The Top 10 Diabetes & Endocrinology Stories in 2024

Medscape Medical News took a deep dive into the diabetes and endocrinology stories of 2024 to develop a list of the 10 most read — those that piqued our readers’ interest and, sometimes, their ire. Dig in as we count down!

No surprise that what was described as the first clinical comparative effectiveness study of tirzepatide (Mounjaro, Eli Lilly) and semaglutide (Ozempic, Novo Nordisk) garnered substantial interest.

The study included close to 10,000 adults with overweight or obesity in each group, half of whom had type 2 diabetes (T2D). They were followed for a mean of 165 days. The proportions achieving at least 5%, 10%, and 15% weight loss within 1 year with tirzepatide vs semaglutide were 81.8% vs 66.5%, 62.1% vs 37.1%, and 42.3% vs 18.1%, respectively. The authors acknowledged limitations, including possible unmeasured confounders and reliance on electronic health record data and on brand as dosing proxy.

Comments regarding the usefulness of the drugs overall were mixed, with several commentators pointing to lack of access and others with questions about the study. Howard Selden, MD, a general practitioner in Canada, pointed out that a comparative study looking at other potential benefits of semaglutide — for example, T2D, lipids, and dementia — would be helpful, as well as a comparison of on/off-label uses and adverse events.

Tirzepatide may have lost in the weight loss comparison with semaglutide, but it was a winner in obstructive sleep apnea (OSA).

In the SURMOUNT-OSA studies, presented at the American Diabetes Association (ADA) 84th Scientific Sessions and simultaneously published online in The New England Journal of Medicine, up to half of study participants with obesity and OSA who received tirzepatide in both trials had less than five events per hour or 5-14 apnea-hypopnea index events per hour and an Epworth Sleepiness Scale score ≤ 10. Indeed, tirzepatide was so effective at reducing sleep disruptions in participants that 40%-50% no longer needed to use a continuous positive airway pressure device.

Readers responded favorably; commentators were skeptical.

“So many questions! Lifetime tirzepatide is not going to happen. In my clinical experience, effective treatment of obesity does not automatically eradicate sleep apnea when patients are restudied. Did these patients at least have an airway score? Lots of wiggle room in those stats,” wrote Dan Baker, MD, a family medicine physician.

“Another way of stating this headline is ‘Weight Loss Improves Sleep Apnea Symptoms.’ We already know that,” wrote endocrinologist Gary Pepper. “But are we being asked to believe our patients now need this expensive medication to achieve this goal?”

This story on an implantable, removable gut liner called EndoBarrier (RESET, Morphic Medical, United States) was popular with readers, but for the most part, commentators were not kind.

During an approximately 1-hour endoscopic procedure, the thin impermeable sleeve is inserted, lining the first 60 cm of the small intestine. Digested food passes through it unabsorbed and then makes contact with pancreatic and bile juices at the other end. This triggers a change in glucose and nutrient metabolism by modulating gut hormones and gut bacteria, as well as disrupting the bile flow.

Data presented at the Diabetes UK Professional Conference 2024 showed that out of 90 patients, 66% completed the study. Upon removal of the liner at 12 months post-implantation, mean weight loss was 16.7 kg, body mass index dropped by a mean of 6, A1c dropped by a mean of 1.8%, and mean systolic blood pressure dropped by 10.9 mm Hg.

Just over half the participants maintained their improvement 2 years after the liner’s removal.

Commentators pointed out that similar devices were previously reported to have dislodged, resulting in bowel obstruction and hepatic abscesses.

Brendan Hanrahan, MD, an internal medicine specialist in Australia, also noted there was no mention of the device’s withdrawal from the market.

“There’s even a Medscape article from 2018 talking about trying to resurrect EndoBarrier then,” Hanrahan wrote. “Personally, I always thought it promising and the risks manageable, but at this time, presenting what sounds like the original 2012 data again without mention of the later issues seems irresponsible.”

This story on an in silico study that identified two plant-based bioactive compounds with potential as GLP-1 receptor agonists (GLP-1 RAs) for weight loss drew both engagement and comments questioning the value of such early findings and cautioning that just because a compound is naturally occurring does not necessarily mean it’s safe.

Researchers focused on using AI to identify new non-peptidic, naturally derived bioactive compounds to activate the GLP-1 RA compounds they thought might be easier to administer and less toxic than the new weight loss drugs. After screening more than 10,000 compounds, they arrived at a shortlist of 65, according to data presented at the European Congress on Obesity. Two compounds with the highest potential as GLP-1 RAs, dubbed Compounds A and B, were found to be promising and are being investigated further in vitro as potential obesity treatments.

Readers more receptive to the use of natural vs synthetic compounds were still skeptical about whether such compounds would actually be developed, given industry interests.

For example, Ryan Ismail, MD, an internal medicine physician in California, wrote, “Cheap and naturally occurring compounds that are beneficial for the human condition surely will end up on the Schedule 1 federal list of illegal compounds. If you can’t profit from it, if it’s too easy to grow, it’s regulated to death.”

This commentary garnered readers’ interest and generally favorable comments. Its author Akshay B. Jain, MD, pinpointed glucocorticoids, antipsychotics, thiazide diuretics, statins, and beta-blockers as drugs with the potential to increase blood glucose levels. He also gave an “honorable mention” to androgen deprivation therapy, noting that close to one out of five men treated with this therapy over the long term may be prone to developing worsening of A1c by 1% or more.

The commentary also offered practical information, with explanations of proposed mechanisms of action and management tips.

Several readers pointed out that some of the information is well known, but Lynn Wolff, an advanced practice nurse in Philadelphia, wrote, “Appreciate the clear explanations for the processes by which these meds induce hyperglycemia! Thank you!”

