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Congress Report: Highlights from the 76th American Diabetes Association (ADA) Scientific Sessions

Congress Report: Highlights from the 76th American Diabetes Association (ADA) Scientific Sessions
  • Cardiometabolic
  • Diabetes

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Practical

New research and developments were discussed during the meeting, which took place in New Orleans, USA, 10–14 June 2016. Chaicharn Deerochanawong presents some of the highlights.


Two type 2 diabetes treatments – empagliflozin and liraglutide – show cardiovascular and renal benefits  

Empagliflozin slows progression of kidney disease

Last year, the results of a large cardiovascular outcomes study (EMPA-REG)1 demonstrated that empagliflozin, an SGLT-2 inhibitor, significantly reduced cardiovascular events in patients with type 2 diabetes, marking the first time any cardiovascular benefit had been reported with a diabetes drug.

A new analysis of the study data examined the effects of empagliflozin on kidney disease.2 A 39% reduction in progression of nephropathy was seen, as was a 55% reduction in the initiation of renal replacement therapy.

The study authors concluded that the mechanisms behind cardiovascular benefits of empagliflozin are likely to be multifactorial.1 Similarly, it is probable many factors are responsible for renal benefits of empagliflozin, including direct renovascular effects.2

These results suggest that empagliflozin may fill a critical unmet need for patients who have diabetes and chronic kidney disease – a patient population with limited current treatment options.

Liraglutide lowers risk for cardiovascular complications, kidney disease and death

Results from the LEADER trial,3 a major cardiovascular outcomes study of liraglutide (a GLP-1 agonist), were announced for the first time by Dr J Buse and colleagues (University of North Carolina School of Medicine, Chapel Hill, USA). Liraglutide was shown to reduce the risk of cardiovascular death, non-fatal heart attacks and strokes, all-cause mortality and diabetic kidney disease in people with type 2 diabetes.

After empagliflozin, liraglutide is only the second type 2 diabetes medicine that has shown cardiovascular benefits.

In both the EMPA-REG and LEADER studies, glycemic control was maintained.

The results from these two studies have important implications for people with type 2 diabetes, as treatments that carry these types of benefits will likely have a significant impact on future management of their disease.

Advances in type 1 diabetes

Artificial pancreas

The development of the artificial pancreas, a technology that pairs insulin pumps with continuous glucose monitors using a computer algorithm, has been a major research focus for many years.

Recent advances in technologies, therapeutics and computing are moving us ever closer to the artificial pancreas becoming a reality for patients. 

Two studies (from Boston University and Massachusetts General hospital, USA) suggest that including glucagon in an artificial pancreas has the potential to solve some of the biggest concerns for people with diabetes, such as reducing the daily burden of diabetes management and avoiding hypoglycaemia.

Glucose monitoring

Technologies used in glucose monitoring have improved over recent years and are now more accurate, more reliable and easier to use.

Continuous glucose monitoring in type 1 diabetes was discussed, with many researchers reporting the outcomes of using it in patients with type 1 diabetes whose insulin therapies were delivered via multiple daily injection (in contrast to previous reports that have concentrated on patients who use an insulin pump). 

Patients with type 1 diabetes assigned to continuous glucose monitoring exhibited significantly reduced HbA1c, with an extra hour a day spent within glycaemic target range, less time in mild and dangerous hypoglycaemia, and less glycaemic variability.

These results suggest a benefit of continuous glucose monitoring for all those with type 1 diabetes who have not attained their glycaemic goals.

Beta cell replacement

Other sources for beta cells, used in beta cell replacement, are being explored, such as stem cells that could serve as “universal donors”.

Dr C Cowan (Harvard Stem Cell Institute) explained that this “universal donor pluripotential stem cell line” is generated using a new “gene editing” technology, by which his team remove the proteins that identify cells as “self” or “not self”. Dr Cowan’s team has shown that these engineered cells do not provoke the immune rejection response in laboratory mice.

This type of work could have a significant impact, by providing an unlimited source of beta cells to be used as “on-demand” treatment for diabetes patients.

Awards

The Banting Medal for Scientific Achievement recipient was Barbara Kahn, MD, of Harvard Medical School and Beth Israel Deaconess Medical Center. In her award lecture, she highlighted the complexity of adipose tissue by describing her recent discovery of a set of novel lipids that are normally produced in fat tissue. High levels of these lipids are associated with insulin sensitivity in humans, and low levels with insulin resistance. In other words, the more of these lipids you have in your body, the more efficiently your body metabolizes glucose. This is an exciting discovery, as it seems that replenishing levels of these novel lipids in insulin resistance and diabetes could improve glucose metabolism.

Each year, the award for outstanding scientific achievement recognizes the contributions of an investigator <50 years old. Tamas Horvath, of Yale University, New Haven, CT, USA, was this year’s recipient. In his award lecture he explained the central role of the brain in food intake and hunger, as well as in health and longevity. He described a tiny set of as few as 800 cells in the brain that are critical to regulating hunger and feeding. Using state-of-the-art technology to manipulate the function of these brain cells in mice, his laboratory was able to demonstrate that these neurons not only altered feeding behaviours, but also controlled non-feeding behaviours, such as anxiety, compulsion and interest in novelty. In addition, his team showed that manipulating the function of these neurons also impacted other body functions like bone quality, immune responses, fat tissue metabolism, and, ultimately, even lifespan. These far-reaching effects of hypothalamic neurons involved in feeding control are changing the way we think about the relationship between the brain and the body.

These data suggest that hunger and metabolism may affect brain function and overall health in ways we had not previously imagined, potentially opening up new ways to understand and combat chronic diseases like diabetes.


References

1. Zinman B, et al. NEJM 2015;373:2117-28.

2. Wanner C, et al. NEJM June 14, 2016; DOI: 10.1056/NEJMoa1515920.

3. Marso S, et al. NEJM June13, 2016; DOI:10.1056/NEJMoa1603827.

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