178
VOLUME 8 NUMBER 4 • NOVEMBER 2011
EASD WATCH
SA JOURNAL OF DIABETES & VASCULAR DISEASE
TABLE OF CONTENTS
DIABETES EPIDEMIC DEMANDS GLOBAL ACTION:
FROM THE UN SUMMIT ON NON-COMMUNICABLE
DISEASES......................................................... 178
Novel treatments................................................. 178
SGLT-2 inhibitors.................................................. 179
Exenatide vs liraglutide........................................ 179
46th Minkowski lecture....................................... 179
ADVANCES IN IMPLEMENTING LIFESTYLE CHANGES
Improving health outcomes through peer diabetes
education: lessons for primary healthcare......... 180
BRAIN CONTROL OF SATIETY AND APPETITE
Brain responses to food....................................... 180
Gastric bypass alters central appetite control....... 180
Other consequences of bariatric surgery: insulin
sensitivity improves only in DM patients............ 180
High risk of depression in type 2 diabetics:
motivation for monitoring of emotional
well-being in collaborative care models............. 181
NUTRITION AND TYPE 2 DIABETES...................... 181
CLINICAL TRIALS OF INTENSIVE GLUCOSE
LOWERING
End-stage kidney disease (ESKD): ADVANCE trial...181
Understanding cardiovascular risk at HbA
1c
levels
below 7%: ACCORD trial................................. 181
UKPDS UPDATED RISK MODEL............................ 181
INCRETIN MIMETICS: THE FUTURE OF TYPE 2
DIABETES MANAGEMENT................................ 182
Once-a-year GLP-1 dosage passes phase 2 trial.... 182
Liraglutide, the human GLP-1 analogue: safe in
mild and moderate renal impairment in type 2
diabetes........................................................... 182
Achieving weight loss with incretin-based therapies,
GLP-1 agonists and DPP-4 inhibitors................. 182
Maintaining weight loss with liraglutide on adding
insulin detemir: one-year follow-on results........ 182
The promise of DPP-4 inhibitors: use them early
in the disease process....................................... 183
CARDIOVASCULAR FOCUS IN DIABETES
Provocative suggestion: that DPP-4 inhibitors could
have a cardiovascular protection affect?........... 183
Type 2 diabetes patients with non-albuminuric renal
impairment are still exposed to coronary events.183
Nephropathy....................................................... 183
Cardiovascular events and risk in type 2 diabetes: the
latest insights and clinical trials ........................ 183
MICROVASCULAR COMPLICATIONS: PERIPHERAL
NEUROPATHY AND THE DIABETIC FOOT........... 183
Charcot foot....................................................... 183
FIELD study: fenofibrate reduction of amputations
explored........................................................... 184
DIABETES EPIDEMIC DEMANDS
GLOBAL ACTION: FROM THE UN
SUMMIT ON NON-COMMUNICABLE
DISEASES
Diabetes remains on its relentlessly upward
trajectory. The International Diabetes
Federation (IDF) figures for 2011 are 366
million people with diabetes globally.
Deaths due to diabetes will number 4.6
million, with one person dying every seven
seconds of complications related to diabe-
tes.
The global diabetes community expects
commitment from international political
leaders at the UN Summit on Non-Com-
municable Diseases (NCDs) focusing on
the challenge posed by diabetes, cancer,
heart and lung diseases. The Summit has
the intention of creating concrete actions
and measurable targets for prevention and
control of NCDs worldwide, with particu-
lar focus on developing countries.
Leading experts attending the EASD
meeting demanded increased funding for
research as a key commitment arising from
the Summit. IDF President Jean-Claude
Mbanya and EASD vice-president Andrew
Boulton (South Africa) have jointly com-
mented that ‘without urgent research into
improved care and prevention models, we
stand little chance of meeting any long-
term targets that arise from the Summit’.
Research into strengthening health sys-
tems should include developing and
evaluating approaches for building care
capacity, as well as integrating diabetes
care with primary healthcare services that
offer management of chronic infectious
diseases and maternal and child health.
Source: UN/NCD press release
Novel treatments
In a session on novel agents in development
for the management of type 2 diabetes,
interesting new molecules were described.
These included a GPR40 protein agonist
2011 UPDATE FROM LISBON, PORTUGAL
European Association for the Study of Diabetes
12–16 September 2011
Contributors:
L Lombard, G Hardy, J Aalbers
SUMMARIES
EASD WATCH
(TAK-875) studied in a phase-two trial and
compared to 4 mg glimepiride.
1
There were 426 patients in the 12-week
study, which achieved a 1% lowering in
HbA
1c
levels, equal to that of glimepiride
4 mg. More than 40% of the patients
achieved an impressive ≥ 1.5% lowering in
HbA
1c
levels. There were fewer incidents of
hypoglycaemia compared with glimepiride
and few reported side effects. This mole-
cule holds promise for the future.
Another agonist, GPR119 (PSN-821)
was also presented in a phase 1 trial. This
receptor is present on the beta-cells as
well as in the gastrointestinal tract.
2
Pre-
vious studies have shown increased levels
of insulin, GLP1, GIP and PYY. This study
showed lowering of LDL cholesterol and of
fasting blood glucose of 2 mmol/l.
It was a small study with only 25 patients
who experienced no serious side effects.
There was a tendency towards weight loss.
HbA
1c
levels were not assessed and there
were small changes in both fasting and
postprandial glucose levels reported. The
results were less impressive than the above
study, although it was only in phase 1.
Another product developed and tested
in a phase 1 trial was a glucokinase acti-
vator in the liver. It showed several side
effects and it appears that further develop-
ment will not continue.
3
Two speakers presented data on gluca-
gon receptor antagonists. Although show-
ing slight increases in liver enzyme levels,
they displayed good lowering in HbA
1c
levels of 1–1.5%. One of the drugs has a
very long half-life.
