Highlights From EASD 2022
diaTribe is excited to bring you additional expanded coverage from the EASD 2022 conference! Hear from leading clinicians and researchers around the world on insights into the latest data on automated insulin delivery, diabetes technology, new medications, and more.
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In his short oral presentation, Dr. Patrick Divilly from King’s College London, compared the frequency of sensor-detected hypoglycemia to patient-reported hypoglycemia.
His team’s Hypo-METRICS study enrolled 401 people with T1D and T2D. The study included people with impaired hypoglycemia awareness, or hypo unawareness. Participants used a "blinded" Freestyle Libre 2 CGM sensor (meaning they could not view their CGM readings during the trial) that recorded hypo events. Meanwhile, participants also self-reported any hypoglycemia events using the Hypo-METRICS app, provided by the study investigators.
His team found that among people with T1D, those with impaired awareness self-reported about the same amount of hypo events as those with normal hypoglycemia awareness. However, in reality, those with hypo unawareness experienced significantly higher rates of hypo events, with many hypo events only detected by CGM.
Following Divilly, Dr. Marga Giménez from the University of Leicester in the UK discussed the three current glucagon options: nasal glucagon (Lilly), glucagon injection (Xeris), and dasiglucagon injection (Zealand). All three options achieved comparable success in reversing hypoglycemia in people with diabetes. However, Giménez noted that nasal glucagon achieved treatment success in a shorter time than glucagon injections.
Starting a CGM Significantly Reduced Hospitalizations for People with Type 2 Diabetes on Basal Insulin
Dr. Jean-Pierre Riveline, an endocrinologist and Professor at the University Center for Diabetes and its Complications, Hôpital Lariboisière in Paris, France, presented a follow-up analysis of the RELIEF Study. Results showed that starting to use a CGM led to significantly fewer hospitalizations for diabetes-related events.
This study, first published in 2021, looked at a French database of over 74,000 people with type 1 or type 2 diabetes to understand the impact of starting to use a CGM. An additional review of the study was published in May 2022.
This follow-up analysis identified 5.933 people with type 2 diabetes on basal-only insulin therapy. The study looked at hospitalizations due to acute diabetes events, which include conditions like diabetic ketoacidosis (DKA) or severe hypoglycemia. The researchers compared the rate of hospitalizations for the 12 month period before starting on a CGM, and up to two years after.
One year after starting, there was a 67% decrease in hospitalizations compared to the 12-month period before using a CGM. The drop in hospitalizations was mostly due to a 75% decrease in instances of DKA.
"The results of the RELIEF study highlight the value [of CGM] in reducing serious diabetes-related events and hospitalizations among patients with Type 2 diabetes on basal-only therapy," Riveline said in a statement from Abbott, released shortly after the presentation of this data.
A Deeper Dive Into the Benefits of Semaglutide and Tirzepatide
Dr. Linda Mellbin from the Karolinska Institute at Stockholm, Sweden, presented an analysis of the SUSTAIN 6 and PIONEER 6 trials with a focus on the effects of semaglutide on cardiovascular outcomes based on baseline A1C. Semaglutide is a type of drug called GLP-1 receptor agonist, commonly known under brand names Ozempic, Wegovy, and Rybelsus. GLP-1s are recommended for people with T2D and high cardiovascular risk, regardless of baseline A1C.
Her research confirmed that semaglutide reduced the risk of major adverse cardiovascular events (MACE) in people with T2D and at high cardiovascular risk across a wide range of baseline A1Cs. This finding serves to confirm the current recommendations.
Dr. Filip Knop from the University of Copenhagen supplemented this information with his analysis of the PIONEER trials to compare glycemic control with semaglutide compared to that of similar drugs. Knop noted that “oral semaglutide resulted in a greater duration of time spent with HbA1C less than 7% versus empagliflozin and sitagliptin.”
In conclusion, Knop explained that oral semaglutide might lead to a longer sustained glycemic control compared to other GLP-1 receptor agonists.
Dr. Tamás Várkonyi from the University of Szeged of Hungary discussed tirzepatide’s impressive ability to reduce triglyceride and cholesterol levels. Tirzepaptide, a drug recently approved in the United States, is known as a “dual GIP/GLP-1 receptor agonist” that has been shown to help people significantly lower their glucose levels and lose weight.
In his analysis of the SURPASS 4 trial, Várkonyi looked at participants with type 2 diabetes at high cardiovascular risk. Specifically, he assessed how fibrates, which are approved to lower triglyceride levels, influenced participant outcomes.
Várkonyi said, “Tirzepatide lowered triglycerides, LDL-cholesterol, and total cholesterol, regardless of concomitant use of fibrates or statins.”
Experts in kidney disease and diabetes discussed two completed clinical trials (FIGARO-DKD and FIDELIO-DKD) evaluating finerenone in study participants with type 2 diabetes and chronic kidney disease at the 2022 EASD meeting in Stockholm.
They also discussed new analyses from the two previously reported clinical trials, which showed the benefits of the drug even in people who were taking an SGLT-2 inhibitor. (Previous studies had shown the benefits of taking SGLT-2 inhibitors on the heart and kidneys in people with diabetes.)
