On-site color from an EASD attendee: A US Perspective

November 01, 2010

Matthew C. Riddle, MD

There’s a yearly rhythm to the lives of scientists and clinicians who work on diabetes.  Each year, in June, comes the annual scientific sessions of the American Diabetes Association (ADA), then in September follows the annual meeting of the European Association for the Study of Diabetes (EASD).  Both are big meetings with a rich variety of presentations which reflect state-of-the-art research and also bring us new findings.  Coming first, the ADA has the edge in presenting new information, while the EASD reflects how new data are incorporated into our collective understanding of diabetes.

Also, and not least important for the minority of researchers and practitioners from North America who go to the EASD, each year another venerable and beautiful European capital is the venue.  This year Stockholm showed us how a major city can perch on a cluster of islands, present us with a pale September sun already low in the sky, and allow us to see reindeer (cute ones, really) at the Skansen open-air museum.  And, as usual, the meeting gave us some indication of what is now hot, and what is not.

Notably on the wane was interest in thiazolidinediones, which a few years ago seemed to promise protection against cardiovascular risks.  This promise has not come to fruition, and instead current debate centers on whether rosiglitazone and pioglitazone may actually increase various risks.

Insulin remained a topic of interest, both with respect to its unquestioned ability to control glycemia and its potentially harmful effects resulting from hypoglycemia, weight-gain, and perhaps stimulation of cell growth.  For example, a long-term follow-up of the DIGAMI 2 study asked whether insulin used by patients with type 2 diabetes after a myocardial infarction should be regarded as “friend or foe.”  The need to pose this question reflects an opportunity for therapies which might limit risks associated with intensified use of insulin or provide alternative means of treating some patients.

Specifically, various presentations dealt with new approaches to treating diabetes without causing hypoglycemia or weight gain.  In this category fell studies of therapies based on gastrointestinal peptide hormones.  Glucagon-like-peptide-1 agonists featured prominently, including studies of longer acting GLP-1 agonists (liraglutide, once weekly exenatide, taspoglutide) in various settings.  Also notable were reports of the sodium-glucose-co-transporter-2 (SGLT-2) blockers (dapaglifozin, canaglifozin, and others), for treatment particularly of postprandial hyperglycemia with additional effects on sodium retention and hypertension. Finally, many meetings offer surprising new ideas, and for some of us a highlight this year was a proof of concept study in humans which extended earlier animal research indicating that the mixture of intestinal bacteria influences disturbances of glucose and lipid physiology.  The study suggested that lower intestinal infusion of bacteria from lean individuals improved insulin resistance and lipids in obese persons.  Who knew?  My take-home from this is that we are just starting to learn about how the gut and diabetes interact.  Even one entirely new idea makes the trip worthwhile.

Matthew C. Riddle, MD is Professor of Medicine, Division of Endocrinology, Diabetes, & Clinical Nutrition, Oregon Health & Science University, Portland, OR

For more related articles, click Diabetes Perspectives.