Improving Outcomes in Congenital and Acquired Lipodystrophy

Faculty

Abhimanyu Garg, MD
Chief, Division of Nutrition and Metabolic Diseases
Program Director, Nutrition and Metabolic Diseases Fellowship Program
Professor and Distinguished Chair in Human Nutrition Research
The University of Texas Southwestern Medical Center
Dallas, Texas

Derek LeRoith, MD, PhD (Moderator)
Professor of Medicine
Director of Research
Chief, Division of Endocrinology, Diabetes and Bone Disease
Director of the Metabolism Institute
Icahn School of Medicine at Mount Sinai Medical
New York, New York

Elif Oral, MD
Associate Professor, Department of Internal Medicine
Medical Director, UMHS Bariatric Surgery Program
Director, MEND Obesity and Metabolic Disorders Program
University of Michigan Health System
Ann Arbor, Michigan

Andra Stratton
Co-Founder and President
Lipodystrophy United
Los Lunas, New Mexico

Target Audience

This educational activity is targeted to an audience of endocrinologists and other healthcare providers involved in the diagnosis and management of the heterogeneous group of disorders referred to as lipodystrophy syndromes.

Statement of Need/Program Overview

Lipodystrophies are a heterogeneous group of disorders characterized by pathologic loss and redistribution of fat tissue as well as reduced levels of adipocyte-derived hormones, such as leptin and adiponectin.1,2 Affected patients may present with a range of metabolic complications, which often include severe insulin resistance, diabetes, hypertriglyceridemia, and hepatic steatosis.3,4 Unfortunately, varied manifestations and unfamiliar etiologies can delay diagnosis and appropriate treatment.2 Even experienced endocrinologists may miss lipodystrophy as they focus on the growing problem of obesity-related insulin resistance and type 2 diabetes.5 To address the often treatment-resistant cardiometabolic complications of lipodystrophies, affected individuals usually require complex treatment regimens, including leptin replacement therapy for appropriately selected patients.4,6 Of note, however, most therapies that are used to treat the associated metabolic issues have not been directly examined in individuals with lipodystrophy, and the prospects for benefit vary depending on the type of lipodystrophy and patient-specific presentation.7 This Clinical Research Updates™ program will discuss key features suggestive of lipodystrophy, clinical clues that can aid the differential diagnosis of underlying causes, and recommendations on using the available treatment armamentarium, including therapies designed to address specific pathophysiologic characteristics of these disorders.4,7,8

References

1. Garg A. Lipodystrophies. Am J Med. 2000;108(2):143-152.
2. Handelsman Y, Oral EA, Bloomgarden ZT, et al. The clinical approach to the detection of lipodystrophy—an AACE consensus statement. Endocr Pract. 2013;19(1):107-116.
3. Garg A, Agarwal AK. Lipodystrophies: disorders of adipose tissue biology. Biochim Biophys Acta. 2009;1791(6):507-513.
4. Fiorenza CG, Chou SH, Mantzoros CS. Lipodystrophy: pathophysiology and advances in treatment. Nat Rev Endocrinol. 2011;7(3):137-150.
5. Ovalle F. Clinical approach to the patient with diabetes mellitus and very high insulin requirements. Diabetes Res Clin Pract. 2010;90(3):231-242.
6. Chan JL, Lutz K, Cochran E, et al. Clinical effects of long-term metreleptin treatment in patients with lipodystrophy. Endocr Pract. 2011;17(6):922-932.
7. Garg A. The Physician’s Guide to Lipodystrophy Disorders. Danbury, CT: National Organization for Rare Disorders, 2012.
8. Brown RJ, Cochran E, Gorden P. Metreleptin improves blood glucose in patients with insulin receptor mutations. J Clin Endocrinol Metab. 2013;98(11):E1749-E1756.

Educational Objectives

Upon completion of this activity, participants will be better prepared to:

• Discuss the causes and common clinical consequences of pathologic reductions in adipose tissue
• Identify patients with various types of congenital and acquired lipodystrophy based on the pattern of adipose tissue loss, other clinical features, and appropriate laboratory testing
• Employ evidence-based therapies to manage lipodystrophy-associated metabolic disturbances and improve health and quality-of-life outcomes 
• Educate patients, family members, and the health care team about lipodystrophy disorders, potential treatment options, and other available resources and support groups

Physician Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas Communications. Global is accredited by the ACCME to provide continuing medical education for physicians.

Global Education Group designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions to Receive Credit

In order to receive credit, participants must complete the preactivity questionnaire, postactivity questionnaire, and program evaluation. Participants must also score at least a 70% on the posttest.

For information about the accreditation of this program, please contact Global at 303-395-1782 or inquire@globaleducationgroup.com.

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.

Disclosure of Conflicts of Interest

Global Education Group (Global) requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

Derek LeRoith, MD, PhD: Nothing to disclose

Abhimanyu Garg, MD: Consultant/Independent Contractor – Aegerion Pharmaceuticals, Inc., Amgen Inc., AstraZeneca Pharmaceuticals LP, Eli Lilly and Company; Grant/Research Support – AstraZeneca Pharmaceuticals LP, Pfizer Inc.; Honoraria – Aegerion Pharmaceuticals, Inc., Amgen Inc., AstraZeneca Pharmaceuticals LP, Eli Lilly and Company

Elif Oral, MD: Consultant/Independent Contractor – Aegerion Pharmaceuticals, Inc., AstraZeneca Pharmaceuticals LP; Grant/Research Support – Aegerion Pharmaceuticals, Inc., AstraZeneca Pharmaceuticals LP

Andra Stratton: Honoraria – AstraZeneca Pharmaceuticals LP

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

Ashley Marostica, RN, MSN: Nothing to disclose

Amanda Glazar, PhD: Nothing to disclose

Andrea Funk: Nothing to disclose

Jim Kappler, PhD: Nothing to disclose

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. Global Education Group (Global) and Integritas Communications do not recommend the use of any agent outside of the labeled indications.  

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.