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EASD conference 2013: Highlights from the European Society for the Study of Diabetes meeting 2013

EASD conference 2013: Highlights from the European Society for the Study of Diabetes meeting 2013
  • Endocrinology and metabolism
  • Diabetes

Resource type


The 49th annual meeting of the European Association for the Study of Diabetes (EASD) was held this year in September in Barcelona, Spain. More than 20,000 participants from Europe and many other countries around the world gathered to hear plenary lectures, oral communications, debates, poster presentations (both basic and clinical science) reviewing the major topics in both type 1 and 2 diabetes management, including pathophysiology, diagnostic procedures, related complications and therapeutic solutions.

The focus of several lectures was the pancreatic islets and the beta-cells within. Indeed, electro-physiology studies have highlighted the altered electric activity of insulin exocytosis in diabetes before the reduction of the beta-cell mass. This dysfunction precedes cell apoptosis but both phenomena are genetically determined and accelerated by obesity and lipotoxicity. Compensatory electric activity of other islet cell-type, ie alpha-cells, occurring in diabetes was described. Also, details were given on how GLP1 analogues can restore the electric activity of the islets.

The UKPDS closed 15 years ago, and the impact on type 2 diabetes care and the post-trial follow up outcomes were presented in a dedicated session. The results demonstrated the decline of efficacy with time of any type of drug used, as well as the major synergistic role of hypertension in causing complications, including myocardial infarction. Initial early and intensive control of the glucose metabolism was shown to be effective in reducing micro- and macro-vascular complications in the long-term. In general, the inclusion of metformin in the therapeutic strategy gave the highest efficacy in reducing cardiovascular events.

The role of inflammation in obesity and type 2 diabetes and the  possible implications for treatment were discussed. Much evidence suggests that cytokines from inflamed adipose tissue, such as TNF-alpha and IL1-beta or IL6, have negative effects on insulin sensitivity and beta-cell function and survival. Antagonising such molecules or preventing type 1 macrophage activation by using selective immune-modulatory drugs could reduce glucose levels and insulin resistance and also cardiovascular complications; clinical trials are already exploring such solutions.

The treatment of type 2 diabetes is founded on several drugs, each of them acting on a different pathophysiological aspect of the disease. Body composition, laboratory features, and associated comorbidities provide guidance for the proper selection of therapeutic combinations. Metformin remains the base, with TZDs and DPP4 inhibitors added in presence of insulin resistance or beta-cell failure. Second line choices are respectively GLP1 receptor agonists and sulfonylureas,  with bromocriptine and SGLT2 inhibitors as third options. Insulin is used at different stages according to cases.

The use of bariatric surgery is increasing as a treatment for obesity-related diabetes in view of the refinement of surgical techniques and the positive outcomes of many years of its application in the field. Gastric by-pass and sleeve gastrectomy are two of the main methods currently used and these achieve good metabolic results balanced against limited side-effects. Diabetes remission or improvement is consistent and persistent accordingly to body weight loss, with reduction of related complications, especially nephropathy, of blood pressure levels, and of cardiovascular morbidity and mortality.

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