Dr. Castro and Dr. Rizzo discuss the evolving world of monoclonal antibodies for severe asthma. Plus, the ALA team discusses September's annual Asthma Peak Week, and what it means for reopening schools.

ALA Discusses Severe Asthma Biologics with Mario Castro, MD, MPH

Listen to an expert discuss the heterogenous, and potentially fatal, lysosomal storage disorder.

The Rare Disease Report Podcast: Niemann-Pick Disease

The vitiligo expert discusses new tactics and therapeutic options in treating inflammatory skin disorders like vitiligo, alopecia areata, and atopic dermatitis.

John E. Harris, MD, PhD: The Current State of Vitiligo and Alopecia Areata Research

Manesh Patel, MD, kicks off his first podcast by discussing HFpEF findings in EMPEROR-Preserved, the GUIDE-HF trial and more with his Duke colleague.

New Heart Failure Data from ESC 2021 with Marat Fudim, MD

On this episode of Coping After COVID, Dr. Yamalis Diaz explained just how challenging this year has been for patients with ADHD.

Coping After COVID: Challenging Circumstances for ADHD Patients

The first iteration of Crisis Point addresses the obesity crisis in the United States and beyond, with expert interviews and discussion.  

Crisis Point - Obesity Crisis

Armand Butera is the assistant editor for 

. He attended Fairleigh Dickinson University and graduated with a degree in communications with a concentration in journalism. Prior to graduating, Armand worked as the editor-in-chief of his college newspaper and a radio host for WFDU. He went on to work as a copywriter, freelancer, and human resources assistant before joining 

. In his spare time, he enjoys reading, writing, traveling with his companion and spinning vinyl records. Email him at 

New data from Pakistan detailed the effect that the chemical bisphenol-A (BPA) had on insulin resistance susceptibility on patients with 

The study was presented at the The Metabolic Institute of America (TMIOA) 2021 World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC) meeting this week.

Muhammad Sajid Hamid Akash, MD, Department of Pharmaceutical Chemistry, Government College University Faisalabad, Pakistan, and fellow investigators cited bisphenol-A as “one of the most harmful endocrine-disrupting chemicals” , and referenced its frequent use for the preparation of resins and plastic products. 

Bisphenol-A is often widely found in resinous lining of everyday object including beverages, juice cans, water containers and baby bottles.

For the present study, Akash and investigators aimed to investigate the exposure of BPA in the human population, while also detailing its association with multiple risk factors that may cause impairment in insulin secretion from β-cells of pancreatic islets and insulin resistance in peripheral tissues accompanying various with metabolic disorders.

Akash and colleagues recruited a total of 400 participants, both with and without diabetes mellitus (DM), in the cross-sectional study. 

The team then created structured questionnaire that was employed to obtain the sociodemographic data from study participants.

From there, the blood and urine samples were collected from each participant, and biochemical analysis was performed to determine the risk factors that were capable of increasing the insulin resistance in peripheral tissues and impaired insulin secretion from β-cells of pancreatic islets.

In their study, Akash and colleagues outlined multiple underlying mechanisms that supported the key role of Bisphenol-A exposure in insulin resistance.

Notable mechanisms included oxidative stress, lipid peroxidation and inflammation.

Akash and investigators also determined the Pearson correlation coefficient for observing the relationship between Bisphenol-A exposure and risk factors that could induce the insulin resistance in peripheral tissues.

The team found significant negative correlations between human bisphenol-A exposure and the levels of antioxidant enzymes in participants, including superoxide dismutase (SOD) and Glutathione (GSH) among those in the diabetic group as compared to non-diabetic participants who showed a nonsignificant correlation.

However, the level of malondialdehyde (MDA) exhibited a significant positive correlation with urinary BPA exposure in both participants with and without DM.

The investigators hypothesized that exposure of bisphenol-A could also provoke some predefined inflammatory mediators such as C-reactive protein (CRP) and interleukine-6 (IL-6) significantly among diabetic participants, which would result in increased insulin resistance.

“Hence, the significant positive correlation of glycemic control parameters i.e., random blood glucose (RBC) and glycosylated hemoglobin (Hb1Ac) with urinary BPA exposure provided a clear indication that individuals with diabetes mellitus were more prone to develop insulin resistance due to BPA exposure as compared to non-diabetic participants,” the team wrote

“Insulin Resistance Susceptibility is associated with BPD exposure,” was published online by WCIRDC.

