Niels Lund, MSc is the vice president of Changing Diabetes at Novo Nordisk.

Addressing Environmental and Cardiovascular Concerns in Diabetes Treatment, With Niels Lund, MSc

Despite increasing the cumulative incidence of cardiovascular complications, maintenance of HbA1c and preventing progression from prediabetes to 

 can substantially reduce a patient’s carbon footprint, according to a recent study.

“Our analysis is fairly robust, but it’s also dependent on keeping HbA1c in control,” Niels Lund, MSc, vice president of Changing Diabetes at Novo Nordisk and lead investigator of the study, told 

 in an exclusive interview. “If anything, the analysis is an important reminder to keep blood sugar in check and address other diabetes-related factors, such as blood pressure, lipids, and so on. However, that is a decision that’s also about the quality of life and is something that has to be decided between the patient and the caregiver.”

Lund and colleagues collected data on 1000 individual patients for a simulation in the IQVIA core diabetes model. Each patient was simulated 1000 times to achieve stability, and the team utilized an annual discount rate of 3.5% for health effects and 0% for environmental effects. Greenhouse gas emissions associated with T2D were estimated via avoidance of ongoing drug treatment, anticipated complications without interventions, and the necessary procedures, medications, and travel components for T2D management.

The study included 2 main scenarios: a comparison between patients >40 years who did and did not progress to T2D due to advice from a nutritionist, and a comparison between patients with well versus poorly controlled T2D. The first scenario assumed that HbA1c remained <6.5% without further progression to T2D during lifetime. All patients in the comparator arm were assumed to receive 3 lines of anti-diabetes therapy – first-line metformin, second-line metformin and DPP4 inhibitor, and third-line basal and bolus insulin.

Greenhouse gas emission was found to be 67% less over a lifetime in patients with prediabetes and no progression, driven primarily by reduced need for management of diabetes-related complications such as cardiovascular disease, renal disease, and eye diseases. Additionally, patients with well-controlled T2D exhibited 21% less greenhouse gas emissions compared to patients with uncontrolled T2D.

The study ultimately showed an extra 6 years of life over a lifetime through prediabetes management compared to natural progression. Patients who remained prediabetic also had substantially lower lifetime complication rates than those who progressed naturally (244 vs 60,167 events per 100 patients), particularly renal (73% fewer events) and eye disease (59% fewer events). However, patients remaining prediabetic had slightly higher cumulative incidence of cardiovascular complications (11% more cumulative events). This was attributed to increased longevity, as heart disease risks increase in older age, irrespective of prediabetes.

“I think there’s room for discussing and weighing carbon emissions, clinical outcomes, and economics,” Lund said. “However, one of the limitations in this area is that unlike with cost per QALYs, we don’t have a threshold. Many health systems have a fairly consistent way of assessing medicines through a cost per QALY threshold, but we don’t have that for carbon emissions.”

Editor’s Note: Lund reports that he is an employee and shareholder of Novo Nordisk.

BMJ Group. Type 2 diabetes prevention could more than halve carbon footprint linked to disease complications. Eurekalert. January 20, 2026. Accessed January 22, 2026. 

https://www.eurekalert.org/news-releases/1112970

Lund N, Maslova E, Chen J, et al. Assessment of greenhouse gas emission of type 2 diabetes management in adults: A modelling study in the UK. BMJ Open. 2026;16(1). 

Videos

Lund highlights the value of preventive treatment in patients with prediabetes on the environment via reduced greenhouse gas emissions.

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Frances Lee, MD, is an assistant professor of medicine in the division of liver diseases at Mount Sinai.

In this episode, “Key Symptoms of PBC: Fatigue, Pruritus, and Bone Health,” the expert hepatologists explore extrahepatic symptoms associated with this disease. 

Segment 2- Key Symptoms of PBC- Fatigue, Pruritus, and Bone Health

In this episode, “Key Symptoms of PBC: Fatigue, Pruritus, and Bone Health,” the expert hepatologists explore extrahepatic symptoms associated with this disease.

