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EASD Conference 2012: Highlights from the European Society for the Study of Diabetes-EASD 2012

EASD Conference 2012: Highlights from the European Society for the Study of Diabetes-EASD 2012
  • Endocrinology and metabolism
  • Diabetes

Resource type

Article

The 48th annual meeting of the European Society for the Study of Diabetes-EASD took place in Berlin, 1-5 October 2012. Around 20, 000 delegates convened from Europe and world wide updating their knowledge and discussing the latest research and progress  in diabetes and its management. Many prestigious specialists gave lectures on the main aspects of this disease, from pathophysiology and secondary complications to treatment guidelines and novel drugs. This report summarises the most interesting ones and their main messages.

The most important session of the meeting focused on the new joint ADA-EASD guidelines for the treatment of diabetes released this year as a combined effort of the American and European societies. These guidelines emphasised the paradigm of a ‘patient’s tailored approach’ when prescribing the different anti-diabetic drugs, especially noting age and associated comorbidities. The aim is to achieve adequate HbA1c levels, without major risks. Life-style changes are of great importance and should be observed continuously, while metformin remains the first-line therapy for all diabetics, even in cases of moderate impairment of renal function. The addition of a second or third oral drug or of an injective agent, i.e. insulin or GLP-1 agonists, is appropriate when  a more appropriated metabolic control or specific goals, such as weight loss are required.

A very unusual topic discussed in a dedicated session was the relationship between diabetes and cancer. Many confounding factors act in this scenario, such as obesity, but the association of insulin and various growth factors with increased risk of cancer is clear, such as in colon cancer. Whether insulin analogues or secretagouges, such as glargine and sulfonylureas, may increase cancers’ incidence is still debated, with various studies reporting only a mild or no increase, but not a decrease. On the contrary, metformin seems to have a neutral or a protective effect on cancer risk probably due to its interaction with specific cell-cycle pathways, thus positively modulating cell proliferation.

Several presentations focused on new anti-diabetic drugs likely to enter the clinical arena. The coactivation of the PPAR-gamma and -alpha receptors by the dual agonist aliglitazar is under scrutiny in phase 3 trials in diabetic patients, with the preliminary results showing a reduction of glycaemia, lipids and cardiovascular disease risks and only mild side effects, i.e. peripheral oedema and weigh gain. The inhibition of hyperactivity of 11beta-hydroxysteroid-dehydrogenase type 1 is the target of some compounds in phase 2 trials in obese diabetics to reduce the excessive hepatic glucose output and the adipose tissue’s overproduction of adipokines and lipids, with initial results showing a decrease of insulin resistance, atherosclerosis, blood pressure, and body weight. Also, the combination of molecules with coagonist effects, e.g. glucagon+GLP-1 or GIP+GLP-1, is being tested in animal models to reduce hyperglycaemia, energy expenditure, appetite and body weight.

Finally, several  talks emphasised the deleterious relationship existing among modern diet, obesity, inflammation and diabetes. In particular, from the experimental settings, a high-fat diet caused adipose tissue expansion up to its partial death for hypoxia. Such stress can induce a local immune response that, when characterized by reduced T-regulatory lymphocytes and an excessive cytokines’ and adipokines’ release, may lead to systemic insulin resistance and hyperglycaemia. Interventions at these early stages could prevent or treat the final disease.

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