American Diabetes Association, June 7-11

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American Diabetes Association, June 7-11

The American Diabetes Association 79th Scientific Sessions

The annual meeting of the American Diabetes Association was held from June 7 to 11 in San Francisco and attracted approximately 14,000 participants from around the world, including clinicians, academicians, allied health professionals, and others interested in diabetes. The conference highlighted the latest advances in diabetes research and improving patient care, with presentations focusing on treatment recommendations and advances toward a cure for diabetes.

In the PIONEER 6 trial, John Buse, M.D., Ph.D., of the University of North Carolina School of Medicine in Chapel Hill, and colleagues found that oral semaglutide was effective in lowering glucose levels and reducing the risk for major cardiovascular events in patients with type 2 diabetes and an elevated cardiovascular risk.

The investigators randomly assigned 3,183 patients with type 2 diabetes and high cardiovascular risk to receive either a 14-mg dose of semaglutide once daily (1,591 participants) or placebo (1,592 participants). After a median follow-up of 15.9 months, the investigators found that oral semaglutide reduced cardiovascular death and all-cause mortality by almost 50 percent.

"The key findings from the PIONEER program are that oral semaglutide is very effective in glucose lowering without intrinsically increasing the risk of hypoglycemia and also promotes weight loss. The cardiovascular safety trial suggests potential cardiovascular benefits, including benefits on mortality. This is all quite exciting," Buse said. "As it suggests, an oral form of the glucagon-like peptide-1 receptor agonist class has similar benefits to the injectable form of the drug. Hopefully, this will reduce barriers to the use of this very effective class of medications."

The PIONEER 6 trial was sponsored by Novo Nordisk, the manufacturer of semaglutide.

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In the international PREVIEW intervention study in patients at risk for developing type 2 diabetes, Ian Macdonald, Ph.D., of the University of Nottingham in the United Kingdom, and colleagues found that the combination of an initial 8 percent weight loss plus a structured lifestyle intervention with a clearly defined diet and physical activity program, delivered with a well-structured behavioral change program, was associated with an incidence of type 2 diabetes of less than one-half to one-fourth of the predicted incidence for such patients.

Patients with prediabetes who were at high risk for developing type 2 diabetes were enrolled in the study and started on an eight-week low-calorie diet. Patients had to lose at least 8 percent of their body weight to continue in the study. The patients were randomly assigned to one of two dietary treatments during the subsequent 34 months: high protein/low glycemic index or moderate protein/moderate glycemic index for weight maintenance. These interventions were combined with one of two different physical activity programs: higher intensity for 75 minutes/week or moderate intensity for 150 minutes/week.

Based on previous data, the researchers predicted that around 15.8 percent of the patients in the moderate-protein group and 10.5 percent of the high-protein group would develop type 2 diabetes during the course of the study. "The actual outcome was that only 4 percent of the participants developed type 2 diabetes over the three years, with no difference between the diet groups," Macdonald said. "Patients with identified prediabetes should be encouraged to lose weight and then follow a weight maintenance program. The challenge, clinically, is to have people available with the necessary expertise to deliver such programs, and the recognition that this has to be delivered over a long time period until the lifestyle change has essentially become permanent."

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In the Pittsburgh Epidemiology of Diabetes Complications (EDC) study, Jingchuan Guo, M.D., Ph.D., of the University of Pittsburgh, and colleagues found that hypertension and high glucose levels both equally increase the risk for cardiovascular disease in patients with type 1 diabetes. The investigators also found that patients with blood pressure levels ≥120/80 mm Hg, compared with those with a blood pressure <120/80 mm Hg, had a twofold increased risk for developing heart disease.

"Our researchers were intrigued by the findings suggesting that blood pressure and glycemia are similarly important for cardiovascular risk prediction in this type 1 diabetes patient group," Guo said in a statement. "Since blood pressure control is likely to be as important as glucose control for cardiovascular risk prevention in people with type 1 diabetes, the initial treatment focus should be on glucose control, when hemoglobin A1c is very high, but as hemoglobin A1c approaches the high-normal range, an increasing focus on blood pressure becomes critical."

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ADA: Combo Injectable Controls Blood Glucose Longer in T2DM

FRIDAY, June 14, 2019 — Compared with insulin glargine, initial injectable therapy with a combination of insulin degludec and liraglutide aids achievement of blood glucose goals for a longer period of time in patients with uncontrolled type 2 diabetes on oral antidiabetic drugs, according to a study published online June 9 in The Lancet Diabetes & Endocrinology to coincide with the annual meeting of the American Diabetes Association, held from June 7 to 11 in San Francisco.

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ADA: Teplizumab Can Delay T1DM Progression in Those at Risk

THURSDAY, June 13, 2019 — A 14-day course of an Fc receptor-nonbinding anti-CD3 monoclonal antibody, teplizumab, can delay progression to type 1 diabetes in individuals at high risk, according to a study published online June 9 in the New England Journal of Medicine to coincide with the annual meeting of the American Diabetes Association, held from June 7 to 11 in San Francisco.

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ADA: Dulaglutide Tied to Decline in Cardiovascular Events in T2DM

TUESDAY, June 11, 2019 — Dulaglutide is associated with a reduction in cardiovascular events and renal outcomes among patients with type 2 diabetes, according to two studies published online June 9 in The Lancet to coincide with the annual meeting of the American Diabetes Association, held from June 7 to 11 in San Francisco.

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ADA: Vitamin D Supplementation Does Not Lower T2DM Risk

FRIDAY, June 7, 2019 — For individuals with prediabetes, vitamin D3 supplementation does not result in a significantly lower risk for type 2 diabetes than placebo, according to a study published online June 7 in the New England Journal of Medicine to coincide with the annual meeting of the American Diabetes Association, held from June 7 to 11 in San Francisco.

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Posted: June 2019

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