Articles

Participants with diabetes mellitus specifically were more prone to develop insulin resistance due to BPA exposure as compared to non-diabetic participants





News

news page, resources on the topics of disease- and specialty-specific medical news and expert insight can be found. Content includes articles, interviews, videos, podcasts, and breaking news on health care research, treatment, and drug development.

Diabetes

Diabetes condition center page is a comprehensive resource for clinical news and insights on diabetic and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for type 1 and type 2 diabetes, as well as related endocrinological conditions and illnesses. 

Conference

 conference coverage page features articles, videos, and expert-led live coverage from major medical meetings throughout the year.

Bisphenol-A Linked to Insulin Resistance in Diabetic Patients

In a new presentation at the The Metabolic Institute of America (TMIOA) 2021 World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC) meeting in Los Angeles this week, Erin D. Michos, MD, MHS, highlighted the lacking general response to increased lipid levels in patients at risk of atherosclerotic cardiovascular disease (ASCVD).

Michos, the Associate Director of Preventive Cardiology at Johns Hopkins University, explained that many at-risk patients are currently not a guideline-set LDL-C thresholds; such guidelines also recommend these patients are considered for combination lipid-lowering therapy with statins.

It’s Michos’ recommendation that combination therapy is considering even earlier in the risk-developing stages.

“First of all, I emphasize that LDL cholesterol is causally related to atherosclerotic cardiovascular disease risk, which is why it’s a central target for both prevention and management for ASCVD,” she explained. “Lower accumulation of LDL delays the onset of CVD events—it slows plaque progression. So you want to be lower and longer, and you also want to get there faster as well.”

Michos also stressed that single-pill combination therapy may have better adherence among high-risk patients, which could harbor more long-term risk reduction success.

She added in her presentation that recent data suggest many high-risk patients in both European countries and the US are generally reaching lipid thresholds while also taking statins without lipid-lowering therapy.

“Really, I was trying to make the plea that we need to be a lot more aggressive, being intensive up front, start high-intensity statins on the onset, and consider initial use of combination therapy if the LDL is more than 50% above one’s goal,” Michos said.

Videos

A case for more proactive lipid-lowering treatment initiation in a high-risk population.

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...

Erin D. Michos, MD, MHS: Managing Dyslipidemia with Novel Agents

As discussed previously in sessions at The Metabolic Institute of America (TMIOA) 2021 World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC) meeting in Los Angeles this week, lipid screening rates are underwhelming for the next generation of cardiovascular-risk patients.

Andrew Moran, MD, MPH, of Columbia University, shared a statistic in his own presentation at WCIRDC that just 1 in every 4 adults ≤40 years old has had such a test done before.

In the second segment of an interview with 

 during WCIRDC, Moran went into details as to where such young patients need to be targeted for screening—and how.

“I think it’s both a matter of mobilizing awareness in the general public and increasing the demand for an earlier screening,” Moran said. “But definitely I think the primary care community, and the pediatric primary care, there’s a lot of need for information on the benefits of earlier screening.”

Moran also discussed the matter that younger high-risk patients may not be receiving health care in a traditional sense nor in a traditional setting.

“The medical system really isn’t set up for screening and treating young people,” he added. “It’s both a matter of making people aware of the current guidelines, but also innovating in terms of how care is delivered.”

Along with these necessary innovations, there’s a need to better address treatment among younger patients once they’re screened, diagnosed, and prescribed lifelong therapy such as statin. As Moran pointed out, such a treatment initiation is “a big commitment.”

“We have to innovate in that way—it’s not just for cholesterol screening, but for delivering healthcare to younger people in general,” he said.

Lipid testing rates are very low among those under 40 years old. Where do clinicians best target high-risk patients—and how?

Arterial Disease

Arterial Disease condition center page, resources on the topics of medical news and expert insight into PAD / CAD can be found. Content includes articles, interviews, videos, podcasts, and breaking news on peripheral artery and coronary artery disease research, treatment, and drug development.

Where to Screen the Next Generation of Cardiovascular-Risk Patients

Connor Iapoce is an assistant editor for 

 and joined the MJH Life Sciences team in April 2021. He graduated from The College of New Jersey with a degree in Journalism and Professional Writing. He enjoys listening to records, going to concerts, and playing with his cat Squish. You can reach him at 

Previous genome-wide association studies have shown the sortilin 1 (SORT1) gene expression to affect lipid metabolism, identifying it as a risk gene for 

, but little is known about its expression in patients with CAD.

