Day 1 at American Diabetes Association annual conference 2019
This year’s American Diabetes Association 79th Scientific Sessions are being held in San Francisco on the Californian coast. Thousands of delegates from around the world are gathering here for more than 180 sessions and over 2,000 original research presentations. Obviously, I cannot go to all of them – at any one time there are up to eight parallel streams running ranging from acute and chronic complications and epidemiology to immunology and insulin secretion – but, over the next five days, I am going to report on the sessions that I think may have most resonance for you, the healthcare professionals accessing the EASD’s new e-Learning platform.
One of the very first sessions of the conference is a debate between the President of the EASD, Professor David Matthews, and Professor Thomas Pieber, from the University of Graz in Austria. Professor Matthews is standing for the motion that “Yes, hypoglycaemia causes cardiovascular events” while Professor Thomas Pieber suggests “No, hypoglycaemia is a marker for cardiovascular frailty”.
This is a good natured and humorous debate with a very even split in the audience both before and after the debate which focussed largely on clinical trial evidence. Professor Pieber says that, in most cardiovascular outcome trials in type 2 diabetes, severe hypoglycaemia is associated with a higher risk of major adverse cardiovascular events and cardiovascular (CV) death but also with non-CV death and argues that existing evidence supports the association but not the causation between severe hypoglycaemia and adverse cardiovascular outcome. Professor Matthews counters that hypoglycaemia does cause CV disease citing both pathophysiological and epidemiological data.
The next session is packed with people wanting to hear about diabetic kidney disease and (DKD) cardiovascular disease in diabetes. Professor Björn Eliasson from the University of Gothenburg in Sweden talks about the epidemiology of DKD emphasising the data from Ganesvoort et al. and Jha et al. which showed that the distribution of chronic kidney disease in the world is very different – in the USA, for example, 45% of the total amount is due to diabetes with 28% accounted for by hypertensive nephrosclerosis and 7% due to chronic glomerulonephritis whereas in Ghana, these figures are very different with 0% due to diabetes but 42% caused by chronic glomerulonephritis and 46% by hypertensive nephrosclerosis. Professor Eliasson also shows data that the percentage of patients dying from CVD increases dramatically from just under 28% in those with eGFR stages 1-2 to almost 60% in those with stage 5. Whilst clinical trials in kidney disease have lagged behind those in other disease states like respiratory and musculoskeletal, a lot of biomarkers have shown improved predictive values for heart and kidney outcomes including interleukin-6, members of the tumour necrosis factor receptor superfamily, N-terminal pro b-type natriuretic peptide and troponin. It is clear by the end of the session that, with both albuminuria and impaired renal function being important risk factors for CVD and death, people accessing the EASD’s e-Learning platform need more information both on DKD and CVD from a cellular level to an epidemiological one. Large courses on both topics are currently being created so please click here and leave your name and email address if you would like to be alerted to these once they launch.
And, finally on Day 1, at the new Concepts in the Molecular Mechanisms Leading to Type 1 Diabetes session, delegates were treated to an in-depth assessment of the possible causes of the condition at a cellular level exploring the CD4 anti-insulin response that dominates in the very early stages of the autoimmune reaction and the selective loss in secretagogue responses in patients with type 1 diabetes that are dependent on mitochondrial function to the role of a reduced oxidative phosphorylation in the T cells of people with type 1 diabetes that could enhance effector function and increase pathogenesis. This pathogenesis is an important area for healthcare professionals working in the field and, over the next few months, the EASD e-Learning platform will be rolling out the first of the modules in this course – Arresting Type 1 Diabetes with Professor Chantal Mathieu from the University of Leuven in Belgium. If you are interested to hear more from us on the launch of this module, please click here to register for an email update.