Patrick Campbell is the senior editor of Endocrinology Network, as well as its sister publication Practical Cardiology. Prior to joining these brands, he led coverage of cardiology and diabetes with HCPLive. Before joining parent company MJH Life Sciences in 2019, he spent time as a beat reporter with the Pocono Record in Stroudsburg, PA and Star News Group in Manasquan, NJ. He also touts experience in multimedia, having spent time as a freelance multimedia specialist with NJ Advance Media and multimedia coordinator at the Pocono Record. In his free time, he enjoys traveling, sports, and exploring the great outdoors. Follow him on Twitter @RealPatCampbell or reach him via email at PCampbell@mjhlifesciences.com.

Patrick Campbell

Data from a meta-analysis of 29 studies suggests the US spent $8 billion on the treatment and diagnosis of 

Published midway through Polycystic Ovary Syndrome Awareness Month, the study builds on previous research suggesting the cost of initial diagnosis and reproductive morbidities cost nearly $4 billion by providing evidence of the additional costs associated with PCOS, such as pregnancy-related and long-term comorbidities, including stroke and 

“Although PCOS affects at least one in seven women and leads to over $8 billion in healthcare costs annually in the United States alone, it is frequently misunderstood or overlooked by clinicians and policymakers,” said lead investigator Carrie Riestenberg, MD, of the University of California, Los Angeles, 

. “With a better understanding of how to diagnose and treat this common condition effectively, we may be able to reduce the economic burden as well as the impact on women’s quality of life.”

With PCOS affecting up to 1-in-5 reproductive-aged women in the US, it is among the most common conditions for female patients. With an interest in building on a previous study, which estimated the economic burden of PCOS to be $2.6 billion in 2004 and $3.7 billion in 2020 after adjusting for inflation, Riestenberg and a team of colleagues designed the current study with the intent of providing a more complete estimate of the annual cost of PCOS in the US. To do so, investigators designed their study as a meta-analysis of data from within the PubMed, EmBase, and Cochrane Library databases with no date restrictions.

For inclusion in the meta-analysis, studies needed to be observational., controlled studies that examined risk of adverse pregnancy outcomes or long-term health outcomes in women with PCOS compared against a control group. Investigators noted studies that reported relative risks, odds ratios, or incidence data were eligible for inclusion but those without a control group, did not match or control for BMI, and those reporting hazard ratios were excluded. Of note, investigators used the NIH diagnostic criteria for PCOS after determining it yielded the most consistent and conservative prevalence estimates and the consumer price index was used to adjust for inflation.

From their search, investigators identified investigates identified a total of 3146 studies for potential inclusion in the study. Of these, 3082 were excluded after abstract screening and 64 were reviewed in detail. Ultimately, 29 studies were included in the meta-analysis.

Using these studies, investigators were able to calculate the prevalence and economic burden associated with various comorbidities and pregnancy-related conditions associated with PCOS, including gestational hypertension, gestational diabetes, preeclampsia, type 2 diabetes mellitus, myocardial infarction, and stroke. From this data, investigators determined the estimated economic burden of managing long-term and pregnancy-related comorbidities with PCOS was $4.3 billion in 2020. When combining this figure with previous estimates of the burden of diagnosis and treatment, investigators estimated the total economic burden of PCOS to be $8 billion annually in 2020.

“Our results suggest that diagnosing PCOS sooner could help reduce the complications women experience and lower the overall cost of providing care,” Riestenberg said. “Increased public awareness of the condition could help improve the quality of care.”

Health Care-Related Economic Burden of Polycystic Ovary Syndrome in the United States: Pregnancy-Related and Long-Term Health Consequences,”

Journal of Clinical Endocrinology & Metabolism.

Articles

A meta-analysis builds upon previous research and provides new insight into the total costs of diagnosis and treating PCOS as well as the costs of treating PCOS-related comorbidities. 

Treating Polycystic Ovary Syndrome Costs $8 Billion in US Annually

In response to the growing obesity epidemic, the American Heart Association (AHA) has released guidance in the form of a scientific statement outlining 

With data suggesting more than 100 million in the US have hypertension, the scientific statement outlines the need for effective, long-term solutions to weight loss to maintain reductions in hypertension and also calls for clinicians to consider other avenues outside of lifestyle modification for weight loss, such as medications and metabolic surgery.

“Weight loss achieved through dietary changes and increased physical activity are the cornerstones of treatment for high blood pressure that’s related to being overweight. However, these lifestyle behaviors are often not sustained over the long term. Subsequently, reductions in blood pressure aren’t maintained over time,” said Chair of the statement writing group Michael E. Hall, MD, MS, FAHA, associate division director for cardiovascular diseases at the University of Mississippi Medical Center in Jackson, Mississippi, in 

. “The new scientific statement suggests medical and surgical strategies may help with long-term weight and blood pressure improvement, in addition to a heart-healthy diet and physical activity.”

The AHA’s scientific statement, which is 13 pages in length and contains nearly 100 references, opens by providing clinicians with an overview of epidemiology and pathophysiology of obesity hypertension before diving into avenues for reducing body weight, including lifestyle modification, pharmacotherapy, and bariatric procedures. Underlining the AHA’s stance from their June 2021 statement, the present statement, which was prepared on behalf of the AHA’s Council on Hypertension, the Council on Arteriosclerosis, Thrombosis, and Vascular Biology, the Council on Lifestyle and Cardiometabolic Health, and the Stroke Council, outlines the importance of dietary interventions and physical activity as first-line treatment for weight loss and hypertension control, but investigators were quick to point out these changes can be difficult to maintain long-term and can lead to recurrent increases in hypertension.

