Endpoints for bone drugs, PCOS, transgender care and more: Cover stories in 2021

Via Peters

December 28, 2021

3 min read

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Endocrine Today editors have compiled the top cover stories published in 2021.

Readers were interested in the need for better criteria to define and treat polycystic ovary syndrome; changes in access to gender-affirming care for minors; the approval of semaglutide for obesity; and more.

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Better evidence needed to define, treat PCOS

Accurate and early diagnosis is essential for women with polycystic ovary syndrome to prevent long-term health consequences; however, confusion persists over diagnostic criteria and the optimal management of metabolic symptoms. NICHD is seeking investigators to apply for funding to optimize treatments of comorbid conditions in adolescents and reproductive-age women with PCOS.


Endpoints beyond fracture promise to facilitate shorter trials, new osteoporosis research

Phase 3 drug trials for osteoporosis therapies require a primary outcome of fracture and have become almost impossible to conduct. Investigators have now proposed a validated alternative outcome for fracture — change in bone mineral density — to serve as a surrogate endpoint to push forward promising osteoporosis agents that have stalled in the development pipeline.


Gender care for minors requires teamwork, centers on family

In a little more than a decade, access to gender-affirming care for minors has increased greatly across the U.S. Multiple studies have shown gender care for children is associated with better mental health outcomes and quality of life.


‘A new era’: How semaglutide could change the obesity treatment landscape

Approved treatments for obesity — particularly pharmacotherapy — remain underutilized, according to experts. But a new agent with remarkable efficacy may change that. In June, the FDA approved once-weekly injectable semaglutide 2.4 mg (Wegovy, Novo Nordisk) for chronic weight management in adults with obesity or with overweight and at least one weight-related condition.


New drugs bring dual benefits to ‘intertwined’ diabetic kidney disease, CVD

Diabetic kidney disease is the leading cause of end-stage renal disease in the U.S., and 50% of adults initiating renal replacement therapy have diabetes, according to the CDC. Until recently, there were no proven therapies that could substantially alter the timeline to ESRD or CV death for this population. Now, new agents are upending the treatment paradigm for DKD, offering the promise of delaying or even preventing dialysis, along with significant reduction in heart failure hospitalization risk and CV death.


Diabetes drugs now ‘pillars of care’ for heart failure

Heart failure and type 2 diabetes are intertwined. People with type 2 diabetes are two to four times more likely to develop heart failure than a person without type 2 diabetes, and HF is also a risk factor for type 2 diabetes, with insulin resistance often the mechanism linking the two. Until recently, cardiologists, and to some extent, endocrinologists managing diabetes, had few good options for these patients. Now, SGLT2 inhibitors may hold the keys to not just preventing HF, but treating existing HF, even for people without diabetes.


CGM as medicine: Technology benefits extend to type 2 diabetes

Continuous glucose monitoring has been standard of care for people with type 1 diabetes for more than 20 years. For people with type 2 diabetes, few efficacy trials of real-time CGM have been conducted. However, recent data show that improvements in glucose management, time spent in the recommended glucose range, and reductions in hypoglycemia also extend to people with type 2 diabetes.


Intersection between heart and liver a rapidly evolving field

About 25% of U.S. adults have nonalcoholic fatty liver disease. NAFLD can progress to nonalcoholic steatohepatitis, which is a leading indication for liver transplant. However, most patients with NAFLD die of cardiovascular disease, not liver disease. In July, eight professional societies joined together to publish a “call to action” on the dangers associated with NAFLD and NASH, calling on endocrinologists, cardiologists, hepatologists, primary care physicians, nutritionists and exercise physiologists to work together and align treatment strategies.


Increased molecular testing accelerates precision thyroid nodule management, cancer care

Each year, approximately 600,000 U.S. residents with thyroid nodules undergo a fine-needle aspiration biopsy. While FNA is mostly accurate, and most nodules are benign, the test returns an indeterminate finding in 20% to 25% of cases. In the past, treatment options for indeterminate nodules were limited to watching the nodule or removing it. Today, management of indeterminate thyroid nodules has expanded to include molecular testing that measures genomic changes in tissue samples taken from the thyroid.


Thyroid eye disease requires joint management with ophthalmologists

Thyroid eye disease is mostly associated with Graves’ disease but can also stem from Hashimoto’s thyroiditis and even develop in people who didn’t know they have thyroid disease. The disease, which is triggered by an immune response to activity in the thyroid that causes a cross-reaction to the tissues around the eye, can cause a number of symptoms, including proptosis, eyelid retraction and inflammation, compression of the optic nerve and more. The disease requires collaborative management between ophthalmologists and endocrinologists.



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