Building the Evidence Base of Blood-Based Biomarkers for Early Detection of Cancer: A Rapid Systematic Mapping Review

 There are a large number of biomarkers with potential utility for early cancer detection from blood samples

Few biomarkers have been studied sufficiently with clinical validation to allow their use in combination for screening in the general population.

We used an iterative mapping review of 20,000 references, retrieving 3,990 relevant papers, and identified 788 markers in blood of potential use

Screening for cancer can save lives, but it is difficult to justify individual screening programmes for many cancer types. However, cancers of different types share many attributes, and markers of cancer biology found in the blood. We surveyed the literature to identify known biomarkers using a new mapping approach. With nearly 20,000 papers on the subject, we retrieved 3990 papers, and identified 788 markers in blood of potential use. Most have not been studied enough to justify their use in clinical practice. This evidence based approach should help us to develop a blood-based cancer screening test in the general population.



The Early Cancer Detection Consortium is developing a blood-test to screen the general population for early identification of cancer, and has therefore conducted a systematic mapping review to identify blood-based biomarkers that could be used for early identification of cancer.


A mapping review with a systematic approach was performed to identify biomarkers and establish their state of development. Comprehensive searches of electronic databases Medline, Embase, CINAHL, the Cochrane library and Biosis were conducted in May 2014 to obtain relevant literature on blood-based biomarkers for cancer detection in humans. Screening of retrieved titles and abstracts was performed using an iterative sifting process known as “data mining”. All blood based biomarkers, their relevant properties and characteristics, and their corresponding references were entered into an inclusive database for further scrutiny by the Consortium, and subsequent selection of biomarkers for rapid review. This systematic review is registered with PROSPERO (no. CRD42014010827).


The searches retrieved 19,724 records after duplicate removal. The data mining approach retrieved 3990 records (i.e. 20% of the original 19,724), which were considered for inclusion. A list of 814 potential blood-based biomarkers was generated from included studies. Clinical experts scrutinised the list to identify miss-classified and duplicate markers, also volunteering the names of biomarkers that may have been missed: no new markers were identified as a result. This resulted in a final list of 788 biomarkers.


This study is the first to systematically and comprehensively map blood biomarkers for early detection of cancer. Use of this rapid systematic mapping approach found a broad range of relevant biomarkers allowing an evidence-based approach to identification of promising biomarkers for development of a blood-based cancer screening test in the general population.


Scientists identify brain molecule that triggers schizophrenia-like behaviors, brain changes

Scientists at The Scripps Research Institute (TSRI) have identified a molecule in the brain that triggers schizophrenia-like behaviors, brain changes and global gene expression in an animal model. The research gives scientists new tools for someday preventing or treating psychiatric disorders such as schizophrenia, bipolar disorder and autism.

“This new model speaks to how schizophrenia could arise before birth and identifies possible novel drug targets,” said Jerold Chun, a professor and member of the Dorris Neuroscience Center at TSRI who was senior author of the new study.

The findings were published April 7, 2014, in the journal Translational Psychiatry.

What Causes Schizophrenia?

According to the World Health Organization, more than 21 million people worldwide suffer from schizophrenia, a severe psychiatric disorder that can cause delusions and hallucinations and lead to increased risk of suicide.

Although psychiatric disorders have a genetic component, it is known that environmental factors also contribute to disease risk. There is an especially strong link between psychiatric disorders and complications during gestation or birth, such as prenatal bleeding, low oxygen or malnutrition of the mother during pregnancy.

In the new study, the researchers studied one particular known risk factor: bleeding in the brain, called fetal cerebral hemorrhage, which can occur in utero and in premature babies and can be detected via ultrasound.

In particular, the researchers wanted to examine the role of a lipid called lysophosphatidic acid (LPA), which is produced during hemorrhaging. Previous studies had linked increased LPA signaling to alterations in architecture of the fetal brain and the initiation of hydrocephalus (an accumulation of brain fluid that distorts the brain). Both types of events can also increase the risk of psychiatric disorders.

“LPA may be the common factor,” said Beth Thomas, an associate professor at TSRI and co-author of the new study.

Mouse Models Show Symptoms

To test this theory, the research team designed an experiment to see if increased LPA signaling led to schizophrenia-like symptoms in animal models.

