Friday, January 27, 2023
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Conference attendees heard the latest research in basic, clinical, and translational science. Among the highlights:
In patients with type 2 diabetes and cardiovascular disease, the use of the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin (Januvia) did not increase risk of cardiovascular events in a large outcomes trial designed specifically to answer this question. There was no increase in the number of patients hospitalized for heart failure with sitagliptin, a critically watched secondary end point, given that other drugs in the class, most notably saxagliptin (Onglyza), showed an increase in heart-failure events in one study. "Given the size of our study, the long duration of follow-up, as well as the higher risk of our population, we feel that this very adequately addresses and puts to bed the question that there is any risk for heart failure with this drug," said Eric Peterson, MD, from Duke Clinical Research Institute, Durham, North Carolina, cochair of the TECOS executive committee.
Lixisenatide (Lyxumia), an injectable glucagonlike peptide (GLP-1) agonist, did not show a benefit on cardiovascular outcomes in the 6000 high-risk patients with type 2 diabetes in the ELIXA trial. But in this FDA-required CV safety study, lixisenatide also did not cause any harm in these patients, who had recently suffered an acute coronary event. There was no difference between the lixisenatide and placebo arms in the primary composite outcome of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. "The effect of lixisenatide was neutral in ELIXA, and this should provide physicians and patients with some reassurance," said lead investigator, Marc Pfeffer, MD, of Brigham and Women's Hospital, Boston, Massachusetts.
Conference attendees were treated to a progress report from several research teams developing "artificial-pancreas" systems. Incremental progress is steady; the remaining challenges include the prevention of hypoglycemia, which the systems have greatly reduced but not eliminated entirely, as well as postprandial glucose spikes resulting from delayed absorption of subcutaneously infused insulin. Scientists at the meeting also stressed that it will still be a few years before any of the systems in development are commercially available, likely around 2018. Nor do they represent a "cure" for type 1 diabetes but, rather, a "bridge" until such time as a cell-based cure is discovered.
Significant weight loss was achieved and maintained for up to 5 years in a real-world study of obese patients with type 2 diabetes who took part in a 12-week, intensive lifestyle intervention program, which emphasizes the preservation of muscle mass. The 53% of participants who lost at least 7% of their weight (about 23 pounds) with the program and kept it off for a year maintained this weight loss long term and saw improvements in certain cardiovascular risk factors in the 5-year follow-up. Osama Hamdy, MD, PhD, from the Joslin Diabetes Center, Boston, Massachusetts, reported the findings from the Weight Achievement and Intensive Treatment (Why WAIT) program here. The study was awarded the Michaela Modan Memorial Award for its major contribution to the understanding of type 2 diabetes.
Image courtesy of Dr Osama Hamdy
In a cohort of adult patients with type 1 diabetes who were hospitalized with diabetic ketoacidosis (DKA), almost all patients survived the hospitalization, but they had an increased risk of early death. After one hospitalization for DKA, patients had a 10% greater risk of dying within 5 years, but after more than four hospitalizations for DKA, they had a 30% increased risk of dying within 6 years, reported Fraser W Gibb, MBChB, PhD, from the Edinburgh Centre for Endocrinology & Diabetes, Scotland. It was also "really quite striking" that the patients had a median age of 31 when they died after multiple DKA hospitalizations, and many died at home, often from "uncertain causes," he said. Session chair Kasia J Lipska, MD, MHS, from Yale University, New Haven, Connecticut, called the findings "very scary (and) sobering."
Image courtesy of Dr Kasia Lipska
The FLAT-SUGAR trial provides proof of concept that glucose variability (GV) can be reduced while maintaining similar glycated hemoglobin (HbA1c) levels through use of a GLP-1 agonist, rather than prandial insulin. A larger trial is required to see whether targeting GV improves clinical outcomes in diabetes, say the researchers, led by Irl B Hirsch, MD, of the University of Washington, Seattle. HbA1c, while associated with diabetes complications, does not reflect GV, which may contribute to vascular disease by inducing inflammation, oxidative stress, and cardiac arrhythmias.
