Yehuda Handelsman, MD: Key Highlights, Takeaways from WCIRDC 2024

In this expert interview at the 22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC), Yehuda Handelsman, MD, medical director and principal investigator for The Metabolic Institute of America (TMIOA) and chair and program director for WCIRDC, reflected on the diverse topics discussed at the 2024 meeting, emphasizing the integration of basic, translational, and clinical research into actionable practice insights across cardiology and endocrinology.

Handelsman highlighted the multidisciplinary exploration of obesity, where cardiologists, nephrologists, and endocrinologists addressed its relationship to organ-specific diseases, including kidney, heart, and liver conditions, alongside findings from the SELECT trial on weight-loss outcomes. He noted that the Congress also delved into sarcopenia, sparking a lively debate on its clinical significance and the impact of muscle loss during weight reduction.

Other key topics included the role of circadian rhythm in health and disease, particularly its impact on cardiac function and the potential of circadian-based dietary interventions. A groundbreaking session on cortisol and the ‘Noxious Nine’ revealed its underappreciated contribution to insulin resistance, hard-to-control diabetes, and hypertension. New research has shown high cortisol levels in approximately 24% of patients with poorly controlled diabetes and 33% with resistant hypertension. In the CATALYST trial, treatment with mifepristone (Korlym) led to a surprising 1.5% HbA1c reduction in patients with difficult-to-control T2D, compared with 0.15% for placebo (P <.0001), potentially reshaping the understanding of diabetes pathophysiology.

Additionally, Handlesman noted that the Congress explored the evolving phenotype of type 1 diabetes (T1D), in which patients increasingly present with obesity and insulin resistance, highlighting the need to adapt type 2 diabetes (T2D) treatments for this population. Overall, Handelsman emphasized that these insights signify a paradigm shift in managing cardiometabolic diseases, underscoring this Congress’s ability to connect research with clinical application.

Relevant disclosures for Handelsman include Amarin, Amgen, BI-Lilly, Novo Nordisk, Sanofi, and others.