Ready For More Clinical Trials in the Field of Endocrinology

Meling is a specialist in internal medicine and endocrinology, holds a doctorate from 2023 on type 2 diabetes, is the leader of the National Diabetes Forum, and is active in the Norwegian Endocrinology Association.

From Diabetes to Thyroid Disease

In addition, he is also Clinical lead endocrinology at NorTrials Clinical Immunology at Stavanger University Hospital. There, he works on building a network of endocrinologists in Norway, thereby contributing to bringing more trials in this field to Norway.

Endocrine diseases are diseases of the hormone-producing glands in the body, such as the thyroid gland (thyroidea) in the neck and the pancreas in the abdominal cavity. This includes, among other things, thyroid diseases (thyroidea) and type 1 and type 2 diabetes (the pancreas).

Exciting News in Type 1 Diabetes

- Many people do not know that insulin is a hormone. But the pancreas’s task is – in addition to producing pancreatic juice for digestion – to produce the vital hormones insulin and glucagon for the regulation of blood sugar. Type 1 diabetes is an autoimmune disease in which the pancreas is attacked by the body’s own immune system and stops producing insulin. If you are unfortunate enough to get this disease, you must therefore supply your body with insulin for the rest of your life. There is unfortunately no cure for type 1 diabetes making the need for more research even moreimportant, says Meling.

There are about 28,000 people with type 1 diabetes in Norway today, where Stavanger University Hospital is responsible for following up nearly 1,900 of them, according to Meling.

- With only a limited number of clinical trials on type 1 diabetes within the field of pharmaceuticals. There are some on medical equipment, in addition to Oslo University Hospital being involved in exciting trials related to viruses as a triggering cause and stem cell therapy.

He followed up by informing that there have been developments related to a medicine which may possibly delay the onset of type 1 diabetes in its early phase. Teplizumab was approved in the USA in 2022 as the world’s first immunotherapy for type 1 diabetes, according to Diabetes UK.

- Currently in Italy, they now screenall newborns for type 1 diabetes, because it may be possible to prevent development. This mainly concerns children, and therefore it is mostly pediatricians who work in this feild. But many parents with type 1 diabetes at the adult outpatient clinic ask if it is possible to measure antibodies in the child’s blood. If the child has two antibodies, they have a higher risk of developing the disease.

Type 2 Diabetes – Obesity and NerveTrials

When it comes to type 2 diabetes, it is the general practitioners who have the main responsibility for treatment. Only exceptionally do patients from this group come to Meling and his colleagues in the Endocrinology Section at SUS. However, it is type 2 diabetes that he has his doctorate on.

- There are quite a few trials on type 2 diabetes, but few here in Norway at the time being.

Type 2 diabetes is often referred to as a lifestyle disease given the primary cause of the disease is related to overweight and an unhealthy lifestyle. However, heredity also plays a significant role.

- Several medications have been introduced in the treatment of type 2 diabetes in recent years, and the medications are well studied in large clinical trials. As more and more medications in the field have proven to provide significant weight reduction and protect against cardiovascular disease and kidney disease, some of the trials have shifted towards other fields. It is therefore important for the industry to remember that even if the endpoints are weight reduction, cardiovascular disease and kidney disease, the recruitment opportunities will be large, especially within the group with type 2 diabetes. At the same time, for new medications, it will still be a significant endpoint to look at blood sugar reduction, says Meling.

In Stavanger, under the field of endocrinology, they currently have an ongoing trial looking at the treatment of painful diabetic neuropathy.

- We are testing a medicine that may have a beneficial effect on nerve pain. The phase 1 trial looks promising, so we are now participating in a phase 2 trial, with Novo Nordisk as the sponsor. Internationally, 200–300 patients are to be recruited, where we hope to contribute with 5 patients here from SUS, in addition three other site in Norway; Oslo University Hospital, Haukeland University Hospital, and Innlandet Hospital.

More Patient Groups in Need of Trials

When it comes to the other diseases within endocrinology, such as thyroid disease, parathyroid diseases, pituitary diseases, and adrenal diseases, there are few industry trials.

- There are some ongoing academic trials in this country on hyperthyroidism and adrenal insufficiency however, treatment methods are considerable well-established and some conditions do not have a high enough prevalence to warrant investment in new medications makes research extra challenging. Nevertheless, there would be potential for more clinical trials here, he says.

Network Under Development

Meling is working on developing and expanding the network of endocrinologists.

- We are today 26 colleagues in the network, spread across 24 different hospitals throughout the country. The goal is to have semi-annual meetings; otherwise, we communicate by email. I also send out newsletters to the network. The goal is to keep the large hospitals informed about trials and to try to get the smaller hospitals up and running in terms of facilities and capacity. So far, there are few inquiries from the industry in the field, but we hope this is changing. Our network of clinicians are ready, do not hesitate to contact us. We look forward to hearing from you!

Clinical Immunology - NorTrials

The article was translated from Norwegian to English using Perplexity and edited by Ingrid Bånerud.