News from the American Diabetes Association Meeting in Chicago
We have summarised selected highlights from the ADA Meeting, June 21-25 in Chicago, IL, USA.
J. Tuomilehto, MD, PhD, (University of Helsinki, Finland) discussed the association between a country's socioeconomic status and its epidemiology of type 1 diabetes mellitus (T1DM), including results from the World Health Organization's Diabetes Mondiale (DiaMond) study. Overall, higher incidences of T1DM are seen in higher-income countries, although T1DM incidences appear to be on the increase worldwide, irrespective of income. Incidence of diabetes may depend on cultural factors, as well as accessibility to care for diagnosis and treatment. The lack thereof may result in high mortality, and in keeping the incidence low.
Results from the Diabetes Control and Complications Trial (DCCT) show that after 18 years, the overall prevalence of diabetes complications is still reduced among T1DM patients who were assigned to intensive glucose control, as compared to those receiving standard treatment. HbA1c levels were similar between the treatment groups at this time.
The final analysis of the Look AHEAD trial was presented at the ADA, and simultaneously published in the NEJM . No significant effect on a composite of cardiovascular outcomes was seen for patients with diabetes mellitus type 2 who had undergone an intensive lifestyle intervention as compared to patients who had only received advice. Improving diet and exercise did not protect patients against heart problems.
Despite the lack of benefit for people in the intensive intervention group, the study shows that obese or overweight patients with diabetes can lose weight and maintain this weight loss. This has health benefits, but does not decrease the risk of cardiovascular disease (at a median follow-up of 9.6 years).
Other study outcomes of the Look AHEAD were also presented at the ADA meeting. For instance, the intensive intervention was associated with less kidney disease, less retinopathy, less depression and a reduction in hospitalisation and medication, thus lower health costs.
Both S. Dhindsa, MD (Buffalo School of Medicine and Biomedical Sciences) and R. Basu, MD (Mayo Clinic, Rochester, MN) spoke about low testosterone, which is seen in many men with T2DM. Dr. Dhindsa discussed the reciprocal relationship and how it may be blurred by obesity. Dr. Basu called for a large RCT that looks into the effects of testosterone supplementation in elderly patients with diabetes.
A Boehringer Ingelheim and Lilly Diabetes Alliance presented results of a 52-week Phase III clinical trial testing the investigational compound empagliflozin in adults with T2DM, a member of the sodium glucose cotransporter 2 (SGLT2) inhibitor class. The SGLT2 inhibitor class removes excess glucose through the urine by reducing glucose reabsorption in the kidney. Empagliflozin showed statistically significant reductions in HbA1c (average blood glucose) at week 24, with the addition of empagliflozin to existing oral glucose-lowering therapy in people with T2DM and mild to moderate renal impairment. A significant reduction in body weight and significant improvements in blood pressure were also seen after treatment with empagliflozin as compared to placebo .
1. Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes. The Look AHEAD Research Group. June 24, 2013DOI: 10.1056/NEJMoa1212914