Special Interview with Prof. Zachary T. Bloomgarden on Diabetes, Cancer Risk, and Metabolic Complications
On October 9, 2026, Metabolism and Target Organ Damage (M&TOD) had the honor of conducting an in-depth academic interview with Prof. Zachary T. Bloomgarden, Clinical Professor at the Icahn School of Medicine at Mount Sinai and an internationally recognized expert in diabetes. Moderated by Prof. Amedeo Lonardo, Editor-in-Chief of M&TOD, the interview explored emerging perspectives on diabetes, cardiovascular disease, cancer risk, MASH, and diabetic kidney disease.
During the interview, Prof. Bloomgarden first discussed the substantial decline in cardiovascular mortality among people with diabetes over the past two decades. He highlighted the important contributions of smoking cessation, improved blood pressure management and glycemic control, and the introduction of newer therapies, including SGLT2 inhibitors and GLP-1 receptor agonists. Looking ahead, he emphasized that further improvements in patient outcomes will depend not only on continued development of new therapies, but also on improving the global accessibility and affordability of effective treatments.
Turning to the relationship between diabetes onset and long-term health outcomes, the discussion then explored the relationship between the age at diabetes onset and the long-term risks of complications and cancer. Prof. Bloomgarden discussed the potential roles of insulin resistance, nutrient excess, and sedentary lifestyles in metabolic disease and cancer risk. He also highlighted the potential of artificial intelligence to help researchers better understand complex metabolic networks and identify new opportunities for early intervention.
Another key area of discussion was sex-related differences in diabetes complications. Prof. Bloomgarden noted that women generally have certain metabolic and cardiovascular protective advantages before menopause, while diabetes may diminish these protective effects. The discussion considered the potential roles of estrogen, inflammation, and differences in lifestyle and metabolic factors, underscoring the importance of further research into sex-specific mechanisms and disease management.
The conversation also turned to the connections between MASH and diabetic kidney disease. Prof. Bloomgarden discussed shared mechanisms through which lipid toxicity may contribute to liver and kidney injury, and highlighted emerging research areas including ferroptosis and members of the FGF family. The conversation also addressed advances in pharmacological treatment for MASH and the evolving role of metabolic therapies, including GLP-1-based treatments.
Finally, Prof. Bloomgarden discussed the changing clinical phenotype of people with type 1 diabetes. As patients experience longer survival and improved glycemic management, an increasing number of individuals with type 1 diabetes now present with overweight, insulin resistance, and features of metabolic syndrome. He noted that these changes should not simply be attributed to treatment failure. The discussion also considered the potential applications of GLP-1- and SGLT2-based therapies in type 1 diabetes, while emphasizing the need to carefully consider safety concerns, including hypoglycemia and diabetic ketoacidosis.
This interview provided a broad perspective on the evolving landscape of diabetes and metabolic disease research, exploring the complex relationships between metabolic disorders and cardiovascular, hepatic, and renal target organ damage. It also highlighted the importance of improving access to effective therapies, understanding differences among patient populations, and exploring new approaches to disease prevention and treatment. M&TOD remains committed to facilitating high-level academic exchange, fostering international collaboration, and advancing research in metabolism and target organ damage.
Interview Questions:
A recent editorial published in the Journal of Diabetes this year discusses data indicating an approximately 69% decline in weighted mean cardiovascular disease mortality among people with diabetes over a period of approximately 20 years. This represents one of the most impressive achievements recorded in the epidemiology of any chronic non-communicable disease. Smoking cessation, widespread statin and antihypertensive therapy, improved glycemic management, and the availability of SGLT2 inhibitors and GLP-1 receptor agonists have collectively contributed to this. Could you comment on these developments, please?
Unfortunately, the decline in cardiovascular mortality has another side: cancer has become the leading cause of death among people with diabetes in several geographical areas. One of your group’s findings is that a longer duration of diabetes represents a meaningful risk factor for cancer. Your investigation, published in Diabetes Care in 2024, found a 48% excess risk among those who developed diabetes between the ages of 20 and 54, compared with 6% among those who developed it between the ages of 70 and 74. Interestingly, similar trends were observed for liver cancer irrespective of sex. Given the pronounced male predominance of primary liver cancer, do you believe that type 2 diabetes may attenuate this sex disparity?
It's another consequence, I think, of your findings, namely that the longer the duration of diabetes, the more increased is the risk of cancer. For example, your data showed that if you develop diabetes between the ages of 20 and 54, you have a 48% risk of cancer, which is much higher compared to only 6% among those who develop diabetes between the ages of 70 and 74. Which means that by delaying the onset of diabetes, we can also prevent cancer. Maybe you agree on this particular question.
