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Lessons learned at American Diabetes Association’s 74th Scientific Sessions
The American Diabetes Association’s 74th Scientific Sessions, held in San Francisco, addressed various emerging areas of study in the treatment of type 1 and type 2 diabetes.
Presentations addressed the various interactions of diabetes, as well as diabetes agents, with other systems of the body, including the cardiovascular, gastrointestinal and central nervous systems. Zachary T. Bloomgarden, MD, an endocrinologist at Mount Sinai Hospital in New York, spoke with Endocrine Today about some of the more memorable sessions he attended.
“My choices are limited by the fact that there were so many to choose from, and I can only cover the sessions I attended,” Bloomgarden said. “But there were so many really fascinating presentations; even if there aren’t any answers yet, they’re important areas to investigate.”
Based on our interview, Endocrine Today presents 5 Lessons Learned from the American Diabetes Association (ADA)'s 74th Scientific Sessions.
1. GLP-1 appears to be involved in the functions of various organs and organ systems.
Bloomgarden noted a presentation given by Daniel J. Drucker, MD, recipient of the Banting Medal for Scientific Achievement. In his presentation, “Deciphering Metabolic Messages from the Gut Drives Therapeutic Innovation,” Drucker discussed the glycemic and non-glycemic effects exerted by glucagon-like peptide 1 (GLP-1) on various functions of the body, suggesting a wide range of possible future indications.
“He talked about how GLP-1 might work on the heart; he cited some interesting studies of myocardial infarction in animals, and how GLP-1 may have a real cardioprotective effect,” Bloomgarden said. “He discussed how it might have therapeutic potential in fatty liver disease, microvascular disease and CVD. Fascinating stuff.”
2. The artificial pancreas may not be quite ready for outpatient use.
Bloomgarden discussed a presentation by William V. Tamborlane, MD, regarding the latest developments in artificial pancreas research. Tamborlane cited various studies on the safety and efficacy of overnight closed loop insulin delivery in type 1 diabetes. He also discussed significant obstacles to outpatient use, including the risk for system malfunctions resulting in excessive insulin delivery.
“He emphasized that it isn’t so easy; you have to have a lot of safeguards in place before the artificial pancreas can be clinically useful,” Bloomgarden said. “He also talked about studies being done in the low-glucose suspend systems, which do actually seem safe and result in the reduction of hypoglycemia.”
3. Antibiotics alone may be adequate to treat diabetic foot ulcers.
Bloomgarden cited a presentation on diabetic foot ulcers by Andrew J.M. Boulton, MD, as part of the Diabetes Care Symposium. Boulton presented a study comparing antibiotics vs. surgery in the treatment of diabetic foot osteomyelitis, which found that the two approaches have similar outcomes regarding healing rates, healing time and short-term complications.
“This is a really interesting study that matches current clinical practice,” Bloomgarden said. “It suggests that in treating neuropathic foot ulcers, antibiotics alone may be sufficient, so that perhaps there will be a move away from operations on diabetic foot ulcers.”
4. There is increasing evidence of diabetes’ effects on the brain.
Bloomgarden discussed presentations pertaining to diabetes and its manifestations in the brain and spinal cord. In one presentation, which was part of the Diabetes Care Symposium, Andrew J.M. Boulton, MD, addressed the decreases in peripheral gray matter seen in patients with both painful and painless diabetic neuropathy. Another symposium included presentations addressing the impact of diabetes on dementia in terms of insulin signaling, structural changes, cholesterol metabolism and more.
“There is growing evidence that diabetic neuropathy may include the spinal cord and brain, and there is evidence from many studies that Alzheimer’s disease is more common in type 2 diabetes,” Bloomgarden said. “This is becoming an increasingly important area.”
5. The issue of glucose variability and diabetes complications warrants further investigation.
Bloomgarden mentioned a debate between Irl B. Hirsch, MD, and Richard Bergenstahl, MD, in which each elucidated different views on the possible impact of blood glucose variability on diabetes complications.
“Irl Hirsch has been saying that it’s not just the average blood sugar, but also the degree of variability,” Bloomgarden said. “Bergenstal maintains that while hypoglycemia is part of what determines variability, variability is more than that, and A1c gives you an average.”
Bloomgarden said he could see the strengths of both points.
“I think, in a sense, avoiding hypoglycemia and having a good average blood sugar is what counts, and if you do that, you’ll have less glucose variability,” he said. — by Jennifer Byrne