Obstructive sleep apnea (OSA) is common in people with type 1 diabetes and is associated with abnormal glycemia and microvascular complications but not body mass index (BMI), reported Laurent Meyer, MD, an endocrinologist at Hôpitaux Universitaires de Strasbourg, France. The link between type 1 diabetes and OSA has been reported in three previous small trials, but this study of 90 adults with type 1 diabetes is the largest such trial to date and the first to use both continuous glucose monitoring and sleep studies. The message for clinicians is to "think of OSA" in type 1 patients with long disease duration, Dr Meyer said. "With the design of our study we can't say check at 10 or 15 years, but in my opinion if [a patient has] a duration of more than 20 years, it's important to check for OSA."
Image from Dreamstime
The use of sulfonylureas in patients with type 2 diabetes mellitus does not increase the risk of all-cause or CV mortality, suggest results of a new meta-analysis. There was also no increased risk of stroke or MI with the antidiabetic agents, reported Dr Dimitris Rados (Hospital de Clinic de Porto Alegro, Brazil). The results were similar when they included and excluded data from the UK Prospective Diabetes Study, the first study to suggest a potential mortality risk among patients treated with metformin plus a sulfonylurea. When analyzing the different sulfonylureas, investigators did observe a statistically significant increase in the risk of all-cause and CV mortality with glipizide, although they caution against making too much of the subgroup analysis given the small number of patients and clinical events.
Image from Dreamstime
Spouses or live-in partners of people newly diagnosed with diabetes are twice as likely to develop diabetes themselves, compared with people in the general population, in the year following the initial diagnosis of their loved one, hint new data from a large Kaiser Permanente study. The findings are "quite striking," said study presenter Mohammed K Ali, MBChB, from Emory University, Atlanta, Georgia. "Not only are they provocative, but the implications are huge. It might be important to think about talking to the spouses or partners [of newly diagnosed patients] about their own risks. Even if you are not genetically related, if you are a residing spouse or domestic partner, just that shared environment is associated with an increased risk, that's what we saw."
Image from iStock
A group of US societies has issued new guidance to doctors on when they should refer patients for diabetes self-management education. "There is confusion as to why diabetes education is needed, when diabetes education should occur, what is needed in diabetes education, and how it should be provided," said Margaret Powers, PhD, ADA healthcare and education president-elect. "Our goal with this paper was to reduce this confusion and provide clear guidelines and expectations for clinicians and for patients," said Dr Powers. The joint position statement has been released by the ADA, the American Association of Diabetes Educators (AADE), and the Academy of Nutrition and Dietetics, in collaboration with the National Diabetes Education Program (NDEP).
Image from Dreamstime
Glucagonlike peptide-1 (GLP-1) may play a role in the brain regarding anticipation of tasty food and may reduce food cravings. Individuals who received injections of the GLP-1 receptor agonist exenatide (Bydureon) had dampened responses in the brain's reward system at the sight of chocolate milk and enhanced responses after drinking the chocolate milk, in a small functional-MRI study. The GLP-1 agonist also increased activation in the brain's reward system after consuming food, which may prevent overeating, Liselotte van Bloemendaal, MD, from VU University Medical Center, Amsterdam, the Netherlands, reported here.
Diabetic peripheral neuropathy is associated with significantly reduced vitamin D levels, independent of sunlight exposure, a new study finds. This suggests a possible role of vitamin D in the pathogenesis of painful diabetic peripheral neuropathy and therefore a potential role of supplementation in its treatment, pending the results of randomized clinical trials, said study author Dinesh Selvarajah, MD, of the University of Sheffield, United Kingdom. This is the first study to carefully control for seasonal differences in vitamin D and for activity variations that affect vitamin D exposure. "We've certainly got a smoking gun. We've got a proof of concept. Now we need to do an intervention study to show whether this is a significant finding, because if it is, it's a simple enough treatment," he said.
Image from Dreamstime
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