American Diabetes Association, June 6-10, 2008

American Diabetes Association's 68th Scientific Sessions

The American Diabetes Association's 68th Scientific Sessions took place June 6-10 in San Francisco and attracted more than 13,000 attendees from around the world. Highlights included the presentation of several large studies showing that intensive glucose control is not associated with significant decreases in cardiovascular events.

"We had three large cardiovascular trials: ACCORD (Action to Control Cardiovascular Risk in Diabetes), the VA Diabetes Trial, and ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation)," said John Buse, M.D., of the University of North Carolina School of Medicine and President for Medicine and Science of the American Diabetes Association. "Basically, the news is that intensive glucose lowering does not seem to have a substantial impact on cardiovascular risk, at least in patients with relatively advanced disease," he added.

"In a way, these results are disappointing because we're always hoping to find new ways to improve patients' health," Buse said. "But in some ways it's the best possible news for doctors and patients. These results show that standard therapy is associated with low rates of cardiovascular diseases and there's no reason to go beyond that. If the results had been positive, we would really be in a pickle because this kind of therapy is very intense to do."

Buse expected that the American Diabetes Association's current recommendation -- achieving an A1C level of 7 percent -- would stay the same. "We're convening a group of people to carefully study the data, but personally I don't see any great need to make major changes in our recommendations," he said.

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"There were other important cardiovascular trials, including DIAD (Detection of Ischemia in Asymptomatic Diabetics)," Buse said. In that study, Frans Wackers, M.D., of the Yale University School of Medicine, and colleagues randomly assigned 1,123 asymptomatic, heart disease-free patients to receive either stress adenosine myocardial perfusion imaging or no screening. After five years, they found no significant group differences in the rates of silent myocardial ischemia, an unexpectedly low 2.8 percent overall cumulative rate of cardiac events, and concluded that expensive coronary artery disease screening should not be routinely offered to asymptomatic, heart disease-free diabetics.

"Over the course of the study, all participants continued to be seen by their own physicians, and the physicians of 30 percent of the unscreened control group independently found reason to recommend various diagnostic and treatment procedures, such as stress testing, cardiac catheterization, angioplasty and bypass surgery, to their patients," Wackers said in a statement. "Since these control patients likely had an equal prevalence of ischemia to those who were screened, standard clinical care and attentive follow-up appear to be sufficient to detect those at risk and in need of intensive cardiologic care."

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"A number of smaller studies addressed specific issues relating to particular drugs," Buse said. "These will have some modest effects on clinical practice as the message is distributed."

As an example, he cited a study by Ralph A. DeFronzo, M.D., of the University of Texas Health Science Center in San Antonio, who showed that the conversion rate from impaired glucose tolerance to type 2 diabetes is 81 percent lower in patients who receive pioglitazone. "This approach could become standard practice," Buse said. "But I'm not sure it will be. There are some issues with pioglitazone around bone health, heart health and weight gain. So we need to take a closer look at the data."

DeFronzo was the 2008 recipient of the Association's most prestigious award: the Banting Medal for Scientific Achievement, which honors researchers who have made significant, long-term contributions to the understanding of diabetes, its treatment and/or prevention.

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TUESDAY, June 10 (HealthDay News) -- In patients with impaired glucose tolerance, the oral drug pioglitazone (Actos) reduces the rate of conversion to type 2 diabetes by 81 percent, according to research presented at the American Diabetes Association's 68th Annual Scientific Sessions in San Francisco.

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TUESDAY, June 10 (HealthDay News) -- An innovative analysis involving glutamic acid decarboxylase 65 (GAD65), a protein associated with type 1 diabetes, may help pave the way for a blood test that identifies the disease in its early stages, according to research presented at the American Diabetes Association's 68th Annual Scientific Sessions in San Francisco.

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TUESDAY, June 10 (HealthDay News) -- In most patients with type 1 and type 2 diabetes, a simple mathematic equation allows for A1C values to be accurately expressed as estimated average glucose, according to research presented at the American Diabetes Association's 68th Annual Scientific Sessions in San Francisco and published online June 7 in Diabetes Care.

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ADA: Intensive Glucose Control Not Beneficial in CVD

MONDAY, June 9 (HealthDay News) -- In U.S. veterans with type 2 diabetes and multiple risk factors for heart attacks and strokes, intensive glucose control results in a non-significant reduction of subsequent cardiovascular disease events, according to research presented at the American Diabetes Association's 68th Annual Scientific Sessions in San Francisco.

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ADA: Intensive Glucose Control May Cause Harm

MONDAY, June 9 (HealthDay News) -- In type 2 diabetics at high risk for heart attacks and strokes, intensive glucose lowering is associated with an increased risk of death over a 3.5-year period and does not significantly reduce major cardiovascular events, according to research presented at the American Diabetes Association's 68th Annual Scientific Sessions in San Francisco, and published in the June 12 issue of the New England Journal of Medicine.

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ADA: Intensive Glucose Control Reduces Complications

MONDAY, June 9 (HealthDay News) -- In type 2 diabetics, intensive glucose control significantly reduces the risk of serious complications, especially kidney disease, according to research presented at the American Diabetes Association's 68th Annual Scientific Sessions in San Francisco, and published in the June 12 issue of the New England Journal of Medicine.

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Physician's Briefing