Tuesday, June 14, 2005

And That's a Wrap!

The meeting is over. Final numbers are now in and the total attendance was nearly 18,000 and by every measure the meeting was a huge success. For more information about the news made at the 65th Annual Scientific Sessions, visit In Diabetes Today on the ADA Web site.

See you next year in Washington, DC!

Inhaled Insulin

Some great talks this morning on inhaled insulin. The safety profile looks very good and the glycemic control that results is very impressive. It shouldn't be long until the drug is approved. The drug is called "Exubera" and would seem to fit in well as adjunct therapy for people with either type 1 or type 2 diabetes. Look for more reports on this drug as possible approval by the FDA draws near.

Monday, June 13, 2005

Record Attendance

Preliminary attendance numbers are in. Attendance is an all-time high - more than 15,000 people. ADA continues to hold the largest meeting in the world devoted to the science and medicine of diabetes. Scientists and clinicians from over 80 countries came to this year's meeting. I wish we had pictures of all the crowded overflowing lecture rooms.

I hope all of you get to see the session webcasts that will available on the ADA site in the coming weeks.

Know Your Numbers!

Clearly we are not getting out the word about the importance of the A1C as a measure of blood glucose control. As you may know, an A1C test (also known as glycated hemoglobin or HbA1c) gives you a picture of your average blood glucose control for the past 2 to 3 months. A study this afternoon from Atlanta showed that almost half the patients in a municipal hospital did not recognize the term A1C and less than a quarter knew what their A1C value should be. In contrast, those who knew their A1C value and what it meant had much better glucose control.

It goes to show you that people with diabetes need to ask their health professional about their A1C, blood pressure and lipid values. Write them down, keep a diary -- know your numbers!

More on the DCCT Report

Lots more discussion and hallway talk about the follow-up from the DCCT study. The results beg many more questions:

  • What could intensive control possibly do over a six year period that would have such a dramatic effect on cardiovascular disease 10 years later?
  • Do these results apply to people with type 2 diabetes who generally have more cardiovascular disease and other co-morbid conditions?
  • Are the results confined to people with type 1 diabetes who are younger and have not as yet developed significant cardiovascualr disease?

Amputations

Great talk today on the impact of a community education program to reduce amputations. This is a program in Charleston, SC which took place in community groups, churches, and other settings. The focus was on getting people with diabetes to look at their feet frequently. They also worked with local health systems and the combined effort led to a 70% drop in amputations in the last year.

Sunday, June 12, 2005

Rimonanbant

Exhibit HallAn interesting report we heard focused on another new drug that we'll likely see in the next 6 months to a year. The drug is called Rimonanbant and is made by sanofi-aventis. It appears to be really good for weight loss and for many cardiovascular disease risk factors.

In the study we heard about, people with diabetes were given the drug or given a placebo. Those who were given the drug lost an average of 12 pounds, their A1C dropped by about .6%, their HDL (good cholesterol) went up , triglycerides went down. Side effects were not very different between the control group and the treated group. So it looks like a promising drug for reducing a lot of the cardiovascular risk factors that are so prevalent in people with diabetes.

So now we have two experimental drugs that will hopefully soon be licensed. Muraglitizar, a new class of agents for lowering blood glucose and Rimonanbant. If all goes well both drugs could be approved and available for use in the next year or so.

But the real buzz in the halls is still the follow-up of the DCCT and the incredible reduction of cardiovascular disease. Just a startling result.

Childhood Diabetes & Complication Risks

Another report focused on the Pima Indians in Arizona - a group of people that have the world's highest rate of type 2 diabetes. Close to 50% of the Pima populatioin is effected by diabetes. The study showed that kids who got type 2 diabetes had a prevalence of kidney disease 4 times higher than those who got diabetes later in life. Of course we know that getting diabetes early in life increases the chances for complications simply because you're living with the disease longer. But we didn't really appreciate how much greater the risk of complications is.

This emphasizes the fact that we must do more about childhood obesity and the childhood diabetes that results from it because if we don't, we're in for a lot of problems for these kids who develop this disease early in life.

Startling News!

Just came out of the late-breaking clinical trial symposium where there were a couple of startling studies reported. I'll save the best news for last...

First the results of the Diabetes Prevention Program. You may recall that this is a study looking at whether lifestyle modification (weight loss and exercise) in people with pre-diabetes could slow down the progression of diabetes and its complications. Indeed it does. For the first time they showed that there were complications of diabetes seen in people with pre-diabetes. Pre-diabetes seems more and more to be not just an omen for the development of diabetes but in itself is a serious condition.

