Results from the LEADER study showing fewer cardiovascular events in patients treated with liraglutide and an update of the EMPA-REG study identifying renal benefits from empagliflozin were just some of the highlights from the 2016 annual meeting of the American Diabetes Association held in New Orleans this week.

The LEADER study, published in the New England Journal of Medicine, compared the GLP-1 analogue liraglutide with placebo, in addition to standard care, in 9,340 patients with type 2 diabetes over a median of 3.8 years.

The primary outcome, a composite of cardiovascular death, nonfatal myocardial infarction or nonfatal stroke, was significantly reduced from 14.9% in the placebo group to 13.0% in the liraglutide group.

The single outcome of cardiovascular death was also reduced, from 6.0% to 4.7%, amounting to a 22% reduction in relative risk.

Rates of nonfatal myocardial infarction, nonfatal stroke and hospitalisation for heart failure were non-significantly lower in those randomised to the GLP-1 analogue.

As expected, GI side effects were the most common reason for discontinuing liraglutide, and it was associated with a non-significant increase in the incidence of pancreatitis.

In 2015 the EMPA-REG OUTCOME trial showed that the SGLT2 inhibitor empagliflozin reduced the risk of major adverse cardiovascular events in patients with type 2 diabetes at high risk for cardiovascular events.

A subsequent analysis, reported at the 2016 ADA meeting and also published simultaneously in the New England Journal of Medicine, concluded that empagliflozin was associated with slower progression of kidney disease and lower rates of clinically relevant renal events than placebo when added to standard care.

The 6,185 patients in the study had an eGFR of at least 30 ml/min/1.73 m² at baseline, and were randomised to empagliflozin 10 mg or 25 mg or placebo.

Incident or worsening nephropathy occurred in 12.7% of patients treated with empagliflozin compared to 18.8% in the placebo group – a 59% relative reduction in risk.

Doubling of the serum creatinine level was significantly reduced, by 44%, and the need for starting renal replacement therapy was reduced by 55%.

Other highlights of the meeting included a ‘best of the best’ abstracts session. They included:

• a study showing that cumulative life stress is associated with islet autoimmunity in genetically vulnerable children. The Environmental Determinants of Diabetes in the Young (TEDDY) study found that about 10% of children experienced consistently high rates of negative life events year after year. Such cumulative events were independently associated with an increased risk for islet autoimmunity in those with predisposing HLA DR3/4 gene complex, but not among children from other HLA risk groups.

• evidence that young patients with a short duration of type 2 diabetes have significant decreases in brain grey matter volume. Compared to controls, those with diabetes (mean duration 2.8 years) had total grey matter reduced by almost 10%. “Whether these findings explain poorer cognitive scores observed previously remains to be determined,” the researchers said.

• a finding that automated delivery of glucagon within a closed-loop system can reduce hypoglycaemia in type 1 diabetes. The strategy aims to overcome the risk of continued absorption of already-delivered insulin even after it has been suspended within a pump system. The study compared micro-doses of glucagon and placebo in 22 adults, and found there were half as many symptomatic hypoglycaemia episodes when using glucagon.

• long-term follow-up data from the Diabetes Prevention Program showing sustained increases in physical activity and associated reductions in type 2 diabetes incidence from lifestyle interventions. After more than 10 years of follow-up, the incidence of diabetes remained lower in at-risk participants assigned to the lifestyle group, and this could not be explained by weight changes alone. In fact, cumulative physical activity remained higher even after prolonged follow-up, and there was a 2% decrease in diabetes incidence for each 6 MET-hrs/week increase in activity (equivalent to about 1.5 more hours per week of brisk walking).