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Congress Report: 50th annual meeting of the European Association for the Study of Diabetes

PART OF Manage Diabetes Online FEATURE
Congress Report: 50th annual meeting of the European Association for the Study of Diabetes
  • Endocrinology and metabolism
  • Diabetes

Author

Resource type

Article

Tags

Diabetes and its complications
T1DM
T2DM
New therapeutic options
GLP-1 receptor agonists
Adherence
Weekly agents
Albiglutide
Long-acting exenatide
FOXO1
Painful diabetic neuropathy
PDN
cardiovascular risk factors
ESC/EASD Symposium
Hypertension and vascular ageing in elderly with diabetes
BP targets
Insulin secretion
insulin sensitivity
Statins
Diabetogenic effects of statins

The 50th EASD annual meeting took place in Vienna from 15th to 19th September. As always, an outstanding scientific programme summoned researchers and clinicians of the highest calibre from all over the world. Prof Ernesto Maddaloni reports.

Interesting symposia preceded the meeting where the main experts in the field debated about complications of diabetes and the new therapeutic options now available for the cure of diabetes. In particular the new long acting GLP1- Receptor Agonists (GLP-1RA) seem to have the potential to really change the habits of subjects affected by type 2 diabetes.  Nowadays diabetic patients need to take lot of pills a day to control glucose levels and the multiple cardiovascular risk factors related to diabetes. This poses concerns about the compliance of patients. Lessons from other endocrine disorders like osteoporosis tell us that weekly and monthly therapies achieve better compliance and outcomes. Now weekly agents are available for the cure of diabetes. These include albiglutide and the long-acting formulation of exenatide. Pre-clinical and clinical data show these drugs are effective for the treatment of type 2 diabetes and also the concerns about the side effects related to long-acting agents have been dispelled, the experts said.

The 46th Claude Bernard Lecture opened the meeting with an outstanding speech by Dr. Domenico Accili about the “new biology of diabetes”. His lecture focused on FOXO1, a key transcription factor in insulin signalling that regulates gluconeogenesis, glycogenolysis, β-cell failure and β-cell differentiation. Because of the comprehensive involvement of FOXO1 in the pathogenesis of both type 1 type 2 diabetes, Dr Accili proposed it as a new target for future therapies for diabetes.

This year the Camillo Golgi prize was awarded to Prof Solomon Tesfaye for his significant achievements in the study and treatment of diabetic neuropathy. While the rate of the other diabetic complications like myocardial infarction and blindness is declining (as shown by Gregg et al. in a paper recently published in the New England Journal of Medicine and as also highlighted during this EASD meeting), diabetes still remain the major non-traumatic cause of lower limb amputations. Moreover painful diabetic neuropathy (PDN) is the most relevant cause of reduced quality of life in subjects affected by diabetes. Luckily new therapeutic strategies showed to be effective in the treatment of PDN symptoms, such as the electrical spinal cord stimulation, which is currently free of charge in some countries, as in the UK. Furthermore international clinical trials exploring the effectiveness of alpha lipoic acid for the cure of PDN are on-going and results are expected to be available in the next years.

Diabetes in not just hyperglycaemia, as multiple cardiovascular risk factors coexist in diabetic patients. Thus a joint ESC/EASD symposium took place during the meeting in Vienna, focusing on hypertension and vascular ageing in elderly people with diabetes. Concerns about the best therapeutic target in this particular sub-group of patients arose. Experts suggest considering a systolic blood pressure target between 140 and 150mmHg in non-frail subjects, while more flexible and personalized targets should be used for frail elderly with diabetes.

Another important issue takled during the meeting was the diabetogenic action of lipid lowering agents. Statins are widely used in subjects with impaired glucose metabolism, but recent data showed an increased risk of developing diabetes in patients treated with statins. Nevertheless, current recommendations are still in favour for the use of statins because the cardiovascular benefits still exceed the risk of diabetes. An excellent talk by Prof Markku Laakso focused on the mechanisms possibly causing the diabetogenic effects of statins. In particular his studies showed that both insulin secretion and insulin sensitivity are affected by simvastatin, but not by pravastatin. Previous data also found that the increased risk of diabetes was mainly associated with simvastatin, atorvastatin and rosuvastatin, but not with pravastatin. These evidences could support the use of pravastatin, but further studies will clarify which is the best statin to be used in diabetic patients, evaluating the overall effect on cardiovascular outcomes.

These are just few of the several topics tackled during the 50th EASD annual meeting, a unique occasion to learn, debate and keep up to date in the field of diabetes and its complications.

Suggested references 12 3 4 5 6 7 8 9.

1.        Trujillo, J. M. & Nuffer, W. Albiglutide: A New GLP-1 Receptor Agonist for the Treatment of Type 2 Diabetes. Ann. Pharmacother. (2014). doi:10.1177/1060028014545807

2.        Wysham, C., Grimm, M. & Chen, S. Once weekly exenatide: efficacy, tolerability and place in therapy. Diabetes. Obes. Metab. 15, 871–81 (2013).

3.        Bouchi, R. et al. FOXO1 inhibition yields functional insulin-producing cells in human gut organoid cultures. Nat. Commun. 5, 4242 (2014).

4.        Talchai, C., Lin, H. V, Kitamura, T. & Accili, D. Genetic and biochemical pathways of beta-cell failure in type 2 diabetes. Diabetes. Obes. Metab. 11 Suppl 4, 38–45 (2009).

5.        Tesfaye, S., Boulton, A. J. M. & Dickenson, A. H. Mechanisms and management of diabetic painful distal symmetrical polyneuropathy. Diabetes Care 36, 2456–65 (2013).

6.        Gregg, E. W. et al. Changes in diabetes-related complications in the United States, 1990-2010. N. Engl. J. Med. 370, 1514–23 (2014).

7.        Rydén, L. et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboratio. Eur. Heart J. 34, 3035–87 (2013).

8.        Sattar, N. et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet 375, 735–42 (2010).

9.        Ridker, P. M., Pradhan, A., MacFadyen, J. G., Libby, P. & Glynn, R. J. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial. Lancet 380, 565–71 (2012).

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International conference
Stockholm, Sweden
Sep 15 - 19, 2015
Target audience
Endocrinologists
Endocrinology and metabolism