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Top 8 updates in endocrinology from the ACP Internal Medicine Meeting

The most important medical studies of 2014 in the field of endocrinology addressed a wide range of topics, including bariatric surgery as a means of inducing diabetes remission, the value of daily vitamin D supplementation in preventing osteoporotic fracture, and the use of corticosteroids in patients with septic shock, to name a few.

Summaries of the selected studies appeared in the Annals of Internal Medicine as part of its Summaries of the Year’s Most Important Studies Pertaining to the Practice of Internal Medicine. The summaries of the studies, which were chosen for their contribution to the advancement of various aspects of internal medicine, were published to coincide with the 100th Annual ACP Internal Medicine Meeting.

The following are the top 8 scientific updates of 2014 in the field of endocrinology. 

1. In older adults, using sulfonylureas with commonly prescribed antimicrobial agents may increase hypoglycemia risk.

This retrospective cohort study found that after adjusting for patient characteristics, the use of sulfonylureas concomitant with clarithromycin, levofloxacin, trimethoprim-suflamethoxazole, metronidazole or ciprofloxacin was associated with increased hypoglycemia risk in older patients.

“Avoidance of these medication combinations may increase patient safety and reduce health care costs,” the researchers wrote.

2. Bariatric surgery may play a role in achieving diabetes remission.

In a prespecified secondary endpoint analysis of participants in the Swedish Obese Subjects (SOS) study, researchers found that bariatric surgery may have usefulness for inducing diabetes remission and decreasing complication rates in obese patients.

“Randomized trials with robust long-term follow-up and comprehensive evaluation of glucose metabolism are needed to better define the role of such interventions in diabetes management,” the researchers wrote. 

3. The adjunctive use of niacin with statins confers no cardiovascular benefits and increases metabolic and infectious complications.

Data from the HPS2-THRIVE trial found that in 25,673 patients aged 50 to 80 years with known cardiovascular disease, a regimen of statin-based therapy followed by extended-release niacin and laropiprant did not decrease the incidence of major cardiovascular events vs. placebo, and was associated with higher rates of adverse events and risk for death.

“Although not specifically addressed in this study, niacin therapy might still be considered for truly statin-intolerant or severely hypertriglyceridemic patients,” the researchers wrote.

4. A Mediterranean diet supplemented with extra-virgin olive oil may decrease diabetes in older patients at increased risk of diabetes.

In a subgroup analysis of the PREDIMED study, researchers found that among 3,541 patients without baseline diabetes, those eating a Mediterranean diet supplemented with extra-virgin olive oil had a lower cumulative incidence of diabetes at 4.1 years (6.93%) vs. patients on a Mediterranean diet plus mixed nuts (7.42%), or a control group (8.81%).

“This dietary strategy, if affordable and reproducible in other regions, represents a promising alternative in diabetes prevention,” the researchers wrote. 

5. Vitamin D plus calcium supplementation may decrease fractures in postmenopausal women and older men.

In this review of data from 53 trials including 91,791 postmenopausal women or older men, researchers found that vs. placebo, calcium supplementation or no intervention, vitamin D supplementation did not decrease the risk for hip or other fractures. However, vitamin D plus calcium was associated with a reduction in new fractures among patients with no previous fracture history vs. those with a history of fracture.

“Vitamin D with calcium may prevent some fractures in older adults, particularly in those without a prior fracture history,” the researchers wrote. “The effects of higher doses of vitamin D require further study, but must be weighed against an increased risk for adverse events.”

6. There is a lack of comparative data available to inform choices in the management of osteoporosis.

According to this review of 315 publications reporting fracture outcomes or adverse events, few studies reported on comparisons between pharmacological therapies, and only one randomized trial evaluated fracture prevention in men.

“With some exceptions, therapies appear to be of similar effectiveness,” the researchers wrote.  “Future studies should directly compare pharmacologic agents because undetected differences may exist, and men should be included because they have been under-represented in trials thus far. “

7. In severely ill patients with septic shock, physiological doses of corticosteroids may decrease mortality.

This retrospective study found that although physiologic corticosteroid therapy may confer decreased mortality to the most severely ill patients with sepsis, the routine implementation of this strategy for sepsis management may be of dubious value.

“The findings are thought-provoking but inconclusive,” the researchers wrote. “Prospective, randomized trials are needed to understand the effects of corticosteroid therapy in patients with varying severities of illness. “

8. The recent increase in thyroid cancer diagnoses may reflect increased disease detection rather than an increase in disease burden.

In this high-level review, researchers found that increases in thyroid cancer diagnosis within the context of stable thyroid cancer mortality suggest an “epidemic of detection.”

“Because the standard treatment of thyroid cancer includes surgical resection and, often, radiation therapy, the complete stability of thyroid cancer mortality over the same period should raise concern,” the researchers wrote. “Guidelines for the management of thyroid nodules and thyroid cancer should be re-evaluated in light of this information, with active surveillance considered as a management option.”