VOLUME 10 NUMBER 3 • SEPTEMBER 2013
109
TABLE OF CONTENTS
SA JOURNAL OF DIABETES & VASCULAR DISEASE
ADA WATCH
Intensive HbA
1c
management in type 1 diabetes sees persistent benefit........................................................ 109
New therapeutic targets for type 2 diabetes................................................................................................. 109
Look AHEAD: lifestyle intervention in type 2 diabetes offers microvascular benefit but does not lower
risk of cardiovascular disease..................................................................................................................... 110
Exercise may be the best medicine for diabetes patients............................................................................... 110
New perspectives on type 2 diabetes risk factors.......................................................................................... 110
2013 UPDATE FROM CHICAGO, USA
American Diabetes Association 73rd scientific sessions
21–25 June 2013
Contributor:
G Hardy
SUMMARIES
ADA WATCH
Intensive HbA
1c
management in
type 1 diabetes sees persistent
benefit
Preliminary results of the latest data from
the Diabetes Control and Complications
trial (DCCT) and Epidemiology of Dia-
betes Interventions and Complications
(EDIC) trial were published as abstracts
and presented at the recent ADA meet-
ing. The 10-year DCCT, which began in
1983, demonstrated a consistent benefi-
cial effect of intensive therapy on reducing
complications compared with conven-
tional therapy.
The DCCT revealed that intensive ther-
apy, lowering HbA
1c
levels to 7% rather
than the 9%, which was standard prac-
tice at the time, in patients with type 1
diabetes diminished a range of complica-
tions by about 35 to 75%, establishing
intensive therapy as the standard of care.
Improved glucose control was achieved
with frequent insulin injections or insulin
pump therapy, guided by frequent self-
monitoring of blood glucose with finger-
prick testing.
The trial was extended into EDIC (now
running for a total of 30 years); 95%of trial
patients who are still alive continue to par-
ticipate in the trial. While the initial DCCT
results were dramatic, the effect of inten-
sive therapy in reducing the longer-term
consequences of complications, including
kidney failure, loss of vision, amputations
and heart disease, were unknown.
Over 18 years, those patients who had
intensive management and maintained
an HbA
1c
target of 7% had a 46% lower
risk of retinopathy, a 39% reduced risk of
microalbuminuria, and a 61% lower risk
of macroalbuminuria (
p
< 0.0001 for all).
The long-term consequences of intensive
therapy have shown a 50% reduction in
risk for developing impaired kidney func-
tion. Intensive therapy also reduced the
incidence of heart disease and stroke by
almost 60%.
Researchers also reported new data on
musculoskeletal complications, particularly
cheiroarthropathy, which presents with
peri-articular skin thickening of the hands
and limited joint mobility. Cheiroarthropa-
thy typically results from the accumulation
of advanced glycation end-products in the
collagen, and includes carpal tunnel syn-
drome, adhesive capsulitis, Dupuytren’s
contracture, flexor tenosynovitis (or ‘trigger
finger’), and prayer sign (or trouble holding
the hands flat when palm-to-palm).
Researchers found that a third of about
1 200 patients (33%) had at least one
type of this complication, with the most
common being adhesive capsulitis, fol-
lowed by carpal tunnel and then prayer
sign. Another 20% of patients had at least
two complications, and a further 10% had
at least three. About 3% had four or more
complications. Risk factors for these con-
ditions included older age, female gender,
longer duration of disease, and higher
HbA
1c
levels over time.
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ADA/40047
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dcct-edic.html
New therapeutic targets for type 2
diabetes
Recent years have seen a dramatic expan-
sion in the range of pharmacological ther-
apy for type 2 diabetes. A range of new
therapeutic targets were under discussion.
Beta-cells
The beta-cell plays a crucial role in type 2
diabetes, with beta-cell pathways offering
multiple potential drug targets. Free fatty
acid receptor 1 (FFAR-1 or GPR40) is one
of the most promising targets. Free fatty
acids are both metabolic fuels and signal-
ling pathways that are highly expressed in
the beta-cells, the hypothalamus and the
gut.
The investigational compound TAK-875
has shown reductions in HbA
1c
levels simi-
lar to those with glimepiride; with signifi-
cantly fewer incidents of hypoglycaemia
and no effect on weight, insulin sensitivity,
blood pressure or pulse. The compound
has also shown no significant drug-related
adverse events.
Insulin receptors
The most important cause of insulin
resistance is obesity and treating obes-
ity is probably the most effective way to
treat insulin resistance. Other approaches
include enhancing insulin receptor activ-
ity and modulating signalling downstream
from the receptor. Enhancement and acti-
vation of insulin receptors has met with
success in rodent models, but none of
these compounds appear to be appropri-
ate for human use. Other investigative
agents potentiate insulin receptor activity
to increase glucose uptake.
Targeting inflammation
Reducing inflammation in adipose tissue
and skeletal muscle with salsalate has