There is also another aspect of the complications of diabetes with reference to primary liver cancer. My background is gastroenterology. I'm not an oncologist either, but I am impressed by the finding that primary liver cancer is typically a male-predominant disease. However, if you look at those who develop primary liver cancer in the context of diabetes, it seems there is no such male predominance. In other words, women are more disadvantaged. And given that ILC seems to be, I was wondering whether IL-6, chronically increased owing to diabetes, particularly exposes women to the risk of primary liver cancer, whereas non-diabetic women are typically spared this disease or develop it, let's say, 10 years after. What's your opinion? I know you are not an oncologist, but this could also be another topic.
Before you mentioned metabolic cues, and that, you know, that I am a pathologist, so I try to combine these two conditions. Another editorial you published in the Journal of Diabetes in 2024 discusses the future shared by diabetic kidney disease and MASH, which used to be called NASH, with the latter showing encouraging responses to the FGF21 analog pegozafermin. However, if pegozafermin is not currently approved for the treatment of MASH, whereas resmetirom and semaglutide are, could you comment on these developments and outline a reasonable research agenda for the MASH field, as seen from your point of view?
The final question concerns type 1 diabetes in the era of obesity, something you were discussing. When I was a medical student many, many years ago, individuals with type 1 diabetes were generally very lean. This is no longer consistently the case, and patients may now present with combinations of high insulin requirements, hypertension, dyslipidemia, metabolic syndrome, and increased cardiovascular and hepatorenal risks. As the clinical phenotype of diabetes has changed, I think so. Are we facing a new form of disorder that presents greater therapeutic challenges and potentially worse outcomes, despite your therapeutic tools?
Personal Introduction:
Prof. Zachary T. Bloomgarden is a distinguished endocrinologist and diabetologist with an international reputation for his contributions to diabetes research, clinical practice, and medical education. He earned his medical degree from Albert Einstein College of Medicine, followed by residency training in internal medicine at Montefiore Medical Center and fellowship training in endocrinology, diabetes, and metabolism at Vanderbilt University Medical Center. He currently serves as Clinical Professor in the Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, at the Icahn School of Medicine at Mount Sinai in New York, USA. He remains actively engaged in clinical practice and medical education, including organizing diabetes clinic conferences and contributing to teaching across multiple medical disciplines.
Prof. Bloomgarden's research and clinical interests encompass a broad range of areas in diabetes and metabolic disease, with particular expertise in diabetes epidemiology, cardiovascular disease, diabetic kidney disease, insulin resistance, and the safety and efficacy of therapeutic interventions. He has closely followed advances in diabetes treatment, including insulin therapy, incretin-based therapies, and glucose transporter inhibitors, with particular attention to their potential cardiovascular and microvascular benefits. He has also served as a principal investigator in multiple clinical studies evaluating diabetes treatments and related therapeutic interventions, contributing to a deeper understanding of diabetes and its complications and to the development of evidence-based approaches to their management.
Prof. Bloomgarden has made substantial contributions to academic publishing in the field of diabetes. He has authored more than 550 articles and has served on the Editorial Board and as an Associate Editor of Diabetes Care. He also wrote the journal's monthly Perspectives on the News column, providing expert perspectives on developments in diabetes research and clinical practice. He currently serves as Editor of the Journal of Diabetes, where he continues to write commentaries addressing various aspects of diabetes treatment and management. His broader academic service includes serving on the Board of the American Association of Clinical Endocrinologists and the Journals Managing Subcommittee of the Endocrine Society. He has also reviewed for numerous leading medical journals, including The Lancet, JAMA Internal Medicine, and Annals of Internal Medicine.
In recognition of his outstanding contributions to endocrinology, Prof. Bloomgarden was awarded the title of Master of the American College of Endocrinology in 2012. He has also been recognized for many years in the Castle Connolly Guide: The Best Doctors New York Metro Area and has been named a SuperDoctor by The New York Times. Through his extensive clinical experience, scholarly contributions, and leadership in academic publishing, Prof. Bloomgarden has established himself as a respected voice in the field of diabetes and endocrinology. He currently serves as a member of the Editorial Board of Metabolism and Target Organ Damage (M&TOD).
Editor: Gia Wang
Production Editor: Xingyue Luo
Respectfully submitted by the Editorial Office of Metabolism and Target Organ Damage
