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Lisa Nainggolan; Darby Rotach; Marlene Busko; Becky McCall; Miriam Tucker; Megan Brooks; Miquel Gonzalez | October 7, 2019
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Top News From EASD 2019: Slideshow
Lisa Nainggolan; Darby Rotach; Marlene Busko; Becky McCall; Miriam Tucker; Megan Brooks; Miquel Gonzalez | October 7, 2019 | Contributor Information
The latest research in diabetes, including a deeper dive into the treatment of type 2 diabetes, with a strong focus on the role of newer medications in the prevention and management of comorbid cardiovascular and renal disease, greeted attendees here at the European Association for the Study of Diabetes (EASD) 2019 Annual Meeting, held September 16 to 20 in Barcelona, Spain.
Top News From EASD 2019: Slideshow
Lisa Nainggolan; Darby Rotach; Marlene Busko; Becky McCall; Miriam Tucker; Megan Brooks; Miquel Gonzalez | October 7, 2019 | Contributor Information
Among the highlights this year:
DAPA-HF shows "stunning and consistent" benefit with dapagliflozin in heart failure
VERIFY supports initial dual therapy with metformin + DPP-4 inhibitor
CGM, not insulin delivery method, the key to better outcomes in type 1 diabetes
In vitro fertilization tied to increased risk for gestational diabetes
Novel first-in-class 'glimin' glucose-lowering agent shows promise in type 2 diabetes
Global data show A1c targets missed in most with type 1 diabetes
Cleaners and factory workers have high rates of type 2 diabetes
CAROLINA published results reaffirm sulfonylurea CV safety
Top News From EASD 2019: Slideshow
Lisa Nainggolan; Darby Rotach; Marlene Busko; Becky McCall; Miriam Tucker; Megan Brooks; Miquel Gonzalez | October 7, 2019 | Contributor Information
FDA OKs 'Game-Changer' Oral GLP-1 Agonist for Type 2 Diabetes
Approval by the US Food and Drug Administration (FDA) of oral semaglutide (Rybelsus, Novo Nordisk) for adults with type 2 diabetes was greeted with enthusiasm on the last day of the meeting. As the first tablet form of a glucagon-like peptide-1 (GLP-1) receptor agonist, oral semaglutide is a "game changer," said Julio Rosenstock, MD, director of the Dallas Diabetes Research Center at Medical City, Texas. "There is no oral agent that can give you a 1.2% to 1.5% A1c reduction with a 3- to 4-kg loss...One of the barriers of the GLP-1 agonists, among other things, is [that they're] injectable," he said. EASD President David Matthews, DPhil, BM, BCh, agreed. "I think it will dramatically change the management of [type 2] diabetes because until now GLP-1 agonists have only been available in injectable form. As soon as we've got an oral form, suddenly there will be many more people who would feel that it's perfectly acceptable to take."
Top News From EASD 2019: Slideshow
Lisa Nainggolan; Darby Rotach; Marlene Busko; Becky McCall; Miriam Tucker; Megan Brooks; Miquel Gonzalez | October 7, 2019 | Contributor Information
DAPA-HF Published: 'Stunning Consistent Benefit With Dapagliflozin'
The landmark DAPA-HF trial, already reported at the ESC meeting earlier in the month, was presented to diabetologists. It shows the glucose-lowering drug dapagliflozin (Farxiga, AstraZeneca) provides "stunning, pretty consistent benefit" in patients with heart failure, both with and without type 2 diabetes, reported principal investigator John McMurray, MD, University of Glasgow, UK. The trial enrolled almost 5000 patients with moderate heart failure and reduced ejection fraction (HFrEF) — with or without type 2 diabetes — and randomized them to once-daily dapagliflozin 10 mg or placebo plus contemporary therapy for HF. Dapagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, is already used to successfully treat type 2 diabetes and prevent development of HF in these patients, but DAPA-HF was a dedicated HF trial that now shows the drug can be used to treat pre-existing HF, even in patients without diabetes. But the positive outcomes are also very important for patients with diabetes, McMurray said, because HF is the "most terrible complication of diabetes" and is more common than myocardial infarction "with a worse prognosis than breast cancer or colon cancer." The results were simultaneously published, to coincide with the EASD presentation, in the New England Journal of Medicine.