Led by Rajiv Narang, Department of Cardiology, All India Institute of Medical Science, a team of investigators analyzed the expression of SORT1 gene at mRNA and protein level in patients with CAD, observing the differential expression of sortilin throughout different stages of CAD could be a useful biomarker for the disease.

The study was presented at the The Metabolic Institute of America (TMIOA) 2021 World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC) Meeting.

Narang and colleagues noted the target sample size was 150 patients with various clinical and subclinical stages of CAD  and 150 healthy control patients. In these patients, quantitative real time PCR and western blotting influenced the expression of SORT1 at mRNA and protein levels.

They drew the peripheral venous blood from the study subjects. Additionally, extracted RNA was used for the cDNA synthesis and Real time quantitative PCR analysis for the SORT1 gene.

Then, total protein was extracted from the plasma samples and SDS PAGE and western blotting experiments measured expression for Sortilin protein. The plasma level of sortilin was found through enzyme-linked immunosorbent assay.

Data show the relative expression of the SORT1 gene was upregulated by 4.438 fold in patients with CAD, compared to the control samples.

Additionally, SORT1 gene expression level was significantly upregulated by 3.4 fold in single vessel disease patients, 4.7 fold in double vessel disease patients and 6.09 fold in triple vessel disease patients, when compared to healthy control.

There were significant differences in average delta-CT value in SORT gene, with higher circulating levels of sortilin proteins observed in CAD patients with and without diabetes.

The team observed the expression level of SORT1 gene was significantly higher in patients with STEMI compared to NSTEMI and patients with stable angina. Moreover, the expression level of SORT1 gene had a positive association with percentage stenosis in patients with CAD.

Further, they found the difference in expression of the SORT1 gene in patients with angina, myocardial infarction, acute coronary syndrome, CAD with diabetes, while the highest expression was observed in patients with acute coronary syndrome.

The study noted quantitative real time analysis of the SORT1 gene indicated the upregulation of its expression in patients with CAD, compared to control.

“The circulating Sortilin levels in patients with coronary artery disease is higher as compared to healthy individuals,” investigators wrote. “Therefore, there is a positive association of SORT1 gene with Coronary artery disease.”

“Role of SORT1 gene in Patients with Coronary Artery Disease,” was published online by WCIRDC.

Data show the relative expression of SORT1 gene was upregulated by 4.438 fold in patients with CAD, compared to control.

Sortilin 1 Gene Shows Positive Association with Coronary Artery Disease 

A new multi-national study presented at The Metabolic Institute of America (TMIOA) 2021 World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC) Meeting, suggested novel tools and strategies be implemented in clinical settings to empower patients with type 2 diabetes (T2D) and enable effective basal insulin (BI) titration.

This suggestion was in response to only 1/3 of the patients with T2D having reached the fasting blood glucose (FBG) after initiating BI in the study.

For T2D patients undergoing BI treatment, optimal titration of their dose can aid in achieving glycemic control. However, many of them remain uncontrolled for reasons related to a lack of understanding of BI titration.

As such, investigators led by Stewart Harris, MD, MPH, Schulich School of Medicine & Dentistry, The University of Western Ontario, Canada, evaluated the perspectives and experiences of BI titration in people with T2D initiating dosing.

Stewart and investigators identified recent BI initiators through enrollment, medical, and pharmacy records from the Optum Research Database.

Inclusion criteria including 2 years or more of medical claims with a diagnosis for T2D ≥30 days apart in the 12-month sample identification period, which ended in March 2021 for wave 1 and April 2021 for wave 2.

Additionally, ≥1 pharmacy claim for BI (insulin glargine 100 U/mL, insulin glargine 300 U/mL, insulin degludec or insulin detemir) in the most recent month of pharmacy data was also required, as was being 18 years and older as of the index date and 12 months of continuous enrollment with medical and pharmacy benefits prior to index date.

From there, all identified BI initiators were tasked with completing a survey, which included questions on experience with BI titration involving titration resources, healthcare provider (HCP) interactions, self-management of titration, clinical information, titration status, and goal attainment.

A total of 416 BI initiators were included in the study.

Of those 416 survey responders, 51% were male, 71% were white, the mean age was 70 years, and mean BMI kg/m2. The mean age at diagnosis was 51 years, and 72% of responders had T2D for more than a decade.

Harris and colleagues reported that most responders (74%) had BI titration explained to them by their provider, and the majority (67%) were very/extremely satisfied with the support received. Only 5% were not at all satisfied.

Regarding glycemic control and hypoglycemia, most responders documented BI dose (89%) and fasting blood glucose (FBG; 80%) daily

Aside from the 35% of responders reached FBG targets, 58% had not reached FGB and were still titrating while 7% had stopped using BI.

