Clinical Trials Arena lists the top five terms tweeted on metabolic disorders in Q4 2020, based on data from GlobalData’s Influencer Platform.

These top tweeted terms are the trending industry discussions happening on Twitter by key individuals (influencers) as tracked by the platform.

1. Obesity – 2,061 mentions

The complexity of obesity, the risk of severe effects of Covid-19 infection in a person with obesity, and the potential of the glucose-dependent insulinotropic peptide (GIP) as a therapeutic target to reduce obesity were the popular points of discussion in Q4 2020.

Neil Floch, a board-certified general surgeon, mentioned that obesity is a very complex problem that significantly increases the risk of type 2 diabetes, osteoarthritis, and various cancers, contributing to the reduction of life expectancy and quality of life.

The prevalence of obesity has reached a pandemic level through the last 50 years, however, differences can be noted in the trends at the regional level. The regional differences could be utilised to figure out the intervention strategies. Sedentary behaviour coupled with alterations in the global food system together are the primary reasons behind the rising obesity pandemic. Addressing these issues through policy changes that regulate fat, sugar and salt content can help in tackling the pandemic.

Dr Suzana Mantovani, a clinical dietitian nutritionist, highlighted new studies that established obesity as an independent risk factor for Covid-19. Obesity allows the coronavirus to increase its impact on the body and could also interfere with the effectiveness of the Covid-19 vaccine. The Centers for Disease Control and Prevention revealed that 73% of hospitalised Covid-19 positive nurses had obesity. Two more studies with about 10,000 patients found a higher risk of death in patients with Covid-19 and obesity compared to patients with a normal body mass.

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Obesity was also discussed by Daniel J Drucker, a scientist at the Lunenfeld-Tanenbaum Research Institute, who highlighted the hypotheses that both the gain and loss of the incretin hormone, GIP reduces body weight. This makes it a potential therapeutic target for treating obesity and requires a broader understanding of GIP biology in modulating the system for weight reduction.

2. Diabetes – 1,589 mentions

Effect of weight loss on type 2 diabetes remission, test for screening type 1 diabetes risk, and results of Eli Lilly’s clinical trial on Tirzepatide for diabetes were the most discussed topics in the fourth quarter. Bill Lagakos, a nutritional sciences researcher, highlighted a research finding showing weight loss can lead to diabetes remission.

Patients with type 2 diabetes and obesity achieved about 15kg weight loss by an intensive management programme, resulting in type 2 diabetes remission in about 80% of the patients. Increased physical activity combined with calorie restriction and weight loss is vital for type 2 diabetes remission, the study found.

Riva Greenberg, a consultant and author, discussed a new test programme by JDRF (formerly known as Juvenile Diabetes Research Foundation), a type 1 diabetes research funding and advocacy group.

The test screens the presence of type 1 diabetes autoantibodies in people, whose presence indicates that they may be at high risk of developing a full-blown type 1 diabetes condition. It allows early diagnosis of the condition, which can help in preventing life-threatening conditions such as ketoacidosis and possible hospitalisation.

Another discussion on diabetes was shared by Ted Kyle, an advisor to the Obesity Society, on how the stock price of Eli Lilly rose by approximately 6% after it announced promising results for its Tirzepatide drug for diabetes and obesity. In a phase III clinical study, the drug significantly reduced the blood glucose level and body weight in patients with type 2 diabetes.

3. Bariatric Surgery – 797 mentions

The disparities in access to bariatric surgery, the link between bariatric surgery and hospitalisation risk, and lack of nutritional monitoring post-bariatric surgery were widely discussed topics in Q4. David Arterburn, a senior investigator at the Kaiser Permanente Washington Health Research Institute, tweeted about the surgical access disparities across North Carolina.

Publicly available data from 2016 was used for a study in which the surgical rate in the five highest-ranked counties of North Carolina was observed to calculate the expected surgical rate in the five lowest-ranked counties of North Carolina. The people living in counties with greater obesity and at higher risk of requiring urgent surgical interventions were found to be significantly less likely to receive bariatric surgery than those living in counties with less obesity.