Hope Mirendil, an alumna of the TSRI graduate program and first author of the new study, spearheaded the effort to develop the first-ever animal model of fetal cerebral hemorrhage. In a clever experimental paradigm, fetal mice received an injection of a non-reactive saline solution, blood serum (which naturally contains LPA in addition to other molecules) or pure LPA.

The real litmus test to show if these symptoms were specific to psychiatric disorders, according to Mirendil, was “prepulse inhibition test,” which measures the “startle” response to loud noises. Most mice—and humans—startle when they hear a loud noise. However, if a softer noise (known as a prepulse) is played before the loud tone, mice and humans are “primed” and startle less at the second, louder noise. Yet mice and humans with symptoms of schizophrenia startle just as much at loud noises even with a prepulse, perhaps because they lack the ability to filter sensory information.

Indeed, the female mice injected with serum or LPA alone startled regardless of whether a prepulse was placed before the loud tone.

Next, the researchers analyzed brain changes, revealing schizophrenia-like changes in neurotransmitter-expressing cells. Global gene expression studies found that the LPA-treated mice shared many similar molecular markers as those found in humans with schizophrenia. To further test the role of LPA, the researchers used a molecule to block only LPA signaling in the brain.

This treatment prevented schizophrenia-like symptoms.

Implications for Human Health

This research provides new insights, but also new questions, into the developmental origins of psychiatric disorders.

For example, the researchers only saw symptoms in female mice. Could schizophrenia be triggered by different factors in men and women as well?

“Hopefully this animal model can be further explored to tease out potential differences in the pathological triggers that lead to disease symptoms in males versus females,” said Thomas.

In addition to Chun, Thomas and Mirendil, authors of the study, “LPA signaling initiates schizophrenia-like brain and behavioral changes in a mouse model of prenatal brain hemorrhage,” were Candy De Loera of TSRI; and Kinya Okada and Yuji Inomata of the Mitsubishi Tanabe Pharma Corporation.

Why Do Blood Types Differ?

Perhaps you know your own blood type, and perhaps you know those types with which you’re compatible to give to and receive from. You might also sense that there’s more to blood than a mere mark on your medical records.

Blood consists of red and white blood cells, platelets and plasma (the goop in which everything sits). Antigens and various proteins float in the plasma and on red blood cells. An antigen is any substance that causes the immune system to produce antibodies — certain proteins — to fight it off.

The ABO grouping system refers to the genetically-determined individual differences in the presence of two antigens (A and B), which stimulate the production of different antibodies. Type-O blood has both the antibodies produced in type-A and type-B, whereas type-AB has neither.


“Polymorphism” describes a stable coexistence of different genetic forms within a species, and the reason for blood group polymorphism is not known.

In 2004 researchers from University College London proposed that the presence of certain bacteria and intracellular viruses may have put evolutionary pressure on certain antigen-producing genetic mutations. In populations where viruses prevailed, gene O dominated. Those with bacteria-heavy environments found themselves more likely to have A or B type.

This theory does not explain why blood types don’t evolve with constantly mutating viruses and bacteria strains. But it is clear that some manner of environmental pressure is a factor in blood group polymorphism.

The major blood groups were not figured out until the early 1900s, and before then blood transfusions sometimes turned mysteriously fatal because the different blood groups are incompatible. In 1940, experiments on Rhesus monkeys revealed an additional antigen factors now known as positive or negative “Rh factors.” This led to the nomenclature “O positive” or “AB negative.” Since then, hundreds of other less-significant antigen differences have been identified, most of which do not lead to transfusion problems.

Artificial blood created.

A team of researchers of the Babes-Bolyai University in Cluj-Napoca, a city in NW Romania, has created a recipe for artificial blood whose preliminary tests have proven encouraging.

The team led by professor Radu Silaghi-Dumitrescu, who is only 39 years old, has been doing research to create the artificial blood for six years and their discovery could prove crucial given the lack of blood doctors need in cases of severe accidents and major surgeries. The blood is made of water, salt, albumin and a protein – hemerythrin -extracted from marine worms which makes the artificial blood stress resistant.


The researchers said the results of the first tests performed on mice are encouraging. „The mice treated with this type of blood ‘made in Cluj’ have remained indifferent and this is what we want, not to display signs of inflammation or disease. The ultimate goal is we don’t get rejection reactions of the artificial blood by the human body which we have for some of the current products” professor Silaghi-Dumitrescu said, as quoted by Mediafax.

