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Highlights From the 2019 ADA Scientific Sessions: Diabetes and Autism Link, Unaffordable Insulin, Artificial Pancreas Success, and More
The annual meeting takes place in Orlando, Florida, and this year, studies on diagnosis, treatment, and prevention all made headlines.
By Shari Roan
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June 27, 2019
The American Diabetes Association’s 78th Scientific Sessions conference featuring the latest developments in diabetes care was held June 22 through 26 in Orlando, Florida. Researchers discussed diagnosis, treatment, and prevention in all ages of patients and types of diabetes, including type 1 diabetes, type 2 diabetes, and gestational diabetes. Here are some highlights from the meeting.
Diabetes in Pregnancy Appears to Increase the Risk of Autism in Children
A new study suggests that maternal diabetes may increase the risk of autism in children. In a review of more than 419,425 children born between 1995 and 2012, researchers found the risk of autism spectrum disorder (ASD) was higher in children whose mothers had preexisting type 1 or type 2 diabetes or gestational diabetes compared with the children born to women without diabetes.
An average of 6.9 years following childbirth, 5,827 children in the study were diagnosed with ASD. The autism rate was 4.4 per 1,000 children for those born to mothers with type 1 diabetes compared with 3.6 for children born to mothers with type 2 diabetes, 2.9 for children born to mothers who developed gestational diabetes by 26 weeks of pregnancy, 2.1 for mothers who developed gestational diabetes after 26 weeks of pregnancy and 1.8 for children of mothers with no diabetes.
The researchers, from Kaiser Permanente in Pasadena, California, noted that their review was an observational study and cannot pinpoint why diabetes exposure may increase the risk of autism. Autism affects about 1 in 59 American children, according to recent statistics from the Centers for Disease Control and Prevention, and rates of both type 2 diabetes and gestational diabetes have soared in the United States in the past few decades. About 7 percent women are diagnosed with gestational diabetes, according to the March of Dimes.
The study was published simultaneously in the June 23 issue of theJournal of the American Medical Association(JAMA).
An additional study on gestational diabetes presented at the ADA meeting found the prevalence of gestational diabetes increased from 4.6 percent in 2006 to 8.2 percent in 2019. The data were gleaned from the National Health Interview Survey, which included 26,340 women who had experienced pregnancy. Gestational diabetes rates were highest in non-Hispanic white women compared with other ethnicities, and was also linked to women who were overweight or low-income, ages 45 to 64, and those who had inadequate physical activity.
RELATED: What Are the Symptoms of Gestational Diabetes and How Is It Diagnosed?
Some People With Diabetes Struggle to Pay for Insulin
A study suggests far too many people with diabetes who require insulin to control blood sugar are not able to pay for adequate supplies of the drug. Insulin prices have been on the rise, according to the study authors.
The study, presented by researchers from Yale University in New Haven, Connecticut, involved a survey of 199 insulin-using patients at the Yale Diabetes Center. Participants were asked questions such as whether they ever used less insulin than prescribed or tried to “stretch” their insulin. Just over 25 percent reported that they underused insulin because of cost. Those patients tended to have lower income levels than people who took all of their prescribed insulin and had threefold higher odds of having poor glycemic control as measured by A1C levels.
A study published April 2019 inJAMA suggests the price of insulin tripled from 2002 to 2013.
“These results highlight an urgent need to address high insulin prices in the U.S.,” the authors wrote.
Revolutionary Cancer Immunotherapies Increase the Risk of Insulin-Dependent Diabetes
A type of cancer therapy that has become popular for treating several types of the disease may increase the chances that a person will develop insulin-dependent diabetes, according to emerging data. The drugs, called immunotherapy or checkpoint inhibitors, are used in people with advanced melanoma, non-small-cell lung cancer, and lymphoma, and have been shown to extend the lives of many patients, according to the National Cancer Institute. But the drugs tweak the immune system in ways that can cause immune-related side effects. Diabetes may be one such effect.
RELATED: Cancer Special Report 2019: Cancer Trends in Diagnosis, Stages, Treatment, and Survival Rates
Preliminary data suggest that 1 percent of patients on checkpoint inhibitors develop insulin-dependent diabetes. Some patients with preexisting type 2 diabetes may become insulin dependent while taking a checkpoint inhibitor, Kevan Herold, MD, a professor of immunobiology and internal medicine and the executive director of the Diabetes Center at Yale School of Medicine, says in a meeting symposium. Dr. Herold called for more research to better understand the association between the cancer drugs and diabetes.
Doctors May Be Under Aggressive About Treating Type 2 Diabetes
Doctors may begin to develop “clinical inertia” and fail to treat their patients with type 2 diabetes as aggressively as needed over time, according to research from the American Medical Group Association in Alexandria, Virginia.
Elizabeth L. Ciemins, PhD, presented data on more than 47,000 patients with poorly controlled glucose levels. The analysis showed that doctors took action to address glycemic control in 90 percent of patients but only 56 percent of the patients improved to the point of achieving glycemic control within two years.
The researchers defined clinical inertia as failure to make adjustments to treatment. Examples of clinical inertia are not prescribing a new class of diabetes medications that may be helpful or not having persistent diabetic control. Cost may be an issue causing clinical inertia. Some of the newer diabetes drugs, such as GLP-1 receptor agonists, are too expensive for some patients.
RELATED: Type 2 Diabetes Drug Semaglutide May Control Glucose Better Than Similar Medications
Study Sheds Light on How Weight Loss Can Alter Diabetes
People with diabetes who experience significant weight loss can experience a remission in diabetes. New research points to one reason why the disease process can reverse after weight loss. The study, by researchers at Newcastle University in the United Kingdom, indicates that liver fat declines dramatically.
