The latest drug, comorbidity and lifestyle findings from the annual European diabetes conference in Madrid.
Some highlights to savour from this year’s Annual Meeting of the European Association for the Study of Diabetes in Madrid.
Weekly insulin just as effective
The new class of insulin efsitora, which needs to be injected only once a week, is as effective as managing blood sugar as daily injections with degludec for people with type 1 diabetes.
The randomised US study included more than 600 adults and found that in participants given weekly efsitora, mean HbA1c levels decreased from 7.88% (62.66mmol/mol) at baseline to 7.41% (57.5mmol/mol) after 26 weeks. For participants given degludec, their mean HbA1c levels decreased from 7.94% (63.3mmol/mol) at baseline to 7.36% (56.9mmol/mol).
But there was a 21% higher risk of combined level 2 or level 3 severe hypoglycaemia among patients receiving efsitora (14 events per patient year of exposure) compared with degludec (11.6 events). Severe hypoglycaemia incidence was higher with efsitora (10% of patients) versus degludec (3% of patients).
“More work is needed to evaluate efsitora dose initiation and optimisation of basal-bolus insulin dosing to maintain efficacy while mitigating the risk of hypoglycaemia with weekly efsitora treatment in people with type 1 diabetes,” said lead author Dr Richard Bergenstal from the International Diabetes Center.
Tirzepatide triggers more weight loss in women
The type 2 diabetes and obesity medication tirzepatide causes greater weight loss in women than men, US research suggests.
The post-hoc analysis of four trials including almost 5000 obese adults found that overall, tirzepatide was associated with significant weight reduction compared to placebo. Female participants lost between 11.5% and 27.6% and males lost between 8.8% and 18.9%.
Across all studies, female participants who had at least one dose of tirzepatide lost more weight (up to 24.6%) compared to male participants (up to 18.1%).
The researchers said the safety profile was broadly similar among men and women, but there were more incidences of nausea and vomiting in women.
16-hour fasting better for blood sugar control
Eating within an eight-hour window each day improves blood sugar control within just three days, according to UK researchers.
Continuous glucose monitoring showed that participants who ate within an eight-hour window each day had significantly increased time within the normal blood glucose range in comparison with participants who ate over more than 14 hours a day.
Lead author Dr Kelly Bowden Davies from Manchester Metropolitan University said moving the eight-hour restricted eating period to earlier or later in the day did not appear to offer additional benefits.
“Our study suggests that watching the clock may offer a simple way to improve blood sugar control in people at risk of type 2 diabetes, irrespective of when they have their 8-hour eating window, which warrants investigation in larger studies and over the longer term,” she said.
Liraglutide ‘safe and effective in children’
The weight loss medication liraglutide is safe for children aged six to 12 and causes greater weight loss in that age group than placebo, US researchers say.
The study included 56 children who had daily liraglutide injections and 26 who had weekly injections of placebo for more than one year. All participants were given healthy eating and exercise counselling sessions.
The researchers found that after 56 weeks, children who had liraglutide had an average drop in BMI of −5.8%, while children in the placebo group had an average increase of +1.6%.
“Diastolic blood pressure and haemoglobin A1c [HbA1c], a measure of blood sugar control, improved more in children receiving liraglutide than in those receiving the placebo,” said lead author Professor Claudia Fox from the University of Minnesota’s Center for Pediatric Obesity Medicine.
The Novo Nordisk-funded research will be published in the New England Journal of Medicine.
Insulin resistance raises risk of 26 diseases
Insulin resistance is linked to a higher risk of 26 diseases including diabetes, gout, dyslipidaemia, sleep disorders, bacterial infections and pancreatitis, research shows.
The Chinese researchers said every one-unit increase in insulin resistance was associated with an 18% higher risk of sleep disorders, an 8% higher risk of bacterial infections and a 31% higher risk of pancreatitis.
But insulin resistance also decreases the risk of five diseases including anaemia (-6% risk), Parkinson’s disease (-16%) and osteoporosis (-13%), according to the observational study including 430,000 British people aged 40 to 69.
The analysis of UK Biobank data also found higher insulin resistance was linked with an increased chance of premature death among women but not in men.
“We found that every one-unit increase in insulin resistance increased the risk of gout by 65% but decreased the risk of Parkinson’s disease by 16%,” said lead author Ms Jing Wu from the Department of Endocrinology, Shandong University.
“Additionally, every one-unit increase in insulin resistance was linked to a 10% higher likelihood of sciatica.”
