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American Association of Clinical Endocrinologists, April 21-25, 2010

American Association of Clinical Endocrinologists' 19th Annual Meeting and Clinical Congress

The American Association of Clinical Endocrinologists' 19th Annual Meeting and Clinical Congress took place April 21 to 25 in Boston and attracted nearly 1,500 endocrinologists and allied health professionals from around the world. The meeting's theme was "A Revolution in Medicine: Leading the Way in Endocrinology," and it featured advances in the care of endocrine diseases such as diabetes, thyroid disorders, growth hormone deficiency, osteoporosis, cholesterol disorders, hypertension and obesity.

"One of the key themes is always diabetes care because endocrinologists take care of diabetes care and are the referral source for primary care physicians for complications of diabetes," said program committee co-chair, Daniel L. Hurley, M.D., of the Mayo Clinic in Rochester, Minn.

According to Hurley, highlights included podium presentations on continuous glucose monitoring and metabolic syndrome. He also cited several studies that promise to improve the clinical management of patients with diabetes.

During one presentation, a panel of experts discussed the emerging use of continuous glucose monitoring in patients with type 2 diabetes, and the benefits of placing patients on monitors for several weeks to get an accurate assessment of blood glucose levels.

"The physician will then be able to chart out the best possible treatment plan for their patient," Robert M. Cuddihy, M.D., medical director of the International Diabetes Center in Minneapolis, said in a statement.

Continuous glucose monitoring may be particularly useful in hospital settings, especially in light of recent studies raising concerns about intensive glycemic control in hospitalized patients. "Good glycemic control [in the hospital] is still relevant if continuous glucose monitors are constantly checked," Cuddihy added.

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"One interesting session addressed metabolic syndrome and some of the mechanisms behind it," Hurley said. "I don't know that it's new information, but it may help improve our understanding of where some of the insulin resistance occurs and why we see differences in lipids from liver resistance versus differences from fat resistance."

During the session, C. Ronald Kahn, M.D., of the Joslin Diabetes Center in Boston, discussed how the constellation of issues associated with insulin resistance can differ from patient to patient, making metabolic syndrome difficult to diagnose and treat. "There is not yet a defined single diagnostic test for metabolic syndrome," Kahn said in a statement. "We need the right biomarkers to understand insulin resistance and its many effects."

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Significant studies presented at the meeting included a case report presented by Anna L. Marina, M.D., a private practitioner in Portland, Ore., suggesting that gastric bypass surgery is not a "cure" for type 2 diabetes. Marina and colleagues studied a 55-year-old man with a body mass index of 45.2 kg/m2 and a history of diabetes who underwent Roux-en-Y gastric bypass and lost more than 100 pounds. Although the patient's fasting blood glucose returned to normal, and his HbA1C level declined to near normal, continuous glucose monitoring showed spikes in blood glucose above 200 mg/dL after meals, which required therapy to reduce postprandial hyperglycemia. Marina and colleagues said the results are in line with another recent study of gastric bypass patients.

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Another significant study, presented by Arthur Chernoff, M.D., of the Albert Einstein Medical Center in Philadelphia, suggested that adding endocrinologists to surgical care teams for patients with diabetes can reduce hospital stays and costs. Comparing the year before and after the intervention, the researchers found that the mean length of stay at their hospital decreased from 5.77 to 5.04 days, and that the average cost declined from $9,301 to $8,009.

Yehuda Handelsman, M.D., of the Metabolic Institute of America in Los Angeles, and colleagues reported the results of a Daiichi-Sankyo-supported study suggesting that use of the cholesterol drug colesevelam (Welchol) improves glycemia in patients with pre-diabetes. In a randomized, double-blind, placebo-controlled study of 216 patients, the researchers found that, compared with placebo, colesevelam was associated with significant changes in low-density lipoprotein cholesterol (−13.9 versus +1.7 percent), mean non-high-density lipoprotein cholesterol (−8.4 versus +0.7 percent), fasting plasma glucose (−4 versus −2 mg/dL), and HbA1C (−0.12 versus −0.03 percentage points).

"The use of colesevelam HCl is an option for managing hypercholesterolemia and may help with the normalization of glucose in patients at high cardiometabolic risk such as those with hypercholesterolemia with or without statins and pre-diabetes," the authors conclude. "Further study is warranted to determine whether colesevelam HCl slows or prevents the progression to type 2 diabetes."

Hurley also cited studies suggesting that hypogonadism is a hidden danger in men with diabetes, that vitamin B12 and folic acid deficiency is prevalent in hospitalized patients with diabetes, and that low vitamin D levels are associated with reversible myositis-myalgia in statin-treated patients.

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