News & Views in 2018

In a longitudinal study that tracked BMI from early life, most children with obesity at age 3 years had overweight or obesity by adolescence. Of adolescents with obesity, ~50% were affected by overweight or obesity from age 5 years onwards, and the most rapid increase in BMI had occurred between 2 and 6 years of age.

Evidence for the predictive value of IADPSG/WHO2013 diagnostic gestational diabetes mellitus criteria for long-term maternal and offspring outcomes is missing. Recently, William L Lowe Jr and colleagues report a high risk of maternal glycaemic disorders and childhood adiposity 10 to 14 years after untreated gestational diabetes mellitus in the HAPO Follow-up Study.

Replacements for the chemical bisphenol A (BPA) have become commonplace in plastics labelled BPA free. However, many of these chemicals have similar structures and properties to BPA. A new study reports that replacement bisphenols, which were discovered as laboratory contaminants, are reproductive toxicants and that their effects might persist for multiple generations.

Pharmacotherapy for obesity, as an adjunct to targeted behavioural modifications, can facilitate weight loss. Previous serotonergic candidates have been withdrawn owing to undesirable cardiovascular effects. A new study in a large sample of high-risk patients shows lorcaserin treatment leads to no greater increase in cardiovascular problems than placebo — what does this result mean for personalized pharmacotherapy for obesity?

Transplanting pancreatic islets in immune-isolating capsules might cure type 1 diabetes mellitus while avoiding the immunosuppression that is normally needed to protect transplanted islets from rejection. A recent study demonstrates that allogeneic islets can survive in capsules with improved biocompatibility without immunosuppression in non-human primates, bringing us one step closer to applying this therapy in humans.

Intravenous steroid therapy in thyroid eye disease has limitations and is potentially harmful at high doses. A steroid-sparing approach is a reasonable option, but combination therapy must be tested in randomized clinical trials designed to establish the efficacy and the potentially increased risk of adverse effects of combined immunosuppressive treatment.

The neurotransmitter GABA has been shown to induce the transdifferentiation of α-cells into β-cells, restoring normoglycaemia in a mouse model of diabetes mellitus. A recent paper by Amanda Ackermann and colleagues, however, failed to reproduce these findings. Here, we discuss the discrepant findings and propose a systematic approach to solve the controversy.

Detailed profiles of fluctuations in glucose obtained via continuous glucose monitoring highlight the complexity of glucose regulation and underscore that the definition of type 2 diabetes mellitus as a homogeneous disease is an oversimplistic approximation for a heterogeneous metabolic disorder. Whether better phenotyping would ultimately result in improved interventions and outcomes, however, remains largely unproven.

Obesity is a major health issue in the developed and developing world, and is in part due to excess dietary energy intake. A new study showed that increased fat content alone was associated with increased energy intake and adiposity, suggesting that the availability of high-fat foods might be driving the development of overweight or obesity.

Body composition and fitness have important roles in predicting prognosis in both primary and secondary prevention of cardiovascular diseases. Additionally, in patients with established cardiovascular diseases, body composition and fitness impact partly explain the ‘obesity paradox’.

Given the increasing incidence of overweight and obesity among young women and the subsequent high prevalence of type 2 diabetes mellitus and gestational diabetes mellitus, metformin treatment during pregnancy is increasing worldwide. A new study reports that metformin exposure in the first trimester of pregnancy does not increase the risk of congenital anomalies.

Viral infections induce muscle insulin resistance in mice through the stimulation of IFNγ. This results in increased insulin levels, which promote antiviral CD8⁺ T cell activation. In obese mice, insulin resistance triggered by IFNγ also leads to deterioration of glycaemic control. These findings highlight the intricate link between the immune system and metabolic regulation.

Up to one-third of patients with diabetes mellitus will develop a diabetic foot ulcer in their lifetime. While this number appears to be rising, breakthrough therapies for this common, complex and costly condition have been, to this point, elusive.

Current recommendations for diagnosing diabetes mellitus require confirmation of an abnormal fasting plasma glucose level or elevated HbA_1c level, with repeated testing. Elizabeth Selvin and colleagues have examined the effectiveness of measuring plasma levels of glucose and HbA_1c simultaneously for diagnosing diabetes mellitus and conclude that the confirmed combination is acceptable.

Novel osteoanabolic strategies are highly desired to treat osteoporotic bone loss or augment fracture repair in patients at risk of healing complications, including individuals with osteoporosis or inflammatory disorders. Whereas current osteoanabolics address osteoblast function, research by Ren Xu and colleagues highlights the skeletal endothelium as a promising target to promote bone formation.

Evidence suggests that physical activity is beneficial for patients with and survivors of cancer. A recent study found that vigorous exercise was associated with reduced mortality in paediatric cancer survivors. Here we discuss these findings in the context of potential mechanisms mediating some of the health effects of exercise in cancer.

Jessica D. Forbes and colleagues found that infants who received formula early in life were more likely to be overweight at 1 year of age than those exclusively breastfed. Formula feeding was associated with altered intestinal microbiome characteristics at 3 months. These findings link early-life formula feeding and an altered microbiome with subsequent overweight.

Do our grandparents’ environmental exposures and experiences shape our health and wellbeing? In a ground-breaking study, Marianthi-Anna Kioumourtzoglou and colleagues show that this might be the case. In their study, a woman’s use of the pharmaceutical diethylstilbestrol during pregnancy increased the risk of attention-deficit hyperactivity disorder (ADHD) in her grandchildren.

Distinct circulating amino acids are suggested to modulate the risk of complications and mortality related to diabetes mellitus. These findings pave the way for future basic and clinical studies to gain new insights into the pathogenesis and treatment of diabetes mellitus.

Hypoglycaemia-induced morbidity and mortality has emerged as one of the major unintended consequences of efforts to achieve optimal glucose control in individuals with insulin-treated diabetes mellitus. A study by Jackson and colleagues offers novel insights into therapies to mitigate the adverse consequences hypoglycaemic events have on the central nervous system.