Top News From EASD 2019: Slideshow
Lisa Nainggolan; Darby Rotach; Marlene Busko; Becky McCall; Miriam Tucker; Megan Brooks; Miquel Gonzalez | October 7, 2019 | Contributor Information
VERIFY: Metformin + DPP-4 Inhibitor as Dual Therapy for Diabetes?
For patients newly diagnosed with type 2 diabetes, the recommended strategy of initiating treatment with metformin and then stepping up treatment with a second agent if monotherapy fails to control blood glucose might not be ideal. Rather, initial dual therapy may be better, according to results of the VERIFY trial, presented by lead investigator and EASD President David Matthews, DPhil, BM, BCh, and two coinvestigators. Among patients with newly discovered diabetes whose A1c level was 6.5% to 7.5% (48–58 mmol/mol), those who initially received combination therapy with metformin plus the dipeptidyl peptidase-4 (DPP-4) inhibitor vildagliptin (Galvus, Novartis) were less likely to experience sustained treatment failure (A1c ≥ 7% [≥ 53 mmol/mol]) during the 5-year study period. The study should "reassure" clinicians that initial dual therapy with these two agents "is well tolerated, safe, and effective," noted Ofri Mosenzon, MD, and Gil Leibowitz, MD, from the Hebrew University of Jerusalem, Israel, in an editorial published simultaneously, along with the VERIFY study, in the Lancet.
Top News From EASD 2019: Slideshow
Lisa Nainggolan; Darby Rotach; Marlene Busko; Becky McCall; Miriam Tucker; Megan Brooks; Miquel Gonzalez | October 7, 2019 | Contributor Information
CGM, Not Insulin Pump, 'Is What Makes Difference' in Type 1 Diabetes
Use of real-time continuous glucose monitoring (rtCGM) can help improve blood glucose control in people with type 1 diabetes whether they use an insulin pump or multiple daily injections (MDI) of insulin, according to 3-year data from the COMISAIR study presented here by Jan Šoupal, MD, PhD, Charles University, Prague, Czech Republic, and simultaneously published in Diabetes Care. At 3 years — the longest duration of any CGM trial — real-time (not flash) CGM was superior to self-monitored blood glucose, or fingerstick, testing at least four times daily in reducing A1c in patients using both pumps and MDI, with little difference between the two insulin delivery modalities. Only the rtCGM group had improvements in time-in-range and reduced time below range. Fewer patients using rtCGM experienced severe hypoglycemic episodes. "It is not so important how insulin is delivered, but more important is how patients with type 1 diabetes monitor their glucose. Individualization of treatment is important. However, according to the results of our trial, in the vast majority of cases, CGM is what makes the difference," Šoupal said.
Top News From EASD 2019: Slideshow
Lisa Nainggolan; Darby Rotach; Marlene Busko; Becky McCall; Miriam Tucker; Megan Brooks; Miquel Gonzalez | October 7, 2019 | Contributor Information
IVF Associated With Higher Risk of Gestational Diabetes
Mothers who undergo assisted reproduction are more likely to develop gestational diabetes than those who conceive naturally, according to a new meta-analysis presented by Panagiotis Anagnostis, MD, from the Aristotle University of Thessaloniki, Greece. "This rigorous assessment of the best available evidence to date shows that singleton pregnancies achieved by in vitro fertilization (IVF) are linked with an increased risk of developing gestational diabetes compared with pregnancies conceived naturally," said Anagnostis. The findings highlight the importance of early detection of gestational diabetes in women who fall pregnant after assisted reproduction, which as well as IVF, covers those conceiving through intracytoplasmic sperm injection, he said. "This can lead to timely and effective interventions, especially for women with pre-existing risk factors for gestational diabetes including polycystic ovary syndrome, obesity, increased maternal age, and family history of type 2 diabetes," Anagnostis said.