Led by the moderator, the panelists examine the following critical questions:

What do we know about the underlying causes of these extrahepatic symptoms of primary biliary cholangitis?

Another common complication associated with PBC is bone disease; about 30% of patients with PBC also have osteoporosis. How often do you see bone complications in clinic, and how does it impact a patient’s quality of life?

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

Explore the complex relationship between pruritus, fatigue, and bone health in patients with primary biliary cholangitis (PBC).

In this episode titled, “An Overview of PBC Pathophysiology, Severity, and Burden,” Aparna Goel, Lance L. Stein, A. Sidney Barritt IV, and Frances Lee highlight the key symptoms and burdens associated with primary biliary cholangitis (PBC)

Segment 1- An Overview of PBC Pathophysiology, Severity, and Burden

Led by the moderator, the expert hepatologists examine the following critical questions:

Please provide an overview of primary biliary cholangitisand signs and symptoms of PBC (hepatic/extrahepatic).


What are the known risk factors for primary biliary cholangitis (such as female sex and age)? What do we know about the underlying reasons for these risks?

What is our understanding of underlying causes leading to a manifestation of primary biliary cholangitis?

How do you assess the severity of primary biliary cholangitis in a patient and their risk of progression?

Please discuss the burden of primary biliary cholangitis and how symptoms like fatigue and pruritus are distinct and can dramatically impact patient quality of life.

Explore expert insights on primary biliary cholangitis, focusing on symptoms, treatment innovations, and emerging clinical data for effective patient management.

How Autoclaving Alters Peanut Allergenicity, OIT Potential, With Casey Cohen, PhD

A new study showed that autoclaving peanuts breaks down major allergens, significantly lowering IgE binding, skin test reactivity, and allergic reactions. This does not mean clinicians should advise patients with a 

 to consume autoclaved peanuts, but the findings suggest they may provide a safer substrate for oral immunotherapy (OIT).

“We're never going to change the way the entire world will cook their peanuts. That's not realistic. But even if we could do that, there's no guarantee that everyone who is allergic to peanuts can tolerate any autoclaved peanuts,” Casey Cohen, PhD, of McGill University, told 

. “What we're seeing is it seems like most people who are allergic would tolerate it, but we can't ever prove that… [We are] more interesting part at this point is to see if we can use this as a better substrate for OIT, because…using raw or roasted peanuts for OIT… [is] not perfect. It's far from it.”

In the first half of HCPLive’s interview with Cohen, he discussed how autoclaving distinguishes from traditional peanut processing methods in terms of allergenicity.

 He also provided insights into notable findings on the reductions in IgE binding and improved oral tolerability.

The analysis showed that autoclaving extensively fragments major peanut allergens, including Ara h 1 and Ara h 2, and completely degrades Ara h 8.

 Investigators observed a 74% reduction in peanut-specific IgE binding in sera from highly allergic patients compared with raw peanuts.

Skin prick testing revealed autoclaved peanut extract produced significantly smaller wheal sizes than standard commercial extract (median 5 mm vs 10 mm; 

 <.001). Patients with the greatest wheal size reductions tended to have lower IgE levels to peanut and allergen components.

During the oral food challenge (OFC), all 10 participants tolerated the maximum cumulative dose of autoclaved peanut (444 mg), equivalent to ≥ 1 whole peanut, with only mild to moderate symptoms. Patients receiving blanched peanuts could only tolerate 9 mg on average and often required epinephrine.

In the latter half of the interview, Cohen discussed why autoclaving reshapes peanut allergenicity and how those mechanistic insights may matter clinically. He explained that the team worked backward from the clinical signal.

After observing markedly reduced peanut-specific IgE binding and smaller skin test responses with autoclaved peanuts, the key question became what molecular changes were driving these effects. Mass spectrometry–based proteomic analysis provided that link. By focusing on peptide fragments below a defined molecular weight threshold, the investigators demonstrated that autoclaving does not simply “destroy” peanut proteins. Instead, it fragments them extensively, producing a diverse pool of smaller peptides derived from major allergens that are largely absent in raw or roasted preparations.

