News & Views in 2019

Bariatric surgery results in sustained weight loss and improvement in many obesity-related comorbidities. However, the effects of bariatric surgery on long-term mental health are less clear. A recent longitudinal cohort study shows that patients undergoing bariatric surgery seek mental health services at higher rates after surgery than before surgery and identifies specific risk factors for increased psychiatric service use.

A cross-sectional study shows that proxies of circadian misalignment, such as late chronotype and social jet lag, are associated with increased adiposity in adolescent girls but not adolescent boys, highlighting a potential sex-specific effect of circadian misalignment. Interventions targeting sleep timing should be considered in the prevention of adolescent obesity.

Early and intensive glycaemic control protects patients with type 2 diabetes mellitus (T2DM) from the development of late cardiovascular complications. The authors of the VERIFY trial now show that a more durable attainment of HbA_1c <7% is observed by adding vildagliptin to metformin as starting therapy in newly diagnosed patients with T2DM.

A nationwide study conducted in the USA demonstrated that an intervention combining gamification with social incentives, conducted within the context of a behavioural economics platform, can result in a moderate yet significant increase in physical activity in adults with obesity over a period of 24 weeks with an additional 12 week follow-up.

Metformin is the mainstay therapy for type 2 diabetes mellitus. A new study shows that metformin acts directly on gut bacteria to elevate cAMP-induced agmatine production, thereby increasing lipid metabolism and lifespan in model organisms. These data identify links between metformin and gut microbiota that might be important for increasing longevity.

Sodium–glucose cotransporter 2 (SGLT2) inhibitors are a fairly new class of treatment for diabetes mellitus. Some data suggest SGLT2 inhibitors are associated with a risk of severe urinary tract infections. However, meta-analyses of trials and a large population-based cohort study show no increased risk, which provides important reassurance for patients and prescribers.

Alternate day fasting (ADF) has gained considerable popularity as a weight loss intervention. A new study provides data showing that zero-calorie ADF (defined as 36-hour water fast alternating with 12-hour feast) is a safe and effective intervention to lower body weight and metabolic disease risk in participants who did not have obesity.

A study in Danish adults over the period 1997–2016 reports a 50% reduction in thyrotoxicosis caused by multinodular toxic goiter, solitary toxic adenoma or Graves disease after the introduction of mandatory salt iodization. During the same period, there was no significant increase in overt hypothyroidism.

A large registry-based study found that maternal overweight and obesity are associated with incident type 2 diabetes mellitus in offspring. The results align with those of prospective cohort studies and emphasize a need for interventions that target maternal weight during very early gestation, to optimize maternal and offspring health.

Faecal microbiota transplantation (FMT) has been suggested to be a therapeutic strategy for inflammatory diseases and it is known that regular physical activity can alter the composition of the gut microbiota. Now, a study proposes that FMT might increase exercise performance in athletes, raising the possibility of ‘faecal doping’.

Psychological problems such as depression and anxiety can hamper self-management in patients with type 2 diabetes mellitus (T2DM). A new prospective study reported that adults with T2DM and diagnosed anxiety disorder had a higher number of emergency visits and a higher cost status, but not total hospitalization costs, than those without diagnosed anxiety disorder.

Bariatric surgery often produces remission of hyperglycaemia in patients with coexistent obesity and type 2 diabetes mellitus, but the hyperglycaemia is prone to return years later. A prospective study demonstrates that therapy with a glucagon-like peptide 1 receptor agonist can reinstate normal glycaemic control in many of these patients.

A comprehensive systematic review has recommended decreasing the number of individuals who receive treatment for subclinical hypothyroidism; however, data included in the study are extremely limited for young individuals. Extrapolating data from older individuals is perhaps unwise; therefore, the onus should be on the urgent need for further research.

Exercise is the elixir of health. However, timing can boost or blunt exercise performance and health benefits. Two complementary studies used transcriptomic and metabolomic tools to dissect how time of day affects the impact of exercise. The findings open new avenues for optimizing timing of physical activity to boost its benefits further.

Lifestyle interventions in patients with prediabetes can delay the onset of type 2 diabetes mellitus, but long-term data on diabetes complications are lacking. A new report from the Da Qing Study provides data on the effect of lifestyle interventions on diabetes mellitus complications and mortality in patients with prediabetes who were followed up for 30 years.

High post-challenge glucose plasma concentrations that are observed during pregnancy screening can help to identify women who are at an increased likelihood of later health issues, predominantly cardiovascular diseases. This finding offers a unique opportunity to improve the health of women, but further work is required to translate into clinical benefits.

A positive association between topical corticosteroid use and risk of type 2 diabetes mellitus has been reported in a large European population-based study. However, the increase in risk is small and should not influence the prescribing of topical corticosteroids when clinically indicated.

Thyroid ultrasonography is an important element of clinical thyroid diagnostics. Unfortunately, the results of this technique can vary based on the skill and experience of the operator. A new study suggests that assessment of ultrasound images using artificial intelligence has similar sensitivity and improved specificity compared with the judgement of experienced radiologists.

Alterations in lipid metabolism are closely linked to disorders such as cardiovascular disease, type 2 diabetes mellitus and non-alcoholic fatty liver disease. A multi-omics study on a mouse genetic reference panel uncovers regulatory networks and potential biomarkers of hepatic lipid metabolism.

By combining genetic, metagenomic and metabolic data in humans, a recent study has identified causal relationships between the capacity of gut microorganisms to produce short-chain fatty acids, such as butyrate and propionate, and metabolic traits of the host, including insulin response during an oral glucose tolerance test and susceptibility to type 2 diabetes mellitus.