New research was presented at AACE 2018, the American Association of Clinical Endocrinologists Annual Scientific & Clinical congress, from May 16-20 in Boston. The features below highlight some of the studies emerging from the conference.

Factors Linked With A1C in Uncontrolled Diabetes

Data are lacking on risk factors associated with A1C levels in patients with poorly controlled type 2 diabetes. Among patients with type 2 diabetes in a study those with A1C levels greater than 7 at baseline (case group) were compared with those who had levels below 7 (control group). Upon collection of biomarker sampling, the researchers found that patients in the case group had higher average levels of serum iron, serum ferritin, and serum transferrin when compared with the control group. Elevated serum iron and serum ferritin were also significantly associated correlated with diabetes-associated nephropathy, retinopathy, and neuropathy. The authors suggest that serum ferritin and serum iron levels may be used as surrogate markers of poor glycemic control in type 2 diabetes.



Electronic Registry Predicts Diabetes Outcomes

Despite multiple state-of-the art tools for treating diabetes, many patients with the condition do not meet their health-related goals. For a study, study investigators sought to assess patient-, clinician-, and healthcare system-related determinants for not achieving these goals. The study assessed nearly 50,000 patient medical records from an electronic diabetes registry to measure diabetes-related clinical inertia, including LDL cholesterol (LDL-C), mean arterial blood pressure (MAP), and A1C levels. Patients who had uncontrolled A1C at time of enrollment and had a lower last A1C reading were most likely to have a healthcare provider who was affiliated with a healthcare system. Patients who had frequent, as well as recent, visits with an endocrinologist had improved last A1C and LDL-C measures, despite enrollment levels. Significant improvement in A1C was associated with patients who had frequent visits with a primary care provider when his or her A1C was between 8% and 9% at time of enrollment. Those with uncontrolled A1C, LDL-C, or uncontrolled MAP at enrollment and time of last measurement were significantly more likely to be younger males. Use of a statin was associated with a lower last LDL and MAP reading, but also with having an elevated last A1C reading when these patients had an A1C of less than 8% at enrollment.



24-Hour Insulin Pump Improves A1C

A disposable, continuous subcutaneous basal-bolus insulin device, aimed as a treatment for type 2 diabetes (T2D) has been tested for use with a U-100 fast-acting insulin that delivers a preset basal rate of insulin during a 24-hour period. With the goal of evaluating the extent of the benefits an alternative treatment could potentially provide patients with T2D, researchers switched insulin-users with T2D and an A1C of more than 8% at baseline from a traditional insulin delivery system to the 24-hour, wearable insulin delivery system. Among participants, 71% achieved the target A1C level of less than 8% and/or an A1C level at least 1% lower than their baseline level, after making the switch. The study authors attribute the system’s success to improved insulin adherence and continuously infused insulin that is not available with traditional insulin delivery systems.



Predicting Post-Op Permanent Hypoparathyroidism
Predicting patients at risk for permanent hypoparathyroidism is key to managing postoperative patients, and it’s essential to draw both preoperative labs and postoperative labs in order to help predict those patients who are at risk. To look into this further, researchers conducted a retrospective chart review of 250 patients with thyroid cancer who underwent total thyroidectomy between 1999 and 2013 to determine predictors of permanent hypoparathyroidism. Permanent hypoparathyroidism was defined as persistent parathyroid hormone level less than 12 pg/mL and calcium level less than 8 mg/dL or requiring calcitriol to maintain normal calcium level for at least 6 months following surgery. The incidence of permanent hypoparathyroidism was 17%, with no differences relative to sex, age or race between those who did or did not develop the condition.



Meal Replacements & Weight Loss

People with obesity often greatly underestimate the amount of calories they consume, and meal replacements offer controlled portion sizes of low-calorie, filling foods. Despite the negative publicity for very low-calorie diets resulting from Oprah Winfrey’s famous 67-pound weight loss on such a plan in 1988, physicians commonly prescribe these programs, which aim to reduce caloric intake to less than 800 kcal/day or less than 50% of resting energy expenditure. Energy-controlled bars, shakes, soups, or other products designed to replace meals can offer patients greater and faster weight loss than meal plans based on regular food, according to Scott D. Isaacs, MD, FACP, FACE. Very low-calorie diets are typically composed of about 70 g to 100 g per day of high-quality protein, about 80 g of carbohydrates, and 10 g to 15 g fat. Users also take a daily multivitamin supplement, because meal replacements may not include all recommended daily allowances, as well as a potassium supplement. These diets cause rapid initial weight loss, which is associated with long-term success. Minimum duration for low-calorie diets are 2 to 4 weeks; 12-week programs are typical. Longer programs of 24 to 52 weeks can be safe, too.


Ratio May Predict Fracture Risk in Obese Patients

Obesity has been considered protective against bone fractures but recent evidence suggests it’s not true. New research indicates the ratio of bone mineral density (BMD) to body mass index (BMI) may be a simple and reliable tool for assessing fracture risk in obese individuals. New research also suggests excess fat mass, especially visceral adipose tissue, is a risk factor for low BMD and fragility fractures. For a study, 2,225 overweight-obese patients with an average BMI of 36.5 kg/m2 were examined. They were an average age of 45 years and 82% were women. BMD increased with increasing BMI while TBS significantly decreased. The BMD/BMI ratio correlated with TBS more strongly than BMD alone. Among the 46% of patients with metabolic syndrome, postulated to increase fracture risk, lumbar spine BMD was comparable with that of patients without metabolic syndrome, while TBS and BMD/BMI were significantly lower.