Posters at the Australasian Diabetes Congress last month featured research on fetal macrosomia in gestational diabetes, eye health among islet transplantation recipients and how Flash CGM use influences glycaemic control.

Here, the limbic presents a selection of some of the more interesting posters presented at the conference.

Ketoacidosis and normoglycaemia

One piece of research that caught our eye was a case report describing euglycaemic ketoacidosis in two patients without diabetes after the introduction of SGLT2 inhibitors for heart failure with reduced ejection fraction (HFrEF).

The first patient was a 28-year old male with Duchenne’s muscular dystrophy and associated HFrEF, who was diagnosed with severe ketoacidosis five months after initiating dapagliflozin 10mg.

The second was a 62-year-old female with HFrEF against a background of COPD and systemic lupus erythematosus, who entered a state of severe ketoacidosis and haemodynamic instability six weeks after initiation of empagliflozin 10mg.

Each case had triggers such as gastritis or diarrhoeal illness, prompting the patient to significant reduce their oral intake, according to the Adelaide-based clinicians who contributed the poster.

And only the latter required insulin administration, although both received high rates of IV dextrose, they said.

“Induction of endogenous insulin secretion can clear ketosis without exogenous insulin administration,” the authors noted.

But the clinical importance of this risk was not appreciated in the initial randomised controlled trials of SGLTi therapy in diabetes, the authors said.

“It remains unclear whether individual with normoglycaemia and presumably normal insulin secretory capacity would be at risk of ketoacidosis,” they added.

“Risk of ketoacidosis and sick day management should be considered and discussed in high risk patients.”

Flash CGM – is better use a predictor of better glycaemic control?

Data from Western Sydney Diabetes suggested how often patients scanned their fCGM devices could be a useful predictor of glycaemic management in patients with T2D.

This assertion was based on a retrospective cohort study including 828 patients who had attended diabetes clinics in the region since 2018 and used fCGM, finding an extra scan a day resulted in a 1.18% improvement in time in range.

Each additional daily scan also correlated with an average reduction in GMI of 0.05%, noted the researchers led by Dr Gideon Meyerowitz-Katz (PhD).

“Scanning of fCGM sensors may be an important predictor of patient activation and thus ongoing self-management in people with T2D,” they concluded.

“This metric may be useful when considering clinical care plans for individuals who are having difficulty controlling their diabetes, or as an indicator of future health issues.”

Gastroparesis with perioperative use of GLP-1 RAs

Another case report detailed significant delays in gastric emptying in patients on GLP-1 receptor agonists in two patients, who had full stomachs with 10 and 13 hours of fasting time respectively.

Procedures – gastroscopy in each case – had to be abandoned as a result, with a follow-up three months later for the latter patient revealing an empty stomach with only 12 hours fasting after semaglutide had been withheld for three weeks.

The report added to a growing literature of such cases, as well as recent advice from the American College of Gastroenterology and American Society of Anesthesiologists, noted the authors led by Dr Lisa Raven of St Vincent’s Hospital, Sydney.

Nevertheless, the optimal time of withholding and fasting was yet to be determined, they added.

Eye health among islet transplantation recipients

Early data collected in 15 patients from St Vincent’s Hospital, Melbourne found the degree of diabetic retinopathy (DR) remained stable after undergoing islet transplantation, with no patients progressing to proliferative DR.

In addition, most eyes remained stable during early improvement in glycaemia at one-year post transplantation, per the medical record review of all recipients at the hospital between 2007 and 2022.

Overall, there were 16 eyes with diabetic retinopathy pre-transplantation and at median five -year follow-up, although two eyes went from ‘mild’ to ‘moderate’ retinopathy grading.

No eyes improved, but only one worsened at one-year and only four out of 25 had worsened at the most recent eye review, according to the authors.

Circulating visfatin levels predict in gestational diabetes

Another poster detailed research suggesting reduced circulating visfatin in early pregnancy could be a predictor of the development of gestational diabetes (GDM).

Additionally, increased circulating visfatin in GDM pregnancies may indicate future risk of future fetal macrosomia, found the researchers led by Dr Tomasz Block from Royal Hobart Hospital and Monash University.

Visfatin is a protein that is preferentially produced in visceral adipose tissue and both its tissue expression and secreted plasma levels increase in parallel with obesity.

The study included 21 women with GDM and 18 without, all of whom had undergone standard glucose tolerance tests at the hospital, as well as fasting samples for glucose, insulin, C-peptide and adipokines including visfatin.

Findings included that adiponectin and visfatin were decreased 35% and 48% respectively in women with GDM those without. Visfatin also showed a 43% increase in women with macrosomia versus those without, and an 81% increases in women with GDM and macrosomia compared with those without macrosomia.

But interestingly, insulin resistance, adiponectin and visfatin all returned to similar levels at 5-8 weeks post-partum, regardless of whether the patient had had GDM, the researchers said.