New research was presented at ADA 2022, the American Diabetes Associations (ADA) 82nd Scientific Session, from June 3-7 in New Orleans and virtually. The features below highlight some of the studies emerging from the sessions.
Patients With T2D Saw A1C Drop While Using Lifestyle Guidance Intervention
Nearly 200 patients with T2D saw their mean A1C drop from 9.0% to 5.7% at 6 months with the use of an app-delivered lifestyle guidance intervention, according to Paramesh Shamanna, MD, and colleagues. Dr. Shamanna observed that 84% had “remission” of diabetes at 6 months following use of the lifestyle guidance app intervention. In addition, the percentage of time participants spent in the target blood glucose range grew from 53% to 81%, Dr. Shamanna noted. Average waist circumference also decreased by 10 cm and weight dropped from 79 kg to 68 kg. The intervention synthesizes multiple data points—heart rate, activity, sleep time, glucose values from a continuous glucose monitor (CGM), blood pressure values, food intake, and weight and body fat data—and offers patient individualized guidance. However, Robert A. Gabbay, MD, PhD, chief scientist and medical officer of the ADA, noted that “remission” from T2D is not a “reversal” or “cure,” and that patients with T2D still need to follow the lifestyle guidance as they still may be at risk for diabetes complications after diabetes remission.
Adolescents With Obesity at Double the Risk for Adult T1D
Adolescents with obesity have double the risk for developing T1D as adults, compared with adolescents of optimal weight, according to a study presented by Gilad Twig, MD, PhD, and colleagues, who noted this is the first study to examine the role of obesity in adolescence and T1D in young adults. The study was simultaneously published in Diabetologia. A retrospective cohort of 1.4 million adolescents (aged 17) were evaluated prior to military enlistment. No participants had a history of either very low or very high blood glucose levels at baseline. A total of 777 incident T1D cases were recorded at follow-up, with a rate of 4.9 cases per 100,000 person-years. Compared with adolescents with optimal BMI, those with obesity showed double the risk for developing T1D. Adolescents with overweight had a 54% increased risk for T1D. Every five-unit increment in BMI correlated with a 35% greater incidence of T1D (adjusted HR, 1.35), and every one increment was linked with a 35% greater risk (1.25), both significant values. “Our study adds to the growing evidence regarding the health hazards associated with adolescent obesity,” wrote Dr. Twig and colleagues. “Not only is adolescent obesity correlated with adult onset of T2D as previously reported, but also with T1D.”
“Bionic Pancreas” Reduces A1C in Adults & Children With T1D
In adults and children with T1D, a novel insulin-only “bionic pancreas” reduced A1C without increasing hypoglycemia, compared with currently available hybrid closed loop or artificial pancreas insulin delivery systems, according to results from the InsulinOnly Bionic Pancreas Pivotal Trial. To date, the iLet Bionic Pancreas (Beta Bionics) trial is the largest randomized clinical trial of any automated insulin delivery system. Compared with previous trials, the iLet trial enrolled a more diverse population of patients with T1D, including those with higher A1C levels at baseline. The trial involved 440 adults and children aged 6 and older with T1D and compared the iLet Bionic Pancreas with standard of care. After 13 weeks, average A1C dropped by 0.5 percentage points with the iLet compared with standard of care, and by 0.7 percentage points among those with baseline A1C levels greater than 7.0%. No increases in hypoglycemia were observed. Participants using the device spent an average of 2.6 hours more time in their optimal glucose range. With the iLet, users only need to enter their body weight to initialize the system. Patients then signal meals in three quantity levels, without having to count carbohydrates or input various mathematical settings. “For most people, this system has potentially less burden,” said Roy W. Beck, MD, PhD, study co-principal investigator and ADA session moderator.
Bariatric Surgery Decreases Cancer & Cancer Mortality Risks
Bariatric surgery reduced the risk for obesity-related cancer, as well as the risk for death from cancer, according to Steven E. Nissen, MD, and colleagues, who conducted a study of more than 30,000 adults with obesity. During a 10-year follow-up, only 2.9% of those who opted for bariatric surgery were diagnosed with cancer versus 4.9% of non-surgical controls. This translated to a 32% reduced risk for developing obesity-related cancer following weight loss from bariatric surgery. Bariatric surgery benefits also extended to cancer-related mortality, according to Dr. Nissen. Compared with 205 patients in the non-surgical group, just 21 patients who had bariatric surgery died from cancer. Bariatric surgery was associated with a 48% reduced risk for cancer-related death overall. The most common cancers seen among these patients included female breast cancer and endometrial cancer. Bariatric surgery was associated with a 53% reduced risk for incident endometrial cancer, compared with no surgery. “Patients can lose 20% to 40% of their body weight after surgery, and weight loss can be sustained over decades,” said a study co-author. “This study indicates that the greater the weight loss, the lower the risk for cancer.”
ADA Recommends Heart Failure Screening for All Patients With Diabetes
Patients with diabetes should have annual biomarker testing for early diagnosis of progressive, but pre-symptomatic, heart failure (HF), according to a recommendation from an ADA consensus report presented at ADA 2022. The ADA also recommends expanded treatment with an agent from the sodium-glucose cotransporter 2 (SGLT2) inhibitor class to include all patients with stage B HF (pre–HF) or more advanced stages. The report acknowledges the high prevalence and increasing incidence of HF in patients with diabetes as the rationale for the new recommendations. Chaired by Rodica Pop-Busui, MD, PhD, the document also suggests thresholds for these biomarkers that are diagnostic for a more advanced stage (stage B) of HF in patients with diabetes who do not exhibit HF symptoms: 1) a B-type natriuretic peptide (BNP) level of ≥50 pg/mL; 2) an N-terminal proBNP level of ≥125 pg/mL; or 3) any high sensitivity cardiac troponin value that is above the usual upper reference limit set at greater than the 99th percentile. “Addition of relatively inexpensive biomarker testing as part of the standard of care may help to refine HF risk prediction in individuals with diabetes,” the report states.”