But the biggest news of all is the follow-up study of the Diabetes control and Complications Trial (DCCT). You might recall that this was a study that showed that intensive glucose control reduced the rate of kidney disease, blindness, neuropathy and amputation. The trial ended some ten years ago but the people enrolled in the trial were continued to be followed. During the trial the control group's A1c was about 9 and the experimental group was at 7%. With a year and a half after the trial both groups came together and had an A1c of about 8 and they maintained that similar A1c for the duration of the 10 years of follow-up. The startling news is that brief period of intensive control - 6 years of intensive control - resulted in nearly a 50% drop in cardiovascular events, cardiovascular mortality, strokes, everything to do with cardiovascualar disease.

This is a huge story that will be covered in the newspapers. Early intensive control of blood glucose even for short periods of time results in a marked reduction of cardiovascular disease.

This may be the greatest therapy of all for people with diabetes. Have intensive glucose control - as good as possible and as early as possible in the progression of the disease - and you may significantly reduce your risk for cardiovascular disease.

Incidence of Diabetes

We heard a report today from the CDC that the incidence of diabetes rose almost 41% from 1997 to 2003. This is just new cases per year - an incredible rise in diabetes. More and more people are becoming overweight and therefore more people are developing type 2 diabetes. In fact 89% of new patients in 2003 were either overweight or obese.

We can see from these statistics on the rising incidence of diabetes that being overweight is taking a major toll.

Pre-diabetes and Health Care Costs

A recent study indicates that people that have pre-diabetes have a greatly increased cost of medical care - some 33% greater cost of medical care than people without pre-diabetes. Even in the state of abnormal high blood glucose levels, not yet at the level of diagnosis for diabetes, there's something going on. These people are still sick and they need to do something about it. This could imply that we may have to revisit the diagnostic threshhold values for diabetes. People need to lose weight and exercise as soon as they can.

Pre-diabetes appears to be an increasingly important state that not only portends the risk of diabetes but other diseases that I think we can prevent through exercise and weight loss.

Exercise and Gestational Diabetes

Another interesting report came from from the Nurses Health Study - a huge study looking at the effects of different treatments and lifestyles on the health of women who were followed for decades. The report showed that women who engaged in exercise in early adulthood (age 18-22) had a much lower risk of gestational diabetes when they got older and became pregnant. This could be modest or vigorous activity such as walking or stair climbing. Gestational diabetes affects about 4 percent of all pregnant women but here's a way to possibly ward it off by exercising at least modestly in youth.

This calls to attention the fact that exercise is not only helpful to prevent cardiovascular disease and promote overall wellness but for women of child-bearing age, it seems helpful in preventing gestational diabetes too.

Insulin-producing cells

There was a great poster today on the fact that there seem to be cells producing insulin in the pancreas even in people with long-standing type 1 diabetes. The study looked at 42 people and obtained sections of their pancreas upon death. In 90% of those people, insulin-producing cells were still present. This comes as a surprise since most people feel that with type 1 diabetes all of the insulin-producing cells are wiped out. But in fact some are still there making insulin.

If we can figure out a way for those cells to divide faster, or prevent the auto-immune destruction that targets these cells, we could get diabetes cured. It's encouraging to think that we don't necessarily have to rely on transplants alone to cure this terrible disease.

Saturday, June 11, 2005

Kidney Disease

Here's some great news. There was a dramatic report from the Centers for Disease Control showing that kidney disease in people with diabetes has actually declined in the years from 1990-2002. Almost a 40% decline in kidney disease is remarkable considering the huge increase in the number of people with diabetes over the same period. This says that we're making progress in treating this major complication of diabetes. The decrease is probably due in large part to improved treatments for high blood pressure, people taking better care of themselves and getting better diabetes care.

The flip side of this coin is the growing prevalence of cardiovascular disease in people with diabetes. If we are able to prevent or delay kidney disease, the odds are many more people will live longer and be subjected to another complication like cardivacular disease. But we're learning much more about cardiovascular disease too and this enables us to keep people healthier for much longer periods of time than ever before.

Can you hear me now?

Attendees at the 65th Scientific SessionsTwo great reports showed the benefits of a technology most of us use every day - cell phones. In these reports teenagers were told to enter their blood glucose readings into cell phones which transmitted the data back to a home base. In one study the cell phone was programmed to ring to remind kids to test their blood sugar. The kids who reported values outside of a predesignated range would receive calls back on their cell phones from nurse case managers who would offer assistance.

Quite an effective reminder and monitoring system using the power of cell phones.

Palm pricks?

Another interesting report today showed that if you prick your palm to test your blood glucose level, you get the same result as fingertip testing. As many of you know, fingertips can be very sensitive and pricking your fingertips to test can be painful. This study showed that pricking your palm can be just as effective.

This is not advice to start palm-pricking. But I think this is the first report that shows you don't have to stick your finger to get the same result as sticking other parts of your body.

TZD Safety

There's a very reassuring study showing safety of thiazolidinediones, a class of diabetes drugs. The two brand names of drugs in this class are Avandia and Actos. This study looked at a whole bunch of reports and so-called "open label clinical studies." (These are studies done when people know which drug they are taking). Over almost 10,000 person-years of people taking these drugs, there continues to be an excellent safety profile.