This fragmentation appears central to reduced allergenicity. The immune system is exposed to peanut proteins in a fundamentally different form—shorter peptides and altered epitopes—rather than intact, highly stable allergens such as Ara h 2. Cohen emphasized that this molecular mediation helps explain why reduced IgE binding, smaller skin prick test responses, and improved OFC outcomes track together. Clinically, it suggests that allergenicity is not solely about the presence or absence of peanut protein, but about its structural presentation to the immune system.

For clinicians, Cohen emphasized that these data do not justify consuming autoclaved peanuts outside a controlled setting. Even if most allergic individuals appear to tolerate autoclaved peanuts, safety will still require supervised food challenges. The immediate relevance lies in immunotherapy development rather than dietary guidance.

Compared with FDA-approved Palforzia, an OIT peanut allergen powder linked to frequent adverse effects, variable efficacy, and high discontinuation rates, autoclaved peanuts may offer theoretical advantages due to minimal side effects. Whether this translates into effective desensitization remains unproven and represents the next critical step.

Cohen proposed a randomized OIT trial directly comparing autoclaved peanut-based therapy with conventional roasted peanut OIT. He emphasized that autoclaving preserves substantial protein content while creating novel fragments, which the team believes could be key to inducing safer, more effective immune tolerance rather than merely reducing allergen exposure.

“Maybe one would think, ‘okay, autoclaving might just be destroying everything that's in there, all the proteins. No wonder they don't get any reaction.’ But we actually prove that that's not the case,” Cohen said. “We…show there is still clearly a substantial amount of protein left in the peanut protein and specific allergens. [The] fact that there is still some protein intact, and of course, all the fragments, meaning different forms of those same proteins, we think those have the biggest potential for OIT.”

Cohen CG, Toscano-Rivero D, Ahmed EA, et al. Autoclaved Peanuts Exhibit Reduced Immunoglobulin E Binding and Improved Oral Tolerability. 

Derman C. Autoclaved Peanuts Reduce IgE Binding, Improve Tolerability, With Casey Cohen, PhD. HCPLive. Published on January 23, 2026. Accessed on January 23, 2026.

Proteomic fragmentation may explain reduced allergenicity and point to a safer substrate for peanut oral immunotherapy compared with current options, new data suggests.


Allergy

Allergy condition center page is a comprehensive resource for clinical news and insights on allergic and inflammatory diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for food and seasonal allergies, as well as allergic asthma and related conditions.

Food Allergy

Anaphylaxis

The HCPLive anaphylaxis page is a comprehensive resource for clinical news and insights on acute allergic reactions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for preventing anaphylaxis, and more.

Proactive Flare Prevention and Practical Use of Advanced Pediatric Topicals

Achieving disease control in pediatric atopic dermatitis and psoriasis requires setting realistic expectations with families regarding onset of action, degree of response, and the need for maintenance therapy. Autumn Atkinson, MD, associate professor in the Department of Pediatrics at McGovern Medical School at UTHealth Houston, notes that caregivers should be counseled that even effective therapies will not normalize skin overnight and that responses vary widely. Regular follow-up in primary care between dermatology visits allows clinicians to assess adherence, access issues, and application technique.

Adelaide Hebert, MD, professor and director of pediatric dermatology at McGovern Medical School at UTHealth Houston, describes proactive therapy strategies, such as continuing topical agents two to three times weekly on previously affected areas to reduce flare frequency. She reviews long-term safety data for newer steroid-sparing topicals, including ruxolitinib, tapinarof, and roflumilast, noting favorable profiles without clinically meaningful systemic absorption or need for routine laboratory monitoring. Hebert also contrasts newer PDE4 inhibitors with earlier agents that were limited by irritation and tolerability.

In this segment, Hebert and Atkinson offer practical guidance on selecting advanced topical therapies in real-world practice. They emphasize documentation of prior treatments, understanding payer formularies, use of samples when available, and shared decision-making based on dosing convenience, anatomic site, and prior patient experience.

Learn how to set expectations, prevent flares, and choose among advanced topical therapies for pediatric atopic dermatitis and psoriasis.

