ADA Conference 2011: The Good, The Bad, and the Errr… News

The annual ADA Scientific Sessions conference is always kind of a mind-blower. It brings together 13,000 scientists, physicians, and other health care professionals (and now, bloggers!) from around the world.

This year, there will be hundreds of symposia, 59 special lectures, nearly 378 abstracts presented, and also nearly 2,000 research posters unveiled. Whew!

Thankfully, the ADA helps out bloggers and the media with a summary called “Clues to the News.” Here is our take on many of the items highlighted:

GOOD NEWS

* Longer Lives for People with Type 1

Researchers in Pittsburgh, PA, followed hundreds of T1 patients born between 1950 and 1980, and discovered that “life expectancy for those diagnosed between 1965 and 1980 was approximately 15 years longer than for those diagnosed between 1950 and 1964, whereas the life expectancy among the general population at that time grew by less than one year.” Their conclusion: “While those with type 1 are still living approximately four years less than those without, the survival gap is clearly shrinking.” Nice!!


* Vitamin D Really Does Help

Two separate new studies seem to confirm that: 1) taking vitamin D helps prevent type 2 diabetes, and 2) vitamin D deficiency leads to complications. A third study even showed that “higher levels of vitamin D predicted better beta cell function and better glucose control during a glucose tolerance test.” It’s actually pretty well-known that vitamin D helps with type 2 diabetes, but what about for young people with type 1? One of these studies found that T1′s who were deficient in vitamin D were twice as likely to develop eye problems, “though it’s unclear why.” This is all good news, IMHO, because taking Vitamin D is certainly an easy fix. Hit the drugstore, Friends!


* CGM for Infants & Toddlers

Image: Luke's D-Day blog

In a first-of-its-kind trial, researchers from around the country studied the feasibility of CGM use in 23 children with type 1 diabetes under the age of 4. Ten of those little folks were using an insulin pump and 13 were using multiple daily injections (MDI). “Each participant was provided with a CGM device (FreeStyle Navigator® or Paradigm®). Safety and use was monitored over 6 months.”

The results? Side effects such as skin reactions were minimal. The kids ran high (hyperglycemia) for more than half the day on average, while lows (hypoglycemia) were infrequent. CGM did not improve glycemic control (A1C levels) in this group, BUT the researchers conclude that “it can help to ease parents’ concerns of hypoglycemia, and in the future may allow more confidence in treating hyperglycemia in infants and toddlers.” Now, if the sensors just weren’t so gi-normous for these little bodies, ay…?


* The Artificial Pancreas Advances

About eight different studies were presented illustrating advancements in the JDRF Artificial Pancreas Project.

One study out of Santa Barbara, CA, involving Dr. Howard Zissser and Dr. Lois Janovic evaluated an “advanced, customized controller that can make determinations about how much insulin is needed and when it should be delivered.”

Another study out of Germany looked at the Paradigm Veo low-glucose suspend (LGS) feature: can it prevent hypoglycemia in children? The answer was ‘Yuppers!’ According to the German doctors, this study “provides evidence for reducing the risk for hypoglycemia with LGS without compromising the safety of (insulin infusion therapy.” Amen.

More studies looked at various aspects of safety and utility of a closed-loop system, including one that “validated” something called the Yale Insulin Infusion Protocol — detailed dosing instructions for in-hospital diabetics. (Wierdly, you can look up this automated dosing decision-maker here; just plug in your current BG level, and it gives you suggestions!)

BAD NEWS

* Heart Risk Higher with Metformin, Sulfonylureas

Using data from an electronic health record database, researchers found that “older patients with type 2 diabetes who started treatment with sulfonylurea (SU) drugs were significantly more likely to experience cardiovascular disease (CVD) than those who started with metformin.” Hmm, old drug = bad / new drug = good?

However, there’s a caveat: “This study was observational and does not prove cause and effect. Other factors may have explained the difference. (Metformin cannot be prescribed in patients with worse kidney and heart function, for example.)” OK. Still, the researchers insist that this finding is important because sulfonylureas continue to be commonly prescribed among elderly T2 patients, “and CVD is the leading cause of death among people with type 2 diabetes.” Ugh.