The experts also discussed ongoing studies evaluating the use of finerenone in people with chronic kidney disease without diabetes and in people with heart failure. Most exciting for people with diabetes was the information regarding two ongoing studies evaluating the combination of finerenone with an SGLT-2 inhibitor. The investigators will compare results from a group taking the combination of the two drugs with another group taking the SGLT-2 inhibitor alone.
The session concluded with discussion of the challenge in trying to increase the number of people prescribed these drugs, which have proven benefits for the heart and kidneys. Cost and reluctance of insurance companies to make it easy for people to obtain new, expensive drugs certainly continue as obstacles to increasing use of these effective treatments.
Surprisingly, there’s relatively little data on the global prevalence of diabetes and how the disease impacts people’s lives. At this symposium, leaders in diabetes care – Setfano del Prato, Robert Heine, Joao Filipe Raposo, and Peter Schwarz – presented on the importance of diabetes data, digital tools, and how they should be made to prioritize people with diabetes.
According to Dr. Heine, director of the Diabetes Centre at the VU (Vrije Universiteit) University Medical Center in Amsterdam, diabetes registries (or databases) that exist are “valuable in teaching us the natural course of disease and identifying key risk factors.” But that data is not embedded in the diabetes healthcare system, said Heine, which is why it’s important to find strategies that can help healthcare providers and researchers use the data to advance diabetes care.
Dr. Schwarz, head of the Division for Prevention and Care of Diabetes at the University Hospital in Dresden, Germany discussed the benefits of using health-related apps for tracking health data. They can be used to monitor targets (such as glucose levels and medications), provide access to communication with healthcare providers, telemedicine, and e-prescriptions, and review data that can inform decision-making. When considering the many apps available, quality and accessibility are two of the most important factors.
“The best tools mean nothing if they're not accessible [to the person with diabetes],” Schwarz said.
To embed apps and other forms of digital health into the classic healthcare process, Schwarz emphasized the importance of a “user-centered” approach. People with diabetes should be included in all stages in the development and validation of apps, and they should be part of the evaluation of apps.
You can read here to learn about some of the best apps for people with diabetes. In addition to diabetes-specific apps, there are other health apps that can help prevent complications and overall help manage your diabetes health. For example, exercise, diet, and stress management apps enable you to track your health information and ultimately provide suggestions and allow you to make more informed choices that could improve your diabetes management.
One of the hottest topics at EASD 2022, tirzepatide (approved in the US as Mounjaro) is a new glucose-lowering therapy called a "dual agonist" or a “dual GIP and GLP-1 receptor agonist.” Trials have already shown the drug’s remarkable effects on helping people with type 2 diabetes lower their glucose and lose weight. A new analysis shows encouraging results that tirzepatide may also slow the progression of chronic kidney disease in people with type 2.
This analysis, published on Sept. 22, looked at the average rates of progressive kidney damage from the SURPASS-4 trial. The SURPASS-4 trial was a large study with 1,995 participants that compared the effects of tirzepatide vs. insulin glargine (commonly known under brand names Lantus, Basaglar, and Toujeo) in people with type 2 diabetes at high risk for cardiovascular (heart) disease.
At the beginning of the SURPASS-4 trial, the kidney function of each participant was tested by two indicators of kidney function: eGFR and UACR. In general, a decrease in eGFR and an increase in UACR are signs of the progression of kidney damage.
*You can read more about these tests for kidney function in Get to Know Your Lab Tests: A1C, eGFR, UACR, and More – the American Diabetes Association recommends that people with type 2 diabetes get their eGFR and UACR tested once a year.
This study showed that after one year, people taking insulin glargine experienced 2.5 times greater decline in their eGFR on average, compared to those taking tirzepatide. For those on insulin glargine, UACR increased by an average of 36.9%, compared to a decrease of 6.8% in the group taking tirzepatide. This follow-up analysis demonstrated that tirzepatide more effectively slowed the rate of kidney function decline compared to insulin.
Diabetes management can be stressful, potentially leading to diabetes distress, anxiety, and other mental health challenges. A study presented at the 2022 EASD meeting from diabetes market research firm dQ&A found a relationship between glucose management and the severity of anxiety among people with diabetes.
This study showed that people with diabetes living in Italy and the United Kingdom had the highest rates of anxiety (63% and 51%, respectively), while individuals in the Netherlands reported lower rates (39%). Women with diabetes were more likely to report experiencing anxiety than men with diabetes (57% vs. 39%). In addition, anxiety was more common among younger adults with diabetes (under 45 years of age) than those 45 and above (59% vs. 34%).
According to dQ&A research analyst Evelyn Cox, people with diabetes who have a time in range (TIR) under 70% have significantly higher rates of moderate or severe anxiety compared to those who spend 70% or more of TIR (22% vs 14%).
“It is crucial that people with diabetes who experience challenges with their mental health speak with their healthcare providers, loved ones or mental healthcare practitioners for support,” said Cox. “Effective treatments are available and can considerably improve the lives of people with diabetes.”
To learn ways to improve your time in range, read here.
Although anxiety in people with diabetes is not uncommon, there are ways to care for your emotional well being. To learn more about mental health and diabetes, you can read here. You can also learn ways to overcome diabetes distress here.
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