Ali Aminian, the director of the Bariatric and Metabolic Institute, further, mentioned that bariatric surgery reduces the risk of hospitalisation and intensive care unit (ICU) admission for patients. In a study performed in the Cleveland Clinic, Covid-19 patients with a history of bariatric surgery were found to be at a lower risk of hospital and ICU admission.

Patients become significantly healthier to combat the virus after bariatric surgery, the study highlighted. Another study showed a 40% reduction in heart complications and death risk in patients with diabetes and obesity after bariatric surgery.

Bariatric surgery was also discussed by Mary O’Kane, chairman of the IFSO Integrated Health Committee, who tweeted research findings that showed that patients after bariatric surgery do not receive recommended nutritional monitoring in primary care.

These patients often miss the nutritional screening blood tests, weight measurement and required nutritional supplements after surgery. The general physicians and patients should be supported to actively participate in follow-up care, she added.

4. Insulin – 375 mentions

The role of a high protein diet in improving insulin sensitivity, advancement in insulin delivery techniques for diabetes management, and former US President Donald Trump’s controversial statement over insulin prices were popularly discussed topics in Q4 2020. Gregory Miller, chief science officer at the National Dairy Council, mentioned the association of protein-rich diet and prediabetes remission, according to a study published in the Nutrition, Metabolism and Cardiovascular Disease. The research showed 100% remission of prediabetes condition in people on high protein diet compared to only 33% remission in patients in a high carbohydrate diet at six months.

Steven D Wexner, a surgeon and physician, further shared an article on how pills, insulin delivery patches and weekly formulation are being rapidly improved for diabetes management.

Insulin for diabetes management has evolved over the years and is currently available in six main types in the US market including rapid-acting, regular insulin, intermediate-acting, long-acting, ultra-long acting and premixed insulin. Technologies for faster insulins that can better mimic insulin production in humans are also being developed, the article detailed.

Another discussion on insulin was shared by Hope Warshaw, a dietitian, and diabetes care and education specialist, on Donald Trump’s statement claiming that he made insulin very cheap. The statement was very surprising for the American people as they still pay hundreds of dollars a month for insulin.

The prices of insulin have increased over the last two decades, making people with diabetes to underuse it or switch to a cheaper or less effective alternative, which increases the risk of strokes, kidney failure or death. Novo Nordisk’s NovoLog was sold at $40 per vial in 2001, which rose to $289 in 2018. The insulin prices of other companies such as Eli Lilly and Sanofi also rose similarly during the period, the article noted.

5. Body mass index (BMI) – 116 mentions

The impact of chain restaurant advertising on obesity, insurance coverage for metabolic surgery, and the connection of body mass index (BMI) and obese Covid-19 patients were popularly discussed during the last quarter of 2020. Jaime Ponce MD, medical director of bariatric surgery at CHI Memorial, shared an article on how chain restaurants spend billions of dollars every year on marketing but their impact on obesity risk in adults is not well understood.

He shared a study that reveals how restaurant advertising leads to a moderate weight gain in the people living in the low-income counties of the US. An increase of 0.053-unit in the BMI was reported in the patients living in low-income counties across 44 US states. Despite the impact, no actions have been taken by the public or private sector to limit the exposure of people to such unhealthy restaurant advertisements.

Ricardo Cohen, a bariatric surgeon, further shared an article on medical procedures making a cumulative impact on a person’s health. Studies have revealed that bariatric or metabolic surgeries improve the immunity and inflammatory state of the patients and decrease the risk of Covid-19, independent of the patient’s BMI and weight lost. The beneficial effects of the surgery stay for the patient regardless of the patient’s initial BMI and post-surgery weight. Colen noted that insurance companies should provide coverage for metabolic surgeries in patients with a BMI greater than 30.

BMI was also discussed by Abd Tahrani, an endocrinologist at the Institute of Metabolism and Systems Research, while referring to a presentation that highlighted an opposite relationship between age and BMI of a patient with Covid-19 in the ICU. People with obesity below the age of 60 years have a higher risk of ICU admissions compared to those aged 60 years and above. Obesity was found to be more common in younger patients who died due to Covid-19.