failure, and he says environment factors may explain this. Devi says, “This, to the best of our knowledge, is the first study to show BPA’s effects in altering effectiveness of a targeted drug treatment approved for use in breast cancer patients, including those with inflammatory breast cancer.”
Now that everyone’s been back home and back to work for a month or so, it’s time to start marking your calendars for the next meeting: ENDO 2015 taking place in March, in sunny San Diego, so bring sunglasses. The future of endocrinology looks bright.
— Bagley is the associate editor of Endocrine News.
He wrote about competition in the April issue.