He said all the previous attempts to create artificial blood have failed because researchers couldn’t find the right protein to keep the substance immune to stress factors. So far the tests on animals didn’t generate the toxicity other types of protein used so far produced.

The lead researcher pointed out the tests on mice will continue until proven there is not toxicity at all, before any attempt to use it on human beings. Silaghi-Dumitrescu said he expected concluding results in at most two years before any further tests. “Tests on humans are a very delicate topic, we need some very serious licenses and they represent an enormous risk” he underlined.

Myths About High Blood Pressure.

1) Myth. High blood pressure runs in my family. There is nothing I can do. I will get it too.

High blood pressure can run in families. If your parents or close blood relatives have had high blood pressure, you are more likely to develop it, too. However, lifestyle choices have allowed many people with a family history of high blood pressure to avoid it themselves. Lifestyle changes you can make to prevent it include:

  • Eat a better diet, which may include reducing sodium.
  • Enjoy regular physical activity.
  • Maintain a healthy weight.
  • Manage stress.
  • Avoid tobacco smoke.
  • Comply with medication prescriptions.
  • If you drink, limit alcohol.

2) Myth. I don’t use table salt, so I’m in control of my sodium intake and my blood pressure isn’t affected.

In some people, sodium can increase blood pressure. But controlling sodium means more than just putting down the salt shaker. It also means checking labels, because up to 75 percent of the sodium we consume is hidden in processed foods like tomato sauce, soups, condiments, canned foods and prepared mixes. When buying prepared and prepackaged foods, read the labels. Watch for the words “soda” and “sodium” and the symbol “Na” on labels; these words show that sodium compounds are present.

3) Myth. I use kosher or sea salt when I cook instead of regular table salt. They are low-sodium alternatives.
Chemically kosher salt and sea salt are the same as table salt – 40 percent sodium – and count the same toward total sodium consumption. Table salt is a combination of the two minerals sodium (Na) and chloride (Cl). Learn more about Sea Salt Vs. Table Salt.

4) Myth. I feel fine. I don’t have to worry about high blood pressure.

More than 76 million U.S. adults have high blood pressure – and many of them don’t know it or don’t experience typical symptoms. High blood pressure is serious. If uncontrolled, high blood pressure can lead to severe health problems. High blood pressure is also the No. 1 cause of stroke.

5) Myth. People with high blood pressure have nervousness, sweating, difficulty sleeping and their face becomes flushed. I don’t have those symptoms so I must not have high blood pressure.

Many people have high blood pressure for years without knowing it. High blood pressure is often called “the silent killer” because it has no symptoms, so you may not be aware that it’s damaging your arteries, heart and other organs. Don’t make the mistake of assuming symptoms will alert you to the problem of high blood pressure. Everybody needs to know their blood pressure numbers. Diagnosis should only be made by a healthcare professional.

6) Myth. I read that wine is good for the heart, so I can drink as much of it as I want.

If you drink alcohol, including wine, do so in moderation. Heavy and regular use of alcohol can increase blood pressure dramatically. It can also cause heart failure, lead to stroke and produce irregular heartbeats. Too much alcohol can contribute to high triglycerides, cancer, obesity, alcoholism, suicide and accidents, and it can be highly addictive. If you drink, limit consumption to no more than two drinks per day for men and one drink per day for women. Generally, one drink equals a 12-ounce beer, a four-ounce glass of wine, 1.5 ounces of 80-proof liquor, or one ounce of hard liquor (100-proof).

7) Myth. I have high blood pressure and my doctor checks it for me so I don’t need to check it at home, too.

Because blood pressure can fluctuate, home monitoring and recording of blood pressure readings can provide your healthcare provider with valuable information to determine whether you really have high blood pressure and, if you do, whether your treatment plan is working. It’s important to take the readings at the same time each day, such as morning and evening, or as your healthcare professional recommends.

8) Myth. I was diagnosed with high blood pressure and I have been maintaining lower readings, so I can stop taking my medication.

High blood pressure can be a lifelong disease. Follow your healthcare professional’s recommendations carefully, even if it means taking medication every day for the rest of your life. By partnering with your healthcare team, you can successfully reach your treatment goals and enjoy the benefits of better health.

Potatoes Found to Combat High Blood Pressure.