“When patients lose weight on the DiRECT (Diabetes Remission Clinical Trial) program, liver fat goes from very high levels, around 16 percent, down to normal, 3 percent, immediately after the weight loss,” , a professor of medicine and metabolism at Newcastle University in Newcastle upon Tyne, England, says in a news release. “That change in hepatic fat content is associated with normalizing the export of fat from the liver and normalizing the fat content of the pancreas. We see beta cells wake up and begin producing normal levels of insulin again.”
The data was part of a study on the effects of a strict weight-loss diet limited to 800 calories a day. Some patients underwent magnetic resonance imaging (MRI) to measure liver and pancreas fat. After a year, the patients in the weight-loss group lost an average of 10.5 kg. Liver fat, pancreatic fat, and triglyceride levels fell to normal.
RELATED: Reversing Type 2 Diabetes Is Possible Through Weight Loss, Study Finds
Artificial Pancreas Can Be Improved by Delivering Other Hormones With Insulin
New data suggests that adding the drug pramlintide to insulin resulted in better outcomes for adults with type 1 diabetes compared with doses of insulin alone. The so-called “artificial pancreas” technology involves a way to use automation to control blood glucose by mimicking the functions of a healthy pancreas, such as by using an insulin pump in a closed-loop system that receives data from a continuous glucose monitor.
Pramlintide is a synthetic version of a hormone, amylin, that is produced by the pancreas and released into the bloodstream after a person eats to help regulate glucose levels. People with type 1 diabetes do not make amylin. Researchers from Canada compared using both insulin and pramlintide with using insulin alone and found that the combination of medications showed greater improvement in the patients’ blood glucose levels. Those receiving both insulin and pramlintide experienced glucose levels in the target range 85 percent of the time compared with 71 percent of the time for those using insulin alone.
“This study shows that the first-generation, insulin-only artificial pancreas can be improved by delivering other hormones along with insulin, which will hopefully encourage the development of insulin-plus-pramlintide co-formulations,” the lead study author, Ahmad Haidar, PhD, an assistant professor in the department of biomedical engineering at McGill University in Montreal, Quebec, says in a news release.
Intensive Diabetes Care Improves Patients’ Health Without a Big Bump in Healthcare Costs
People with type 2 diabetes are urged to use both medication and lifestyle modification to control the disease, according to the American Diabetes Association. Now a study has shown that this type of intensive therapy does not add significantly to healthcare costs.
Danish researchers compared a group of patients receiving multifactorial care — which included conventional medication treatment and disease management plus nutrition, exercise, and smoking cessation counseling — with a group who received just conventional care. After almost eight years of follow-up, the group receiving intensive treatment had a 50 percent reduction in diabetes-related damage to the heart, brain, and legs compared with those receiving conventional care. After 13 years, those receiving the intensive treatment had a 50 percent reduction in death compared with the people receiving conventional care.
Researchers found no difference in total direct medical costs between the intensified treatment group and the conventional treatment group after more than 21 years of follow-up.
"We discovered that while intensified, multifactorial treatment may lead to an initial increase in healthcare costs, this investment is recouped over time by the impressive health benefits and increased longevity the patients experienced,” the junior lead study author, Joachim Gaede, a graduate student in the medicine program at the University of Copenhagen in Denmark, says in a news release. “Additionally, the total direct costs of intensified, multifactorial intervention, which leads to disease-free-life length improvement of about eight years, was neutral compared to conventional treatment.”
RELATED: How to Age Well With Type 2 Diabetes
Taking Liraglutide Improves Outcomes for Adults With Type 1 Diabetes
Adults with type 1 diabetes have an especially difficult time maintaining blood glucose levels. But research suggests that adding the drug Victoza (liraglutide) produced better glucose control and increased weight loss.
The study was a one-year, randomized controlled trial including 46 adults with type 1 diabetes. Half the patients received daily injections of liraglutide, and half received injections of a placebo. Continuous glucose monitoring was performed for four weeks before the treatment started and at the end of the study.
Researchers from the State University of New York (SUNY) at Buffalo found patients who took liraglutide had better glucose control as well as a weight loss of about 6 pounds.
“The magnitude of improvement in blood glucose control in our study was significant, and this medication could have a positive impact on the lives of people with type 1 diabetes,” the lead study author, Paresh Dandona, MD, the head of the division of endocrinology and distinguished professor of medicine and pharmacology at SUNY Buffalo, says in a news release. “Because the number of patients with adequate control of type 1 diabetes is small, the availability of an additional, effective drug like liraglutide could contribute greatly to the prevention of complications, improve quality of life, and make patients’ lives more stable and predictable.”
Artificial Pancreas Was Effective in a Study of Hospitalized Patients
A closed-loop glucose control system, in which insulin is automatically delivered in response to continuous glucose monitoring, has been shown to be effective in a group of hospitalized patients with type 2 diabetes. The study, presented at the ADA meeting and published June 25 in theNew England Journal of Medicine, is more evidence of the usefulness of so-called “artificial pancreas” technology.
Researchers in the United Kingdom and Switzerland looked at noncritical patients in general hospital wards who had type 2 diabetes. More than 25 percent of hospitalized patients in the U.S. and other developed countries have diabetes, and controlling blood glucose during an illness or hospitalization is challenging, the authors noted. The researchers assigned 136 patients to receive either closed-loop insulin delivery or conventional treatment, which involves insulin injections.
They found that patients using the closed-loop system had significantly better glycemic control without having a higher risk of developing hypoglycemia. “A strength of our trial is that it addressed the unmet need for better glycemic control among hospitalized patients with diabetes, an issue that affects nearly all areas of in-hospital care, patient outcomes, and healthcare costs,” the authors write in their paper.
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