American Diabetes Association, June 9-13

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The American Diabetes Association's 77th Scientific Sessions

The annual meeting of the American Diabetes Association was held from June 9 to 13 in San Diego 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 an effort to test whether two-way text messaging helps adolescent patients maintain or improve hemoglobin A1c (HbA1c) levels, Lori Laffel, M.D., M.P.H., of the Joslin Diabetes Center and Harvard Medical School in Boston, and colleagues conducted a randomized controlled trial, performed at two sites, which included 301 teens with type 1 diabetes, age 13 to 17 at entry. Patients had HbA1c between 6.5 and 11 percent and diabetes for at least six months; they were all undergoing treatment with insulin.

"We performed a study using a two by two factorial design, which included four arms. The first arm was a problem solving (PS) intervention delivered to the teen in which research staff reviewed self-care focused on checking blood glucose levels and giving bolus insulin doses. These interventions were delivered during routine clinic visits every three months, thereby serving as a clinic-based intervention," Laffel explained. "The second arm was a text-messaging (TM) intervention, in which teens selected times when they wanted to receive text-message reminders to check blood glucose levels and then text back their glucose level to a secure server. The third arm included both the PS and TM interventions and the fourth arm was a control group receiving usual care."

The investigators assessed a primary end point of glycemic control over a one-year period. The team observed various response rates, and categorized respondents into three groups: low responders, moderate responders, and high responders.

"Low responders demonstrated an increase in HbA1c, or worsening of glycemic control over the period. Similarly, those who did not receive the text reminders also demonstrated deterioration in glycemic control. However, patients who were moderate or high responders demonstrated no worsening of glycemic control, and their HbA1c remained stable over the year," Laffel said. "Of those who received text messages, 58 percent were moderate or high responders, which shows that the intervention benefited more than half of those who received it, thereby showing that the TM intervention was able to preserve glycemic control in teens with type 1 diabetes."

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In another study, Lawrence A. Leiter, M.D., of the University of Toronto, and colleagues evaluated the efficacy of alirocumab, an approved proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, in insulin-treated patients with long-standing diabetes.

"We evaluated participants with diabetes who had a low-density lipoprotein (LDL) cholesterol above target despite maximum-tolerated statin therapy. Two hundred ninety-four patients with type 2 diabetes mellitus (T2DM) were randomized to receive alirocumab and 147 to receive placebo," Leiter said. "The primary end point was percent LDL cholesterol reduction at 24 weeks. We found a 49 percent reduction relative to placebo, which was highly statistically significant."

The investigators also found significant reductions in many secondary lipid parameters, including non-high-density lipoprotein cholesterol, apolipoprotein B, and lipoprotein a. Alirocumab was generally safe and well tolerated, according to Leiter, with no new safety issues identified.

The study was supported by Sanofi and Regeneron, the manufacturers of alirocumab.

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Madhumita Sinha, M.D., of the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health in Phoenix, and colleagues evaluated the risk of type 2 diabetes (T2DM) among obese and severely obese American Indian children and adolescents.

"Incidence of youth-onset T2DM was 2.3 to 5.1 times higher in the most severe obesity group compared to the least severe obesity group," Sinha said. "Early-onset T2DM with longer exposure to dysglycemia is likely to give rise to diabetes related multi-system complications manifesting earlier in life and also increases the risk for early mortality."

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Lise G. Bjerregaard, Ph.D., of Frederiksberg Hospital in Copenhagen, Denmark, and colleagues found that being overweight in childhood (5.4 percent) and in young adulthood (8.2 percent) was associated with increased risk of T2DM.

"We found that overweight boys who normalize their weight from age 7 to age 18 years do not carry an increased risk of T2DM in adulthood compared with men who were normal weight both at age 7 and 18 years. However, men who were persistently overweight or became overweight as young adults had three times the risk of developing T2DM as non-overweight men who were overweight as children," Bjerregaard said. "Our results suggest that adverse consequences for T2DM of childhood overweight are reversible. Therefore, it is very beneficial for overweight boys, and possibly girls, to normalize their weight before adulthood. If they do, they can reduce their otherwise sharply increased risk of developing T2DM in adulthood."

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ADA: Nasal Glucagon Feasible for Hypoglycemic Episodes

TUESDAY, June 13, 2017 (HealthDay News) -- Nasal glucagon can effectively and efficiently manage moderate or severe hypoglycemic episodes (HEs) in real-world settings in adult patients with type 1 diabetes, according to a study presented at the annual meeting of the American Diabetes Association, held from June 9 to 13 in San Diego.

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ADA: Canagliflozin Tied to Lower Risk of Cardiovascular Events

TUESDAY, June 13, 2017 (HealthDay News) -- For patients with type 2 diabetes and high cardiovascular risk, canagliflozin is associated with a lower risk of cardiovascular events, according to a study published online June 12 in the New England Journal of Medicine. The research was published to coincide with the annual meeting of the American Diabetes Association, held from June 9 to 13 in San Diego.

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ADA: Degludec Noninferior for Cardiovascular Events in T2DM

TUESDAY, June 13, 2017 (HealthDay News) -- Among high-risk patients with type 2 diabetes, degludec is noninferior to glargine in terms of the incidence of cardiovascular events, according to a study published online June 12 in the New England Journal of Medicine. The research was published to coincide with the annual meeting of the American Diabetes Association, held from June 9 to 13 in San Diego.

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ADA: Glucose Self-Monitoring Often Lacks Benefit in T2DM

MONDAY, June 12, 2017 (HealthDay News) -- For most patients with non-insulin-treated type 2 diabetes, routine self-monitoring of blood glucose does not significantly improve hemoglobin A1c levels or health-related quality of life, according to a study published online June 10 in JAMA Internal Medicine. The research was published to coincide with the annual meeting of the American Diabetes Association, held from June 9 to 13 in San Diego.

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