 Are you worried about high blood pressure? Researchers studying the effects of potatoes on human health have noted that potato consumption is linked to a reduction in blood pressure among obese people with high blood pressure.

potatopurple 260x162 Potatoes Found to Combat High Blood Pressure

Lowering Blood Pressure Naturally

Just a few servings of potato each day can reduce blood pressure in overweight people who have high blood pressure, states researchers in a new report. The potato study was conducted using purple potatoes without any fat or oil. Two groups of participants were chosen for the study, a healthy group and an overweight group who suffered from high blood pressure.

The healthy participants ate 6 small purple potatoes a day or the equivalent of starch in the form of biscuits. At the end of the trial, it was found the antioxidant capacity of their blood and urine was increased by eating potatoes and decreased by eating biscuits. The overweight group ate 6 purple potatoes each day for 4 weeks followed by a 4-week period of no potatoes, followed by another 4-week period of eating potatoes. The results demonstrated that although eating the potatoes caused no change in body weight, blood fats or sugar levels, blood pressure did decrease.

One of the primary reasons for potatoes lowering blood pressure has to do with high levels of potassium found in the food. Potassium has several functions in the body, aiding with the proper workings of the heart, kidneys, nerves, muscles and the digestive system. A lack of potassium can manifest itself in many ways, including high blood pressure.

At the end of the study, researchers claimed that the consumption of purple potatoes was, in fact, effective for lowering blood pressure and reducing the risk of heart disease and stroke in people who have high blood pressure. It is thought that red-skinned potatoes would have the same impact.

The Blacklisted Potato

Unfortunately, many Americans have blacklisted potatoes from their diet completely. The potato is often seen as an empty calorie, high carbohydrate, fattening food that has no nutritional value. This is actually a long way from the truth. But when a potato is topped with mounds of butter, sour cream, fried in oil or otherwise changed from its original state, this is where problems begin. In actuality, a potato only has slightly over 100 calories and numerous beneficial vitamins and phytochemicals such as those found in spinach, Brussels sprouts and broccoli.

A Little Potato History

Potato roots began in the Andes Mountains of South America where inconsistent temperatures and extremely poor soil were the norm. The potato, however, survived and even thrived in these conditions, some 15,000 feet up in the air. Pre-Columbian farmers, impressed by the heartiness of this vegetable began cultivating the potato almost 7,000 years ago. It was not until around 1537 that people in the west encountered the potato. Of course, everyone is aware of the potato’s use in Ireland. Because potatoes contain most vitamins that are needed for survival, it was a popular food. This explains the great famine in Ireland that followed the crop failure of the 1800′s.

Simple urine test uses nanotechnology to detect dangerous blood clotting

Life-threatening blood clots can form in anyone who sits on a plane for a long time, is confined to bed while recovering from surgery, or takes certain medications.

There is no fast and easy way to diagnose these clots, which often remain undetected until they break free and cause a stroke or heart attack. However, new technology from MIT may soon change that: A team of engineers has developed a way to detect blood clots using a simple urine test.

The noninvasive diagnostic, described in a recent issue of the journal ACS Nano, relies on  that detect the presence of , a key  factor.

Such a system could be used to monitor patients who are at high risk for blood clots, says Sangeeta Bhatia, senior author of the paper and the John and Dorothy Wilson Professor of Biochemistry.

“Some patients are at more risk for clotting, but existing blood tests are not consistently able to detect the formation of new clots,” says Bhatia, who is also a senior associate member of the Broad Institute and a member of MIT’s Koch Institute for Integrative Cancer Research and Institute for Medical Engineering and Science (IMES).

Lead authors of the paper are Kevin Lin, a graduate student in chemical engineering, and Gabriel Kwong, a postdoc in IMES. Other authors are Andrew Warren, a graduate student in Health Sciences and Technology (HST), and former HST postdoc David Wood.

Sensing thrombin

Blood clotting is produced by a complex cascade of protein interactions, culminating in the formation of fibrin, a fibrous protein that seals wounds. The last step of this process—the conversion of fibrinogen to fibrin—is controlled by an enzyme called thrombin.

Current tests for blood clotting are very indirect, Bhatia says. One, known as the D-dimer test, looks for the presence of fibrin byproducts, which indicates that a clot is being broken down, but will not detect its initial formation.

Bhatia and her colleagues developed their new test based on a technology they first reported last year for early detection of colorectal cancer. “We realized the same exact technology would work for blood clots,” she says. “So we took the test we had developed before, which is an injectable nanoparticle, and made it a thrombin sensor.”

