June 12, 2019
The 79th Scientific Sessions of the American Diabetes Association (ADA) was held June 7-11, 2019 in San Francisco, California (USA). Here, what we believe are the biggest announcements from the annual meeting.
Vitamin D doesn’t prevent type 2 diabetes
Prediabetes puts millions of people at risk for type 2 diabetes. Lifestyle changes—including weight loss and exercise—can reduce the risk, but new research presented at the ADA 2019 Scientific Sessions strongly suggest the use of vitamin D supplements may not be a beneficial aid, although prior observational studies indicated an association between low blood 25-hydroxyvitamin D level and type 2 diabetes risk.
The study, “The Vitamin D and Type 2 Diabetes (D2d) Study – A Multicenter Randomized Controlled Trial for Diabetes Prevention,” included 2,423 adults aged ≥ 30 years and was conducted at 22 sites across the United States.
The study screened participants every three to six months for an average of 2.5 years to determine if type 2 diabetes had developed. Researchers then compared the number of people in each of the two study groups that had progressed to type 2 diabetes. At the end of the study, 293 out of 1211 participants (24.2%) in the vitamin D group developed type 2 diabetes compared to 323 out of 1212 (26.7%) in the placebo group – a difference that did not reach statistical significance. The study was designed to detect a risk reduction of 25% or more.
Why this is important: The findings dispel the myth that Vitamin D improves the body’s sensitivity to insulin, and aids insulin resistance.
Technology for type 1 diabetes: Medtronic and Tidepool partner
Getting huge traction on social media for ADA 2019 is a new partnership between diabetes tech giant Medtronic and the non-profit organization Tidepool. The two announced that they will collaborate to develop an interoperable, automated insulin delivery system. Both Medtronic and Tidepool plan on working with the U.S. Food and Drug Administration (FDA) for the Loop app and the compatible Minimed pump. The two will also collaborate on regulatory and software processes. Tidepool is also currently working on a partnership with the Omnipod Dash system, and we’re sure there’s even more to come.
Why this is important: The Tidepool loop is a hybrid closed loop system for iPhone and Apple Watch. Looping is essentially a term that describes artificial pancreas delivery systems that respond to glucose data from a Continuous Glucose Monitor and deliver adequate insulin or suspend delivery for optimal results.
The DIY loop community has been operating for a few years with homemade automated systems, with great success but without support from established insulin pump manufacturers and with little data sharing. This will all change as market leader Medtronic takes the bold step of working with Tidepool, diabetes advocates in the DIY community, including the first pioneers of the #wearenotwaiting community. The partnership is the first step in opening up much broader opportunities for people with diabetes to choose the automated technology that’s the best fit for their lives. What’s so exciting about this particular partnership is that a tiny grassroots movement developed so much traction and momentum that established industry understood joining the “glucose management” needs of people with type 1 diabetes is the best investment they can make.
A drug that may delay type 1 diabetes
A drug that targets the immune system may delay the onset of type 1 diabetes in people at high risk of developing the disease. The study was published in The New England Journal of Medicine (NEJM) and presented on June 9 at ADA 2019.
Investigators at 14 TrialNet clinical trial sites collaborated on a randomized, placebo-controlled study using teplizumab, a drug that disrupts the immune system’s destruction of beta cells. They enrolled 76 individuals without diabetes who fit specific criteria for being at high risk for type 1 diabetes. Study participants all had a relative with type 1 diabetes. Participants were randomly selected to receive either teplizumab intravenously or a placebo for two weeks. Their glucose tolerance was tested at regular intervals throughout the trial or until they developed type 1 diabetes.
Why this is important: Relatives of people with type 1 diabetes are significantly more likely to develop the disease themselves. At the end of the trial, the investigators determined that individuals in the treatment group who developed type 1 diabetes did so an average of two years later than those who received the placebo. The study demonstrated a promising prevention strategy for type 1 diabetes, although further study is needed.
CV safety in the CAROLINA study
Findings from the CAROLINA trial, the first active-comparator CV outcomes study to evaluate two commonly used antidiabetes medications, the sulfonylurea glimepiride against the DPP-IV inhibitor linagliptin, in a cohort of more than 6,000 adults with type 2 diabetes demonstrated no differences for incidence of non-fatal myocardial infarction, non-fatal stroke and cardiovascular death during a median of 6 years.
There was a higher incidence of hypoglycemia and weight gain in the glimepiride group, but researchers noted that the findings vindicate glimepiride from “an old cardiovascular stigma.”
Why this is important: Sulfonylureas, which work by increasing insulin secretion, have been available for more than 60 years, provide good glycemic response and are low cost.
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