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VOLUME 9 NUMBER 1 • MARCH 2012
37
SA JOURNAL OF DIABETES & VASCULAR DISEASE
REPORT
TABLE OF CONTENTS
INTRODUCTION AND OVERVIEW........................... 37
Patients’ bill of rights............................................. 37
GETTING TO THE HEART OF DIABETIC
CARDIOVASCULAR DISEASE............................... 37
Relationship between adiponectin and
carotid IMT......................................................... 38
Oxidative stress and vascular complications
of diabetes......................................................... 38
Visceral fat and cardiovascular risk in a
Chinese study..................................................... 38
Gastrectomy and atheroscerlosis progression......... 38
Sagittal abdominal diameter a better predictor
of arterial stiffening than waist circumference..... 38
Raised adiponectin in orthostatic hypotension
in diabetes. ........................................................ 39
Vascular stiffening response in type 2 diabetes. ..... 39
ADVANCE model better predictor of
cardiovascular risk in diabetes............................. 39
Further results from global A
1
chieve
TM
study
of insulin usage in type 2 diabetes...................... 39
LATE-BREAKING CLINICAL TRIALS
Data show insulin degludec/insulin aspart
combination significantly reduced
hypoglycaemia in type 1 and 2 diabetes
patients.............................................................. 40
Pooled analysis: fewer major adverse cardiovascular
events in type 2 diabetes patients treated with
sitagliptin. .......................................................... 40
Flat and stable blood glucose lowering shown with
once-daily insulin degludec in both type 1 and 2
diabetes patients................................................ 40
2011 UPDATE FROM DUBAI, UNITED ARAB EMIRATES
International Diabetes Federation Congress
4–8 December 2011
Contributors:
Prof B Joffe, Dr A Kengne, J Aalbers
SUMMARIES
IDF WATCH
INTRODUCTION AND OVERVIEW
Prof BJ Joffe, CDE Centre, Houghton,
Johannesburg
In keeping with previous International Dia-
betes Federation congresses, the Dubai
meeting presented an exciting and varied
series of lectures and symposia. This paral-
leled the diverse and unique architecture of
the city.
Preceding the official start of the congress
was a Novo-Nordisk-sponsored programme
titled Advances in metabolic science and
therapies. It focused on the glucagon-like
peptide-1 (GLP-1) agonists, liraglutide in
particular, for the treatment of the obesity–
pre-diabetes–diabetes continuum, as well as
the potential future use of ultra-long-acting
insulins such as insulin degludec (see Late-
breaking clinical trials, page 4).
The congress began with a symposium
dealing with reform in a post-United Nations
diabetes world summit. Dr Richard Smith,
former editor of the
British Medical Journal
,
gave a thought-provoking review on new
health strategies for dealing with diabetes.
He stressed that we should concentrate
on pre-diabetes, to prevent its progression
to diabetes (his personal viewpoint). This
should involve mainly lifestyle modification,
with patients being encouraged to ‘take
charge’ of their own medical problems.
Following this was a debate on best strat-
egies to prevent diabetes in high-risk indi-
viduals. Dr Fronzo (USA) was of the opinion
that early intervention must include drugs
such as metformin, pioglitazone, acarbose
and, for future use, exenatide and liraglu-
tide. Dr Tuomiletho (Finland) however was
against the use of drugs – but rather advo-
cated lifestyle changes, including diet and
exercise.
Diabetic neuropathy was the subject of
a cutting-edge symposium in which the
importance of early diagnosis was again
emphasised. The usual clinical tests are too
crude and techniques such as lower-limb
skin biopsy and corneal confocal microscopy
for detecting a fall-out in small nerve fibre
density were demonstrated. Gastroparesis
is a frequently overlooked autonomic mani-
festation and is difficult to manage. Pyloric
botox injections were even suggested.
A debate on whether blood pressure
should be lowered as much as possible
in diabetic patients aroused considerable
interest. A blood pressure target of below
140/80 mmHg was generally regarded as
reasonable, with the ideal hypotensive
agents including ACE inhibitors, diuretics,
calcium antagonists, and even the almost
obsolete drug, reserpine.
The final topic attracting interest was
the metabolic memory hypothesis. This
hinges on the theory that alternative met-
abolic pathways of intracellular glucose
metabolism remain dormant if tight gly-
caemic control is instituted and initiated in
diabetic subjects, thereby reducing the risk
of microvascular complications developing
several years down the line, irrespective of
later control. However, the reverse situation
similarly applies.
Patients’ bill of rights
The IDF traditionally focuses on the patient–
caregiver interface and this year’s meet-
ing in Dubai also raised the profile of the
diabetic patients’ bill of rights. Education
for Society noted that the role of a young
generation of patients is essential to the
building of public awareness, according to
Amir Karman Tayar, diabetologist and chair
of the IDF for the Middle East and North
Africa Region.
The contributions of Ibn Sina or Avicenna
(980–1037), a Persian, born in Afshana
near Bukhara in today’s Uzbekistan, who
described diabetes in his 14-volume
The
Canon of Medicine
, was cited among the
early contributions to today’s understanding
of diabetes from the Middle East region.
GETTING TO THE HEART OF
DIABETIC CARDIOVASCULAR
DISEASE
Dr A Kengne, Medical Research Council,
Cape Town
This cardiovascular session, co-chaired by
Profs A Chait and R Eckel (USA), took place
in the Sheikh Maktoum A auditorium and
included eight presentations, dominated
by studies conducted in Asia, with a single
African contribution.