Finding blood clots before they wreak havoc

The system consists of , which the Food and Drug Administration has approved for human use, coated with peptides (short proteins) that are specialized to interact with thrombin. After being injected into mice, the nanoparticles travel throughout the body. When the particles encounter thrombin, the thrombin cleaves the peptides at a specific location, releasing fragments that are then excreted in the animals’ urine.

Once the urine is collected, the protein fragments can be identified by treating the sample with antibodies specific to peptide tags included in the fragments. The researchers showed that the amount of these tags found in the urine is directly proportional to the level of blood clotting in the mice’s lungs.

In the previous version of the system, reported last December in Nature Biotechnology, the researchers used mass spectrometry to distinguish the fragments by their mass. However, testing samples with antibodies is much simpler and cheaper, the researchers say.

Rapid screening

Bhatia says she envisions two possible applications for this kind of test. One is to screen patients who come to the emergency room complaining of symptoms that might indicate a blood clot, allowing doctors to rapidly triage such patients and determine if more tests are needed.

“Right now they just don’t know how to efficiently define who to do the more extensive workup on. It’s one of those things that you can’t afford to miss, so patients can get an unnecessarily expensive workup,” Bhatia says.

Another application is monitoring patients who are at high risk for a clot—for example, people who have to spend a lot of time in bed recovering from surgery. Bhatia is working on a urine dipstick test, similar to a pregnancy , that doctors could give  when they go home after surgery.

“If a patient is at risk for thrombosis, you could send them home with a 10-pack of these sticks and say, ‘Pee on this every other day and call me if it turns blue,'” she says.

The technology could also be useful for predicting recurrence of clots, says Henri Spronk, an assistant professor of biochemistry at Maastricht University in the Netherlands.

“High levels of activation markers have been related to recurrent thrombosis, but they don’t have good sensitivity or specificity. Through application of the nanoparticles, if proven well-tolerated and nontoxic, alterations in the normal low levels of physiological thrombin generation might be easily detected,” says Spronk, who was not part of the research team.

Bhatia plans to launch a company to commercialize the technology, with funding from MIT’s Deshpande Center for Technological Innovation. Other applications for the nanoparticle system could include monitoring and diagnosing cancer. It could also be adapted to track liver, pulmonary, and kidney fibrosis, Bhatia says.

The Buzz Around Coffee Bean Extract.


Does the latest weight-loss supplement work?

Marketing slogans tout green coffee bean extract as a miracle supplement for weight loss. But if you’ve spent time looking at supplements, you’ve probably heard that claim before.

Every time a new weight loss product makes waves in the media, the questions start to roll in from patients. Does it work? Is it safe? How much weight will I lose? The buzz around coffee bean extract has spurred similar questions, so let’s look at some of the answers.

What does coffee bean extract do?

The primary ingredient of coffee bean extract is chlorogenic acid, which is abundant in green coffee beans before they are roasted.

Chlorogenic acid prevents the release of glucose in your blood stream by inhibiting an enzyme in the liver. The theory: When our bodies have less glucose available, they tap into stored fat for energy. So you lose weight, and your metabolism shifts toward burning fat.

Can’t I just drink coffee?

As much as I love coffee, I wish it led to weight loss. But roasting beans changes the chlorogenic acid itself. That’s why nobody is touting your favorite morning beverage as a weight loss supplement. Coffee bean extract also has only a fraction of the caffeine of brewed coffee — a plus if you’re concerned about your caffeine intake.

OK, but does it work?

In a small study published last year, overweight participants lost body weight, decreased their body mass index to within the normal range and reduced their body fat percentage significantly.

Some participants saw a slight rise in their systolic blood pressure, but it stayed within the normal range. The study used doses of 700 mg and 1050 mg per day, and no bad side effects were observed. The typical daily recommended dose is 800 mg.

It’s worth re-emphasizing that this was a small study. There is not a lot of other data around coffee bean extract, and supplements don’t undergo the same rigorous testing as medications. Just be sure to get your doctor’s opinion before jumping on the bean bandwagon.

Is it enough on its own?

Contrary to the sales pitch, no supplement or medication is the end-all, be-all of weight loss. That includes coffee bean extract.

A smart weight loss or weight management plan will include diet and exercise — positive lifestyle changes you make for yourself. So in addition to any supplements or medications you take on the advice of your doctor, make sure you move more and eat better, too.


