Risk factors

5 Australian highlights from EASD 2019, Barcelona

The annual scientific meeting of the European Association for the Study of Diabetes (EASD) is one of the largest gatherings of diabetes healthcare professionals in the world. In 2019, the EASD meeting is being held in Barcelona. and here are some of the highlights of presentations and research results from the many Australian diabetes clinicians who attended:

Flash subcutaneous glucose sensing does not prevent severe hypoglycaemia in at-risk patients, according to trial results presented by Professor Tim Davis of the University of Western Australia. In a study of 59 patients with insulin-treated diabetes who had a recent (within 2 weeks) severe hypoglycaemic episode and median HbA1c of 61.8 mmol/mol (7.8%), half were randomised to Freestyle Libre glucose sensing technology and half to usual care (self-monitoring of blood glucose). During six months of follow up there was no difference in the primary outcomes of incidence of severe hypoglycaemia (requiring external assistance for recovery) between the intervention and control groups (incident rate ratio: 1.49). The incidence of self-recorded hypoglycaemic episodes was twice as high in the intervention versus control group. There was no difference in the change in HbA1c between glucose sensing technology and usual care after adjusting for baseline HbA1c, (-1.8 vs 1.2 mmol/mol). “Although glucose sensing technology is safe, it does not appear to have a key role in preventing severe hypoglycaemia in at-risk patients,” the study investigators concluded.

High-intensity interval training improves glycaemic control in overweight and obese adults with type 1 diabetes, according to a trial conducted at the Department of Endocrinology, Royal Prince Alfred Hospital, Sydney. A significant reduction in HbA1c of -0.40 was seen in 24 previously sedentary participants who completed a 12 week course of HIIT, without  an increase in hypoglycaemia or insulin dose. The HIIT exercise program consisted of 4×4 min of aerobic exercise performed three times  a week. The trial participants had an average age of 44 years, diabetes duration of 19 years, HbA1c 8.5%, and BMI 30.1. Improvements in HbA1c were greatest for those participants who competed at least half the program (-0.64 vs 0.14 control)

An Australia-wide cohort study of children at genetic risk of developing diabetes because of a first degree relative has now recruited 1285 of its target of 1400 participants and has followed up more than half beyond 18 months, according to WA researchers. Investigators for the Environmental Determinants of Islet Autoimmunity (ENDIA) Study say that 5% of the 730 children tested for islet autoantibodies have been persistently positive and/or have developed T1D. This suggests the predicted 6-8% islet autoantibody seroconversion rate at median age of 2-3 years will be realised, said researchers from the Telethon Kids Institute, Perth. The median age of the ENDIA cohort is currently 22 months, with 61% having a mother with T1D, 27% a paternal link and 12% a sibling with T1D. The study will follow them up with regular monitoring of demographic, lifestyle, dietary clinical and anthropometric measurements as well as collecting biological samples including blood, urine, stool, saliva and breast milk.

Advice for people with type 2 diabetes to avoid eating potatoes because of the high GI index may be misplaced, according to a study sponsored by the Alliance for Potato Research. Eating potatoes as part of an evening meal had less effect on nocturnal blood glucose levels in people with T2D than eating rice, according to a trial conducted by dieticians at LaTrobe University, Victoria. The study which involved 19 participants with T2D found that mean interstitial glucose levels in the nocturnal period of midnight to 6am were significantly lower after a potato-containing dinner compared to one containing an equivalent amount of basmati rice (7.6 mmol/L for roasted potatoes vs 9.0 mmol/L for rice). There was no difference between potatoes and rice in the incremental Area Under the Curve (AUC) for glucose in the 3 h postprandial period. “Current dietary advice regarding potatoes and blood glucose control may not be as valid when potatoes are consumed as part of a mixed meal in the evening and advice solely based on avoiding high GI foods may be counterproductive, they said.

Denosumab may offer some benefit in the destructive joint disorder complication of diabetes, Charcot neuroarthopathy, according to NSW researchers. A study led by the Liverpool Diabetes Collaborative Research Unit, Sydney, found that a single dose of denosumab significantly shortened disease activity in 22 patients with acute ‘Charcot foot’ compared to a control group of 12 patients who received immobilisation devices, multidisciplinary and care. In the trial conducted at three High Risk Foot Services in Brisbane, Melbourne and Sydney, resolution was eight weeks for the denosumab treated patients and 21 weeks for controls. The researchers said that if the benefits are validated in larger trials, denosumab could be the first pharmacological therapy for a disabling complication of diabetic peripheral neuropathy that is currently only manageable with immobilising and off-loading foot devices that have poor adherence. Denosumab may reduce Charcot arthropathy disease activity by reducing inflammation and bone turnover, they postulated.

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