Close to 1800 participants from all over the world, including healthcare professionals, industry partners and diabetes advocates came together in Lisbon last month for it's 50th annual meeting.
A wide range of topics were included in their posters and presentations-I'll cover some highlights in this edition and save some for the next!
- Studies from the US had shown a concerning trend in youth who developed type 2 diabetes-they had a more rapid progression to nerve, kidney and eye damage as compared to similar aged people with type 1 diabetes. A study conducted in central Europe explored if this was true for youth (in mainly German speaking countries) as well, and found that the risk of developing these microvascular complications was indeed higher (odds ratio for microalbuminuria, retinopathy and neuropathy was 1.47 (1.15-1.88) in T2D compared to T1D adolescents.
- A study by the NIDDK explored the effect of metformin+liraglutide on gut microbiota in youth onset type 2 diabetes. It is suspected that some of the effect of these 2 common therapies for type 2 diabetes is mediated by their effect on gut organisms but the evidence in adults is not that clear. In this study, a before and after comparison of stool samples from 22 adolescents with T2DM who used metformin and liraglutide for 3 months showed a significant shift towards short chain fatty acid (SCFA) producing organisms. Of note, SCFA producing gut organisms are generally associated with improved gut health and immunity, delayed metabolic disease progression and improved cardio-metabolic health
- In sub-Saharan Africa, the majority of youth diagnosed with type 1 diabetes clinically may not have an autoimmune reason for their diabetes! 800 non-obese, insulin using patients diagnosed with type 1 diabetes in their youth in Cameroon, Uganda and South Africa were tested for multiple T1D autoantibodies, genetic risk score, HLA type and stimulated c-peptide. Results found only a third of these patients had evidence of autoimmunity (even the ones diagnosed <1 year ago) and the rest had negative clinical, biomarker and genetic features of T1D. This indicates the presence of a severe beta-cell deficient sub-type of diabetes that is non-autoimmune in nature. This underscores the need for biomarker testing for confirmation of diabetes type whenever possible.
- Several institutions continue to focus on transition readiness for patients with diabetes. This is the process of transferring care of people with diabetes from pediatric to adult teams and varies significantly between clinics and institutions. This variability results in poor blood sugar control and decreased adherence to care at a very vulnerable time when adolescents are newly navigating adulthood. Abstracts from
Nationwide Children's Hospital
and
加拿大麦吉尔大学
advocated for standardization of this process and inclusion of key patient factors such as family support and dynamics.
- Observations from one of the largest initiative that offers free screening for type 1 diabetes and celiac disease were reported at ISPAD. These showed that a proportion of people who have multiple positive autoantibodies for type 1 diabetes have "antibody regression" and may become negative for some of the antibodies that they tested positive for previously. This can be a hindrance in their eligibility to receive approved therapies that can slow progression to "frank diabetes" and calls for a discussion on revising eligibility criteria for novel agents.
- A relatively new CGM metric, Time in Tight Range (TITR) was described and utilized in several abstracts. TITR refers to percentage of time spent between 70-140mg/dL and is suggested to reflect cardiovascular risk exposure for children and adolescents with type 1 diabetes. TITR may be used more frequently in the future as a key marker of glycemic control, specially in advanced hybrid closed loop users.
- Another CGM metric which is well-known, the Glucose Management Indicator (GMI), was compared to the HbA1c in several different populations and was found to correlate quite closely to A1c. Based on these analyses it was suggested that the 1-month GMI can be used as an alternative to HbA1c in settings where frequent labs are not appropriate.
The next edition covers use of AI, newest diabetes technology, new insulins and anti-diabetic agents, digital health and telemedicine with a focus on outcomes and care models. Stay tuned!