Blood Protein Rejuvenates Aging Heart.

A molecule found only in the blood of young mice dramatically reverses thickening and stiffening of the heart muscle in old mice.

Using proteomics in combination with a 19th-century surgical technique in which the circulatory systems of two mice are joined together, researchers have demonstrated that a protein found only in the blood of young mice reverses the effects of aging in old mice, according to a study published this week (May 9) in Cell.

“I think it’s a stunning result that, for the first time, points at a secreted protein that maintains the heart in a young state,” cardiologist Deepak Srivastava of the Gladstone Institute of Cardiovascular Disease in San Francisco, who was not involved with the research, told Nature. “That’s pretty remarkable.”

Heart failure in elderly people is often caused by cardiac hypertrophy, a thickening of the heart muscle that results in the shrinking of the chambers within. To understand what causes this age-related thickening, and to search for a way to reverse it, stem cell biologists from Harvard University tested the effect of circulating factors in young blood on aging hearts.

To do so, they turned to a centuries-old technique called heterochronic parabiosis, in which two live animals of different ages are surgically joined together to share blood circulation. Having surgically linked the blood supply of five 2-year-old mice with five 2-month-old mice, the researchers found that, after 4 weeks of exposure to young blood, the older mice’s heart muscles had dramatically thinned and softened.

Using protein-analysis techniques to narrow down the list of what could be responsible for this reversal, the researchers identified a molecule called growth differentiation factor 11 (GDF-11), a circulating factor in young mice that declines with age. The team then showed old mice treated with GDF-11 for 30 days experienced that same heart rejuvenation as those in the parabiosis experiment, demonstrating that the molecule—which also appears in human blood—may hold promise for treating cardiac aging.

“It’s conceivable that this is just an interesting mouse story,” Richard Lee of the Harvard Stem Cell Institute told ScienceNOW, “but we’re hoping to get data that might tell us that it pertains to humans.”


PreDx finger stick comparable to venous blood assay in detecting diabetes risk.

Clinicians may be able to accurately detect a patient’s likelihood of developing type 2 diabetes with the use of a finger stick capillary blood collection test, according to data presented here at the AACE Annual Scientific and Clinical Congress.

“We’ve developed what we call the PreDx score (Tethys Bioscience). It’s a multimarker algorithm-based diagnostic. It combines the results from seven different blood-based biomarkers along with the patient’s age and gender to produce a single score between 1 and 10,” researcher Theodore Tarasow, PhD, senior vice president of research and development at Tethys Biosciences, said during a late-breaking abstract presentation here. “We’ve done clinical studies to show that that score is directly tied to a person’s 5-year risk for developing diabetes.”

Tarasow said the accuracy of the finger stick blood assays yielded promising results that were comparable to venous blood assays. Data presented indicate that the coefficient of variation ranged from 2.4% for HbA1c to 11.3% for adiponectin. Upon calibration, results showed impressive agreement between PreDx values and matched samples. Overall slope was 0.997 (95% CI, 0.916-1.078) and intercept was –0.048 (95% CI, –0.206 to 0.110) by Deming regression, according to data.

Further, data from the Inter99 study indicated no significant differences in area under the curve (AUC), positive predictive value or sensitivity when comparing simulated finger stick scores with venous scores. Both PreDx venous and PreDx finger stick were also superior to fasting glucose by AUC and other measures in predicting development of diabetes.

“What we really need is the ability to find those at the highest risk and apply additional resources to try and prevent or delay that conversion to diabetes,” Tarasow said.

Tarasow said the PreDx is no more expensive than current tests available for its diagnostic purpose.

“From a clinical perspective what this is really going to allow us to do is have greater access to patients where there is not access to onsite phlebotomy,” Tarasow said. – by Samantha Costa



  • Using a litmus paper — a simple technique to do this test — allows greater adoption of this predictive tool for how to aggressively treat diabetes or not. If you have a patient at high risk for diabetes in the prediabetes population, you then may use pharmaceutical agents (i.e., metformin), but if you’re treating a low-risk patient, you probably don’t need to do so. Or, you may put them into a supervised exercise program or some type of diet or bariatric surgery. Your intervention will be much stronger.
  • Bruce W. Bode, MD
  • o    Atlanta Diabetes Associates
    Endocrine Specialty Group

Source: Endocrine Today