Top News From EASD 2019: Slideshow
Lisa Nainggolan; Darby Rotach; Marlene Busko; Becky McCall; Miriam Tucker; Megan Brooks; Miquel Gonzalez | October 7, 2019 | Contributor Information
Novel Agent Imeglimin Improves Glucose Control in Type 2 Diabetes
A novel investigational first-in-class drug called imeglimin (Poxel Pharma) has shown promise for type 2 diabetes, according to data presented by Julie Dubourg, MD, Poxel's medical director of clinical development. "In all phase 2 and phase 3 trials, imeglimin has demonstrated very robust efficacy in the type 2 diabetic population, as well as in subpopulations such as elderly patients and those with chronic kidney disease. The safety and tolerability profile is also very good. So this [may be] a new option for the treatment of patients with type 2 diabetes as mono- or add-on therapy," said Dubourg. Imeglimin works by improving mitochondrial function, which in turn increases insulin secretion and insulin sensitivity in the muscle while also decreasing hepatic glucose production, Ralph DeFronzo, MD, of University of Texas Health Sciences Center, San Antonio, noted during the symposium. Imeglimin is the first of what will be a new "glimin" class of glucose-lowering agents. "These drugs actually correct three of the big problems that are present in our diabetic patients...It provides us with a new mechanism of action," DeFronzo said. In addition, because preclinical data suggest that imeglimin also mobilizes fat in the liver, "this drug also has the potential to be used in [nonalcoholic steatohepatitis]," he noted.
Top News From EASD 2019: Slideshow
Lisa Nainggolan; Darby Rotach; Marlene Busko; Becky McCall; Miriam Tucker; Megan Brooks; Miquel Gonzalez | October 7, 2019 | Contributor Information
'A Bad Result': A1c Targets Missed in Most With Type 1 Diabetes
Only a small proportion of adults with type 1 diabetes worldwide are achieving optimal glucose control, according to findings from the multinational, observational Study of Adults' Glycemia in TID (SAGE). The study included nearly 4000 adults aged 26 years and older with type 1 diabetes from 17 countries in Western Europe, Eastern Europe, Latin America, Asia, and the Middle East. (North America and Africa weren't included.) Overall, only a quarter to a fifth of patients were achieving A1c levels < 7% (< 53 mmol/mol) or individualized targets set by their clinician. Of concern, 43% had an A1c ≥ 8% and 20% had an A1c ≥ 9%. Better control was achieved in Western Europe compared with other regions, and the least amount of patients met A1c goals in the Middle East. "Unfortunately, it is a bad result for most people...There is really a need for education because what we see is that technology is not improving results so much," said Eric Renard, MD, PhD, Medical School of the University of Montpellier, France.
Top News From EASD 2019: Slideshow
Lisa Nainggolan; Darby Rotach; Marlene Busko; Becky McCall; Miriam Tucker; Megan Brooks; Miquel Gonzalez | October 7, 2019 | Contributor Information
Cleaners and Factory Workers Have High Rates of Type 2 Diabetes
Certain unskilled workers such as factory employees, cleaners, and truck drivers were two to three times more likely to have type 2 diabetes than skilled workers such as teachers and engineers in a national study of the 30 most common occupations in Sweden. This higher risk for diabetes among workers in certain occupations goes beyond the already established risk associated with having poor socioeconomic status, according to Sofia Carlsson, PhD, Institute of Environmental Medicine, Stockholm, Sweden, and colleagues. We "show that job title is a much more specific indicator of type 2 diabetes risk than socioeconomic status alone," they note. The results indicate that if companies set up workplace wellness programs to target particular employees at high risk of diabetes, this could potentially have a big impact on improving population health, they say. Carlsson presented the findings during a press briefing and as a poster, with simultaneous publication in Diabetologia.
