Diabetes Pro Quarterly - Summer 2019 - 2

79TH SCIENTIFIC SESSIONS NEWS
Scientific Sessions Recap continued from page 1
Can We Prevent or Delay the Onset
of Type 1 Diabetes?
Years of research have led to insights on
many of the genetic and environmental
factors that increase risk for development
of type 1 diabetes. Now, scientists are trying to leverage that information to prevent
or delay the onset of type 1 diabetes in
people known to be at high risk. Several
trials presented this year demonstrated
progress toward this goal. In one study,
an immune therapy was able to delay the
manifestation of type 1 diabetes for 2 years
in a very-high-risk population. A second
trial demonstrated a new therapy that was
able to preserve insulin production and
improve glucose control in patients who
were recently diagnosed.

Studies Provide Long-Term Safety
and Efficacy Data for Artificial
Pancreas Use
Several studies presented at this year's
Scientific Sessions demonstrated the
safety and efficacy of artificial pancreas
systems for insulin delivery and glycemic
control, a sign that this long-discussed
technological advancement is moving
closer to full realization, regulatory approval, and widespread use.
Results were presented from the first
human study testing a closed-loop fully
automated bionic pancreas system called
the iLet. The iLet significantly increased
the percentage of time glucose levels were
in the target range compared to either
multiple daily insulin injections or continuous subcutaneous insulin infusion
(insulin pump) therapy.
"It was encouraging to see that multiple daily injection users achieved good
glucose control with the iLet in the home
setting despite their lack of prior experience with an insulin pump," lead study
author Rabab Jafri, MBBS, MD, said. "The
dosing algorithms in the bionic pancreas
automatically adapted to the patient and
their changing insulin requirements, no
training period was needed for either the
pump or multiple daily injection subjects,
and their weight was the only data point
needed to initiate the iLet."
Additional studies showed that closedloop systems are safe and effective at
lowering average blood glucose.
2

New Results Show Potential for
Reducing the Need for Injections in
Type 2 Diabetes
Glucagon-like peptide 1 (GLP-1) receptor agonists have consistently shown
beneficial effects in people with type 2
diabetes, including enhanced weight loss,
improved glucose control, and a reduction in heart attacks. Since the first GLP-1
receptor came to the U.S. market in 2003,
several different drugs within this class
of medications have also been approved.
However, all have been injectables, which
poses a significant deterrent to use and
adherence for many patients. That soon
may change. An oral GLP-1 receptor agonist has now been developed, and results
of PIONEER 6 (A Trial Investigating the
Cardiovascular Safety of Oral Semaglutide
in Subjects With Type 2 Diabetes)
presented at the Scientific Sessions show
that it had the same significant beneficial
effects as other drugs in its class, without
the need for injections.

Insulin-Producing β-Cells Are Not
Irreversibly Lost in Type 2 Diabetes
The loss of insulin-producing β-cells is
believed to be a key factor in the development of type 2 diabetes. Previous studies
have hinted that it might be possible
to reverse type 2 diabetes with enough
weight loss, challenging the long-held
belief that development of type 2 diabetes
can only be managed, not reversed.
Results presented from the Diabetes
Remission Clinical Trial (DiRECT)
indicate that, if intervention is initiated
early after diagnosis, the function of
insulin-producing β-cells can be restored
when sufficient weight is lost and the loss
is maintained.

New Study Suggests That Beneficial
Effect of Bariatric Surgery on
Glucose Control Can Be Mimicked
Without Surgery
The ability of bariatric surgery to reverse
type 2 diabetes in some patients has long
perplexed and excited scientists. However,
for a variety of reasons, only a small
percentage of people with type 2 diabetes undergo gastric bypass surgery and
thus may benefit from this effect. What if

there were a way to mimic the beneficial
diabetes-reversal effect of bariatric surgery
without the need for surgery?
Dr. Tricia M. Tan, BSc, MBChB, FCRP,
PhD, FRCPath, of Imperial College
London in the United Kingdom, presented results of a study that showed that infusion of three hormones over a 1-month
period caused reduced caloric intake and
promoted significant weight loss. These
three hormones are known to be elevated
after bariatric surgery.
"Our study group had glucose improvements comparable with gastric bypass
and had better glucose tolerance than
gastric bypass even though gastric bypass
had twice the weight loss," Dr. Tan said.
In the future, it may be possible to
dramatically improve glucose control in
people with type 2 diabetes without the
need for bariatric surgery.

Updates on Diabetic Kidney Disease
Diabetic kidney disease (DKD) is a serious complication of diabetes characterized by reduced kidney function. DKD
affects between 20 to 40% of patients
with diabetes. New medications have led
to reduced rates of many complications
related to diabetes; however, DKD has
proven more difficult to prevent or treat.
Now, research presented at the Scientific
Sessions suggests exciting progress in the
fight against DKD.
A major clinical trial, CREDENCE
(Evaluation of the Effects of
Canagliflozin on Renal and
Cardiovascular Outcomes in Participants
With Diabetic Nephropathy), evaluated the ability of sodium-glucose
cotransporter 2 (SGLT2) inhibitors to
slow progression of DKD. More than
4,000 people participated in the study,
which showed a significant reduction
in progression of DKD associated with
the SGLT2 inhibitor canagliflozin. These
results, which were so dramatic that
the trial was stopped early, could have a
substantive impact on the clinical care of
patients with type 2 diabetes with or at
high risk for DKD.
continued on page 16

Diabetes Pro Quarterly - Summer 2019

Table of Contents for the Digital Edition of Diabetes Pro Quarterly - Summer 2019