Society for Endocrinology Clinical Update 2009

Clinical Update, Manchester, 02-04 November, 2009

This is the third in the series of residential clinical training events providing essential training for all trainees and new consultants. The excellent collegiate atmosphere generated at the meeting provides an effective forum for networking opportunities with peers and established endocrinologists; the thirty faculty members will attend for the majority of the three days.

The event incorporates the Society’s Summer School and the Oxford Advanced Endocrinology Seminar series. 

Over a three-year period, the programme covers the national curriculum in endocrinology & diabetes and is the UK’s premier national training event.  Sessions will comprise didactic lectures for all delegates and a number of parallel, themed, interactive workshops.  These workshops will be repeated a number of times providing delegates with the opportunity of attending all sessions over the three days.

Vitamin D Deficiency In The Obese Patient Awaiting Bariatric Surgery

 Vitamin D insufficiency prior to bariatric surgery: risk factors and a pilot treatment study

In a population where severe obesity is becoming increasingly prevalent, bariatric surgery is being employed more often.  This study assessed the vitamin D status of such patients and looked at other influential factors as well as evaluating the efficacy of 2 preoperative vitamin D repletion regimens.

Obesity and the risk of pancreatic cancer

Body Mass Index and Risk, Age of Onset, and Survival in Patients With Pancreatic Cancer. Donghui Li; Jeffrey S. Morris; Jun Liu; Manal M. Hassan; R. Sue Day; Melissa L. Bondy; James L. Abbruzzese. JAMA 2009;301(24):2553-2562

This case-control study by Li and colleagues adds pancreatic cancer to the growing list of cancers,  including of the colon, kidney,  oesophagus, breast (in post-menopausal women) and endometrium, that  are now recognised to be associated with obesity. The study included 841 patients with pancreatic adenocarcinoma and 754 healthy individuals frequency matched by age, race, and sex. Overweight or obesity during early adulthood was associated with a greater risk of pancreatic cancer and a younger age of disease onset. Obesity at an older age was associated with a lower overall survival in patients with pancreatic cancer.

Diabetic retinopathy, but not nephropathy, benefits from angiotensin receptor blocking

A very interesting study which explores the role of angiotensin receptor blocking treatment in preventing diabetic nephropathy in normotensive and normoalbuminuric patients. The benefits of early introduction of ACEI/ARB treatment in slowing progression of nephropathy in albuminuric patients has already been established but the investigators of this study conclude that such treatment has no benefit in preventing biopsy  proven nephropathy in normoalbuminuric patients.

Renal and Retinal Effects of Enalapril and Losartan in Type 1 Diabetes. Michael Mauer, M.D., Bernard Zinman, M.D., Robert Gardiner, M.D., Samy Suissa, Ph.D., Alan Sinaiko, M.D., Trudy Strand, R.N., Keith Drummond, M.D., Sandra Donnelly, M.D., Paul Goodyer, M.D., Marie Claire Gubler, M.D., and Ronald Klein, M.D., M.P.H. N Engl J Med 2009 361: 40-51

Background Nephropathy and retinopathy remain important complications of type 1 diabetes. It is unclear whether their progression is slowed by early administration of drugs that block the renin–angiotensin system.
Methods We conducted a multicenter, controlled trial involving 285 normotensive patients with type 1 diabetes and normoalbuminuria and who were randomly assigned to receive losartan (100 mg daily), enalapril (20 mg daily), or placebo and followed for 5 years. The primary end point was a change in the fraction of glomerular volume occupied by mesangium in kidney-biopsy specimens. The retinopathy end point was a progression on a retinopathy severity scale of two steps or more. Intention-to-treat analysis was performed with the use of linear regression and logistic-regression models.
Results A total of 90% and 82% of patients had complete renal-biopsy and retinopathy data, respectively. Change in mesangial fractional volume per glomerulus over the 5-year period did not differ significantly between the placebo group (0.016 units) and the enalapril group (0.005, P=0.38) or the losartan group (0.026, P=0.26), nor were there significant treatment benefits for other biopsy-assessed renal structural variables. The 5-year cumulative incidence of microalbuminuria was 6% in the placebo group; the incidence was higher with losartan (17%, P=0.01 by the log-rank test) but not with enalapril (4%, P=0.96 by the log-rank test). As compared with placebo, the odds of retinopathy progression by two steps or more was reduced by 65% with enalapril (odds ratio, 0.35; 95% confidence interval [CI], 0.14 to 0.85) and by 70% with losartan (odds ratio, 0.30; 95% CI, 0.12 to 0.73), independently of changes in blood pressure. There were three biopsy-related serious adverse events that completely resolved. Chronic cough occurred in 12 patients receiving enalapril, 6 receiving losartan, and 4 receiving placebo.
Conclusions Early blockade of the renin–angiotensin system in patients with type 1 diabetes did not slow nephropathy progression but slowed the progression of retinopathy.