Top News From EASD 2019: Slideshow
Lisa Nainggolan; Darby Rotach; Marlene Busko; Becky McCall; Miriam Tucker; Megan Brooks; Miquel Gonzalez | October 7, 2019 | Contributor Information
Bariatric Surgery in Obese Type 1 Diabetes Has Pros, Cons
Middle-aged obese patients with type 1 diabetes who had gastric bypass surgery had lower rates of cardiovascular death and stroke but higher rates of diabetic ketoacidosis than their peers who did not have surgery, in the largest and longest study of bariatric surgery in type 1 diabetes, with close to 400 case-control dyads and a mean follow-up of almost 5 years. Nevertheless, questions remain, said presenter Gudrun Höskuldsdottir, MD, Sahlgrenska University Hospital, Sweden. Because patients with type 1 diabetes lack functioning beta cells, they cannot hope for possible remission of diabetes after bariatric surgery (unlike patients with type 2 diabetes), but the operation may help them maintain glycemic control with less insulin. According to Höskuldsdottir, the current study "meaningfully extend[s] earlier research" in obese patients with type 1 diabetes and suggests "potentially sizeable benefits of gastric bypass surgery...with regard to cardiovascular events and cardiovascular mortality. But at the same time, there's a higher risk for serious hyperglycemic events [that] need to be taken seriously," she cautioned. Hence, it is important to evaluate patients with type 1 diabetes for bariatric surgery on a case-by-case basis.
Top News From EASD 2019: Slideshow
Lisa Nainggolan; Darby Rotach; Marlene Busko; Becky McCall; Miriam Tucker; Megan Brooks; Miquel Gonzalez | October 7, 2019 | Contributor Information
Publication of the Cardiovascular Outcome Study of Linagliptin Versus Glimepiride in Type 2 Diabetes reaffirms the cardiovascular (CV) safety of the sulfonylurea glimepiride, according to the study authors and outside experts. Results from CAROLINA were presented here and simultaneously published in JAMA. The data were first presented in June. The randomized, double-blind, active-controlled, noninferiority trial showed no difference in CV outcomes over a mean of 6.3 years between the DPP-4 inhibitor linagliptin (Tradjenta, Boehringer Ingelheim/Lilly) and glimepiride (Amaryl, Sanofi) in over 6000 adults with relatively early type 2 diabetes at elevated risk of CV events. CV safety "should no longer be a consideration in the decision-making process for selecting between either of these two oral agents," said Julio Rosenstock, MD, chief of the Dallas Diabetes Research Center at Medical City, Texas. But because rates of hypoglycemia and weight gain were greater with the sulfonylurea, "Other than a cost consideration, CAROLINA supports the use of a DPP-4 inhibitor before a sulfonylurea," said Rosenstock.
Top News From EASD 2019: Slideshow
Lisa Nainggolan; Darby Rotach; Marlene Busko; Becky McCall; Miriam Tucker; Megan Brooks; Miquel Gonzalez | October 7, 2019 | Contributor Information
Vegan Diet Alters Microbiome and Insulin Sensitivity, Drops Weight
A low-fat vegan diet induces changes in gut microbiota that are related to altered body composition and insulin sensitivity, and result in weight loss, according to the results of a randomized controlled trial in overweight/obese adults. Over the 16-week intervention, body weight was significantly reduced in individuals on the vegan diet compared with those who stayed on their everyday (nonvegan) diet, with a loss of –5.8 kg (P < .001), which was largely because of a drop in fat mass, with a treatment effect of –3.9 kg (P < .001). Visceral fat was also significantly reduced with the vegan eating plan. No calorie restriction was imposed in either diet. "This is a pretty good result of about one pound or half a kilogram [weight loss] on average per week in the vegan group," said lead investigator Hana Kahleova, MD, PhD, director of clinical research at the Physicians Committee for Responsible Medicine, Washington, DC, the main remit of which is to promote plant-based diets. The results hint at changes to the gut microbiome producing beneficial effects, she said.
Top News From EASD 2019: Slideshow
Lisa Nainggolan; Darby Rotach; Marlene Busko; Becky McCall; Miriam Tucker; Megan Brooks; Miquel Gonzalez | October 7, 2019 | Contributor Information
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Lisa Nainggolan
Medscape Diabetes & Endocrinology News Editor
Darby Rotach
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