Acromegaly: Jan Brady No More?

Diabetes got a lot of the attention at the annual meeting of the American Association of Clinical Endocrinologists in San Diego, and with good reason. We know that diabetes research is important.

But a clinical endocrinology meeting is about more than diabetes. Other studies presented here focused on the endocrine conditions that don’t usually make the front pages in the mainstream media, but the research represents work that is equally important to the clinicians who have made these conditions the focus of their careers, as well as to the patients those physicians hope to help.

Take acromegaly, a condition caused by abnormal production of growth hormone that causes various tissues in the body to enlarge. Acromegaly occurs in 6 of 100,000 adults, according to the website of the National Library of Medicine.

photo copyright Elsevier, Inc.

This condition isn’t nearly as common as diabetes, but this year’s AACE meeting highlighted some hope for these patients. A drug called octreotide helps acromegaly patients by controlling the release of growth hormone, but the current standard treatment involves monthly injections. Preliminary data presented at the meeting showed that an octreotide hydrogel implant can provide steady release of the drug for 6 months, which would make a real difference in the quality of life of these patients.

Other common endocrine disorders got their day in the sun in San Diego: thyroid and parathyroid disorders were featured in hot topics sessions, and a general session was dedicated to a review of recent guidelines for managing osteoporosis.

And, “Medical Therapy for Acromegaly” got its own general session. But wait, there’s more. The AACE is issuing new clinical practice guidelines for the diagnosis and treatment of acromegaly later this year.

If diabetes is the Marcia Brady of endocrinology, perhaps acromegaly is Jan, but it looks like this year she’s coming out of Marcia’s shadow.

courtesy of flickr user Roadsidepictures (creative commons)

–Heidi Splete (on twitter @hsplete)

The Lowdown on Low Blood Sugar: 55% of Type 2 Diabetics Report Hypoglycemia

 From the annual meeting of the American Association of Clinical Endocrinologists (AACE), San Diego,CA:

More than half of adults in the U.S. with type 2 diabetes have had a low blood sugar episode, based on data from a survey of 2,530 adults diagnosed with type 2 diabetes. The online survey was developed by the American College of Endocrinology (ACE), the educational and scientific arm of the AACE, and supported by Merck. The survey was conducted in November and December 2010.

photo by Heidi Splete

Notably, 42% experienced hypoglycemia while working, 26% reported it while exercising, and 19% reported it while driving.

“We know that hypoglycemia is very common,” Dr. Etie Moghissi, vice president of AACE. “The surprising part was that these had occurred during daily activities.” Dr. Moghissi presented the survey findings during a press briefing at the meeting.

Although a majority of the respondents knew that dizziness and shakiness were signs of hypoglycemia, 22% and 17% of respondents, respectively, were unaware that these symptoms could be hypoglycemia signs. In addition, 46%, 35%, and 27%, respectively, could not identify excessive exercise, certain diabetes medications, and skipping meals (particularly breakfast) as hypoglycemia triggers.

Furthermore, 6% of diabetes patients who reported hypoglycemia ended up in the emergency department as a result, and 21% said they needed help from someone to manage the episode.

 “Hypoglycemia is underappreciated by both patients and health care providers,” Dr. Moghissi said. To help patients (and health care providers) learn more about what causes high or low blood sugar, ACE has developed a Web site, www.BloodSugarBasics.com. The site, supported by Merck, features fact pages, downloadable information, and interactive features, Dr. Moghissi noted.

–Heidi Splete (on twitter @hsplete)

Walgreens’ Ill-Timed Entry Into The Diabetes Fray

The nation’s biggest drugstore chain, Walgreens, announced today that it is extending its many-tentacled health care strategy into diabetes care — a move that’s sure to irritate the nation’s endocrinologists, and perhaps primary care docs, too.

Courtesy of Walgreens

The company’s senior vice president of pharmacy told the Wall St. Journal that the company aims to enhance primary care physicians’ services, not replace them.  But the announcement comes at a time when primary care doctors are hoping to bring patients into all-inclusive, care-coordinated medical homes, not lose them piecemeal to various and sundry providers.

And, if the diabetic never makes it to the primary care physician — or only occasionally — he or she might not ever get referred to an endocrinologist.  Endocrinologists, in the quest for the diabetic patient, are also hoping to be the medical home care coordinator.

But endocrinologists are starting to feel like they might not get any patients at all.  A Medicare rule that went into effect Jan. 1 means that endocrinologists and other specialists are no longer able to bill for the extra time it takes to meet with a patient who’s been referred by a primary care doctor or other specialist.  These Medicare consultation codes were eliminated for 2010, in what some doctors see as a move to shift more dollars back to primary care.

The American Association of Clinical Endocrinologists (AACE) has led a petition drive to get Congress to adopt  Sen. Arlen Specter’s (D-Penn.) health reform bill amendment to delay the Medicare move by a year.  Gastroenterologists also joined the effort.

As far as physicians are concerned, there may never have been an optimal time for Walgreens to announce it was trying to take a piece of their business away.  But now seems an especially unpolitic time to do so.

— Alicia Ault (on Twitter @aliciaault)