Becky McCall

September 06, 2016

With under a week to go until the European Association for the Study of Diabetes (EASD) 2016 Meeting, last-minute touches are being made to ensure that the EASD upholds its position as the largest clinical diabetes meeting worldwide, with around 17,000 attendees expected in Munich, the capital of the German state of Bavaria.

Sharing his thoughts on this year's conference, Rayaz Malik, MD, PhD, professor of medicine, Weill Cornell Medicine-Qatar and member of the EASD 2016 program committee, spoke to Medscape Medical News to provide a taste of the biggest and best events to look out for this year.

Explaining the rationale for the program choices, Dr Malik said the committee aimed to compile a lineup with clinically relevant sessions, prioritizing the appeal to clinicians who wish to pick up the latest in terms of understanding and managing diabetes.

"We also aim to ensure that we get a fair share of large breaking clinical trials, which always secure a good audience," he noted. This year the big draw will be the first presentation of the Trial to Evaluate Cardiovascular and Other Long-term Outcomes With Semaglutide in Subjects With Type 2 Diabetes (SUSTAIN-6) data from the cardiovascular-outcomes trial with semaglutide, a once-weekly glucagonlike-peptide 1 (GLP-1) agonist from Novo Nordisk for type 2 diabetes that is not even on the market yet.

There will also be much to discover about the complications of diabetes this year, said Dr Malik.

The Claude Bernard opening lecture on Tuesday, "Uncomplicating diabetes: Interactions between metabolic and hemodynamic signaling pathways in the pathogenesis of diabetic complications," will be delivered by Mark Cooper, MD, from the Baker IDI Heart and Diabetes Institute, Melbourne, Australia.

Dr Malik highlighted that it would be one not to miss with Dr Cooper's long-standing interest in the microvascular complications of diabetes, particularly diabetic renal disease. "Mark is an excellent speaker and will highlight the interactions between metabolic and hemodynamic changes that lead to complications, particularly in nephropathy."

Another of the keynote lectures is the 31st Camillo Golgi lecture on the topic of personalizing the prevention of diabetic nephropathy that will be given by Peter Rossing, DMSc, of the Steno Diabetes Center, Gentofte, Denmark, on Tuesday afternoon.

"Steno and Peter have both contributed a great deal on how we currently manage diabetic nephropathy," Dr Malik noted.

SUSTAIN-6, plus More From LEADER, EMPA-REG

These days, no diabetes conference is complete without a nod to the latest, rapidly expanding range of antidiabetic medications.

Brand-new data always attract the crowds, and at the EASD meeting, semaglutide promises to deliver, with the first full presentation of data from SUSTAIN-6 on Friday morning.

This examines the long-term cardiovascular and other safety outcomes of 0.5-mg and 1.0-mg semaglutide, administered subcutaneously once weekly and compared with placebo, in over 3000 people with type 2 diabetes treated for 104 weeks.

The company already reported top-line data from this trial in April, showing noninferiority of semaglutide compared with placebo and in addition, it said, a significant reduction in cardiovascular risk, but EASD will see the trial presented in its entirety for the first time.

"It tells us that there is cardiovascular safety at least," Dr Malik pointed out. "In the past, we have always had concerns about glitazones and sulfonylureas causing excess cardiovascular outcomes, so these results are great for our patients as it means we can prescribe a once-weekly therapy that not only will improve HbA1c but will also reduce weight and reduce the risk of hypoglycemia."

Semaglutide is not yet available, however; Novo Nordisk anticipates filing for approval of the agent by the end of the year.

Semaglutide is the second GLP-1 agonist to show a cardiovascular benefit in type 2 diabetes patients at high risk of cardiovascular disease, after liraglutide (Victoza, Novo Nordisk).

Primary results of the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results—A Long Term Evaluation (LEADER) were presented at the American Diabetes Association (ADA) meeting earlier this year and simultaneously published in the New England Journal of Medicine.

At the EASD meeting, there will be an important update to the results of LEADER on Thursday afternoon. "We can look forward to more recent data, more analysis on cardiovascular outcomes, as well as findings on pancreatic function and more detail on the microvascular outcomes," said Dr Malik, adding, "We had an inkling that there was a benefit with liraglutide, but I think we will see more time devoted to this at the EASD, especially in relation to microvascular outcomes."

Researchers will also present an update on the EMPA-REG OUTCOME trial with the sodium/glucose cotransporter 2 (SGLT2) inhibitor empagliflozin (Jardiance, Boehringer Ingelheim/Lilly), which stole the show at last year's EASD meeting when it became the first trial with a contemporary glucose-lowering agent to show a cardiovascular benefit.

