Diabetes Core Update – October 2015
Podcast: Diabetes Core Update
Host: American Diabetes Association
Date: September 24, 2015
Hosts: Dr. Neil Skolnik & Dr. John J. Russell
Episode Overview
This episode presents and discusses six recently published, clinically relevant articles from the American Diabetes Association’s journals. The topics range from risk factors and lifestyle influences on type 2 diabetes to emerging interventions and a groundbreaking clinical trial on cardiovascular outcomes for diabetes medication. The hosts dissect the data, highlight key implications for clinical practice, and provide practical takeaways for healthcare professionals.
Key Discussion Points & Insights
1. Body Weight, Metabolic Dysfunction, and Risk of Type 2 Diabetes
Source: Diabetes Care
Study: Prospective Secondary Manifestations of Arterial Disease Cohort Study
Timestamps: [02:03 – 04:46]
- Nearly 7,000 participants were classified by BMI and metabolic syndrome status; assessed for development of type 2 diabetes over 6 years.
- Key Findings:
- Overweight without metabolic dysfunction: 2.5x increased risk.
- Obesity without metabolic dysfunction: 4.3x risk.
- With metabolic syndrome, risk increased dramatically:
- Normal weight: 4.7x
- Overweight: 8.5x
- Obese: 16x
- Clinical Implications:
- Metabolic syndrome is a stronger predictor than weight alone.
- Emphasis on monitoring for metabolic syndrome components, not just BMI.
Notable Quotes:
- “The metabolic syndrome certainly is the quintessential American disease. I think it affects about 40% of American seniors.” – Dr. Russell [03:32]
- “If you have metabolic syndrome plus you're overweight, you’re much more likely to be a diabetic than overweight in its own right.” – Dr. Russell [04:17]
2. Sedentary Time and Type 2 Diabetes Development
Source: Diabetes Care – CARDIA Study
Timestamps: [04:46 – 05:58]
- 20-year follow-up of 2,027 young adults, aged 38-50 at end, tracked with pedometers.
- Findings:
- Average sedentary time ≈ 8 hours/day.
- Each additional sedentary hour/day associated with 3% higher fasting insulin.
-
10 hours sedentary/day doubled risk of impaired fasting glucose, nearly quadrupled risk of developing diabetes (OR 3.8).
Clinical Implications:
- Sedentary behavior is an independent risk factor, even in physically active people (“active couch potato” phenomenon).
- Clinicians should encourage breaking up sitting time with movement throughout the day.
Notable Quotes:
- “That sedentary time as a separate parameter from exercise incurs both cardiovascular and diabetes risk.” – Dr. Skolnik [05:58]
- “Active couch potato: someone who exercises their 150 minutes a week but sits at work... that grabs our attention.” – Dr. Skolnik [05:58]
3. Breakfast Consumption and Metabolic Response
Source: Diabetes Care
Timestamps: [06:00 – 10:40]
- Randomized, crossover trial in 22 type 2 diabetics (mean A1C: 7.7).
- Compared days with vs without breakfast, measured metabolic parameters after subsequent meals.
- Results:
- Skipping breakfast led to significantly higher (36-41%) postprandial glucose, free fatty acids, glucagon, and lower (17%) insulin after lunch/dinner.
- Delayed insulin peaks by 30 min post-lunch and dinner on no-breakfast days.
Clinical Implications:
- Skipping breakfast worsens glycemic control for rest of day.
- Supports recommendation of at least a light breakfast for patients with diabetes.
Notable Quotes:
- “If you skip breakfast, you're setting yourself up metabolically to have a lot more mess after lunch and after dinner.” – Dr. Russell [10:25]
- “I think having at least a light breakfast... makes lots and lots of sense for our patients.” – Dr. Russell [10:40]
4. Probiotics (Lactobacillus reuteri) and Insulin Response
Source: Diabetes Care
Timestamps: [10:44 – 12:00]
- Placebo-controlled study: Lactobacillus reuteri in 21 glucose-tolerant and 10 obese adults over 4 weeks.
- Major Findings:
- Probiotic intake increased GLP-1 and GLP-2 secretion by 76% and 43%.
- 49% higher insulin and 55% higher C-peptide secretion; no effect on BMI in short term.
