Some 13,000 healthcare professionals from around the world gathered in San Diego, CA, in June 2011 to attend the annual meeting of the American Diabetes Association. Cutting-edge research presented at the meeting included more than 2000 abstracts and 96 symposia, as well as 7 state-of-the-art lectures and 131 late-breaking posters, reflecting the growing urgency of the diabetes epidemic and the focus on improving patient care and clinical outcomes.
Presentations included the latest on new strategies in the management of type 2 diabetes, improving insulin treatment in type 1 and type 2 diabetes, the translation of research to improvement in patient outcomes, and trends in diabetes education and its impact on health outcomes—including data from the LOOK AHEAD trial, the first study to compare the effect of intensive diabetes education and usual care in the management of diabetes.
The complex interaction between diabetes and the cardiovascular (CV) system was featured prominently throughout the sessions, with the renewed focus of CV safety of medications to treat diabetes. New data about several new and promising drugs for the treatment of type 2 diabetes—once-weekly exenatide, linagliptin, alogliptin, and the investigational sodium-glucose cotransporter 2 inhibitors—were abundant, as well as the investigational ultra-long-acting basal insulin known as insulin degludec, which has a duration of action of 40 hours that potentially could reduce the frequency of insulin dosing.
Progress on the artificial pancreas was the focus of several abstracts. The most recent stage is the development of fully automated, closed-loop devices in which all insulin calculations and delivery are done automatically, without direct intervention from patients or researchers.
New research into the ocular complications of common medications to treat type 2 diabetes were presented, as well as phase 3 data that showed that an antivascular endothelial growth factor could improve vision in patients with diabetes and macular edema.
Much of the research today revolves around patients with type 2 diabetes, but the following new drugs are currently in late stages of development for type 1 diabetes.
The anti-CD3 drug teplizumab, which modulates Tcells, failed to show in a phase 3, double-blind, multinational study a significant improvement over placebo on reducing the hemoglobin A1c level to <6.5% for patients newly diagnosed with type 1 diabetes or reducing the amount of insulin needed to <0.5 U/kg of body weight per day. Nevertheless, 5% of those receiving teplizumab no longer needed insulin at the end of 1 year compared with zero of those who received placebo.
In a phase 2 study, those receiving teplizumab continued to show improved (a 77% decrease) beta-cell function, even 2 years after diagnosis, over an untreated group (a 45% decrease). In addition, at 24 months, the untreated group used 57% more insulin, on average, than the group that received teplizumab.
DiaPep277 is a potential vaccine for type 1 diabetes, with the goal of preventing beta-cell destruction. During the development of type 1 diabetes, an increase in a protein in the beta-cell called “heat shock” protein is thought to cause beta-cell destruction through activation of destructive T-cells. In a phase 2 study, the altered “heat shock” protein, given subcutaneously to 100 patients with type 1 diabetes, protected the beta-cells, replicating in humans the findings in laboratory mice. The use of this vaccine also allowed beta-cells to continue to secrete insulin for up to 2 years after a type 1 diabetes diagnosis. The drug is now in phase 3 trials in which beta-cell function, insulin use, and glucose control are being monitored.
In a phase 2 randomized study, abatacept recipients had a 59% increased C-peptide level after 2 years compared with placebo. On average, abatacept preserved beta-cell function for an additional 9.6 months.
For complete meeting coverage and key presentations, visit www.AHDBonline.com.