The researchers also found that insulin resistance was associated with all-cause mortality in women but not in men.
Steroids more than double diabetes risk
Patients taking systemic glucocorticoids have a 2.6 higher risk of developing diabetes compared with people not taking the drugs, according to research from the Diabetes Trials Unit at the University of Oxford
The study included more than 450,000 adults admitted to hospital over a 10-year study period. The patients did not have diabetes and who were not taking systemic glucocorticoids.
More than 17,200 of the patients were given systemic glucocorticoids for autoimmune and inflammatory diseases and for infections while in hospital. Of those, 1.8% developed diabetes compared with 0.8% of the patients who were not given systemic glucocorticoids.
Losing weight may cut infection risk
A high BMI increases the risk of being admitted to hospital with an infection, according to UK research.
The analysis of UK Biobank data included almost 500,000 participants who had either been hospitalised for a bacterial infection, hospitalised for a viral infection, or who had no infection history (the control group).
Participants with higher BMIs were more likely to be admitted to hospital with a bacterial infection, with every five-point increase in BMI associated with a 30% increased risk. Patients with viral infections had a 32% increased risk of being hospitalised with every five-point increase in BMI.
The researchers said participants were also more likely to be hospitalised with a bacterial infection if they had high blood sugar levels.
“Up to one in three hospitalisations in people with diabetes are for infections and people with diabetes are twice as likely to be hospitalised with infections than the general population,” said lead author Ms Rhian Hopkins from the University of Exeter Medical School. “They are also at high risk of readmission.
“If one or both of these factors can be shown to be causal, it may be possible to design interventions to lower the risk of severe infections in those at high risk, such as people with diabetes.”
Diabetes risk for late risers
People who choose to go to bed later and wake up later than average are more likely to develop type 2 diabetes, according to Dutch research.
Dutch researchers looked at the link between sleep hours, type 2 diabetes and body fat in 5000 people. They found that the participants with the latest sleeping times had a 46% higher risk of type 2 diabetes over more than six years of follow-up.
They also found that the late sleepers had 0.7kg/m2 higher BMI, 1.9cm larger waists, 7cm2 more visceral fat and 14% higher liver fat content, the conference heard.
The results were adjusted for age, sex, education, total body fat and lifestyle factors such as exercise, diet, alcohol, smoking and sleep.
Lead researcher Dr Jeroen van der Velde from Leiden University Medical Centre, said this suggested the increased risk was not due to lifestyle alone.
“We believe that other mechanisms are also at play,” Dr van der Velde said. “A likely explanation is that the circadian rhythm or body clock in late chronotypes is out of sync with the work and social schedules followed by society. This can lead to circadian misalignment, which we know can lead to metabolic disturbances and ultimately type 2 diabetes.”
Asthma and diabetes egg each other on
Individuals with type 2 diabetes are more likely to develop asthma, and vice versa, Taiwanese research shows.
The systematic review and meta-analysis included 17 million adults and found that people with asthma were 28% more likely to develop type 2 diabetes than those without asthma.
And participants with type 2 diabetes were 83% more likely to develop asthma than those without the chronic disease.
“Our findings have important implications for clinical practice,” said lead author Dr Nam Nguyen from the College of Medicine, Taipei Medical University.
“Firstly, this relationship emphasises the need for greater awareness among patients with type 2 diabetes or asthma and their health care providers.
“Secondly, preventive strategies should be considered to lower the risk of type 2 diabetes in individuals with asthma. For instance, screening for and addressing prediabetes in asthma patients promptly before it develops into type 2 diabetes, or carefully managing the use of systemic corticosteroids, which can not only cause temporary hyperglycaemia but are also linked to an increased risk of type 2 diabetes.”
Fear of low blood sugar prevents exercise
Adults with type 1 diabetes may avoid physical exercise for fear of triggering hypoglycaemia, research suggests.
The UK study included 463 participants who answered a questionnaire about their diabetes management and attitudes towards exercise.
The researchers found that participants were less fearful of hypoglycaemia when they understood the importance of adjusting insulin dose and carbohydrate intake.
“Our findings demonstrate that in order to break down the barriers to physical activity, and empower our patients to exercise safely and effectively, we need to improve the education we provide and our dialogue about exercise in clinics,” said lead author Dr Catriona Farrell from the University of Dundee, Scotland.
The EASD’s 60th annual meeting ran in Madrid from 12 to 15 September. Next year’s congress will be 16-19 September in Vienna.