Only half (204, 49%) of partcipants experienced hypoglycemia during titration.

Mean Diabetes Treatment Satisfaction Questionnaire (DTSQ) total score was 28 (range 0–36; higher score indicates greater satisfaction), while mean Patient Activation Measure (PAM) total score was 65.

The score from PAM measured patient’s knowledge, ability, and confidence in managing their own health, on a 100-point scale, with higher scores indicating greater activation levels.

Patients were categorized into 1 of 4 activation levels according to their overall PAM score, and only 6% were categorized as “disengaged and overwhelmed”.

Investigators felt that the study had addressed the lack of understanding about the patient experience with BI titration.

“While many people with T2D initiating BI had received titration education/support, only one-third reached the FBG target, suggesting novel tools and strategies to empower patients and enable effective BI titration are needed,” the team wrote.

Of the 416 basal insulin initiators, only one-third of them reached the appropriate fasting blood glucose level.





New Study Details PWT2D Experiences with Basal Insulin Titration

Dr. Zeitler highlights the long-term microvascular risk complications observed in T2D patients in the TODAY2 observational study. 

Endocrinology

The HCPLive endocrinology page is a comprehensive resource for clinical news and insights on endocrine system conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for diabetes, hormonal disease, and more.

Phil Zeitler, MD: Risk Factor Development in Youth-Onset Type 2 Diabetes

These reductions, investigators noted, were slightly greatest yet not statistically significant.





 Greater Reductions in HbA1c in Insulin-Naïve PW2D Treated with Gla-300

Data show all 7 studies using relative risk found an association between metabolic syndrome and the development of PAD, but one study (RR: 1.31). 

Inconsistencies Observed in Defining Metabolic Syndrome As Risk Factor for PAD 

Guselkumab is the first and only selective interleukin inhibitor therapy in the US that's approved for both moderate-severe plaque psoriasis and active psoriatic arthritis regardless of prior TNFi exposure. 

Rheumatology

Rheumatology condition center page is a comprehensive resource for clinical news and insights on rheumatologic disease. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for arthritis, gout, nr-AxSpA, and more.

Psoriatic Arthritis

On the HCPLive psoriatic arthritis page, resources on the topics of medical news and expert insight into PsA can be found. Content includes articles, interviews, videos, podcasts, and breaking news on arthritis, and more.

Plaque Psoriasis

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

Inflammation

On the HCPLive Inflammation condition center page, resources on the topics of medical news and expert insight into inflammatory disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on psoriatic, rheumatic, and allergic disease research, treatment, and drug development.

Janssen Announces Phase 3 Data Results: Guselkumab Improves PsA Symptoms

The DCRM Task Force recommendations were described as first-of-its-kind guidance for patients with overlapping diabetic, cardiorenal and metabolic disease.

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.

Internal Medicine

Internal Medicine condition center page, resources on the topics of medical news and expert insight into internal medicine can be found. Content includes articles, interviews, videos, podcasts, and breaking news on internal medicine research, treatment, and drug development.

Diabetes Cardiorenal & Metabolism Institute Share New Care Recommendations

Data show cfPWV at 17.7 years was independently and directly associated with total fat mass and trunk fat mass at 24.5 years. 

Arterial Stiffness Bidirectionally Associated with General, Central Adiposity in Adolescents 

Investigators added that they interact directly with the insulin signal transmission pathways.





Adipocytokines, Oxidized LDL Aid in Metabolic Balance in Hypertensive Patients.

Investigators also reported that cardiorespiratory fitness was superior in patients with complete revascularization when compared to the patients with incomplete revascularization.





Complete Revascularization in ACS Patients Related to Cardiorespiratory Fitness 

Expert clinicians discuss insulin therapy for treating type 2 diabetes and comment on what to look forward to in the future of diabetes care.

Insulin Therapy and the Future of Type 2 Diabetes Care

Drs Dennis Bruemmer and Jennifer Green review recent trial data on a novel combination of GIP and GLP1 receptor agonists to treat type 2 diabetes.

Latest News

Bisphenol-A Linked to Insulin Resistance in Diabetic Patients

Erin D. Michos, MD, MHS: Managing Dyslipidemia with Novel Agents

Where to Screen the Next Generation of Cardiovascular-Risk Patients

Sortilin 1 Gene Shows Positive Association with Coronary Artery Disease

New Study Details PWT2D Experiences with Basal Insulin Titration