Video Series

Daniel M. Siegel, MD, is a clinical professor of dermatology at SUNY Downstate Health Sciences University, New York, and is the former president and honorary member of the American Academy of Dermatology (AAD).

Siegel addressed additional points presented in his Maui Derm 2026 session, 'How To Maximize Your Billing Effectiveness in the Era of Dwindling Reimbursements and ICD-10.'

Dermatology

The HCPLive dermatology page is a resource for medical news and expert insights on skin disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for dermatologic conditions, and more.

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Tips on Billing Issues in Dermatology Practices, With Daniel Siegel, MD

In this interview, Siegel highlights key points presented in his Maui Derm 2026 talk, 'How To Maximize Your Billing Effectiveness in the Era of Dwindling Reimbursements and ICD-10.'

Discussing Billing Challenges in Dermatology, With Daniel Siegel, MD

Victoria Johnson joined the MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and now HCPLive. You can reach her at vjohnson@mjhlifesciences.com

Articles

An audio recap of the top 5 stories in healthcare news from the week of 01/18-01/24.

HCPLive 5 Stories in Under 5: Week of 01/18

Henry Lim, MD, is the senior vice president of academic programs at Henry Ford Health. He previously served as chair of the department of dermatology.

This interview with Lim highlights knowledge gaps examined by an international expert panel reviewing existing literature on dermatologic disease in skin of color.

Expert Consensus on Knowledge Gaps in Dermatology for Skin of Color, With Henry Lim, MD

Stay updated with the latest healthcare breakthroughs, including new phase 2/3 data and updated asthma guidelines, in this week’s essential news roundup.

Cardiology

Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

The HCPFive: Top News for Healthcare Providers from the Week of 01/18

Mauro D'Amato, PhD, is Ikerbasque Research Professor and head of the Gastrointestinal Genetics Lab at CIC bioGUNE.

D’Amato explains his research on the biological mechanisms that control bowel movements and vitamin B1’s potential role in gut motility.

Gastroenterology

Gastroenterology condition center page is a comprehensive resource for clinical news and insights on digestive and GI conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for 

, IBS and IBD, Crohn's disease, and more.

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From Physiology to Genetics: A New Lens on Gut Motility, With Mauro D’Amato, PhD

Logan Briggs is a senior urology resident at Mayo Clinic Arizona.

The first scoping review of kidney cancer pre/ rehabilitation suggests psychological support outdoes exercise and nutrition. 

Nephrology

The HCPLive nephrology page is a resource for medical news and expert insights on kidney disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in nephrology, and more.

 Kidney Cancer Survivors Benefit From Increased Psychological Support, With Logan Briggs, MD

Vivian Fonseca, MD, is professor of medicine, assistant dean for clinical research, and the Tullis-Tulane Alumni Chair in Diabetes at Tulane University School of Medicine.

Fonseca explains the structure and goals of the ongoing trial, which has enrolled its first patient to clofutriben treatment against hard-to-control T2D.

CAPTAIN-T2D: New Trial Investigates Treating Elevated Cortisol in T2D, With Vivian Fonseca, MD

New data show heat- and pressure-treated peanuts significantly reduce IgE binding, skin test reactivity, and oral challenge severity in allergic patients.

Autoclaved Peanuts Reduce IgE Binding, Improve Tolerability, With Casey Cohen, PhD

Carly Maucione, MD, a resident physician at Washington University in St. Louis

Study investigator Carly Maucione, MD, discusses how artificial intelligence could support laboratory workflows while emphasizing education as a near-term solution.

Latest News

Addressing Environmental and Cardiovascular Concerns in Diabetes Treatment, With Niels Lund, MSc

Segment 2- Key Symptoms of PBC- Fatigue, Pruritus, and Bone Health

Segment 1- An Overview of PBC Pathophysiology, Severity, and Burden

How Autoclaving Alters Peanut Allergenicity, OIT Potential, With Casey Cohen, PhD

Proactive Flare Prevention and Practical Use of Advanced Pediatric Topicals