Clinical Implications:
- Supports the intriguing link between the gut microbiome and metabolic regulation.
- Suggests future potential for microbiome-targeted therapies in diabetes.
Notable Quotes:
- “It's pretty mind-boggling to think that we're looking at a study that's assessing whether Lactobacillus would increase insulin response.” – Dr. Skolnik [12:00]
- “The potential therapies... are both exciting and hard to imagine. So it's important to keep an open mind about this.” – Dr. Skolnik [12:00]
5. Monetary Incentives for Adolescent Type 1 Diabetes Self-Monitoring
Source: Diabetes Care
Timestamps: [12:00 – 15:33]
- 12-week pilot with 10 adolescents with poorly controlled type 1 diabetes; paid per glucose test, with bonuses.
- Findings:
- SMBG frequency increased from 1.8 to 4.9 tests/day.
- Mean A1C reduced from 9.3 to 8.4.
- Both adolescents and parents reported high satisfaction.
Clinical Implications:
- Monetary incentives may effectively improve disease management in some adolescents.
- May be a cost-effective strategy for high-risk groups.
Notable Quotes:
- “I think it's very hard for us to have fine teenagers and we can get to do anything. But... if we can have better control of diabetics by partnering with our adolescents, in the long run will be cheaper for the healthcare system.” – Dr. Russell [14:23]
- “Some thinking outside the box approaches... might make a difference for some of the kids that we can pull back from the abyss.” – Dr. Russell [15:25]
6. EMPA-REG OUTCOME: Empagliflozin and Cardiovascular Outcomes
Source: New England Journal of Medicine, Sept 17, 2015
Timestamps: [15:33 – 20:39]
- 7,020 type 2 diabetes patients with existing CVD assigned to empagliflozin (10 or 25 mg) or placebo; mean follow-up 3.1 years.
- Outcomes:
- Major CV events: 10.1% (empagliflozin) vs 12.1% (placebo)
- Death: 3.7% vs 5.9% (38% relative reduction)
- Hospitalization for heart failure: 2.7% vs 4.1% (35% reduction)
- Death from any cause: 5.7% vs 8.3% (32% reduction)
- Number Needed to Treat (NNT): 39 over 3 years
Clinical Significance:
- First diabetes drug trial showing significant reduction in CV deaths and all-cause mortality in the short-term.
- Effects were above and beyond standard-of-care (antihypertensives, statins, etc.)
- Raises clinical questions: class effect vs. drug-specific; applicability to broader diabetes populations.
Notable Quotes:
- “When Silvio Andzucci announced the results... the audience roared with applause, which is an unusual occurrence at a scientific meeting.” – Dr. Skolnik [16:48]
- “This is the first outcome study for any medicine that is primarily for diabetes that has showed a short term... positive effect on total mortality and cardiac outcomes.” – Dr. Skolnik [16:48]
- “Number needed to treat of 39 over three years. To compare that number... original Simvastatin trial... NNT of 30 over five years.” – Dr. Skolnik [19:28]
Memorable Moments
- The 'active couch potato' concept: Even those who meet exercise recommendations can be at high risk if much of their day is sedentary ([05:58]).
- Audience applause for EMPA-REG: The enthusiasm in the diabetes research community when the empagliflozin trial results were revealed ([16:48]).
- Historical breakfast trivia: A light interlude on how breakfast became a modern staple, adding depth to the breakfast-skipping discussion ([09:44]).
Final Takeaways
- Metabolic syndrome assessment is crucial in diabetes risk evaluation, more so than weight alone.
- Sedentary habits warrant direct intervention, distinct from advice to increase exercise.
- Breakfast is vital in glycemic control; skipping can have detrimental metabolic effects.
- Microbiome research is promising, though clinical applications remain in early stages.
- Behavioral economics (incentivization) may improve self-management, especially in adolescents.
- Empagliflozin’s CV benefits mark a paradigm shift for type 2 diabetes treatment, with broad implications for practice and upcoming guidelines.
Further Information
For article links and more, visit www.diabetesjournals.org
Summary compiled by PodcastAI — covering the latest in diabetes clinical research and practice for healthcare professionals.