* TZDs Linked to Eye Disease

As if the above weren’t enough, researchers in the UK found that people who take thiazolidinediones (TZDs, such as rosiglitazone and pioglitazone) are 3.6 times more likely to develop diabetic macular edema (DME, a thickening and swelling of the retina due to leaking of fluid from blood vessels, which can lead to vision loss) than people who have never taken these drugs. In the words of the Madagascar Penguins, “Well, this sucks.”


* Working the Night Shift Linked to T2 Risk

This shouldn’t be surprising, I guess. Working the night shift for a long period of time doesn’t sound very healthful, does it? Researchers in Boston found that for women doing so mildly increases the risk developing type 2 diabetes, even when BMI was accounted for. “Previous studies have shown that working the night shift interrupts circadian rhythms and is associated with obesity, metabolic syndrome and glucose dysregulation (abnormalities in regulating blood glucose),” the authors point out.


* Sleep Apnea Bad for Your Eyes, Nerves

And when you have sleep problems, it’s all bad news too. Obstructive Sleep Apnea, which is growing more common and associated with type 2 diabetes. Researchers in the UK conducted two studies and found two bits of bad news: 1) that sight-threatening retinopathy (eye disease) was more than twice as common in those with diabetes and sleep apnea, and 2) that nearly 60 percent of those with diabetes and sleep apnea also had peripheral neuropathy, compared to 27 percent of those without the sleep disorder. Now they are presumably working on what to do about it.


* Diabetics 2x As Likely to Lose Hearing

This is REALLY bad news. DO YOU HEAR? This one scares me.

In a “meta-analysis” of 11 different related studies, Japanese researchers found that age-related hearing loss is twice as common in people with diabetes. Further investigation is required as to why, but “some researchers feel that neuropathy or vascular disease may be the mechanism.” Man, isn’t the vision threat enough?

* For Women with T1, Heart Risk Starts Early

“Women with type 1 diabetes are at four times greater risk for cardiovascular disease (CVD) than those who don’t have diabetes, and pre-menopausal women with diabetes do not seem to have the beneficial effects on heart disease risk factors that other pre-menopausal women do.” This according to a Colorado-based study that found significant differences in CVD risks between girls with type 1 diabetes and those who did not have diabetes, as early as adolescence.

“By contrast, boys with type 1 had no greater CVD risk factors than boys who did not have diabetes, though researchers are still investigating why.” It seems that girls’ risk factors in that age group are elevated level of c-reactive protein (CRP – a marker of inflammation), and high cholesterol. What the heck? In teen girls?  More evidence that the world is unfair.

Why is there always more bad news from these studies than anything else, anyway?!


ERRR…

* Discounted / Generic Drugs Are “A Mixed Blessing”

What, affordable medications can do damage? This one caught me off-guard. It’s an economic conundrum called “The Wal-Mart Effect,” and it goes like this:

“People who have diabetes take an average of nine medications each day. When they don’t take them, they are less likely to control their blood glucose, blood pressure and cholesterol, which may increase the risk of developing complications, having to go to the emergency room or being hospitalized. When drug prices go up, adherence often goes down. Discounted generic drugs (as low as $4 for a one-month supply) offered at stores such as Wal-Mart and Kmart have made some diabetes medications more affordable. However, this study shows that discounters of generics have since sharply raised average overall medication prices because of hikes in brand name drugs, eroding the savings for consumers.”

In other words, aggressive pricing for generic medications has reportedly driven up the cost of non-generic meds by 113%. Holy Cow! I guess retailers have to make up for their losses somewhere, ay? So we pay for it in the end.  (Note: I left this out of the ‘Bad News’ category because I’d have to agree with these authors that generics are a “mixed blessing.”)


* It’s Total Calories, Stupid!

There are always a few presentations that make me chuckle, with their no-brainer quality. Like this one this year: key to successful weight loss is not about the exact gram-count of carbs or protein — or any other single food component — at all, but rather about how many TOTAL CALORIES you take in. Surprise! It never ceases to amaze me that people don’t recognize the simple math equation of weight loss: Total calories going in vs. total number of calories being expended.

Meanwhile, “the ideal dietary macronutrient composition for weight loss in patients with type 2 diabetes remains unclear.” OK, gotcha. No one knows the perfect meal plan. But I still say fewer total calories (i.e. food) + more physical activity = weight loss. Pretty simple.

Look for more news from ADA here tomorrow.