“There’s no doubt that eating healthy foods has beneficial effects on both weight and blood pressure,” Hall explained. “Numerous weight-loss diets are often successful in the short term; however, eating healthy foods consistently and long term, and maintaining weight loss are challenging.”

The next portion of the statement called for an increase in consideration of pharmacologic therapies for obesity hypertension, if lifestyle modifications have proven unsuccessful in achieving weight reduction and blood pressure control. In addition to FDA approved therapies for long-term weight loss, authors highlight the latest revelations related to the potential for reductions in body weight and blood pressure seen with GLP-1 receptor agonists. Specifically, liraglutide and once-weekly semaglutide 2.4 mg, which was not yet approved at the time of writing, were highlighted by statement authors.

“We often don’t consider medications or metabolic surgery until after there has been target organ damage, such as heart injury or having a stroke. However, we may be able to prevent these complications. When combined with lifestyle changes, anti-obesity medicines and surgical procedures can be effective long-term solutions for weight loss and blood pressure control in select individuals who are overweight or have obesity,” Hall added.

The last treatment approach discussed within the statement highlighted surgery for weight loss. Although considered a newer approach to mitigating the effects of obesity, authors point out the popularity and safety of these procedures have grown in recent years. According to the statement, more than 215,000 metabolic procedures were performed in 2016, with the most popular being sleeve gastrectomy followed by Roux-en-Y gastric bypass. With these types of procedures typically reserved for candidates with a BMI at or equal to 35 kg/m2, investigators point out observational data suggests bariatric procedures could contribute tor solution of hypertension in 63% of procedures. Additionally, authors highlight the contributions of the GATEWAY trial, as it is the only controlled trial involved metabolic surgery with blood pressure as a primary end point, to our current understanding of the effects of metabolic surgery. In that trial, patients were 6 times more likely to experience resolution of hypertension with metabolic surgery than they were with standard medical therapy.

“Metabolic surgery techniques are continuing to evolve, and they are getting less invasive and less risky,” Hall said. “For select individuals, medications or metabolic surgery or both may be considered in addition to healthy diet and increased physical activity.”

Before the conclusion of their statement, authors highlighted what they perceive as areas in need of further research related to obesity hypertension. Specific research recommendations included the need for more randomized trials in the space, research into the mechanisms of obesity-related diseases, and the need for a greater understanding of the long-term safety and efficacy of various treatment and prevention strategies.

“There are still many unanswered questions and many opportunities for research that can help people live healthier, longer,” Hall added.

Weight-Loss Strategies for Prevention and Treatment of Hypertension,

Released on September 20, the latest scientific statement from the AHA outlines potential strategies, including lifestyle modifications, pharmacologic therapies, and weight loss surgery, for the prevention and treatment of obesity hypertension. 

AHA Outlines Weight Loss Strategies for Preventing Obesity Hypertension

For all the attention that has been brought to the ongoing diabetes epidemic in recent years, many endocrinologists and other members of the diabetes care team argue forms of diabetes outside of 

 are still overlooked and underrecognized.

rates of gestational diabetes have been increasing

 in the US across all ethnicities and racial subgroups over the last 20 years, highlighted this very fact. With presence of diabetes increasing the risk for other cardiometabolic comorbidities, identification of avenues for improving diagnosis and management of gestational diabetes could have a profound impact on the disease state as a whole.

During the Metabolic Institute of America’s (TMIOA) 5th Heart in Diabetes sessions in New York, NY, Erica P. Gunderson, PhD, MS, MPH, a senior research scientist in the Kaiser Permanente Northern California Division of Research, led a presentation centered around gestational diabetes, insulin resistance, and prognostic value of coronary artery calcium in women based on data from analyses of the CARDIA study.

To learn more about the management of gestational diabetes in 2021 and her presentation, our sister publication 

 sat down with Gunderson following her presentation at the conference. Learn more about her perspective in the video below.

Videos

Erica P. Gunderson, PhD, MS, MPH, offers perspective on the current state of gestational diabetes management as well as avenues for improving current diagnostic and management standards. 

Improving Awareness and Management of Gestational Diabetes, With Erica Gunderson, PhD

“The discovery of insulin was a tremendous landmark in medicine. People were dying, kids were dying within 6-12 months of diagnosis—wasting away.”

has been highlighting the 100-year anniversary of the discovery of insulin through hosting the perspectives of those involved with diabetes management. In recent months, we’ve showcased a 3-part video series on insulin affordability and how recent advances could influence pricing as well as written perspective from an internal medicine resident with type 1 diabetes reflecting on how his personal journey with insulin use.

To continue our celebration of Sir Frederick Banting and the 100th anniversary of the discovery of insulin, we’re hosting a portion of a video interview from our sister publication 

 with Vivian Fonseca, MD, chief of endocrinology at Tulane University School of Medicine. Recorded at the Metabolic Institute of America’s 5th Heart in Diabetes Meeting, Fonseca provides his perspective on the importance of the discovery 100 years later and how the role of insulin has evolved since its initial discovery.

Vivian Fonseca, MD, reflects on the 100-year anniversary of the discovery of insulin and how the role of insulin has evolved since Sir Frederick Banting's historic discovery. 

Patrick Campbell

Articles

Treating Polycystic Ovary Syndrome Costs $8 Billion in US Annually

AHA Outlines Weight Loss Strategies for Preventing Obesity Hypertension

Improving Awareness and Management of Gestational Diabetes, With Erica Gunderson, PhD

Reflecting on 100 Years of Insulin, With Vivian Fonseca, MD