Diabetes Update - American Diabetes Association 2006

Medical Author: Ruchi Mathur, MD, FRCP(C)
Medical Editor: Jay W. Marks, MD

The American Diabetes Association's (ADA) annual 66th Scientific Sessions were recently held in Washington DC. The meeting brought close to 18,000 health professionals together to discuss issues related to diabetes (type 1, type 2 and gestational diabetes), prediabetes , metabolic syndrome, and other related disease processes. Topics of interest ranged from trying to understand the pathophysiology of disease (what happens in the body that causes diabetes to develop) to new ways to prevent and treat diabetes including both pharmacotherapy with drugs, and with lifestyle intervention.

The interesting thing about the ADA annual meeting is that many different types of health care providers attend the meetings -- MDs, PhDs, researchers, nutritionists, educators, nurses, and community health workers. Each of these professional groups make a commitment to work together to help treat and prevent diabetes. A team approach is really the only way to attempt to conquer diabetes, which at present affects about 20 million of us in the U. S. alone.

While some of the science presented at symposia was novel and very exciting, particularly advances in beta cell preservation and transplantation (beta cells are the cells that produce insulin) ,I would like to focus on some of the newer therapies that were discussed at the ADA meeting, and tell you about what's up-and-coming in the realm of treatment for diabetes. For the sake of length, I've chosen 3 topics I think will be interesting for the majority of readers: glucose sensors, a new class of drugs called DPP-IV inhibitors and inhaled insulin.

Continuous Glucose Sensors

One of the major advances this year was in the development of technology for continuous glucose sensors. A sensor is a device that is inserted into the subcutaneous fat (just beneath the skin) in the abdomen or upper arm. After calibration with glucose measurements obtained from blood, the sensor then provides real-time glucose readings at five minute intervals. Some of the sensors display a graph for watching trends in blood sugar levels. Other sensors allow for warning beeps to be programmed before blood sugars get too high or to low. Some sensors even calculate the rate of change of blood sugar, allowing a patient to anticipate upcoming hypoglycemic events. Other sensors, such as the model by Medtronic, work especially well with the insulin pump. In this case, the sensor sends a signal directly to the pump which then performs calculations to determine a suggested course of action--which the patient must then approve. A sensor is ideal for patients using insulin pumps, patients prone to large fluctuations in blood glucose, athletes, those with hypoglycemia (particularly at night), or anyone wanting to better understand the relationship between daily activity and food intake with blood glucose levels.

As diabetologists, our goal is to provide our patients with therapies that mimic natural physiology as closely as possible. Aside from successful transplantation or regeneration of the body's insulin producing cells, the ultimate goal is an artificial pancreas that senses the body's sugar level and responds immediately with the appropriate amount of insulin needed to keep blood sugar in the normal range. We are not there yet but are getting closer.

DPP-IV Inhibitors

Another area of interest this year stems from the success of a drug released last year know as exenatide (Byetta). Details regarding exenatide can be found by reading the exenatide (Byetta) drug monograph. Basically, it is an injectable, synthetic, incretin-like hormone (similar to an incretin that we humans make ourselves called GLP-1) that works to slow the stomach's emptying, creating a sensation of fullness. It also acts centrally on the brain to promote fullness, on the liver to decrease production of sugar, and on the pancreas to perhaps increase the mass of insulin producing beta cells. Exenatide has the benefit of promoting weight loss in patients (which is a big problem in type 2 diabetes) but has the disadvantage of being in injectable drug requiring injections twice daily.