5 highlights from ADA 2019

The American Diabetes Association 79th Scientific Sessions (#ADA2019) were held in San Francisco from 7-11 June 2019. Here are five of the major results presented at the meeting

Insulin-producing pancreatic beta cells are not irreversibly damaged in early type 2 diabetes. Their function can be restored by losing weight to remove excess fat in the cells, according to UK research. Results from the DIRECT trial showed that 36% of participants who took part in an intensive weight management program and lost an average of 15kg saw remission of their T2D (HbA1c <48mmol/mol or 6.5%) after two years. The trial involved 306 adults participants under 65, with a BMI of 27-45 kg/m2, who had up to six years duration of T2D. Read more: ADA

Continuous Glucose Monitors (CGM) produce mixed results on glycaemic control in children and young adults with T1D. Primary results from the SENCE trial of CGM in 143 children aged 2-7 with T1D showed that time-in-target range did not improve with CGM use, but there was less time spent with hypoglycaemia, severe hypoglycaemic events and hyperglycaemia. Results from the CITY (CGM Intervention in Teens and Young Adults With Type 1 Diabetes trial in 153 teens and young adults, showed that after six months there were reductions in HBA1c and in the amount of time in hyperglycaemia or hypoglycaemia with CGM compared to self monitoring of blood glucose. Read more: ADA

Vitamin D supplementation does not prevent type 2 diabetes. Although low levels of vitamin D have been associated with higher diabetes risk, a prospective trial of high doses of vitamin D3 (4000 IU per day) found no protective effect in more than 2400 people deemed at high risk of T2D (glycaemic factors for prediabetes) during 2.5 years of follow up. It remains to be seen whether vitamin D supplements have any effect in people with vitamin D deficiency (<12ng/ml). Read more: NEJM

No ‘legacy effect’ seen with intensive glucose control in older people with a longer duration T2D. Long term follow up of 892 older T2D patients who had undergone 5.6 years of intensive glucose control found that at 15 years there was no sign of a ‘legacy’ benefit on cardiovascular outcomes or overall survival compared to a control group with standard glycaemic targets (HbA1c of 8-9%). Since intensive glucose control is difficult to achieve and associated with weight gain and hypoglycaemia risk, this must be weighed up when advising older patients with longstanding disease on glycaemic targets, the study authors said. Read more: NEJM

SGLT2 inhibitors reduce serum urate levels and can reduce the risk of gout in people with T2D. Analysis of data from CANVAS (CANagliflozin cardioVascular Assessment Study) involving more than 10,142 participants with type 2 diabetes showed that mean serum urate levels were 23 µmol/L lower in the canagliflozin versus placebo group at 6 to 13 weeks and during follow-up. The risk of gout was reduced by 36% (HR 0.64) in those treated with canagliflozin compared to placebo. The corresponding HR for hyperuricemia or hyperuricosuria was 0.57. Read more: Diabetes journal.

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