EASD 2019 Roundup: CGM Benefit Confirmed
BARCELONA -- New therapies and insights to type 1 and 2 diabetes were at the forefront of the European Association for the Study of Diabetes 2019 meeting held here.
Some highlights included additional DAPA-HF data showing SGLT-2 inhibitors benefit the heart even in those without diabetes, the CAROLINA trial determining the cardiovascular safety of sulfonylureas, and the heart benefits of metformin even with compromised renal functioning.
Now, here are a few quick takes on other important research at EASD 2019.CGM's Benefit in T1D
Continuous glucose monitoring (CGM) was superior to self-monitoring of blood glucose for improving disease managment in people with type 1 diabetes. The COMISAIR real-world study found this benefit was independent of the patient's insulin delivery method including multiple daily injections or insulin pump.
Jan Šoupal, MD, PhD, of Charles University in Prague, and colleagues followed 94 adults with type 1 diabetes for 3 years. Those who used CGM saw significantly better HbA1c levels -- 7% and 6.9% for the multiple daily injection and insulin pump groups, respectively -- versus 7.7% and 8.0% for conventional self-monitors. CGM users also saw significantly more time spent in range, as well as less time spent in hypoglycemia. The results were simultaneously published in Diabetes Care.
"Importantly, our findings demonstrate that the use of [continuous glucose monitoring] with [multiple daily injections] can be considered an equivalent but more cost-effective treatment alternative to sensor-augmented insulin pumps for many individuals with T1D," the group concluded.Global Diabetes Incidence: On The Decline?
Since 2006, the diabetes incidence has either remained stable or decline in the majority of the world. During these recent years, only 33% of the world had rising rates of new diabetes cases, mainly in the Pacific Islands, Middle East, and south Asia. But this only came after a steep increase from 1990 through 2005, where 66% of the world's populations saw increases in diabetes incidence, and only 2% saw a decline.
Led by Dianna Magliano, PhD, of the Baker Heart and Diabetes Institute in Australia, the study was also simultaneously published in .
Stating her group was "not totally surprised" by these findings, Magliano told MedPage Today that this recent downturn in diabetes incidence is likely due to a culmination of factors. Some of these factors include an increase in health awareness, changes in food formulations, increase in labeling, and taxes such as the sugar sweetened beverage and junk food taxes.
"There also have been changes to other risk factors, intake of saturated fats has decreased, smoking continues to decrease. Lipid levels and hypertension levels have also fallen. All of these factors may have contributed to the decline or stabilization of diabetes incidence rates," she added.
As far as future incidence trends in areas that are currently still showing rising rates, Magliano said there is "very scant data to inform us about what the patterns would be in low- to middle-income countries. But given the epidemic hit later in these countries, I suspect the downturn in incidence may also be delayed assuming it happens at all." She added that this must be assessed in future research.Obesity's Impact on Risk
When it comes to risk factors for type 2 diabetes, obesity single-handedly dominates other factors including genetics and lifestyle. Those with an "unfavorable" lifestyle had 18% higher risk (HR 1.18, 95% CI 1.06-1.30) for developing type 2 diabetes, and those with a high genetic risk score had doubled risk (HR 2.0, 95% CI 1.75-2.27) for incident type 2 diabetes. But those with obesity had nearly sixfold higher risk (HR 5.81, 95% CI 5.16-6.55) during an average 15 year follow-up.
Most notably, adults who ranked high for all three risk factors -- high genetic risk, unfavorable lifestyle, and obesity -- had 14.5-fold higher risk for newly diagnosed diabetes (95% CI 8.09-26.13).
"We found that individuals with an unfavorable lifestyle and obesity are at greater risk of incident type 2 diabetes regardless of their genetic risk," lead author Hermina Jakupović, PhD, of the University of Copenhagen, told MedPage Today.
"This means that we should promote the lifestyle interventions since they are primarily designed for weight management and shown already to delay the onset of type 2 diabetes among patients with impaired glucose tolerance. The earlier we start by implementing these interventions -- favorable lifestyle behavior patterns -- the better the effect."
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