From Bench to Bedside: ENDO 2019 Ties Science to Clinical Care

Miriam E. Tucker

March 18, 2019

ENDO 2019: The Endocrine Society Annual Meeting promises to bring scientific research and technology straight into the realm of clinical endocrinology practice, organizers say. 

The meeting takes place March 23-26 in New Orleans.

"For clinicians, what distinguishes ENDO from other meetings is that you get a curated view of what is the newest, hottest, and best in science, which you know in a couple of years, if not sooner, is going to be impacting care," Endocrine Society president Susan J. Mandel, MD, told Medscape Medical News.

"We give you the best in cutting-edge clinical practice, but in addition, there is the whole dimension of science and it's really exciting," she added.

The steering committee's clinical science chair, Ghada El-Hajj Fuleihan, MD, professor of medicine at the American University of Beirut Medical Center, Lebanon, agrees, telling Medscape Medical News that the meeting will "help members position themselves in understanding how new technologies will harness and augment the practice of endocrinology in a superior and more efficient way."

Clinical highlights of the meeting include new practice guidelines on four topics, including the pharmacologic management of osteoporosis in post-menopausal women and the treatment of diabetes in older adults.

There will also be two exciting debates, one on a topic close to everyone's heart — what target HbA1c clinicians should aim for in people with diabetes. And the other is on an equally contentious issue — screening for thyroid disease in pregnancy.

Hot Topic Debate on ADA vs ACP Guidelines

Conference highlights include an opening keynote address by Francis S. Collins, MD, PhD, director of the National Institutes of Health, on "Whole genome approaches to unraveling diseases," and other plenary talks on "big data," gene editing, and stem cells.

"The plenaries are an opportunity to learn state-of-the-art science...It's a way to hear about advances that will impact clinical care in the future," said Mandel, who is professor of medicine and radiology and associate chief, division of endocrinology, diabetes, and metabolism, University of Pennsylvania, Philadelphia.

In addition to sessions on the new clinical practice guidelines on osteoporosis and diabetes, the other two sessions will cover congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency and hypothalamic-pituitary and growth disorders in survivors of childhood cancer.  

Meanwhile, the first hot topic clinical debate, on HbA1c, will pit John B. Buse, MD, a coauthor of the American Diabetes Association (ADA) guidelines, who will argue for targeting an HbA1c < 7%, against American College of Physicians (ACP) guideline coauthor Timothy J. Wilt, MD, who will argue for a looser HbA1c target of 7% to 8%.

The ACP's 2018 announcement of that departure from long-time guidance set off a firestorm of opposition from professionals in the diabetes community last year.

El-Hajj Fuleihan commented: "I think this debate will be quite interesting. The Endocrine Society does not promote other society's guidelines, but I think the particular benefit of this debate is that it will help resolve some of the confusion these two sets of guidelines led to among practitioners."

"The debate brings together two world experts...to identify the differences and point out similarities, thus affording [attendees] a solid grasp of nuances that may have been overshadowed by confusing commentaries and lay press."

New Data Will Inform Debate on Thyroid Screening in Pregnancy

A debate on whether or not to screen for thyroid disease in pregnant women will feature Alex Stagnaro-Green, MD, University of Illinois College of Medicine, Rockford, speaking for the practice, and Kristien Boelaert, MD, PhD, of the University of Birmingham, UK, who is speaking against the practice.

The debate will take place 3 days after the presentation of results from an oral abstract that could influence their arguments: the first-ever randomized trial investigating pregnancy outcomes following preconception use of levothyroxine in euthyroid women with positive thyroid peroxidase antibodies.

A 2017 trial, published in the New England Journal of Medicine, found no effect on pregnancy outcomes from treatment of subclinical hypothyroidism and hypothyroxinemia during pregnancy.

But the study — and others like it that had similar findings — included women who started treatment when already pregnant, typically in the second trimester, Mandel points out.

"Maybe the adverse effects happen earlier...It may be that you miss the window to effect change by starting in pregnancy rather than before conception," she said.

If the trial results show an effect of preconception thyroid hormone replacement on pregnancy outcomes it would support the practice of screening at least some pregnant women, such as those with a family history of thyroid disease or autoimmunity.   

How AI Will Contribute to Care in Endocrinology

Some additional news-making clinical research will include a report on how using HbA1c misses many cases of diabetes; long-term opioid use and hormone deficiencies; the link between prenatal HIV exposure and later obesity; and the benefits of walking downhill on bone health.

And a new "meeting within a meeting" feature will combine basic and translational science presentations under three subject areas: neuroendocrinology, nuclear receptors and gene regulation, and reproductive endocrinology.

Meanwhile, the topic of this year's special "Year in" session will be artificial intelligence (AI) and digital health.

Three speakers will review research from the past year on how AI enhances health care with a focus on diabetes, the role of AI in diabetic retinopathy care, and use of electronic health record data to predict and prevent adverse health outcomes such as hypoglycemia.  

El-Hajj Fuleihan, who is also founding director of the Calcium Metabolism and Osteoporosis Program at the World Health Organization's Collaborating Center for Metabolic Bone Disorders, had championed this particular topic for the ENDO program.

"This is a session I really lobbied for and am very much looking forward to...We are hoping that although this special session falls on the last day of the meeting it will draw solid attendance in view of its anticipated huge impact on clinical practice."    

Mandel is also excited about the session. "It's so important because AI is going to transform what we do in practice. If you could use AI to predict readmissions in patients with diabetes or whether adverse outcomes are going to happen in subclinical Cushing's...it's a huge opportunity." 

Understanding How Genetic Tools Will Aid Endocrine Evaluation

Lastly, two "Scientific literacy" sessions are designed to help clinicians understand important basic science tools that are bringing discovery to the bedside.

One will focus on approaches to evaluating genetic disorders, the other on epigenetics and endocrine disease. 

According to El-Hajj Fuleihan, "The concept is to introduce clinicians to basic science tools. Some of the best papers providing evidence that may transform clinical practice are based on such tools."

To date such papers "are often very intimidating because of the dense methodology used. We would like to offer clinicians insight into these powerful tools and understanding of how they can be used in the diagnosis and prognosis of endocrine diseases."

Overall, Mandel hopes clinicians benefit from the exchange with other endocrinology stakeholders that the conference affords.

"I hope clinicians will enjoy the huge, rich Endocrine Society community and derive a sense of excitement, stimulation, and learning from the speakers. I hope they'll take the information back and share it with their colleagues and carry it forward to their patients...and hopefully come back next year."

Medscape US at ENDO 2019: Meet us at booth #2319 and receive a special thank you gift.

Mandel and El-Hajj Fuleihan have reported no relevant financial relationships.

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