The American Diabetes Association's 69th Scientific Sessions took place from June 5 to 9 in New Orleans and attracted more than 13,000 researchers, physicians and other health care professionals from around the world. The meeting featured over 700 presentations and oral abstracts that addressed advances in basic research, diagnosis, and treatment of diabetes.
Highlights included new sub-analyses of the VA Diabetes Trial, which randomly assigned 1,791 diabetic U.S. veterans to intensive glucose control or standard therapy and followed them for an average of 6.25 years. Although findings presented at last year's meeting suggested that intensive glucose control did not significantly reduce cardiovascular events, the new sub-analyses identify which patients are or are not likely to benefit from the therapy.
According to VA Diabetes Trial co-chair, William C. Duckworth, M.D., of the University of Arizona, patients who initiated intensive glucose control within 15 years of a diagnosis of type 2 diabetes had a significantly lower risk of heart attacks, strokes, and death. Among patients who had diabetes for 10 to 15 years, for example, intensive glucose control was associated with a 40 percent reduced risk of heart attacks and strokes. However, patients who initiated intensive glucose control between 16 and 20 years after diagnosis reaped no benefits and those who initiated it 20 or more years after diagnosis had a more than doubled risk of heart attacks and strokes.
"Unless other factors are present that would contraindicate intensive treatment, such as hypoglycemia, intensive control is appropriate in the first 15 years after diagnosis," Duckworth said in a statement. "However, intensive treatment should not be initiated if the individual has already had diabetes for 20 years." He added that further study is needed to determine if patients on intensive glucose control can safely continue it beyond the 20-year mark.
The new sub-analyses also showed increasing high-density lipoprotein levels were strongly linked with better outcomes. In addition, the new sub-analyses showed that severe hypoglycemia was associated with increased risk. "In the VA Diabetes Trial, those who had episodes of severe hypoglycemia were much more likely to have severe adverse effects up to and including death," Duckworth said in a statement. "In both groups combined, those who had had hypoglycemia severe enough to cause changes in consciousness had an 88 percent increase in primary cardiovascular events and a three-fold increase in cardiovascular death."
In other developments, researchers presented results of the Whitehall II study, which also was published on June 8 in The Lancet. During the 10-year study, British and Danish researchers followed 6,538 civil servants who were diabetes-free at baseline and identified 505 who subsequently developed diabetes. Among the diabetics, they observed significant metabolic changes, including a linear increase in fasting glucose which spiked three years before diagnosis, a rapid decrease in insulin sensitivity during the five years before diagnosis, and increased B-cell function that began four to three years before diagnosis.
"Our findings show various opportunities for screening and prevention," the authors conclude. "Although most prevention studies focused on pre-diabetic people, our findings suggest that people with pre-diabetes are already on the steep part of the glucose trajectory. We hypothesize that prevention would be more effective before this unstable period, but more research is needed to successfully identify people at this stage of disease development. If a person could be kept on linear part of the fasting glucose (or post-load glucose) trajectory, the onset of diabetes might be substantially delayed. Further research is needed to confirm or refute these hypotheses."
The authors of an accompanying Comment, however, expressed doubt that the study's findings would allow clinicians to identify at-risk patients three or even four years before developing diabetes. "The sensitivity and specificity of the forward predictions would be poor," they state. "Now the hunt has to be intensified for the pathology that causes the decompensation that precipitates diabetes."
Other highlights included a Merck & Company-supported study by researchers at the University of Connecticut in New Haven showing a link between depression and low insulin sensitivity, and a link between depression treatment and decreased insulin resistance; and a Vivus-supported study by researchers from the Weill Cornell Medical Center and New York Presbyterian Hospital, both in New York City, showing that the investigational weight-loss drug Qnexa -- which combines phentermine and a controlled-release formulation of topiramate -- reduces A1C levels in non-diabetic obese patients and may halt the progression toward type 2 diabetes.
A trio of studies sponsored by the MannKind Corporation in Valencia, Calif., demonstrated the safety and efficacy of Afresa, a new form of inhaled insulin known as technosphere insulin. One study showed that Afresa has an onset of action similar to that of endogenous insulin. A second study showed that Afresa plus the long-acting analog glargine was associated with comparable A1C reductions as Afresa plus the rapid-acting analog lispro but also with a significantly lower risk of weight gain and hypoglycemia.
A third study, presented by Nikhil Amin, M.D., of MannKind Corporation, assessed pulmonary function among 730 diabetics who received Afresa, 824 diabetics who received standard care, and 145 healthy controls. After two years, the researchers found that there were no significant group differences in the mean change in forced expiratory volume in one second.
"Current mealtime insulin therapies, while accepted as an effective means to control glucose levels, have several limitations," Peter Richardson, M.D., corporate vice president and chief scientific officer of MannKind Corporation, said in a statement. "Our encouraging findings indicate that Afresa may be a promising new treatment option with less weight gain and lower risk of hypoglycemia compared with current mealtime insulin therapy."
ADA: Lower Glucose Levels May Not Explain Excess Mortality
TUESDAY, June 9 (HealthDay News) -- A new analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, which reported that intensive treatment strategy to lower blood glucose was associated with an increased risk of death, shows that lower glucose levels alone might not be the cause, according to a report presented at the American Diabetes Association's 69th Scientific Sessions, held from June 5 to 9 in New Orleans.
ADA: New Drugs Show Promise for Type 2 Diabetes
TUESDAY, June 9 (HealthDay News) -- In patients with type 2 diabetes, once-daily liraglutide may be superior to twice-daily exenatide, and the investigational drug aleglitazar may be superior to pioglitazone, according to two studies published online June 8 in The Lancet to coincide with presentations at the American Diabetes Association's 69th Scientific Sessions, held from June 5 to 9 in New Orleans.
ADA: Genes Affect Control in Type 1 Diabetes
MONDAY, June 8 (HealthDay News) -- In patients with type 1 diabetes, four genetic variations are significantly associated with poorer glycemic control, according to research presented at the American Diabetes Association's 69th Scientific Sessions, held from June 5 to 9 in New Orleans.
ADA: Medicines Compared to Surgery in Diabetic Heart Disease
MONDAY, June 8 (HealthDay News) -- In patients with type 2 diabetes and coronary artery disease, various treatment strategies result in a similar survival outcome. However, when revascularization is indicated, coronary-artery bypass grafting (CABG) may be associated with a lower risk of major cardiac events than optimal medical therapy alone, according to a study published online June 7 in the New England Journal of Medicine to coincide with a presentation at the American Diabetes Association's 69th Scientific Sessions, held from June 5 to 9 in New Orleans.
ADA: A1C Assay Most Accurate in Diabetes Diagnosis
MONDAY, June 8 (HealthDay News) -- The A1C assay should be the definitive test to diagnose diabetes, according to a report presented at the American Diabetes Association's 69th Scientific Sessions, held from June 5 to 9 in New Orleans.
ADA: Rosiglitazone Effect on Heart Attack Risk Studied
FRIDAY, June 5 (HealthDay News) -- Adding rosiglitazone to diabetic therapy does not significantly affect the risk of cardiovascular disease or death, although risks of heart failure and fracture are higher, according to a study reported in the June 5 online edition of The Lancet and discussed at the American Diabetes Association's 69th Scientific Sessions, held from June 5 to 9 in New Orleans.
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