What's Cooking in Diabetes? All Revealed at EASD in Barcelona

Miriam E. Tucker

September 09, 2019

The upcoming European Association for the Study of Diabetes (EASD) 2019 Annual Meeting, to be held in Barcelona, Spain, next week, will offer attendees 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.

Of course the conference, taking place September 16-20, will also cover type 1 diabetes, including results from SAGE, a global study with some surprising findings on HbA1c targets from patients around the world, and a huge array of other diabetes-related topics spanning pregnancy, technology, genetics/epigenetics, and basic science.

"Anyone working in diabetes, whether you're a clinician or a scientist, will find something of interest," EASD honorary secretary (program committee chair) Mikael Rydén, MD, senior consultant at the Karolinska Institute, Stockholm, Sweden, told Medscape Medical News.

But there will be a heavy emphasis on drug therapy in type 2 diabetes. The EASD meeting comes hard on the heels of the August release of new guidelines for cardiovascular disease prevention in people with diabetes or prediabetes from the European Society of Cardiology (ESC) in collaboration with EASD, at the European Society of Cardiology (ESC) 2019 Congress in Paris.

And at EASD, the landmark results from DAPA-HF (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure) also recently reported at the ESC meeting, will be summarized, and Silvio Inzucchi, MD, Yale University School of Medicine, New Haven, Connecticut, will present new metabolic and safety data from the trial.

In this study, the sodium-glucose cotransporter 2 (SGLT2) inhibitor dapagliflozin (Farxiga/Forxiga, AstraZeneca) reduced heart failure morbidity and mortality even in patients without diabetes.

Importantly, Inzucchi will also discuss "implications for the diabetologist" of the trial results.

And new results from a companion study, DEFINE-HF, on the effect of dapagliflozin on biomarkers, symptoms, and functional status in patients with heart failure and reduced ejection fraction, with or without diabetes, will also be presented in a separate session.

New Trials: VERIFY, PRIORITY, and CONCLUDE

Other first-to-be announced trial results to be presented at EASD will include those from VERIFY (Vildagliptin Efficacy in Combination With Metformin for Early Treatment of Type 2 Diabetes) and PRIORITY (Proteomic Prediction and Renin Angiotensin Aldosterone System Inhibition Prevention of Early Diabetic Nephropathy in Type 2 Diabetic Patients With Normoalbuminuria).

Regarding VERIFY, EASD president David R. Matthews, DPhil, BM, BCh, emeritus professor of diabetic medicine at the University of Oxford, UK, told Medscape Medical News: "I think there will be an interest about whether the monotherapy aspect is the right modality. A lot of people believe you should start with more than one agent and not wait till failure with monotherapy. This is one of the first trials to look at that."

And the potential importance of PRIORITY, Rydén said, is, "We appreciate that microalbuminuria is a biomarker for [renal disease] progression. But for the ones who don't have microalbuminuria, we don't have anything...related to the kidney to help us understand...[or] to predict other than blood pressure, lipids, and blood glucose."

Another first-time presentation will be of CONCLUDE, a trial comparing degludec and insulin glargine 300 units/mL in patients with type 2 diabetes inadequately treated with basal insulin and oral antidiabetic drugs.

And during a session entitled "The PIONEER Journey", oral delivery of a GLP-1 agonist through to the successful development of Novo Nordisk's agent, semaglutide, including new data, will be discussed. (The US Food and Drug Administration is expected to announce whether it will approve oral semaglutide for the US market on September 20, the last day of the meeting.) 

Avalanche of Data in 2019; Helping Diabetologists Interpret it All

New analyses and perspective will be provided in sessions covering studies that were previously presented at the American Diabetes Association (ADA) 2019 Scientific Sessions and the International Society of Nephrology (ISN) 2019 World Congress

These include more details on CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation), the renal outcomes trial of canagliflozin (Invokana, Janssen) first reported in April at ISN 2019, followed by further analyses of the trial presented in June at the ADA 2019.

There will also be deeper dives into the CAROLINA (Cardiovascular Safety of Linagliptin) study comparing linagliptin (Tradjenta, Boehringer Ingelheim/Lilly) and glimepiride (Amaryl, Sanofi), and the long-term REWIND (Researching Cardiovascular Events With a Weekly Incretin in Diabetes) trial, both first reported at ADA 2019.

"Many of the outcome studies were presented at [prior 2019 meetings] and now have follow-ups. At EASD, we'll have discussions about how to interpret them," Rydén said, noting that "the big avalanche of data [on incretins and SGLT2 inhibitors] basically makes our guidelines outdated every 6 months."

Matthews said he hopes the clinicians who attend the EASD meeting "will go away with more enthusiasm for early treatment and diagnosing of incipient complications."

"Instead of just saying 'You have type 2 diabetes,' I hope people will look into heart failure and renal status. I think the more data there are about the SGLT2 inhibitors, the more people will gradually get around to the idea that they have a clear renoprotective function as well as cardiovascular disease reduction."

Novel Agent: Glimin Targets Mitochondrial Bioenergetics

Additional noteworthy session topics include a novel investigational oral glucose-lowering agent called imeglimin (Poxel), described as the first in a new class called glimins, which because of its unique mechanism of action targeting mitochondrial bioenergetics, is anticipated to act on the liver, muscles, and pancreas, which play a role in diabetes.

Additional sessions include talks on nonalcoholic fatty liver disease in the context of diabetes, the link between diabetes and neurodegenerative disease, metabolic surgery, targeting inflammation in diabetes treatment, and the role of imaging in diabetes research.

"If you want to know what's cooking in the diabetes world, there's no better place to be than Barcelona," Rydén said. "This is really one of the broadest meetings you can have."

Rydén is on the speakers' bureau, is an advisory board member for, and/or is a consultant for Novo Nordisk, Eli Lilly, Boehringer Ingelheim, Novartis, AstraZeneca, and Sigrid Therapeutics. Matthews has reported receiving research support from, serving on advisory boards for, and/or is a consultant for Janssen, Novo Nordisk, Novartis, Sanofi Aventis, Servier, Mitsubishi Tanabe, and Aché Laboratories.

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