Dr Malik said new data from EMPA-REG will be presented on Friday afternoon of the meeting. "These results will cover heart failure and renal outcomes, which appear to be independent of an improvement in HbA1c," he noted.

He added that these data emerging from the plethora of relatively new drugs are reassuring for clinicians who have been through a period of uncertainty about what to prescribe for type 2 diabetes.

"There was always the worry that in trying to lower the HbA1c and improve patients' microvascular complications, we were causing more harm in terms of worse cardiovascular outcomes. As a result, the [US] FDA became very strict on approvals for new medications, and indeed some of the gliptins [DPP-4 inhibitors] reported no cardiovascular benefit and even some heart-failure signals. As prescribers, we wondered what to use," remarked Dr Malik.

MODY and Diabetes in Pregnancy

Delivering the EASD/Novo Nordisk Foundation Diabetes Prize for Excellence on Wednesday will be consultant physician Andrew Hattersley, MD, from the University of Exeter, United Kingdom. His talk is entitled "Defining heterogeneity in diabetes to improve clinical care," and one focus will be on mature-onset diabetes of the young (MODY).

"A lot of clinicians don't think about this, but I believe it represents an important subset of young people with diabetes who are inappropriately labeled as having type 1 or type 2 diabetes when they don't," emphasized Dr Malik. "This is easily managed with a sulfonylurea and is a perfect example of the old saying 'if you don't think it, you'll never diagnose it.' "

And appealing to those doctors who care for women with gestational diabetes or those with diabetes who become pregnant, Dr Malik explained that the committee decided on a session that aimed to explore how to manage microvascular complications of diabetes during pregnancy.

Three speakers will discuss these complications and provide an update on the best way to manage them. "It can be a problem knowing how to manage a pregnant lady with renal dysfunction or diabetic retinopathy or neuropathy, for example. We already know that with a rapid improvement in glycemic control, proliferative retinopathy and insulin neuritis — a severe painful neuropathy and autonomic neuropathy — can develop."

Debates Offer Entertainment Value as Well as Useful Information

On Wednesday, the Michael Berger debate on "Statins for all" is widely expected to be overflowing with attendees keen to hear Naveed Sattar, MD, professor of metabolic medicine from the University of Glasgow, Scotland, for the "no" side and Kausik Ray, MD,Imperial College London, United Kingdom, a cardiologist, for the "yes."John Betteridge, MD, diabetologist from University College London Hospitals, United Kingdom, will chair the debate.

"It'll be fun if nothing else because these speakers always put on a good show," said Dr Malik, adding, "I reckon the majority will say yes because diabetic patients are at higher risk. However, some people are concerned about exactly when a diabetic patient becomes high risk — it is questionable. Nevertheless, I think unless there is a compelling reason not to, then all patients with type 2 diabetes and all patients with type 1 diabetes over the age of 40 years or who have had diabetes for more than 10 years or nephropathy should be on a statin."

Other topics up for discussion include a session on how low to go with blood-pressure control, always a contentious issue in diabetes, to be examined on Friday afternoon. There is also a presentation on whether diastolic blood pressure should be measured at all.

How far to lower systolic blood pressure is constantly changing, depending on which big trial is being published at any one time, Dr Malik elaborated.

"There was a time when we thought the lower the better, until we saw the J-shaped curve, and then some recent data suggested that too low was increasing mortality," he added.

Advances in Diabetic Neuropathy

A session on advances in neuropathy on Thursday promises to draw together difficult-to-manage diverse aspects of neuropathy.

Speaking will be neurologist Praveen Anand, MD, from Imperial College London, who will address targeting painful neuropathy, and Dr Dinesh Selvarajah, also from the United Kingdom at Sheffield Teaching Hospitals NHS Foundation Trust, will share novel CNS imaging data and argue that the brain is a key area modulating symptoms of peripheral neuropathy. Finally, Roy Freeman, MD, a neurologist from Harvard University, Boston, Massachusetts, will discuss advances in diabetic autonomic neuropathy.

"Autonomic neuropathy is terrible to deal with, and Roy is good at his subject. Imaging is sexy and provides new insights in diabetic neuropathy, and the Sheffield group are world leaders in this area," Dr Malik remarked.

Asked what he believed was one of the main draws for the EASD meeting compared with other large international diabetes meetings, Dr Malik explained that the EASD meeting has more clinical relevance than some of the American meetings.

"The ADA has more high science, whereas at the EASD, because the majority of attendees are clinicians, we try to have the latest and best in terms of helping clinicians to understand diabetes and apply the latest clinical-trial outcomes data to their clinical practice."

The European Association for the Study of Diabetes 2016 Meeting is taking place in Munich, Germany, September 12–16, 2016.

Medscape is at EASD 2016. Please come and see us at Booth S.05.

Dr Malik has no relevant financial relationships.

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