Miriam E. Tucker

June 06, 2014

To get the most out of the American Diabetes Association (ADA) 2014 Scientific Sessions, attendees will need to stay from the beginning to the very end.

Next week's ADA meeting in San Francisco runs from the afternoon of Friday, June 12, through Tuesday morning, June 17.

Tuesday morning will feature the ADA president's oral session, a collection of the top research abstracts of the meeting ― 6 submitted through the regular schedule and 2 late-breakers ― on a range of important diabetes-related topics.

They include a large study that may call into question whether LDL cholesterol is a marker for cardiovascular disease in type 1 diabetes, the latest look from Canadian researchers at the role of neighborhood "walkability" in the development of type 2 diabetes, and an assessment of the impact of depression on mortality in type 1 diabetes.

"These abstracts, I think, will really knock your socks off," ADA chief scientific and medical officer Robert Ratner, MD, told Medscape Medical News.

And David A. D'Alessio, MD, chair of the 2014 Scientific Sessions Meeting Planning Committee, said that the president's abstract session is intended to be eclectic and to reflect the meeting as a whole.

"The idea was to emphasize the breadth of the meeting, which I really think is the essence. Usually when you build a symposium, you want it to be thematic and focused. In this case, we wanted it to be almost more of a celebration of the meeting....I really hope it attracts people to hang on and stay for that last morning," Dr. D'Alessio, professor of medicine and chief of the division of endocrinology, metabolism, and nutrition at Duke University Medical Center, Durham, North Carolina, told Medscape Medical News.

Attendees who stay through Tuesday morning can also look forward to another hot-button session: a pro/con debate about the appropriateness of the new American College of Cardiology/American Heart Association lipid guidelines for people with diabetes.

That debate is 1 of 6 current-issues sessions on controversial topics that will be held throughout the meeting. Others will address whether exercise is beneficial without weight loss, whether improving HbA1c levels reduces cardiovascular risk, whether screening for subclinical cardiovascular disease is necessary for people with diabetes, and whether lower or higher blood-pressure targets are appropriate for patients with diabetic kidney disease.

"These debates are going to give the clinician the opportunity to look at the pro and con sides of all of these issues," Dr. Ratner said.

The sixth "current-issue" session, a panel discussion rather than a debate, will address the implications of the Affordable Care Act for people with diabetes.

Type 1 Diabetes Focus

Among the overarching themes of the meeting is a focus on the unique challenges presented by the rising incidence of type 1 diabetes.

Topics covered in type 1 diabetes–related symposia will include pathways to drug and device development, the changing presentations of this form of diabetes, functional genomics, closed-loop insulin delivery, and the adequacy of current glucose, blood-pressure, and lipid guidelines for patients with type 1 diabetes. These sessions are supported by grants from the Leona M. and Harry B. Helmsley Charitable Trust.

In addition, the ADA is expected to issue a new type 1 diabetes position statement on Monday.

"Type 2 gets a lot of the attention, but in the background, type 1 has been percolating along, the incidence has been going up, and the clinical picture changes a lot....The changing face of autoimmune diabetes is a problem we haven't grappled with. It's confusing but important," Dr. D'Alessio explained.

Breadth of the Meeting: Obesity Will Feature Significantly Too

No surprise, there will also be a lot of new information on obesity, including a focus on new theories about the role of the brain, the gut, and the maternal environment in the development of obesity, along with clinical and public-health aspects of the disease.

The Banting Award lecture, to be delivered by Daniel J. Drucker, MD, from the University of Toronto, Ontario, will be entitled "Deciphering Metabolic Messages From the Gut Drives Therapeutic Innovation."

And among the largest trials to be presented at the meeting, one of the Tuesday morning talks will look at genetic variation, dietary intake, and adiposity in more than 16,000 children and adolescents.

Dr. Ratner said: "Obesity is getting covered from a number of different areas. It really goes to the multifactorial nature of obesity. It's really simplistic to say that it's calories in vs calories out, because so many other things play a critically important role. When you start looking at genetics and epigenetics, you realize it's time to stop blaming the person."

Although there will be no major trial results announced this year, there will be follow-up data from studies for which pivotal data have been previously reported. Among these are a 15-year update from the landmark Diabetes Prevention Program and the latest data from the SEARCH for Diabetes in Youth study.

Dr. Ratner told Medscape Medical News, "There are no blockbuster trials, but there is really a lot of exceptionally good science." Indeed, Dr. D'Alessio said, "the ADA meeting is the clearinghouse for all the cutting-edge stuff in diabetes."

Dr. Ratner is an ADA employee and has no additional relevant financial relationships. Dr. D'Alessio consults for Eli Lilly, Novo Nordisk, Merck, Roche, and Janssen.

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