This is reassuring because, as you might remember, a few years ago one of the drugs in this "TZD" class had a greater level of hepatic disease or liver toxicity. This analysis, with a huge number of people, shows that these drugs really are safe.

Regenerating Beta Cells

Another symposium this morning addressed the issue of regenerating beta cells - the insulin-producing cells in the pancreas. One of the investigators was able to identify a particular cell type in the adult pancreas that acts as a stem cell to produce all the other pancreatic cell types, including beta cells. They also showed that, if treated properly, this cell could renew itself in the "undifferentiated" state (make more copies of itself). Then those cells go on to "differentiate" or become the various cell types found in the pancreas.

For the first time it indicates that there may be stem cells located within the pancreas with the abilty to produce all the various cells found there, including the insulin-producing cells. If there are significant numbers of these cells we could potentially "harness" this ability to augment the body's own insulin-producing capability.

PYY & Appetite

We just heard an interesting debate regarding a certain protein called PYY, a hormone secreted into the blood from the intestines after meals. One speaker indicated that PYY acted in the brain to reduce appetite. In his experiments with both mice and humans, injections of PYY would cause the subject to feel full, the injections reduced food intake and reduced body weight. This would suggest that PYY is a major protein released by the lower intestine that may control appetite.

But the next speaker indicated that his data didn't show that at all. He could not find that PYY reduced food intake in animals and claimed that other labs couldn't find the same result.

Then they each had the chance to rebut each other. It turns out there were some subtle but potentially very important differences in the way each one conducted their experiments.

The interesting thing about this controversy is that it highlights how difficult and complicated these studies are to do. It really speaks to the complexity of science and the complexity of the human body and how it works.

So at this point we don't know if PYY is key in letting us know when we're full or if it is just a protein released by the intestine that has some other action that we have yet to discover.

The truth is out there...

Friday, June 10, 2005

Exhibit Hall

The San Diego Convention CenterEveryone is looking forward to the exhibit hall opening tomorrow. Nearly 200 companies, each showing their latest products as well as future supplies & devices that are in the pipeline. It's a great opportunity for the clinicians here to get a good feel for what's available and what's coming.

You can go here to learn more about the companies exhibiting at this year's Scientific Sessions.

New Oral Drug for Type 2?

Just heard a great presentation on a likely new oral drug for treating type 2 diabetes. "Muraglitazar" is the first drug in its class and was shown in this talk to be very effective in reducing blood glucose when used in combination with other oral drugs.

In talks to be given Sunday and Monday, we'll hear more information about this drug and how well it performs.

The Buzz

Crowded hallways, lots of people. The big scientific buzz is the relationship between inflammation, diabetes and heart disease. Seems like the sequence of events goes like this: Being overweight or obese results in more fatty acids being released by fat cells. These molecules trigger inflammatory substances to be released by white cells and other cells around the body. In turn, the inflammatory substances stimulate "insulin resistance" and atherosclerosis. Insulin resistance is the first step on the road to developing diabetes - it's a term used to describe the inability of insulin to allow the movement of glucose into cells for energy.

A couple of great papers were presented today showing the relationship between substances secreted by fat cells, how they stimulate the release of inflammatory molecules and how they affect other tissues.

A Worldwide Event

Registration lines are really long as everyone pours into San Diego. It's fascinating to look at the attendee badges (which in addition to your name, shows where you are from). It's clear how many people come to this meeting from all over the world.

The sessions start at 2pm today. Look for an update later regarding a symposium that looks really interesting...

Friday Morning

Signs outside the convention center

The sessions start today in the San Diego Convention Center. The place is huge! It takes about 5 minutes just to walk from one end to the other.

There is clearly a buzz in the air with all the science that will be presented. More updates throughout the day...

Thursday, June 09, 2005

Greetings from the West Coast

Postcard from San Diego

Arrived in San Diego today. Moderate temperatures, clear skies, and I'm excited about the meeting. This is our 65th Annual Meeting. They have all taken place in June, in various cities around the country that can hold the crowd.

Speaking of crowds, about 15,000 people will come to this meeting from nearly every country in the world. About half will be Americans, and 1/4th will be Europeans. It's an exciting time because even when you're in the airport, there are signs everywhere saying "Welcome American Diabetes Association."

Monday, June 06, 2005

Hello & Welcome

San DiegoHi I'm Richard Kahn, Chief Scientific and Medical Officer for the American Diabetes Association. I invite you to join me here as I share news and information from our 65th Annual Scientific Sessions.

Each year, the world's top health professionals involved in diabetes research and care gather together at this ADA conference to share their knowledge and exchange ideas. I will use this forum to share some of the more interesting research and information presented at the conference.

This year's meeting takes place June 10-14 in beautiful San Diego. I look forward to speaking to you from (hopefully) sunny California.