Amycretin led to up to 13% body weight loss in participants with overweight or obesity in a phase 1, first-in-human study, according to data presented at the European Association for the Study of Diabetes 2024 annual meeting. The drug is a novel protein-based unimolecular amylin combined with a GLP-1 RA and is the first oral formulation of this combination under development.

The single-center, placebo-controlled dose-escalation study demonstrated that all tested doses up to and including 2 × 50 mg were safe and tolerable. Gastrointestinal events were mostly mild to moderate and were experienced by 50%, 87.5%, and 16.7% of participants receiving amycretin 50 mg, amycretin 2 × 50 mg, and placebo, respectively. Novo Nordisk, which is developing the drug, said the magnitude of weight loss supports future development in patients with overweight or obesity.

While readers responded favorably, commentators were embroiled in controversies over whether weight loss drugs are really needed, whether patients can lose weight with various modes of eating and exercising, and whether individuals with overweight are really taking responsibility for keeping their bodies healthy.

Why do many people plateau after losing weight consistently on the new drugs? Experts suggest it happens because the body eventually acclimates to the intervention (and this is true even with older drugs and bariatric surgery), so it no longer has the same effect.

In addition, losing weight generally entails losing both fat and lean body mass, and that loss of lean mass causes the metabolism to slow down. Eventually, the number of calories you’re taking in matches your metabolic rate, and you stop losing weight, even if you’re eating less than when your weight was higher.

More important for general practice is what to do to help patients manage the plateau and move through it?

Suggestions included adding a different drug, getting patients off other drugs that cause weight gain, and tapering the drug dose. And, of course, emphasizing lifestyle changes, including exercise.

Most of the commentators focused on this last point and, like commentators on the amycretin story, implied that people with overweight and obesity need to take responsibility for their weight and make changes in diet and exercise habits.

Sara A., an advanced practice nurse in New Jersey, said, “People aren’t being taught lifestyle changes. People want to continue to eat and not exercise. We should be pushing nutritional education and healthy living the way drugs are pushed.”

David Kiernan, a healthcare provider in Canada, agreed but said more than 20 years working in cardiovascular rehabilitation makes him skeptical that this will change. “I hear that patients want to ‘get off these medications’ but will turn to the meds instead of making necessary lifestyle changes.”

Bruce Stenman, a health business administrator in California, wrote that pills and surgery are passive ways to lose weight, noting, “All these passive approaches are far more expensive than the cost of a gym membership and a fitness coach.”

Rather than simply panning compounded GLP-1s or defending compounders, cardiologist Eldad Einav, MD, medical director of cardiometabolic health in Guthrie Lourdes in Binghamton, New York,provided a balanced view of the risks and benefits of using compounded weight loss drugs and offered advice on when to consider prescribing these drugs and what to tell patients.

He also offered a novel solution to the compounding controversy: “Rather than outright banning compounded GLP-1 medications, expert associations can contribute to the solution by creating a ‘seal of approval,’ recognizing high-quality compounded medications. This would contribute to informed decision-making for clinicians and patients.”

Whether this will happen is an open question, although the outlook likely is not promising, given the recent statement from the ADA advising against the use of compounded GLP-1 RAs and dual glucose-dependent insulinotropic polypeptide/GLP-1 RA medication classes.

Comments on the article were made before the ADA statement was released. Commentators generally appreciated the article, though some questioned where compounders are getting the active compounds while the drugs are in shortage. Others wondered how they could find legitimate, reputable compounding pharmacies when they have little experience using them.

Summer Lepley, MD, an internal medicine physician in Oklahoma, wrote, “As an internist certified in obesity medicine, I incorporate GLP-1s into my primary care practice almost as often as insurance/supply allows. I took the FDA and OMA [Obesity Medicine Association] statements warning against compounded versions to heart and yours is the first statement to make me reconsider that.”

This story tackles the “oatzempic” diet popularized on social media. In it, two registered dietitians responded to questions about whether the diet could help people lose weight, whether it’s safe for people with diabetes, and how clinicians can respond to patients about safe and effective diets. For the most part, the dietitians cautioned against the diet (and the related “ricezempic” diet) and suggested that doctors be advised to share information from the Academy of Nutrition and Dietetics and the ADA.

While the story was popular with readers, commentators were not kind. They questioned the validity of the opinions in the article because no real data exist.

For example, H. Robert Silverstein, MD, a physician in Connecticut, wrote that the opinions are “no more than an educated guess…It is unfair to disregard the possibility that either rice- or oatzempic might be effective in some people and, as benign/inexpensive as they are, deserve a trial.”

Medscape Medical News’ coverage of the recent Endocrine Society guideline on screening for vitamin D triggered an outpouring of contentious comments, with some commentators even erroneously blaming the writer who reported on the guideline for the society’s recommendations.

The guideline recommends against routine screening, while pinpointing several groups who might benefit from screening, such as adults older than 75 years to lower the risk for mortality and adults with prediabetes to lower the risk for T2D.

Given the scale of the negative comments, Medscape Medical News did a follow-up story on readers’ objections to the guideline. Many said the guideline ignores potential benefits for a much wider population — in particular, benefits for conditions such as oral health that don’t fall under endocrinology — and some commentators suggested the society may have been influenced by pharma and/or insurance company considerations.

Overall, readers brought up situations where vitamin D screening helped patients, and many questioned why they had to be told what to do by a guideline.

As Richard Lachiver, MD, a preventive medicine physician in Tennessee, quipped, “I suppose that without a guideline, most doctors will fail to exercise prudent and patient-centric advice.”

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.